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Because there is limited empirical literature addressing child abuse potential (CAP) in pregnant substance users, our study investigated associations between trauma, route of drug administration (IV use), and CAP in pregnant substance abusers. We explored this association using CAP as both a continuous and dichotomous measure, and with both narrow-band (i.e., PTSD) and broad-band (i.e., anxious arousal, depression, and anger/irritability) trauma symptoms. Participants were 44 ethnically diverse substance using pregnant women (61.4% Hispanic, 15.3% Native American, and 15.3% Caucasian women) who had completed a NIDA clinical trial. We found that women in our sample reported high CAP, with 43% reaching the conservative CAP cutoff, and the majority of women (56%) meeting the more liberal CAP cutoff. Trauma symptoms, both narrow- and broad-band, as well as IV status, accounted for significant and unique CAP variance. Specifically, women with greater trauma symptomatology and women who were IV users reported significantly greater CAP. To a lesser extent, trauma exposure also ac-counted for significant CAP variance. Exploratory analyses revealed that 'problems with others' drove the CAP difference between the IV status groups.Our results suggest that both trauma and IV use are significant predictors of child abuse potential. IV use was more highly associated with broad-band compared with narrow-band trauma symptoms, suggesting broader trauma spectrum problems in the form of affect dysregulation in this subsample. Overall, our findings were largely concordant when CAP was used as a continuous versus categorical variable. Regarding the level of trauma symptom specificity required to represent trauma in predicting CAP, our results suggest that narrow-band and broad-band trauma symptoms may be relatively equivalent, with clinical considerations determining which measure is employed in assessing trauma in this population. In addition, IV status is likely a proxy variable for 'high-risk' status, and high-risk women, regardless of substance use, have been shown to evidence high levels of child abuse potential.The results from this community sample of low SES, ethnically diverse pregnant women suggest that because of the high levels of child abuse potential among this group, preventative interventions targeted toward child abuse potential are warranted for these women. Although there has been a burgeoning of substance abuse intervention services for this population, they have not addressed child abuse potential specifically (e.g., in the form of targeting parental expectations or discipline strategies), nor have they systematically evaluated outcomes. Secondly, the high level of trauma exposure and trauma symptoms in this group suggests that trauma-specific interventions are warranted. Although our study was unable to address questions of causality, and the relationship between trauma symptoms and IV use is likely bidirectional, identifying individual characteristics that predict IV use as a means of coping with trauma would be an important area for future research. Furthermore, to the extent that IV-using women report greater difficulties with others, this may exacerbate child abuse potential, as both substance use and low social support have been identified as child abuse potential risk factors in this population. [ABSTRACT FROM AUTHOR]

PURPOSE: To study a large, population-based sample of adolescents with the goal of expanding our knowledge base about the relationship of coping and health outcomes. METHOD: We examined 1769 nonclinical, high school students (48% girls, mean age 16 years, predominantly white) using one class period to establish a link between coping styles, health problems, and health risk behaviors. Instruments employed included the Coping Response Inventory - Youth form (abbreviated version) and the Juvenile Wellness and Health Survey. ANCOVAs were used to test the main effects of coping typology, gender, and their interaction on the five health domains. RESULTS: Findings were consistent with previous research and showed that approach coping correlated negatively with indicators of health problems and health risk behaviors, while avoidance coping correlated positively with these domains. The presence of both forms of coping mitigated the negative effects of avoidance coping. CONCLUSION: As early as mid-adolescence, habitual coping styles appear to be associated with significant health outcomes. In screening nonclinical samples the clinician can rely on habitual coping styles as indicators of potential health problems. [ABSTRACT FROM AUTHOR]

Objective: To report longitudinal differences in baseline characteristics, treatment, and outcomes in patients with coronavirus disease 2019 (COVID-19) admitted to intensive care units (ICUs) between the first and second waves of COVID-19 in Australia. Design, setting and participants: SPRINT-SARI Australia is a multicentre, inception cohort study enrolling adult patients with COVID-19 admitted to participating ICUs. The first wave of COVID-19 was from 27 February to 30 June 2020, and the second wave was from 1 July to 22 October 2020. Results: A total of 461 patients were recruited in 53 ICUs across Australia; a higher number were admitted to the ICU during the second wave compared with the first: 255 (55.3%) versus 206 (44.7%). Patients admitted to the ICU in the second wave were younger (58.0 v 64.0 years; P = 0.001) and less commonly male (68.9% v 60.0%; P = 0.045), although Acute Physiology and Chronic Health Evaluation (APACHE) II scores were similar (14 v 14; P = 0.998). High flow oxygen use (75.2% v 43.4%; P < 0.001) and non-invasive ventilation (16.5% v 7.1%; P = 0.002) were more common in the second wave, as was steroid use (95.0% v 30.3%; P < 0.001). ICU length of stay was shorter (6.0 v 8.4 days; P = 0.003). In-hospital mortality was similar (12.2% v 14.6%; P = 0.452), but observed mortality decreased over time and patients were more likely to be discharged alive earlier in their ICU admission (hazard ratio, 1.43; 95% CI, 1.13-1.79; P = 0.002). Conclusion: During the second wave of COVID-19 in Australia, ICU length of stay and observed mortality decreased over time. Multiple factors were associated with this, including changes in clinical management, the adoption of new evidence-based treatments, and changes in patient demographic characteristics but not illness severity., Competing Interests: No relevant disclosures., (© 2021 College of Intensive Care Medicine of Australia and New Zealand.)

Objectives: There are few robust, national-level reports of contemporary trends in pediatric oncology admissions, resource use, and mortality. We aimed to describe national-level data on trends in intensive care admissions, interventions, and survival for children with cancer., Design: Cohort study using a binational pediatric intensive care registry., Setting: Australia and New Zealand., Patients: Patients younger than 16 years, admitted to an ICU in Australia or New Zealand with an oncology diagnosis between January 1, 2003, and December 31, 2018., Interventions: None., Measurements and Main Results: We examined trends in oncology admissions, ICU interventions, and both crude and risk-adjusted patient-level mortality. Eight thousand four hundred ninety admissions were identified for 5,747 patients, accounting for 5.8% of PICU admissions. Absolute and population-indexed oncology admissions increased from 2003 to 2018, and median length of stay increased from 23.2 hours (interquartile range [IQR], 16.8-62 hr) to 38.8 hours (IQR, 20.9-81.1 hr) ( p < 0.001). Three hundred fifty-seven of 5,747 patients died (6.2%). There was a 45% reduction in risk-adjusted ICU mortality, which reduced from 3.3% (95% CI, 2.1-4.4) in 2003-2004 to 1.8% (95% CI, 1.1-2.5%) in 2017-2018 ( p trend = 0.02). The greatest reduction in mortality seen in hematological cancers and in nonelective admissions. Mechanical ventilation rates were unchanged from 2003 to 2018, while the use of high-flow nasal prong oxygen increased (incidence rate ratio, 2.43; 95% CI, 1.61-3.67 per 2 yr)., Conclusions: In Australian and New Zealand PICUs, pediatric oncology admissions are increasing steadily and such admissions are staying longer, representing a considerable proportion of ICU activity. The mortality of children with cancer who are admitted to ICU is low and falling., Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2023 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)

Objectives: We sought to update our 2015 work in the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) guidelines for the diagnosis and management of pediatric acute respiratory distress syndrome (PARDS), considering new evidence and topic areas that were not previously addressed., Design: International consensus conference series involving 52 multidisciplinary international content experts in PARDS and four methodology experts from 15 countries, using consensus conference methodology, and implementation science., Setting: Not applicable., Patients: Patients with or at risk for PARDS., Interventions: None., Measurements and Main Results: Eleven subgroups conducted systematic or scoping reviews addressing 11 topic areas: 1) definition, incidence, and epidemiology; 2) pathobiology, severity, and risk stratification; 3) ventilatory support; 4) pulmonary-specific ancillary treatment; 5) nonpulmonary treatment; 6) monitoring; 7) noninvasive respiratory support; 8) extracorporeal support; 9) morbidity and long-term outcomes; 10) clinical informatics and data science; and 11) resource-limited settings. The search included MEDLINE, EMBASE, and CINAHL Complete (EBSCOhost) and was updated in March 2022. Grading of Recommendations, Assessment, Development, and Evaluation methodology was used to summarize evidence and develop the recommendations, which were discussed and voted on by all PALICC-2 experts. There were 146 recommendations and statements, including: 34 recommendations for clinical practice; 112 consensus-based statements with 18 on PARDS definition, 55 on good practice, seven on policy, and 32 on research. All recommendations and statements had agreement greater than 80%., Conclusions: PALICC-2 recommendations and consensus-based statements should facilitate the implementation and adherence to the best clinical practice in patients with PARDS. These results will also inform the development of future programs of research that are crucially needed to provide stronger evidence to guide the pediatric critical care teams managing these patients., Competing Interests: Dr. Barbaro is currently receiving grant support (R01 HL153519; R01 HD015434) from the National Institutes of Health (NIH); he is currently Chair of the Extracorporeal Life Support Organization Registry. Dr. Bembea receives research funding to her institution from the NIH/National Institute of Neurological Disorders and Stroke (R01NS106292) and the Grifols Investigator Sponsored Research Grant. She serves as Chair of the Scientific Committee of the Pediatric Acute Lung Injury and Sepsis Investigators Research Network. Dr. Cheifetz is a medical consultant for Phillips and Medtronic. His institution receives research grant funding from the NIH. Dr. Cruces received funding from the Chilean Ministry of Sciences (Fondecyt 1220322). Dr. Curley received funding from the NIH (UH3HL141736, R01HD098269, R01HL149910, R01HL153519, R01HD104618). Dr. Dahmer received funding from the NIH (National Institute of Child Health and Human Development [NICHD], R21 HD097387; National Heart, Lung and Blood Institute [NHLBI] R01 HL149910). Dr. Dalton received funding from the Department of Defense (No. 13363072). She is a consultant for Innovative Extracorporeal Membrane Oxygenation Concepts, Hemocue, Entegrion, Medtronic, and advisory board member for Abiomed. Dr. Emeriaud’s research program is supported by the Fonds de Recherche du Québec-Santé and the Quebec Respiratory Health Network. Dr. Emeriaud is leading a study, which is financially supported by Maquet. Dr. Jouvet’s research program and salary is supported by the Fonds de Recherche du Québec-Santé and the Quebec Respiratory Health Network. Dr. Jouvet is leading studies, which is financially supported by VitalTracer, Dymedso and public financial agencies (Canadian Foundation for innovation, Institut TransMedTech, Quebec Ministry of Health, Sainte-Justine Hospital). Dr. Killien received funding from the NIH (NICHD K23HD100566). Dr. Kneyber received research funding from the NIH/NICHD (UG3 HL141736-01/U24 HL141723-01) and ZorgOnderzoek Nederland and the area Medical (848041002), Stichting Vrienden Beatrix Kinderziekenhuis, Fonds NutsOhra, University Medical Center Groningen, VU University Medical Center, and the Royal Academy of Dutch Sciences (TerMeulen stipend). Dr. Kneyber’s research program is technically supported by Vyaire, Applied Biosignals, and Timpl. Dr. Kneyber received honoraria from Vyaire. Dr. Kneyber serves as consultant for Metran and served as consultant for Vyaire. Dr. Kudchadkar received funding to her institution from the NIH/NICHD (R01HD103811 & R21HD093369) and the Donaghue Foundation. Dr. López-Fernández is funded by an academic grant from the Instituto de Salud Carlos III, Madrid, Spain (PI19/00141). Dr. Maddux received funding to her institution from the NIH/NICHD (K23HD096018). Dr. Morrow has received honoraria for Continuing Medical Education presentations from EduPro Health. Her research is part-funded by the National Research Foundation of South Africa, through the Incentive Funding for Rated Researchers program. Dr. Nadkarni receives unrestricted research grants to his institution from the NIH, U.S. Department of Defense, Agency for Healthcare Research and Quality, Laerdal Foundation, RQI Partners, Zoll Medical, Defibtech, HeartHero, and Nihon-Kohden. Dr. Nadkarni is an elected member of the Executive Committee (Council) of the Society of Critical Care Medicine. Dr. Napolitano research and consulting relationships with: Drager, Timpel, VERO-Biotech, Actuated Medical, and Philips/Respironics. Dr. Pons has been on the speaker’s bureau of Philips, ResMed and Fisher & Paykel; Hospital Sant Joan de Déu has received disposable material from these companies. Dr. Randolph receives funding from the Centers for Disease Control and Prevention, NIH (National Institute of Allergy and Infectious Diseases AI154470). Dr. Rowan receives funding from the NHLBI (NHLBI K23HL150244). Dr. Sanchez-Pinto received funding from the NIH (NICHD R01 HD105939). Dr. Sauthier research program and salary is supported by the Fonds de Recherche du Québec-Santé. Dr. Takeuchi receives funding from Japan Society for the Promotion of Science grant (KAKENHI 21K09063). Dr. Tse receives research funding to her institution from the Canadian Institute of Health Research and salary support from the Fonds de Recherche du Québec—Santé. Dr. Watson receives research funding to his institution from the NIH. Dr. Zimmerman received research funding from NIH and Biomedical Advanced Research and Development Authority; royalties from Elsevier Publishing. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)

Objectives: In 2015, the Pediatric Acute Lung Injury Consensus Conference (PALICC) provided the first pediatric-specific definitions for acute respiratory distress syndrome (pediatric acute respiratory distress syndrome [PARDS]). These definitions have since been operationalized in cohort and interventional PARDS studies. As substantial data have accrued since 2015, we have an opportunity to assess the construct validity and utility of the initial PALICC definitions. Therefore, the Second PALICC (PALICC-2) brought together multiple PARDS experts and aimed to identify and summarize relevant evidence related to the definition and epidemiology of PARDS and create modifications to the definition of PARDS., Data Sources: MEDLINE (Ovid), Embase (Elsevier), and CINAHL Complete (EBSCOhost)., Study Selection: We included studies of subjects with PARDS, or at risk for PARDS, excluding studies pertaining primarily to adults except as specified for identifying age-specific cutoffs., Data Extraction: Title/abstract review, full-text review, and data extraction using a standardized data collection form., Data Synthesis: The Grading of Recommendations Assessment, Development, and Evaluation approach was used to identify and summarize evidence and develop recommendations. A total of 97 studies were identified for full-text extraction addressing distinct aspects of the PARDS definition, including age, timing, imaging, oxygenation, modes of respiratory support, and specific coexisting conditions. Data were assessed in a Patient/Intervention/Comparator/Outcome format when possible, and formally summarized for effect size, risk, benefit, feasibility of implementation, and equity. A total of 17 consensus-based definition statements were made that update the definition of PARDS, as well as the related diagnoses of "Possible PARDS" and "At-Risk for PARDS." These statements are presented alongside a summary of the relevant epidemiology., Conclusions: We present updated, data-informed consensus statements on the definition for PARDS and the related diagnoses of "Possible PARDS" and "At-Risk for PARDS.", Competing Interests: Dr. Yehya’s institution received funding from the National Heart, Lung, and Blood Institute; he received support for article research from the National Institutes of Health. Dr. Lee’ s institution received funding from the National Research Medical Council, Singapore. Dr. Shein received funding from Hill Ward Henderson Law Firm. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2023 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)

A clearer understanding of the association between a biomarker of long-term stress reactivity and family functioning among pediatric cancer survivors may guide both survivorship research and clinical practice. The current study examined the relationship between a long-term measure of hypothalamic-pituitary-adrenal (HPA) activity (cortisol concentration; CORT HAIR ) and parent-reported family functioning (Family Environment Scale; FES) in a cross-sectional sample of survivors (n = 26) and controls (n = 53). Child CORT HAIR was not different in survivors and controls, though treatment severity was significantly related to child survivor CORT HAIR . Child CORT HAIR and parent CORT HAIR were positively correlated. Cancer survivor parents reported greater FES Organization. Child CORT HAIR was inversely associated with FES Independence, while parent CORT HAIR was inversely correlated with FES Organization. Parent CORT HAIR and FES Independence were significant and unique predictors of child CORT HAIR . Our results provide preliminary evidence for a relationship between a stress biomarker, child CORT HAIR , and family functioning among pediatric cancer survivors and controls., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: To compare the demographic and clinical features, management, and outcomes for patients admitted with COVID-19 to intensive care units (ICUs) during the first, second, and third waves of the pandemic in Australia., Design, Setting, and Participants: People aged 16 years or more admitted with polymerase chain reaction-confirmed COVID-19 to the 78 Australian ICUs participating in the Short Period Incidence Study of Severe Acute Respiratory Infection (SPRINT-SARI) Australia project during the first (27 February - 30 June 2020), second (1 July 2020 - 25 June 2021), and third COVID-19 waves (26 June - 1 November 2021)., Main Outcome Measures: Primary outcome: in-hospital mortality., Secondary Outcomes: ICU mortality; ICU and hospital lengths of stay; supportive and disease-specific therapies., Results: 2493 people (1535 men, 62%) were admitted to 59 ICUs: 214 during the first (9%), 296 during the second (12%), and 1983 during the third wave (80%). The median age was 64 (IQR, 54-72) years during the first wave, 58 (IQR, 49-68) years during the second, and 54 (IQR, 41-65) years during the third. The proportion without co-existing illnesses was largest during the third wave (41%; first wave, 32%; second wave, 29%). The proportion of ICU beds occupied by patients with COVID-19 was 2.8% (95% CI, 2.7-2.9%) during the first, 4.6% (95% CI, 4.3-5.1%) during the second, and 19.1% (95% CI, 17.9-20.2%) during the third wave. Non-invasive (42% v 15%) and prone ventilation strategies (63% v 15%) were used more frequently during the third wave than during the first two waves. Thirty patients (14%) died in hospital during the first wave, 35 (12%) during the second, and 281 (17%) during the third. After adjusting for age, illness severity, and other covariates, the risk of in-hospital mortality was similar for the first and second waves, but 9.60 (95% CI, 3.52-16.7) percentage points higher during the third than the first wave., Conclusion: The demographic characteristics of patients in intensive care with COVID-19 and the treatments they received during the third pandemic wave differed from those of the first two waves. Adjusted in-hospital mortality was highest during the third wave., (© 2022 The Authors. Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd.)

Objective: This study examined the factor validity of health risk behaviors and resilience indicators and their covariation across a large racially/ethnically diverse adolescent population., Design: The study subsample (47% Hispanic, 31% White Non-Hispanic, 17% American Indian) was derived from the 2013 New Mexico Youth Risk Resilience Survey (YRRS; N-19,033). We conducted a confirmatory factor analysis on the 6 health risk domains identified by the CDC as contributing most to adolescent morbidity/mortality: (1) cigarette use, (2) alcohol and other illicit drug use, (3) marijuana use, (4) sexual activity, (5) nutrition habits, and (6) physical activity., Results: A 4-factor CFA model of adolescent health risk behaviors was replicated, and a hypothesized 6-factor structure based on behaviors that contribute most to adolescent morbidity/mortality was confirmed. The pattern of covarying risk behaviors differed by Hispanic, Native American, and Non-Hispanic White groups. We also confirmed a single external resilience-interference factor (decreased parental support, low school/community engagement, negative peer associations) that positively correlated with all six risk behaviors., Conclusion: This study described the structure of adolescent health risk behaviors within a context of psychosocial resilience for American Indian and Hispanic adolescents in contrast to Non-Hispanic White adolescents. Our findings provided evidence for the construct validity of six health-risk behavior dimensions within a large racially/ethnically diverse adolescent sample, which reveal different patterns of loadings, degrees of model fit, and factor inter-correlations across the three racial/ethnic groups. Patterns of covarying risk behaviors differed in strength and direction by racial/ethnic group. Results suggest that interventions should target multiple behaviors and be tailored for different racial/ethnic groups. Targeting health risk and resilience indicators supports the use of multi-level health interventions at the individual, school, family, and community level by identifying individuals based on external resilience scores.

Stress regulation begins to develop in the first year of life through interactions with caregivers, particularly in the presence of stressors. High quality caregiving, characterized by maternal sensitivity and responsiveness to the infant's emotional cues, is particularly important in the development of infant stress regulation. The purpose of this study was to assess the longitudinal stability of, and associations between, maternal interactive behavior and infant stress regulation (indexed by positive infant affect and cortisol reactivity) in response to the Still Face paradigm (SF) in a cohort of infants born preterm (< 32 weeks gestation, N = 22) at four months and nine months (adjusted age). The percent of time mothers spent using specific interaction styles (contingent maternal interaction (CMI), attention seeking, and watching) during Play/baseline, Reunion#1, and Reunion#2 SF episodes was calculated To assess infant stress regulation, two indices were obtained at both 4 and 9 months during the SF paradigm: the percent of positive affect displayed over each SF episode (0-100%) and a neuroendocrine stress response score based on salivary cortisol reactivity. We found three non-significant but medium-large effect size differences between 4 and 9 month variables, with more positive findings at 9 months. Regarding stability within the 4 month and 9 month episodes, maternal behavior and positive infant affect were non-significantly but moderately stable, with maternal watching behavior being particularly stable. Positive infant affect stability between Reunion#1 and Reunion#2 at 4 months was significantly greater than positive infant affect stability across these two episodes at 9 months. Regarding stability across 4 and 9 month (same) episodes, CMI and positive infant affect showed modest but non-significant stability across (same) 4 and 9 month episodes. Finally, with positive infant affect at Reunion#2 as the "outcome" of the Still Face, CMI at both 4 month Play and Reunion#1 episodes were significantly correlated with this "outcome." Further, positive infant affect at Reunion#2 was more strongly correlated with CMI at both Play and Reunion#1 for 4 month old compared with 9 month old infants. Thus, sensitive care appears particularly important for younger infants born preterm, and mothers' behavior early in a repeated stress exposure paradigm may be particularly important in maintaining positive infant affect and in the development of infants' stress regulation more generally. Identifying the longer-term effects of early stress on infant stress regulation, and its relationship with maternal interaction, has important implications for understanding trajectories of regulatory patterns and deficits. A greater understanding of these relationships is particularly important given that greater emotion and neuroendocrine stress regulation in infancy have been directly associated with numerous positive outcomes throughout childhood., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: To determine whether the formation of a multidisciplinary team, pharmacist-led therapeutic interchange, and streamlined electronic health record optimization improved biosimilar adoption throughout Mayo Clinic., Patients and Methods: The project focused on the use of reference products and biosimilars for 5 biologics-bevacizumab, epoetin alfa, filgrastim, rituximab, and trastuzumab-at all Mayo Clinic locations. Pharmaceutical wholesale purchase histories of those reference products and biosimilars were assessed from September 1, 2020, through August 31, 2021, and compared with data from September 1, 2019, through August 31, 2020. Formulary decisions were implemented across 5 biologics for most ordering pathways on September 1, 2020. Pharmaceutical purchased drug units and expenditures were tracked at 3-month intervals for conversion to formulary-preferred contracted biosimilars., Results: In the final postimplementation period, the absolute percentage increase of formulary-preferred biosimilars was 69% for bevacizumab, 63% for epoetin alfa, 80% for filgrastim, 79% for rituximab, and 72% for trastuzumab. Pharmaceutical line item savings in the 12-month postimplementation period totaled $23.1 million across all 5 biologics., Conclusion: Creation of a multidisciplinary team to implement formulary-preferred contracted biosimilars led to the adoption of biosimilars throughout Mayo Clinic with considerable pharmaceutical line item savings., (Published by Elsevier Inc.)

Introduction: The epidemiology and clinical manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are different in children and adolescents compared with adults. Although coronavirus disease 2019 (COVID-19) appears to be less common in children, with milder disease overall, severe complications may occur, including paediatric inflammatory multisystem syndrome (PIMS-TS). Recognising the distinct needs of this population, the National COVID-19 Clinical Evidence Taskforce formed a Paediatric and Adolescent Care Panel to provide living guidelines for Australian clinicians to manage children and adolescents with COVID-19 and COVID-19 complications. Living guidelines mean that these evidence-based recommendations are updated in near real time to give reliable, contemporaneous advice to Australian clinicians providing paediatric care., Main Recommendations: To date, the Taskforce has made 20 specific recommendations for children and adolescents, including definitions of disease severity, recommendations for therapy, respiratory support, and venous thromboembolism prophylaxis for COVID-19 and for the management of PIMS-TS., Changes in Management as a Result of the Guidelines: The Taskforce currently recommends corticosteroids as first line treatment for acute COVID-19 in children and adolescents who require oxygen. Tocilizumab could be considered, and remdesivir should not be administered routinely in this population. Non-invasive ventilation or high flow nasal cannulae should be considered in children and adolescents with hypoxaemia or respiratory distress unresponsive to low flow oxygen if appropriate infection control measures can be used. Children and adolescents with PIMS-TS should be managed by a multidisciplinary team. Intravenous immunoglobulin and corticosteroids, with concomitant aspirin and thromboprophylaxis, should be considered for the treatment of PIMS-TS. The latest updates and full recommendations are available at www.covid19evidence.net.au., (© 2021 AMPCo Pty Ltd.)

Background: Nephrolithiasis in living kidney donors is concerning due to the potential impact on long-term postdonation kidney function., Methods: We performed a cohort study of living kidney donors from 2 centers with a baseline computed tomography scan and implantation renal biopsy. Donors (>5 y since donation) completed a follow-up survey or underwent chart review to assess eGFR and incident hypertension. Stone formers were classified as symptomatic if they had a past symptomatic episode or asymptomatic if only incidental radiographic kidney stones were identified during donor evaluation. We compared baseline clinical, imaging, and biopsy characteristics by stone former status including review of metabolic evaluations in stone formers. Long-term risks of renal complications (low eGFR and hypertension) by stone former status were evaluated., Results: There were 12 symptomatic and 76 asymptomatic stone formers among 866 donors. Overall, baseline clinical characteristics and implantation biopsy findings were similar between stone formers and non-stone formers. After a median follow-up of 10 y, stone former status was not associated with eGFR <60 mL/min/1.73 m2, eGFR <45 mL/min/1.73 m 2 , or hypertension., Conclusions: Both asymptomatic and symptomatic SF have favorable histology findings at baseline. Long-term kidney outcomes were favorable in select stone formers with no evident increased long-term risk for decreased kidney function or hypertension after donation., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.)

Background: Emotion regulation develops through bidirectional affective communication., Aim: To investigate the role of maternal interactive behavior in predicting infant affect among preterm versus full-term infants., Study Design: The association between maternal interactive behavior (contingent, attention seeking, watching) and infant affect during a modified Still Face (SF) paradigm in a sample of 22 preterm and 28 full term infants (3 ½ - 4 ½ months old) was investigated., Methods: Maternal behavior and infant affect were coded in one second intervals., Results: Maternal contingent interaction was positively correlated with positive infant affect (p < 0.001 for Play; p < 0.001 for Reunion#1; p < 0.01 for Reunion#2, respectively), with a stronger association during the second reunion for preterm infants (p < 0.001). In the preterm sample but not in the full-term sample, attention seeking maternal interaction at Play (baseline), Reunion#1, and Reunion#2 were all positively correlated with negative infant affect at Still Face#2. Maternal watching was negatively associated with positive infant affect for the full sample for both Reunion episodes (p < 0.05). Full term infants' negative affect increased from baseline to the first SF episode and then plateaued, whereas preterm infants demonstrated greater negative affect and less recovery throughout. Mothers of full-term infants showed increased contingent responding after the first SF stressor, while mothers of preterm infants did not (p < 0.05)., Conclusions: Preterm infants may be more susceptible to both positive and negative maternal behaviors and mothers of full-term infants may be more responsive to infants' increased distress. Relationship-focused interventions addressing maternal behaviors may enhance positive emotionality and improve self-regulation in medically at-risk infants., (Copyright © 2021. Published by Elsevier B.V.)

Infants who experience sensitive caregiving are at lower risk for numerous adverse outcomes. This is especially true for infants born preterm, leading them to be more susceptible to risks associated with poorer quality caregiving. Some research suggests that preterm and full-term infants differ on temperament, which may contribute to these findings. This study aimed to investigate associations between infant temperament (negative emotionality, positive affectivity/surgency, and orienting/regulatory capacity) and maternal sensitivity among infants born preterm (M = 30.2 weeks) and full term. It was hypothesized that mothers of infants born preterm and mothers of infants with more difficult temperaments would display lower sensitivity, indicated by lower responsiveness to nondistress, lower positive regard, and higher intrusiveness. Videotaped play interactions and a measure of temperament (Infant Behavior Questionnaire) were coded for 18 preterm and 44 full-term infants at 9 months (corrected) age. Results suggest that mothers of preterm and full-term infants differed significantly in responding to their infants, but these results cannot be explained by infant temperament. Preterm status and sociodemographic risk emerged as correlates of maternal behavior, such that mothers of infants born preterm and mothers with greater sociodemographic risk displayed lower levels of maternal sensitivity., (© 2021 Michigan Association for Infant Mental Health.)

Objectives: To describe the characteristics and outcomes of patients with COVID-19 admitted to intensive care units (ICUs) during the initial months of the pandemic in Australia., Design, Setting: Prospective, observational cohort study in 77 ICUs across Australia., Participants: Patients admitted to participating ICUs with laboratory-confirmed COVID-19 during 27 February - 30 June 2020., Main Outcome Measures: ICU mortality and resource use (ICU length of stay, peak bed occupancy)., Results: The median age of the 204 patients with COVID-19 admitted to intensive care was 63.5 years (IQR, 53-72 years); 140 were men (69%). The most frequent comorbid conditions were obesity (40% of patients), diabetes (28%), hypertension treated with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (24%), and chronic cardiac disease (20%); 73 patients (36%) reported no comorbidity. The most frequent source of infection was overseas travel (114 patients, 56%). Median peak ICU bed occupancy was 14% (IQR, 9-16%). Invasive ventilation was provided for 119 patients (58%). Median length of ICU stay was greater for invasively ventilated patients than for non-ventilated patients (16 days; IQR, 9-28 days v 3 days; IQR, 2-5 days), as was ICU mortality (26 deaths, 22%; 95% CI, 15-31% v four deaths, 5%; 95% CI, 1-12%). Higher Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores on ICU day 1 (adjusted hazard ratio [aHR], 1.15; 95% CI, 1.09-1.21) and chronic cardiac disease (aHR, 3.38; 95% CI, 1.46-7.83) were each associated with higher ICU mortality., Conclusion: Until the end of June 2020, mortality among patients with COVID-19 who required invasive ventilation in Australian ICUs was lower and their ICU stay longer than reported overseas. Our findings highlight the importance of ensuring adequate local ICU capacity, particularly as the pandemic has not yet ended., (© 2020 AMPCo Pty Ltd.)

Objectives: To assess the feasibility, safety, and efficacy of a sedation protocol using dexmedetomidine as the primary sedative in mechanically ventilated critically ill children., Design: Open-label, pilot, prospective, multicenter, randomized, controlled trial. The primary outcome was the proportion of sedation scores in the target sedation range in the first 48 hours. Safety outcomes included device removal, adverse events, and vasopressor use. Feasibility outcomes included time to randomization and protocol fidelity., Setting: Six tertiary PICUs in Australia and New Zealand., Patients: Critically ill children, younger than 16 years old, requiring intubation and mechanical ventilation and expected to be mechanically ventilated for at least 24 hours., Interventions: Children randomized to dexmedetomidine received a dexmedetomidine-based algorithm targeted to light sedation (State Behavioral Scale -1 to +1). Children randomized to usual care received sedation as determined by the treating clinician (but not dexmedetomidine), also targeted to light sedation., Measurements and Main Results: Sedation with dexmedetomidine as the primary sedative resulted in a greater proportion of sedation measurements in the light sedation range (State Behavioral Scale -1 to +1) over the first 48 hours (229/325 [71%] vs 181/331 [58%]; p = 0.04) and the first 24 hours (66/103 [64%] vs 48/116 [41%]; p < 0.001) compared with usual care. Cumulative midazolam dosage was significantly reduced in the dexmedetomidine arm compared with usual care (p = 0.002).There were more episodes of hypotension and bradycardia with dexmedetomidine (including one serious adverse event) but no difference in vasopressor requirements. Median time to randomization after intubation was 6.0 hours (interquartile range, 2.0-9.0 hr) in the dexmedetomidine arm compared with 3.0 hours (interquartile range, 1.0-7.0 hr) in the usual care arm (p = 0.24)., Conclusions: A sedation protocol using dexmedetomidine as the primary sedative was feasible, appeared safe, achieved early, light sedation, and reduced midazolam requirements. The findings of this pilot study justify further studies of sedative agents in critically ill children.

Background: A unique and limiting component in the research on functional impairment among children has been the exclusive use of parent proxy reports about child functioning; and there is limited information regarding the impact of pediatric cancer treatment on children's day-to-day functioning and how this is related to neurocognitive functioning. The objective of the current study was to examine a novel measure of self-reported functional impairment, and explore the relationship between self-reported and parent-reported child functional impairment in pediatric cancer survivors compared to controls., Methods: A cross-sectional cohort of survivors (n = 26) and controls (n = 53) were recruited. Survivors were off treatment an average of 6.35 years (SD = 5.38; range 1-15 years) and demonstrated an average "medium" Central Nervous System treatment intensity score. Participants completed measures of functional impairment (FI), intellectual assessment (RIST) and executive functions (NIH Examiner), while parents reported on children's functional impairment., Results: Survivors were similar to controls in functional impairment. Regardless of group membership, self-reported FI was higher than parent-reported FI, although they were correlated and parent report of FI significantly predicted self-reported FI. Across groups, increased impairment was associated with four of seven Examiner scores., Conclusions: Research regarding self-reported functional impairment of cancer survivors and its association with parent-reported functional impairment and neurocognitive deficits has been limited. Our results suggest that self-reported FI appears to be a reasonable and viable outcome measure that corresponds with and adds incremental validity to parent reported FI. While low treatment intensity may confer relative sparing of functional impairment among survivors, children report higher FI levels than parents, suggesting that FI can be of clinical utility. In conclusion, pediatric cancer survivors should be screened for self-reported functional difficulties.

The purpose of this study was to assess the association between maternal interactive behavior and infant cortisol stress reactivity in response to the Still Face paradigm (SF) in a cohort of four-month old infants (adjusted age) born preterm (<32 weeks gestation, N = 22) compared with infants born full term (>37 weeks gestation, N = 28). Infant cortisol reactivity was calculated as area under the curve (AUC) from baseline to the third cortisol sample (30 min post-SF) using the trapezoidal rule, while the percent of time mothers spent using a contingent interaction style was measured (0-100%) during episodes 1 (Play; baseline), 3 (Reunion#1), and 5 (Reunion#2) while mother-infant dyads participated in the SF paradigm. We hypothesized that because infants born preterm are at increased risk for dysregulation, they would show, compared to full-term infants, a blunted stress response, involving under-responsiveness. We found blunted cortisol stress reactivity among the preterm infants. We also found that mothers of preterm infants demonstrated less contingent maternal interaction during Renion#1 of the SF; and that contingent maternal interaction at Reunion#2 of the SF was protective against cortisol stress reactivity in response to the SF. However, we did not find that the influence of maternal interaction on cortisol reactivity was moderated by gestational age group (full term vs preterm): the association between contingent maternal interaction and stress reactivity was similar for both gestational groups across episodes. In order to improve self-regulation and longer term social and cognitive developmental outcomes in medically at-risk infants, future research is warranted to determine how these findings relate to infants' stress reactions in naturalistic settings, and the directionality and temporal relationship between cortisol stress responses and maternal interactive behavior., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: To examine the impact of cancer treatment upon neurocognitive and functional impairment; and to explore the relationship between these constructs in pediatric cancer survivors compared to controls., Method: A cross-sectional cohort of survivors (n = 26) and controls (n = 53) was included. Survivors were off treatment an average of 6.35 years (SD = 5.38; range 1-15 years) and demonstrated an average "medium" Central Nervous System (CNS) treatment intensity score. Participants completed measures of neurocognitive functions including intellectual assessment (RIST) and executive functions (NIH Examiner), while parents reported on children's functional impairment (BIS)., Results: Survivors were similar to controls in neurocognitive ability, including intellectual and executive functions, and functional impairment. Regardless of group membership, NIH Examiner performance and functional impairment increased with age. Increased impairment was associated with different neurocognitive variables for survivors versus controls., Conclusions: Research regarding functional impairment of cancer survivors and the association between neurocognitive deficits and functional impairment has been limited. Our results demonstrate that, while low treatment intensity may confer relative sparing of neurocognitive and executive functioning among survivors, functional impairment continues to be a potential risk. In conclusion, pediatric cancer survivors should be screened for functional difficulties, particularly in the areas of interpersonal relations and self-care., (© The Author(s) 2018. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Subsyndromal posttraumatic stress among pediatric cancer survivors has been associated with negative physical and mental health outcomes. However, adolescent self-report and mother-proxy report of adolescents' posttraumatic stress symptoms evidenced varying concordance depending on methodology. There was moderate concordance, particularly among younger respondents, when total posttraumatic stress symptoms were viewed continuously and low-moderate concordance when viewed categorically; moderate-strong concordance for only one posttraumatic stress disorder symptom cluster; low-moderate agreement for high-frequency items; and no concordance for identifying caseness. Although a significant subset of pediatric cancer survivors experience posttraumatic stress, mothers and adolescents demonstrate limited symptom, categorical, and caseness agreement, potentially impacting adolescents' healthcare service utilization.

Objectives: To describe the incidence and mortality of invasive infections in Indigenous children admitted to paediatric and general intensive care units (ICUs) in Australia., Design: Retrospective multi-centre cohort study of Australian and New Zealand Paediatric Intensive Care Registry data., Participants: All children under 16 years of age admitted to an ICU in Australia, 1 January 2002 - 31 December 2013. Indigenous children were defined as those identified as Aboriginal and/or Torres Strait Islander in a mandatory admissions dataset., Main Outcomes: Population-based ICU mortality and admission rates., Results: Invasive infections accounted for 23.0% of non-elective ICU admissions of Indigenous children (726 of 3150), resulting in an admission rate of 47.6 per 100 000 children per year. Staphylococcus aureus was the leading pathogen identified in children with sepsis/septic shock (incidence, 4.42 per 100 000 Indigenous children per year; 0.57 per 100 000 non-Indigenous children per year; incidence rate ratio 7.7; 95% CI, 5.8-10.1; P < 0.001). While crude and risk-adjusted ICU mortality related to invasive infections was not significantly different for Indigenous and non-Indigenous children (odds ratio, 0.75; 95% CI, 0.53-1.07; P = 0.12), the estimated population-based age-standardised mortality rate for invasive infections was significantly higher for Indigenous children (2.67 per 100 000 per year v 1.04 per 100 000 per year; crude incidence rate ratio, 2.65; 95% CI, 1.88-3.64; P < 0.001)., Conclusions: The ICU admission rate for severe infections was several times higher for Indigenous than for non-Indigenous children, particularly for S. aureus infections. While ICU case fatality rates were similar, the population-based mortality was more than twice as high for Indigenous children. Our study highlights an important area of inequality in health care for Indigenous children in a high income country that needs urgent attention.

Substance users are at increased risk for HIV and HCV infection. Still, many substance use treatment programs (SUTP) fail to offer HIV/HCV testing. The present secondary analysis of screening data from a multi-site randomized trial of rapid HIV testing examines self-reported HIV/HCV testing patterns and serostatus of 2473 SUTP patients in 12 community-based sites that had not previously offered on-site testing. Results indicate that most respondents screened for the randomized trial tested more than a year prior to intake for HIV (52 %) and HCV (38 %). Prevalence rates were 3.6 and 30 % for HIV and HCV, respectively. The majority of participants that were HIV (52.2 %) and HCV-positive (40.5 %) reported having been diagnosed within the last 1-5 years. Multivariable logistic regression showed that members of high-risk groups were more likely to have tested. Bundled HIV/HCV testing and linkage to care issues are recommended for expanding testing in community-based SUTP settings.

The goal was to identify perinatal predictors of early executive dysfunction in preschoolers born very low birth weight. Fifty-seven preschoolers completed 3 executive function tasks: Dimensional Change Card Sort-Separated (inhibition, working memory, and cognitive flexibility), Bear Dragon (inhibition and working memory), and Gift Delay Open (inhibition). Relationships between executive function and perinatal medical severity factors (gestational age, days on ventilation, size for gestational age, maternal steroids, and number of surgeries) and chronological age were investigated by multiple linear regression and logistic regression. Different perinatal medical severity factors were predictive of executive function tasks, with gestational age predicting Bear Dragon and Gift Open; and number of surgeries and maternal steroids predicting performance on Dimensional Change Card Sort-Separated. By understanding the relationship between perinatal medical severity factors and preschool executive outcomes, we can identify children at highest risk for future executive dysfunction, thereby focusing targeted early intervention services., (© The Author(s) 2014.)

Body dissatisfaction is common in preadolescent girls. In this qualitative study, preadolescent girls (N=145) wrote descriptions of factors that made them feel good and bad about their bodies. Their mothers (N=145) also wrote about factors they believed made their daughters feel good and bad about their bodies. Statements were coded using thematic analysis. Chi-square analyses examined mother-daughter dyad agreement, and differences in influential factors based on ethnic identity. Despite general agreement in overall themes, results indicated limited agreement within mother-daughter dyads. Specifically, one significant result was detected: mothers and their daughters agreed on the importance of teasing as a negative influence on body satisfaction. There was one significant difference based on ethnic identity, with Hispanic girls mentioning more frequently than White girls that physical activity/exercise helped them feel good about their bodies. Recommendations are made for family-based interventions to support the body image of preadolescent girls., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: Childhood cancer survivors are at risk for long-term neurocognitive and psychosocial morbidities. Research has seldom examined the relationship between these morbidities; thus, little empirical evidence exists concerning overall salience and how morbidities converge to impair day-to-day functioning. An increased understanding of functional impairment resulting from the pediatric cancer experience can inform early risk identification as well as sources for intervention. The purpose of this study was to characterize the frequency/severity of functional impairment and identify significant neurocognitive and psychosocial determinants of functional impairment., Methods: Fifty child-parent dyads were enrolled. Children were aged 7-19 years who were at least 2 years postdiagnosis with leukemia/lymphoma and were recruited through a pediatric oncology late effects clinic. Parents completed questionnaires, rating their own adjustment to their child's illness as well as their child's level of functional impairment, while a brief neuropsychological exam was administered to children., Results: Twenty-six percent of the sample evidenced clinically significant functional impairment. Regression analyses indicated that neurocognitive deficits did not predict functional impairment, whereas parental stress was a significant predictor., Conclusions: Although children demonstrated both neurocognitive deficits and functional impairments, results favor psychosocial factors, such as parental stress, as a predictor of overall functional impairment. The implications of this study suggest that late effects aggregate to impact day-to-day functioning in pediatric cancer survivor populations and parental stress may serve as a marker for heightened risk. The results suggest that broader functional domains, especially school and self-care domains, should be evaluated and considered when identifying potential targets for psychosocial interventions., (Copyright © 2014 John Wiley & Sons, Ltd.)

Background: Deficits in executive function, including measures of working memory, inhibition and cognitive flexibility, have been documented in preschoolers born very low birth weight (VLBW) compared with preschoolers born normal birth weight (NBW). Maternal verbal scaffolding has been associated with positive outcomes for both at-risk and typically developing preschoolers., Aims: The purpose of this study was to examine associations between maternal verbal scaffolding, Verbal IQ (VIQ) and executive function measures in preschoolers born VLBW., Subjects: A total of 64 VLBW and 40 NBW preschoolers ranging in age from 3 ½ to 4 years participated in the study., Outcome Measures: VIQ was measured with the Wechsler Preschool and Primary Scale of Intelligence - Third Edition. Executive function tests included the Bear Dragon, Gift Delay Peek, Reverse Categorization and Dimensional Change Card Sort-Separated Dimensions., Study Design: Maternal verbal scaffolding was coded during a videotaped play session. Associations between maternal verbal scaffolding and preschoolers' measures of VIQ and executive function were compared. Covariates included test age, maternal education, and gender., Results: Preschoolers born VLBW performed significantly worse on VIQ and all executive function measures compared to those born NBW. Maternal verbal scaffolding was associated with VIQ for VLBW preschoolers and Gift Delay Peek for the NBW group. Girls born VLBW outperformed boys born VLBW on VIQ and Bear Dragon., Conclusion: Integrating scaffolding skills training as part of parent-focused intervention may be both feasible and valuable for early verbal reasoning and EF development., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

A generation-2 (Gen-2) handheld optical imager capable of two-dimensional surface and three-dimensional tomographic imaging has recently been developed. Herein, the ability of the handheld imager to detect and resolve two targets under diffuse and fluorescence imaging conditions has been demonstrated via tissue phantom studies. Two-dimensional surface imaging studies demonstrated that two 0.96 cm diameter Indocyannine Green targets were detected and resolved ~0.5  cm apart (between edges) at a target depth of 1 cm during diffuse imaging and up to 2 cm depth during fluorescence imaging. Preliminary 3D tomographic imaging capability to resolve the two targets was also demonstrated, but requires extensive future studies.

Background: Parental "scaffolding" behavior has been associated with developmental outcomes in at-risk children., Aims: Because there are limited empirical data regarding how scaffolding is associated with emotion-based developmental skills, the purpose of this study was to compare associations between maternal verbal scaffolding and toddler emotion regulation, including fewer displays of negative affect and increased contentment and enjoyment during play, in toddlers born preterm and full term., Study Design: This study was a cross-sectional cohort design. Maternal and toddler behavior was assessed during 5 min of videotaped free play with standardized toys., Subjects: 131 toddlers (18-22 months) and their mothers were included (77 born preterm; 54 born full term)., Outcome Measures: Toddler emotion regulation, negative affect, and dyadic mutual enjoyment were coded from videotaped play., Results: The association between maternal scaffolding and emotion regulation was different for dyads with a toddler born preterm versus full term, wherein the association was positive for toddlers born preterm and non-significant for toddlers born full term. Similarly, the association between maternal scaffolding and negative affect was different for the two groups: negative for toddlers born preterm and non-significant for toddlers born full term. Finally, the association between maternal scaffolding and mutual enjoyment was positive for toddlers born preterm and non-significant for toddlers born full term., Conclusions: Our findings highlight early differences in mother-child interactive style correlates of children born preterm compared to those born full term. Maternal scaffolding behavior may be uniquely associated with emotion regulation and a positive dyadic encounter for toddlers born preterm., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Psychological stress responses may have both emotional and cortisol reactivity correlates, but there are limited data addressing the association between generalized negative and positive emotional states and cortisol reactivity to a psychological stressor among infants born very low birth weight (VLBW; <1250 g) compared to infants born full-term. Examining this relationship between behavioral (affect) and physiological (cortisol) responses may provide insight into the nature of regulation difficulties identified in infants born VLBW. The purpose of this study was to assess the association between infant affective and cortisol responses to the Still Face paradigm (SF) in a cohort of six- to eight-month old infants born VLBW compared with infants born full-term (N=53 total; N=29 and N=24, respectively). Infant affect was coded in 1-s intervals while mother-infant dyads participated in the SF paradigm, and percent positive affect and percent negative affect were calculated separately for each SF episode. We had hypothesized that because infants born VLBW are at increased risk for dysregulation, they would show, compared to full-term controls, greater dysregulation in the form of less synchrony (i.e., less correlated affective and cortisol responses) across the two SF stressors (episodes 2 and 4). This hypothesis was largely supported: the associations between affective and cortisol responses were different for the two groups across the two stressors for percent positive affect (both stressor episodes 2 and 4) and percent negative affect (episode 4 only). For the full-term group, follow up correlations revealed significant negative associations between percent positive affective and cortisol responses for both stressors. Mothers' responsiveness did not explain the term group association differences between infant affective and cortisol responses across stressors. The (lack of) association of stress reactivity systems may index dysregulation or dysregulation correlates in preterm children. Understanding how this lack of coordination among stress systems relates to greater dysregulation, learning, and attentional difficulties may be important in recognizing early precursors to such problems in preterm children, and in this way, aid in early intervention efforts. Future research is warranted to determine how these findings relate to infants' stress reactions in naturalistic settings, and the directionality and temporal relationship between cortisol and infant affective stress responses., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Diffuse optical imaging using non-ionizing radiation is a non-invasive method that shows promise towards breast cancer diagnosis. Hand-held optical imagers show potential for clinical translation of the technology, yet they have not been used towards 3D tomography. Herein, 3D tomography of human breast tissue in vivo is demonstrated for the first time using a hand-held optical imager with automated coregistration facilities. Simulation studies are performed on breast geometries to demonstrate the feasibility of 3D tomographic imaging using a hand-held imager under perfect (1:0) and imperfect (100:1, 50:1) fluorescence absorption contrast ratios. Experimental studies are performed in vivo using a 1 µM ICG filled phantom target placed non-invasively underneath the flap of the breast tissue. Results show the ability to perform automated tracking and coregistered imaging of human breast tissue (with tracking accuracy on the order of ∼1 cm). Three-dimensional tomography results demonstrated the ability to recover a single target placed at a depth of 2.5 cm, from both the simulated (at 1:0, 100:1 and 50:1 contrasts) and experimental cases on actual breast tissues. Ongoing efforts to improve target depth recovery are carried out via implementation of transmittance imaging in the hand-held imager.

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis causes autonomic disturbances, behavioural changes and abnormal movements. It is often a paraneoplastic phenomenon that occurs in association with ovarian teratomas and is the most common paraneoplastic encephalitis. We report nine cases of critically ill patients with anti- NMDA receptor encephalitis from Australia and New Zealand. One patient died and one had a poor neurological recovery. The remaining patients made substantial or complete neurological recoveries. This case series highlights that patients with anti-NMDA receptor encephalitis: • often require long periods of support in an intensive care unit; • may develop tracheostomy complications related to hypersalivation; • may develop life-threatening hyperthermia; • can have ovarian teratomas despite normal investigations; and • often have very abnormal movements that are difficult to control and make ongoing care difficult.

Aim: Parental behaviour described as 'scaffolding' has been shown to influence outcomes in at-risk children. The purpose of this study was to compare maternal verbal scaffolding in toddlers born preterm and full term., Methods: The scaffolding behaviour of mothers of toddlers born preterm and healthy full term was compared during a 5-min videotaped free play session with standardized toys. We compared two types of scaffolding and their associations with socio-demographic, neonatal medical factors and cognition., Results: The mothers of toddlers born full term used more complex scaffolding. Maternal education was associated with complex scaffolding scores for the preterm children only. Specifically, the preterm children who were sicker in the neonatal period, and whose mothers had higher education, used more complex scaffolding. In addition, children born preterm, who had less days of ventilation, had higher cognitive scores when their mothers used more complex scaffolding. Similarly, cognitive and scaffolding scores were higher for children born full term., Conclusion: Our findings highlight early differences in mother-child interactive styles of toddlers born preterm compared with full term. Teaching parents play methods that support early problem-solving skills may support a child's method of exploration and simultaneously their language development., (©2012 The Author(s)/Acta Paediatrica ©2012 Foundation Acta Paediatrica.)

Children born very low birth weight (<1500 g, VLBW) are at increased risk for developmental delays. Play is an important developmental outcome to the extent that child's play and social communication are related to later development of self-regulation and effective functional skills, and play serves as an important avenue of early intervention. The current study investigated associations between maternal flexibility and toddler play sophistication in Caucasian, Spanish speaking Hispanic, English speaking Hispanic, and Native American toddlers (18-22 months adjusted age) in a cross-sectional cohort of 73 toddlers born VLBW and their mothers. We found that the association between maternal flexibility and toddler play sophistication differed by ethnicity (F(3,65) = 3.34, p = .02). In particular, Spanish speaking Hispanic dyads evidenced a significant positive association between maternal flexibility and play sophistication of medium effect size. Results for Native Americans were parallel to those of Spanish speaking Hispanic dyads: the relationship between flexibility and play sophistication was positive and of small-medium effect size. Findings indicate that for Caucasians and English speaking Hispanics, flexibility evidenced a non-significant (negative and small effect size) association with toddler play sophistication. Significant follow-up contrasts revealed that the associations for Caucasian and English speaking Hispanic dyads were significantly different from those of the other two ethnic groups. Results remained unchanged after adjusting for the amount of maternal language, an index of maternal engagement and stimulation; and after adjusting for birth weight, gestational age, gender, test age, cognitive ability, as well maternal age, education, and income. Our results provide preliminary evidence that ethnicity and acculturation may mediate the association between maternal interactive behavior such as flexibility and toddler developmental outcomes, as indexed by play sophistication. Addressing these association differences is particularly important in children born VLBW because interventions targeting parent interaction strategies such as maternal flexibility must account for ethnic-cultural differences in order to promote toddler developmental outcomes through play paradigms., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Hand-held optical imagers are developed by various researchers towards reflectance-based spectroscopic imaging of breast cancer. Recently, a Gen-1 handheld optical imager was developed with capabilities to perform two-dimensional (2-D) spectroscopic as well as three-dimensional (3-D) tomographic imaging studies. However, the imager was bulky with poor surface contact (~30%) along curved tissues, and limited sensitivity to detect targets consistently. Herein, a Gen-2 hand-held optical imager that overcame the above limitations of the Gen-1 imager has been developed and the instrumentation described. The Gen-2 hand-held imager is less bulky, portable, and has improved surface contact (~86%) on curved tissues. Additionally, the forked probe head design is capable of simultaneous bilateral reflectance imaging of both breast tissues, and also transillumination imaging of a single breast tissue. Experimental studies were performed on tissue phantoms to demonstrate the improved sensitivity in detecting targets using the Gen-2 imager. The improved instrumentation of the Gen-2 imager allowed detection of targets independent of their location with respect to the illumination points, unlike in Gen-1 imager. The developed imager has potential for future clinical breast imaging with enhanced sensitivity, via both reflectance and transillumination imaging.

Aim: To better understand differences between Bayley Scales 3rd edition (Bayley III) Cognitive Scale and Bayley Scales 2nd edition (Bayley II) Mental Developmental Index (MDI) in 18-22-month-old children born term and preterm and to create a conversion algorithm using Bayley II MDI to calculate Bayley III Cognitive score., Methods: This study included 51 term and 26 preterm children between 18 and 22 months, ages adjusted for prematurity. Children's scores on Bayley II MDI and Bayley III Cognitive Scale were compared using t-tests. The items from Bayley II MDI were used to calculate a score for the Bayley III Cognitive Scale. ANCOVA was used to create a conversion scale., Results: Bayley III Cognitive scores were significantly higher than Bayley II MDI scores for term and preterm toddlers combined and separately (p < .0001). A conversion formula to convert Bayley II MDI to a Bayley III Cognitive score was calculated., Conclusion: Term and preterm children had similarly elevated scores on the Bayley III calculated Cognitive score compared to the previous Bayley II MDI score. The use of a conversion algorithm may be helpful in studies that used both Bayley editions to get comparable outcome measurements within a clinical or research paradigm., (© 2011 The Author(s)/Acta Paediatrica © 2011 Foundation Acta Paediatrica.)