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The article offers the author's insights on the Christians and Muslims in Europe, and mentions topics including the election of Sadiq Khan as mayor of Londosn, England, separation of Church and state, and Christianity.

Background and Aim: Physical activity may have positive effects on preschoolers' mental health and self-regulation. The preschool setting provides children with opportunities to meet physical activity guidelines and could improve with staff training in delivering physical activity. This study examined the effect of physical activity professional development for preschool staff on preschoolers' proxy-measured mental health and self-regulation., Methods: In total, 1265 children from 46 preschools were cluster randomised to either the intervention or the control group. The intervention was nested within two levels implemented concurrently: the preschool level, formed as a professional development where preschools conducted development work, and the child level, with whom the staff implemented physical activity with four core components. Data were analysed using an ANCOVA model through structural equation modelling with latent outcome factors of: emotional problems, peer problems, hyperactivity, and prosocial behaviour from the Strength and Difficulties Questionnaire; and cognitive, emotional, and behavioural self-regulation from the Child Self-regulation and Behaviour Questionnaire., Results: No effects of the intervention (standardised effect sizes -0.195-0.145, p-values 0.118-0.893) were observed. Secondary analysis showed that children with initially high prosocial behaviour and behavioural self-regulation positively benefited from the intervention (p = 0.035 and p = 0.047, respectively)., Conclusion: The ACTNOW intervention had no effects on preschoolers' mental health or self-regulation after 18 months, besides effects for children with initially the highest prosocial behaviour and behavioural self-regulation. Although the professional development was more extensive than previous studies it may have been insufficient to change the preschools physical activity practices., Clinical Trial Registration: www., Clinicaltrials: gov identifier NCT04048967., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Enough is known about self-regulation to establish it as a priority target for education and intervention efforts beginning in early childhood, yet not enough to meaningfully and reliably alter developmental trajectories. Rather than resigning our aspirations, we need more nuanced and integrative understanding of self-regulation abilities and change., Methods: Launching in 2024, SPROUTS is a 3-year longitudinal study of early self-regulation, beginning in the pre-school period (3-5 years old at Wave 1) with retrospective data back to birth and annual data collection across the transition to school period (ages 5-7 years at Wave 3). Data will be collected on children's self-regulation, related abilities, outcomes, as well as prior and current contexts. One nested study within each Wave-that contributes complementary insights via supplementary and in-depth methods and data-will enable further exploration of contemporary issues related to self-regulation., Discussion: Insights generated can potentiate more effective intervention and education efforts by: improving intervention cost-benefit ratios; identifying likely mechanisms of change; easing burdens of unhealthy and antisocial behaviours associated with low self-regulation; and, most importantly, contributing to giving children the best early start to life. These benefits are timely in the context of intense policy and educational interest in fostering children's self-regulation., Trial Registration: Open Science Framework: osf.io/maqdg. Date of registration: 26 Sep 2024., (© 2024. The Author(s).)

Importance: The multifaceted nature of screen use has been largely overlooked in favor of a simplistic unidimensional measure of overall screen time when evaluating the benefits and risks of screen use to early childhood development., Objective: To conduct a systematic review and meta-analysis to examine associations of screen use contexts in early childhood with cognitive and psychosocial outcomes., Data Sources: PsycINFO, Embase, MEDLINE Ovid, ProQuest, CINAHL, Web of Science, and Scopus were searched from inception to December 31, 2023., Study Selection: A total of 7441 studies were initially identified. Studies were included if they examined associations between a contextual factor of screen use among children aged 0 to 5.99 years and cognitive or psychosocial development. Observational, experimental, and randomized clinical trial study designs were included., Data Extraction and Synthesis: All studies were independently screened in duplicate following PRISMA guidelines. Effect sizes of associations (r) from observational studies were pooled using random-effects 3-level meta-analyses. The remaining study designs were narratively synthesized., Main Outcomes and Measures: Screen use contexts included content (child directed and age inappropriate), type (program viewing and game or app use), co-use (or solo use), background television, caregiver screen use during child routines, and purpose. Outcomes were cognitive (executive functioning, language, and academic skills) or psychosocial (internalizing and externalizing behavior problems and socioemotional competence)., Results: Overall, 100 studies (176 742 participants) were included, and of these, 64 observational studies (pooled sample sizes ranging from 711 to 69 232) were included in meta-analyses. Program viewing (n = 14; k = 48; r, -0.16; 95% CI, -0.24 to -0.08) and background television (n = 8; k = 18; r, -0.10; 95% CI, -0.18 to -0.02) were negatively associated with cognitive outcomes, while program viewing (n = 6; k = 31; r, -0.04; 95% CI, -0.07 to -0.01), age-inappropriate content (n = 9; k = 36; r, -0.11; 95% CI, -0.17 to -0.04), and caregiver screen use during routines (n = 6; k = 14; r, -0.11; 95% CI, -0.20 to -0.03) were negatively associated with psychosocial outcomes. Co-use was positively associated with cognitive outcomes (n = 8; k = 28; r, 0.14; 95% CI, 0.03 to 0.25)., Conclusions and Relevance: Findings show small to moderate effect sizes that highlight the need to consider screen use contexts when making recommendations for families, clinicians, and educators beyond screen time limits; including encouraging intentional and productive screen use, age-appropriate content, and co-use with caregivers.

Compelling evidence supports the foundational importance of early self-regulation (SR). It also supports parents in the home environment as having the foremost influence on early development. Yet, prevailing approaches to support early SR growth have tended to leverage early education and clinical settings. Partners in Play (PiP) was developed as a sustainable approach for parents to learn how and when to support children through experiences of self-regulation challenges in the home learning environment. This study reports the first randomised control trial evaluation of the PiP program, with 21 parent-child dyads (consisting of twelve girl-mother dyads, eight boy-mother dyads, and one boy-father dyad; mean child age = 4.12 years, SD = 0.65). Dyads were randomised to a PiP intervention group ( n = 10), which entailed four online parent information sessions and four out-of-home guided practice dyadic play sessions across 8 weeks, or an active control group ( n = 11). The primary outcome was parent autonomy support, and the secondary outcome was child SR. Results indicated a significant increase in parents' use of autonomy support and a non-significant but moderate-sized effect on child SR. This innovative proof-of-concept program and evaluation provides a roadmap for effecting change in parental support during children's play, to the prospective benefit of important abilities such as child SR. Analyses show promise for a parent-based model toward parent behaviour change and child SR improvement.

Background: Previous research has characterised EEG changes associated with resting activation in primary school children and adults, while task-related activation has only been considered in adults. The current study characterises physiological activation in preschool children and examines the potential value of activation indices for predicting mental health status at two time points., Aims: To investigate how resting activation and task-related activation are represented in 4- to 5-year-old preschool children and examine if these activation indices can predict current and future mental health status., Methods and Procedures: Frontal EEG was recorded from 81 preschool children during eyes-closed resting, eyes-open resting, and an inhibitory control task to allow calculation of activation indices. The Child Behaviour Checklist was completed by the child's parent at this time, and again 6-8 months later after the child's transition to kindergarten., Outcomes and Results: Resting activation was represented by reductions in frontal delta, theta, and alpha power in the eyes-open compared to eyes-closed condition, and an increase in frontal beta power. Task-related activation was represented by increases in frontal delta, theta, and alpha power and a decrease in beta power. Frontal delta and theta task-related activation significantly predicted externalising behaviours in both preschool and kindergarten, with stronger prediction in kindergarten., Conclusions and Implications: This study characterised resting and task-related activation in preschool children, and reported similar effects to those found in older children and adults for resting activation, with novel effects for task-related activation. As task-related activation indices were predictive of externalising behaviours in both preschool and kindergarten, these results have implications for early identification of children who experience externalising behavioural problems across the transition to school period. WHAT DOES THIS STUDY ADD?: This study provides new data on how the fundamental physiological processes of resting and task-related activation, both of which are theorised to contribute to "upstream" processes such as executive functions and broader behaviour, are represented in the frontal EEG of preschool aged children. We also learn that the top-down task-related activation indices for delta and theta activity were predictive of current mental health status and future status after the transition to kindergarten, while the bottom-up resting activation indices were not., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Executive functions (EFs) in early childhood are predictors of later developmental outcomes and school readiness. Much of the research on EFs and their psychosocial correlates has been conducted in high-income, minority world countries, which represent a small and biased portion of children globally. The aim of this study is to examine EFs among children aged 3-5 years in two African countries, South Africa (SA) and The Gambia (GM), and to explore shared and distinct predictors of EFs in these settings. The SA sample (N = 243, 51.9% female) was recruited from low-income communities within the Cape Town Metropolitan area. In GM, participants (N = 171, 49.7% female) were recruited from the rural West Kiang region. EFs, working memory (WM), inhibitory control (IC) and cognitive flexibility (CF), were measured using tablet-based tasks. Associations between EF task performance and indicators of socioeconomic status (household assets, caregiver education) and family enrichment factors (enrichment activities, diversity of caregivers) were assessed. Participants in SA scored higher on all EF tasks, but children in both sites predominantly scored within the expected range for their age. There were no associations between EFs and household or familial variables in SA, except for a trend-level association between caregiver education and CF. Patterns were similar in GM, where there was a trend-level association between WM and enrichment activities but no other relationships. We challenge the postulation that children in low-income settings have poorer EFs, simply due to lower socioeconomic status, but highlight the need to identify predictors of EFs in diverse, global settings. RESEARCH HIGHLIGHTS: Assessed Executive Functioning (EF) skills and their psychosocial predictors among pre-school aged children (aged 3-5 years) in two African settings (The Gambia and South Africa). On average, children within each setting performed within the expected range for their age, although children in South Africa had higher scores across tasks. There was little evidence of any association between socioeconomic variables and EFs in either site. Enrichment activities were marginally associated with better working memory in The Gambia, and caregiver education with cognitive flexibility in South Africa, both associations were trend-level significance., (© 2023 The Authors. Developmental Science published by John Wiley & Sons Ltd.)

Executive function (EF) theory and research continues to under-represent the contexts in which the majority of the world's children reside, despite their potential to support, refute, or refine our current understandings. The current study sought to contribute to our understanding of EF in low-income settings in South Africa by investigating longitudinal associations of context-specific risk and protective factors for EF development in three- to five-year-old children who had limited access to ECCE services before the age of five. Child-caregiver dyads (N = 171) participated in two rounds of data collection (approximately seven months apart) during which child EF was assessed using the Early Years Toolbox; context-specific risk and protective factors were assessed through a caregiver questionnaire. Hierarchical linear regressions revealed that after controlling for age, attending ECCE services at time 2 ( β = 0.30, p < 0.001 ), and diversity of caregivers at time 1 ( β = 0.14, p = 0.041 ) were the only factors positively associated with EF at time 2. Other factors commonly associated with EF such as caregiver education, and household income were not significant, while resources in the home were significantly associated with EF ( β = -0.18, p = 0.007 ) but in the opposite direction to what was expected. These results add to accumulating evidence that predictors of EF established in Minority World contexts may not be consistent across contexts, emphasising the need to broaden the EF evidence base. For instance, future studies could incorporate qualitative and ethnographic methods to better capture the cultural and contextual nuances relating to EF, to better inform our statistical and theoretical models., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Two working memory (WM) measures were contrasted, to clarify the nature of advantages in gifted children's cognitive processing. It was predicted that cognitively gifted children would excel in WM tasks taxing mental attention (i.e., n-back) but not tasks supported by perceptual attention (i.e., self-ordered pointing, SOPT). Ninety-one children aged 9-10 and 13-14 years, in a gifted or mainstream classroom, received n-back and SOPT, plus measures of mental-attentional ( M -) capacity, inhibition, and shifting. Older children generally scored higher than younger children. As predicted, gifted children outperformed mainstream peers on all tasks, except for SOPT. Results demonstrate the need to distinguish between mental and perceptual attention in measurement of WM., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Direct assessments of executive functions (EFs) are increasingly used in research and clinical settings, with a central assumption that they assess "universal" underlying skills. Their use is spreading globally, raising questions about the cultural appropriateness of assessments devised in Western industrialized countries. We selectively reviewed multidisciplinary evidence and theory to identify sets of cultural preferences that may be at odds with the implicit assumptions of EF assessments. These preferences relate to motivation and compliance; cultural expectations for interpersonal engagement; contextualized vs. academic thinking; cultural notions of speed and time; the willingness to be silly, be incorrect, or do the opposite; and subject-matter familiarity. In each case, we discuss how the cultural preference may be incompatible with the assumptions of assessments, and how future research and practice can address the issue. Many of the cultural preferences discussed differ between interdependent and independent cultures and between schooled and unschooled populations. Adapting testing protocols to these cultural preferences in different contexts will be important for expanding our scientific understanding of EF from the narrow slice of the human population that has participated in the research to date.

Background: Water and sanitation are vital to human health and well-being. While these factors have been studied in relation to health, very little has been done to consider such environmental risk factors with child development. Here, we investigated possible relations between household water access/storage and early childhood development in four low-income settlements in the City of Cape Town, Western Cape province of South Africa. Our objectives were 1) to determine water access/storage practices in dwellings of children; 2) to assess early childhood development; and 3) and to understand the relationship between water access/storage practices in relation to early childhood development., Methods: We used a questionnaire to assess household water risk factors and the International Development and Early Learning Assessment (IDELA) tool to assess child early learning / cognitive, socio-emotional and motor development., Results: Mean age of the children (N = 192) was 4 years and 55% were female. The mean IDELA score was 48% (range: 36-54%) where the higher the score, the better the child's development. Around 70% of households had a tap inside their dwelling and half said that they stored water with the largest percentage of storage containers (21%) being plastic/no lid. Child IDELA scores were lower for children living in households that did not have an indoor tap and for households who stored water., Conclusions: Given the risks associated with climate change and the already poor conditions many children face regarding water and sanitation, research is needed to further investigate these relations to provide evidence to support appropriate interventions and ensure healthy child development., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2023 The Author(s).)

Research combining physical activity with the training of cognitive skills such as executive functions is emerging as a novel and fruitful intervention approach for children. Purpose: This study aimed to examine the impact of an intervention program including cognitively engaging physical activity on preschool children's cognitive outcomes and physical activity. Methods: Children (N = 144, 65 female; M age  = 4.41 years, SD  = 0.61), randomly assigned to one of three groups: cognitively engaging physical activity (CPA; i.e., storytelling, cognitive activities, and motor tasks, n = 55), cognition (i.e., storytelling and cognitive activities without motor tasks, n = 48), or control (i.e., traditional storytelling, n = 41). Sessions lasted approximately 17 minutes, conducted twice a week, for 6 weeks. Children's executive function, self-regulation, and related outcomes (i.e., numeracy) were assessed at baseline and again-along with perceived enjoyment-at the end of the program. Accelerometers measured children's physical activity during each session. Teachers completed a logbook for each session, and two fidelity checks per preschool took place by the researcher. Main analyses used linear mixed models adjusted for covariates (age, sex) and clustering at the preschool level. Results: Results showed no significant group by time interaction for executive function, self-regulation, numeracy, enjoyment. During the sessions, children in the CPA group were more physically active than children in the cognition and control groups. Conclusion: While we did not find the expected amplified cognitive benefits, making storytelling more active has the potential to meet two needs (increase cognitive stimulation and physical activity levels) in one deed.

Young children's use of digital technologies has presented challenges for parents, particularly in response to an increased reliance on digital resources during the Covid-19 pandemic. This mixed-methods study explored young children's digital practices within the context of their families and homes. Although this study was originally planned, the timing of data collection meant that it was uniquely positioned to capture parent perspectives as the pandemic and first lockdown was unfolding in Australia. Data was collected through questionnaire ( N  = 101) and semistructured interview ( n  = 20) about status and change in children's digital practices, and parents' rules and flexibility in governing these experiences. Quantitative findings suggested children's frequency and duration of digital device use trended upwards during lockdown, and parents were more flexible in their rules about the amount of screen time, as well as when and where children could use digital devices. Qualitative results suggested that, more than a temporary and situational change, for many parents, exposure to new ways of engaging with digital technologies facilitated a shift in their perceptions, leading to greater consideration of quality in their choices for their children. This study highlights the influential role of parents in shaping children's digital experiences. Understanding their perceptions, as well as children's current and shifting digital practices in the home, is important for informing efforts and guidance for supporting young children's safe and effective use of digital technologies., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

This study examined changes in physical activity (PA), sedentary behavior (SB), screen time, sleep, and executive function among Japanese preschoolers between COVID-19 pre-pandemic and pandemic periods, using cross-sectional and longitudinal data. Accelerometer data from 63 children aged 5-6 years were collected from three kindergartens in Tokyo, Japan, in late 2019 (pre-COVID-19). This was compared to the data of 49 children aged 5-6 years from the same kindergartens, collected in late 2020 (during COVID-19). Sixteen children in the pre-COVID-19 cohort also participated in the 2020 survey and provided data for the longitudinal analysis. The mean minutes of PA, SB, screen time, and sleep duration, as well as executive function, were compared between the pre- and during COVID-19 cohorts. After adjusting for school, sex, and accelerometer wear time, there were no significant differences in any of the measured outcomes between the two cohorts. However, the analysis of longitudinal data revealed significant increases in time spent in SB and on screens, and a decrease in light-intensity PA and sleep duration during the pandemic compared to the pre-pandemic period. Results suggest that, despite the COVID-19 pandemic, young children's activity levels and SB did not significantly differ from pre-pandemic levels. However, school-aged children's SB, light PA, and sleep time were affected, although this cannot be disentangled from the effects of the transition to school.

Introduction: Substantial research indicates that high quality early childhood education and care (ECEC) confers a wide range of benefits for children, yet quality in ECEC remains inconsistent. Given the variability in training and qualifications, one strategy for improving ECEC quality is in-service professional development (PD)., Methods: The current study evaluated an evidence-based in-service PD programme, Leadership for Learning, via a cluster randomised controlled trial involving 83 ECEC services and 1,346 children in their final year of pre-school., Results: Results indicated significant improvements in teaching quality across treatment centres and child development outcomes in language, numeracy and social-emotional development., Discussion: This study provides strong support for making evidence-informed PD routinely available for ECEC practitioners., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Siraj, Melhuish, Howard, Neilsen-Hewett, Kingston, De Rosnay, Huang, Gardiner and Luu.)

Biological and psychosocial stressors that have been associated with income include family dynamics such as household chaos, family conflict, maternal depression, harsh parenting, lower parental responsiveness, and exposure to violence. Research from high income countries has shown that exposure to violence may have detrimental effects on children's self-regulation, with possible flow-on implications for broad later-life outcomes, but less is known about such links in low- and- middle income countries, where many children live in violent communities and households and where physical punishment remains the norm. This study aimed to investigate exposure to violence, in addition to coercive parenting, and its associations with self-regulation among 243 3- to 5-year-olds (M = 4.7 ± 0.6; 51.9 % female) from low-income settings in Cape Town and who were not attending Early Childhood Care and Education (ECCE). Results showed that self-regulation was not associated with child exposure to community violence, but it was positively associated with coercive parenting (β = 0.17; p = 0.03). The null concurrent associations between exposure to violence and self-regulation suggest the need for additional research aimed at understanding later potential developmental sequelae. It is important that findings regarding coercive parenting are contextualised within local social norms around parenting styles, as well as the influence of living in dangerous communities on parenting practices., (Copyright © 2022. Published by Elsevier Ltd.)

The evidence regarding associations between intensity-specific physical activity and cognitive and learning outcomes in preschoolers is inconsistent and limited by low sample sizes and analytical approaches that cannot handle the multicollinearity among multiple physical activity intensity variables. We aimed to determine the multivariate physical activity intensity signatures associated with self-regulation, executive function, and early academic learning in preschool children aged 3-5 years. A 711 Norwegian preschool children (mean age 4.6 years, 52% boys) provided valid data on physical activity (ActiGraph GT3X+), self-regulation, executive function, and early academic learning during 2019-2020. Multivariate pattern analysis was used to determine associations between uniaxial and triaxial intensity spectra (time spent in intensities from 0-99 to ≥15,000 counts per minute) and the outcomes in the total sample and in subgroups split by sex and age (median split). Uniaxial data led to the highest explained variances ( R 2 ) and were reported as the primary findings. We found significant association patterns between physical activity and numeracy ( R 2  = 4.28%) and inhibition ( R 2  = 1.48%) in the total sample. The associations with numeracy were negative for time spent sedentary (0-99 counts per minute) and positive for time spent in moderate to vigorous intensities (≥ 1,000 counts per minute). The associations with inhibition were positive for time spent sedentary (0-99 counts per minute) and in vigorous intensities (≥ 8,500 counts per minute) and negative for time spent in low to moderate intensities (100-3,499 counts per minute). Associations with numeracy were stronger in boys ( R 2  = 5.58%) and older children ( R 2  = 7.27%), and associations with inhibition were stronger in girls ( R 2  = 3.12%) and older children ( R 2  = 3.33%). In conclusion, we found weak associations with numeracy and inhibition across the physical activity intensity spectrum in preschool children., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Vabø, Aadland, Howard and Aadland.)

Self-regulation (SR) is considered foundational in early life, with robust evidence demonstrating a link between early self-regulation and longer-term outcomes. This has been the impetus for a growing body of intervention research into how best to support early SR development, yet approaches and effects are diverse, which complicates an understanding of the critical characteristics for effective early SR intervention. Using Self-Determination Theory (SDT) as a guiding framework, we present a scoping review of early SR-intervention research to identify the characteristics of pre-school interventions that show significant and strong effects on young children's SR. Studies from peer-reviewed journal articles were included if they evaluated a SR intervention with pre-school children, were published between 2010 and 2020, written in English, and included a SR outcome measure. This yielded 19 studies, each reporting the efficacy of a different SR intervention. Results showed that content factors (what interventions do) interacted with their implementation (how, when, and by whom interventions are implemented) to discriminate the more versus less efficacious interventions. Through the lens of SDT, results further suggested that targeting competence through encouragement and feedback, and nurturing children's autonomy distinguished more from less effective interventions. Relatedness was least able to discriminate intervention efficacy.

Despite a tendency to study executive function (EF) and self-regulation (SR) separately, parallel lines of research suggest considerable overlap between the two abilities. Specifically, both show similar developmental trajectories (i.e., develop rapidly in the early years), predict a broad range of overlapping outcomes across the lifespan (e.g., academic success, mental and physical health, and social competence), and have overlapping neural substrates (e.g., prefrontal cortex). While theoretical frameworks diverge in how they reconcile EF and SR - ranging from treating the two as functionally synonymous, to viewing them as related yet distinct abilities - there is no consensus and limited empirical evidence on the nature of their relationship and how this extends developmentally. The current study examined bi-directional longitudinal associations between early EF and SR, and their longitudinal associations with subsequent early academic skills, in a sample of 199 3- to 5-year-old pre-school children. The adopted measures permitted EF and SR to be modelled as composite indices for these analyses, thereby decreasing task-specific components of these associations. Early academic skills were captured by a standardized direct assessment. Bi-directional associations between EF and SR were found, with both accounting for unique variance in early academic skills 7 and 19months later. The current results provide important evidence to distinguish between EF and SR abilities, yet also for their reciprocal influence in situ and across early development., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Howard, Vasseleu, Neilsen-Hewett, de Rosnay, Chan, Johnstone, Mavilidi, Paas and Melhuish.)

Supplementation of omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFA) may enhance self-regulation (SR) and executive functioning (EF) in children of preschool age. The aim of the Omega Kid Study was to investigate the effect of n-3 LCPUFA supplementation on SR and EF in typically developing preschool-aged children. A double-blind placebo-controlled pilot trial was undertaken, the intervention was 12 weeks and consisted of 1.6 g of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) per day compared to placebo. The HS-Omega-3 Index ® was assessed by capillary blood samples at baseline and post-intervention. Seventy-eight children were enrolled and randomised to either the n-3 LCPUFA treatment ( n = 39) or placebo ( n = 39) group. Post intervention, there was a significant three-fold increase in the HS-Omega-3 Index ® in the n-3 LCPUFA group ( p < 0.001). There were no improvements in SR or EF outcome variables for the n-3 LCPUFA group post intervention compared to the placebo group determined by linear mixed models. At baseline, there were significant modest positive Spearman correlations found between the HS-Omega-3 index ® and both behavioural self-regulation and cognitive self-regulation (r = 0.287, p = 0.015 and r = 0.242, p = 0.015 respectively). Although no treatment effects were found in typically developing children, further research is required to target children with sub-optimal self-regulation who may benefit most from n-3 LCPUFA supplementation.

This article develops an analysis of population-level priority setting informed by Bevir's decentred theory of governance and drawing on a qualitative study of priority setting for service improvement conducted in the complex multi-layered governance context of English primary care. We show how powerful actors, operating at the meso-level, utilize pluralistic and contradictory elements of complex governance networks to discursively construct, legitimize and enact service improvement priorities. Our analysis highlights the role of situated agency in integrating top-down, bottom-up and horizontal influences on priority setting, which leads to variation in local priorities despite the continuous presence of strong hierarchical influences., Competing Interests: The authors declare that they have no competing interests., (© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Executive functions and psychosocial health during childhood are positively associated with health and developmental outcomes into adulthood. Electronic media use has been reported to adversely affect health and development in children; however, what remains unclear is whether contemporary media behaviors, such as electronic application (app) use, exerts similar effects on health and development. We investigated the associations of electronic media use (program viewing and app use) with cognitive and psychosocial development in preschoolers. Parents of preschool children ( n = 247, 4.2 ± 0.6 years) reported the time their child spent using electronic media. Direct assessment of the children's executive functions (working memory, inhibition, and shifting) and educator-reported psychosocial difficulties were also collected. Associations were examined using linear regression adjustments for covariates and preschool clustering. Small, but significant, negative associations were observed for total electronic media use ( b = -0.001; 95% CI: -0.003, -0.000; p = 0.026) and program viewing ( b = -0.002; 95% CI: -0.003, -0.000; p = 0.033) with children's visual-spatial working memory. However, high-dose app users demonstrated higher phonological working memory scores compared to non-users ( MD = 0.31; 95% CI: 0.04, 0.58; p = 0.025). Similarly, compared to non-users, low-dose app users displayed statistically significantly fewer total difficulties ( MD = -1.67; 95% CI: -3.31, -0.02; p = 0.047). No associations were evident for high-dose app users and the remaining outcomes. The results may suggest that attempts to reduce program viewing while promoting moderate levels of app use may exert positive influences on children's executive functions and psychosocial development.

Self-regulation, the regulation of behaviour in early childhood, impacts children's success at school and is a predictor of health, wealth, and criminal outcomes in adulthood. Self-regulation may be optimised by dietary supplementation of omega-3 long-chain polyunsaturated fatty acids (n-3 LCPUFAs). The aim of the "Omega Kid" study is to investigate the feasibility of a protocol to investigate whether n-3 LCPUFA supplementation enhances self-regulation in preschool-aged children. The protocol assessed involved a double-blind, randomised, placebo-controlled trial of 12 weeks duration, with an intervention of 1.6 g of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) per day (0.3 g EPA and 1.3 g DHA) in a microencapsulated powder compared to placebo. Children (n = 78; 40 boys and 38 girls) aged 3-5 years old were recruited and randomly allocated to the treatment (n = 39) or placebo group (n = 39). The HS-Omega-3 Index ® served as a manipulation check on the delivery of either active (n-3 LCPUFAs) or placebo powders. Fifty-eight children (76%) completed the intervention (28-30 per group). Compliance to the study protocol was high, with 92% of children providing a finger-prick blood sample at baseline and high reported-adherence to the study intervention (88%). Results indicate that the protocol is feasible and may be employed in an adequately powered clinical trial to test the hypothesis that n-3 LCPUFA supplementation will improve the self-regulation of preschool-aged children.

Background: Over the past decade, targeting acute kidney injury (AKI) has become a priority to improve patient safety and health outcomes. Illness complicated by AKI is common and is associated with adverse outcomes including high rates of unplanned hospital readmission. Through national patient safety directives, NHS England has mandated the implementation of an AKI clinical decision support system in hospitals. In order to improve care following AKI, hospitals have also been incentivised to improve discharge summaries and general practices are recommended to establish registers of people who have had an episode of illness complicated by AKI. However, to date, there is limited evidence surrounding the development and impact of interventions following AKI., Design: We conducted a quality improvement project in primary care aiming to improve the management of patients following an episode of hospital care complicated by AKI. All 31 general practices within a single NHS Clinical Commissioning Group were incentivised by a locally commissioned service to engage in audit and feedback, education training and to develop an action plan at each practice to improve management of AKI., Results: AKI coding in general practice increased from 28% of cases in 2015/2016 to 50% in 2017/2018. Coding of AKI was associated with significant improvements in downstream patient management in terms of conducting a medication review within 1 month of hospital discharge, monitoring kidney function within 3 months and providing written information about AKI to patients. However, there was no effect on unplanned hospitalisation and mortality., Conclusion: The findings suggest that the quality improvement intervention successfully engaged a primary care workforce in AKI-related care, but that a higher intensity intervention is likely to be required to improve health outcomes. Development of a real-time audit tool is necessary to better understand and minimise the impact of the high mortality rate following AKI., Competing Interests: Competing interests: Between 2014 and 2017, TB was a member of the NHS England Think Kidneys Programme. The authors declare no other competing interests., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

To examine the longitudinal associations of objectively measured physical activity and modified organized sport participation with executive functions and psychological health in preschoolers. One hundred and eighty-five preschool children, mean age 4.2 ± 7.68; (years:months), 34% girls were followed for one year. Physical activity was measured using accelerometery, examining light, moderate, vigorous, moderate-to-vigorous, and total physical activity. Parents reported children's participation in modified organized sport. Direct assessment of children's executive functions (working memory, inhibition and shifting) and educator-reported psychosocial difficulties were also collected. Associations were examined using linear regression adjusting for covariates, baseline developmental outcomes and preschool clustering. Vigorous physical activity at baseline was positively associated with children's shifting performance (b = 0.245; 95% CI: 0.006, 0.485, p =.045) at follow-up, while the association for moderate-to-vigorous physical activity approached significance (b = 0.119; 95% CI: -0.001, 0.239, p =.051). Children not participating in modified organized sport at baseline demonstrated better inhibition scores 12-months later compared to sports participants (Mdiff 0.06; CI: 0.00, 0.13, p =.046). Increasing time spent in higher intensity physical activity among preschool children may be a viable target for supporting their later cognitive development, although there was no clear benefit of early participation in modified organized sport.

Discussion regarding the regulatory status of genome-edited crops has focused on precision of editing and on doubts regarding the feasibility of analytical monitoring compliant with existing GMO regulations. Effective detection methods are important, both for regulatory enforcement and traceability in case of biosafety, environmental or socio-economic impacts. Here, we approach the analysis question for the first time in the laboratory and report the successful development of a quantitative PCR detection method for the first commercialized genome-edited crop, a canola with a single base pair edit conferring herbicide tolerance. The method is highly sensitive and specific (quantification limit, 0.05%), compatible with the standards of practice, equipment and expertise typical in GMO laboratories, and readily integrable into their analytical workflows, including use of the matrix approach. The method, validated by an independent laboratory, meets all legal requirements for GMO analytical methods in jurisdictions such as the EU, is consistent with ISO17025 accreditation standards and has been placed in the public domain. Having developed a qPCR method for the most challenging class of genome edits, single-nucleotide variants, this research suggests that qPCR-based method development may be applicable to virtually any genome-edited organism. This advance resolves doubts regarding the feasibility of extending the regulatory approach currently employed for recombinant DNA-based GMOs to genome-edited organisms.

Objective: To examine whether meeting the Australian 24-Hour Movement Guidelines was associated with cognitive and psychosocial health in preschoolers., Design: Prospective observational study., Methods: Cross-sectional (n=247) and 12-month longitudinal (n=185) data from the PATH-ABC study were examined. Physical activity was assessed by accelerometry. Parents reported children's screen time and sleep. Children were categorised at baseline as meeting: i) none/one guideline, ii) two guidelines, or iii) 24-Hour Movement Guidelines. Associations with executive functions and psychosocial health were examined using linear regression, adjusting for covariates and preschool clustering. Longitudinal associations were additionally adjusted for baseline levels of development., Results: High proportions of children met the physical activity (94.3%) and sleep (89.9%) guidelines, 17.8% and 17.4% met screen time and 24-Hour Movement Guidelines, respectively. Cross-sectionally, children meeting both sleep and physical activity guidelines displayed better phonological working memory (p=0.026) and shifting (p= 0.034) scores compared to children who did not. Meeting two (p=0.037) and three (p=0.017) guidelines were associated with better phonological working memory and shifting scores, respectively (vs. meeting 0/1 guideline). Longitudinally, children meeting the physical activity guideline at baseline displayed better shifting performance 12-months later compared to those who did not (p<0.002). No associations with remaining cognitive outcomes, and no associations with psychosocial outcomes were evident., Conclusions: Null associations suggest that meeting the recommendations may not be adequate for broad cognitive and psychosocial health outcomes in preschoolers. However, supporting preschool children to meet the physical activity and sleep guidelines, may be beneficial for aspects of cognitive health., (Crown Copyright © 2020. Published by Elsevier Ltd. All rights reserved.)

Background: The aim of this study was to examine the efficacy of an embedded after-school intervention, on promoting physical activity and academic achievement in primary-school-aged children., Methods: This 6-month, 2-arm cluster randomized controlled trial involved 4 after-school centers. Two centers were randomly assigned to the intervention, which involved training the center staff on and implementing structured physical activity (team sports and physical activity sessions for 75 min) and academic enrichment activities (45 min). The activities were implemented 3 afternoons per week for 2.5 hours. The control centers continued their usual after-school care practice. After-school physical activity (accelerometry) and executive functions (working memory, inhibition, and cognitive flexibility) were assessed pre- and postintervention., Results: A total of 60 children were assessed (7.7 [1.8] y; 50% girls) preintervention and postintervention (77% retention rate). Children in the intervention centers spent significantly more time in moderate to vigorous physical activity (adjusted difference = 2.4%; 95% confidence interval, 0.6 to 4.2; P = .026) and scored higher on cognitive flexibility (adjusted difference = 1.9 units; 95% confidence interval, 0.9 to 3.0; P = .009). About 92% of the intervention sessions were implemented. The participation rates varied between 51% and 94%., Conclusion: This after-school intervention was successful at increasing moderate to vigorous physical activity and enhancing cognitive flexibility in children. As the intervention was implemented by the center staff and local university students, further testing for effectiveness and scalability in a larger trial is required.

Objectives: We sought to understand the factors influencing the implementation of a primary care intervention to improve post-discharge care following acute kidney injury (AKI)., Design: Qualitative study using semi-structured interviews and thematic analysis., Setting: General practices in one Clinical Commissioning Group area in England., Participants: A total of 18 healthcare staff took part in interviews. Participants were practice pharmacists, general practitioners, practice managers and administrators involved in implementing the intervention., Results: We identified three main factors influencing implementation: differentiation of the new intervention from other practice work; development of skill mix and communication across organisations. Overall, post-AKI processes of care were deemed straightforward to embed into existing practice. However, it was also important to separate the intervention from other work in general practice. Dedicating staff time to proactively identify AKI on discharge summaries and to coordinate the provision of care enabled implementation of the intervention. The post-AKI intervention provided an opportunity for practice pharmacists to expand their primary care role. Working in a new setting also brought challenges; time to develop trusting relationships including an understanding of boundaries of clinical expertise influenced pharmacists' roles. Unclear and inconsistent information on discharge summaries contributed to concerns about additional work in primary care., Conclusions: The research highlights challenges around post-discharge management in the primary care context. Coordination and communication were key factors for improving follow-up care following AKI. Further consideration is required to understand patient experiences of the interface between secondary and primary care. The issues pertaining to discharge care following AKI are relevant to practitioners and commissioners as they work to improve transitions of care for vulnerable patient populations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: There is a dearth of high-quality evidence on effective, sustainable, and scalable interventions to increase physical activity (PA) and concomitant outcomes in preschoolers. Specifically, there is a need to better understand how the preschool context can be used to increase various types of physically active play to promote holistic child development. The implementation of such interventions requires highly competent preschool staffs, however, the competence in promoting PA is often low. The main aim of the ACTNOW study is therefore to investigate the effects of professional development for preschool staffs on child PA and developmental outcomes., Methods: The study will be conducted in Norway 2019-2022 and is designed as a two-arm (intervention, control) cluster randomized controlled trial (RCT) with 7- and 18-months follow-ups. We aim to recruit 60 preschools and 1,200 3- to 5-years-old children to provide sufficient power to detect effect sizes (ESs) between 0.20 and 0.30. The intervention is nested within two levels: the preschool and the child. Central to the ACTNOW intervention are opportunities for children to engage in a variety of "enriched," meaningful, and enjoyable physically active play that supports the development of the whole child. To this end, the main intervention is a 7-month professional development/education module for preschool staff, aimed to provide them with the necessary capacity to deliver four core PA components to the children (moderate-to-vigorous PA, motor-challenging PA, cognitively engaging play, and physically active learning). We will include a range of child-level outcomes, including PA, physical fitness, adiposity, motor skills, socioemotional health, self-regulation, executive function, and learning. At the preschool level, we will describe implementation and adaptation processes using quantitative and qualitative data., Discussion: Professional development of staff and a whole-child approach that integrates PA with cognitively engaging play and learning activities in the preschool setting may provide a feasible vehicle to enhance both physical and cognitive development in young children. ACTNOW is designed to test this hypothesis to provide a sustainable way to build human capital and provide an early solution to lifelong public health and developmental challenges., Clinical Trial Registration: www.ClinicalTrials.gov identifier NCT04048967., (Copyright © 2020 Aadland, Tjomsland, Johannessen, Nilsen, Resaland, Glosvik, Lykkebø, Stokke, Andersen, Anderssen, Pfeiffer, Tomporowski, Størksen, Bartholomew, Ommundsen, Howard, Okely and Aadland.)

Background: The integration of community health and social care services has been widely promoted nationally as a vital step to improve patient centred care, reduce costs, reduce admissions to hospital and facilitate timely and effective discharge from hospital. The complexities of integration raise questions about the practical challenges of integrating health and care given embedded professional and organisational boundaries in both sectors. We describe how an English city created a single, integrated care partnership, to integrate community health and social care services. This led to the development of 12 integrated neighbourhood teams, combining and co-locating professionals across three separate localities. The aim of this research is to identify the context and the factors enabling and hindering integration from a qualitative process evaluation., Methods: Twenty-four semi-structured interviews were conducted with equal numbers of health and social care staff at strategic and operational level. The data was subjected to thematic analysis., Results: We describe three key themes: 1) shared vision and leadership; 2) organisational factors; 3) professional workforce factors. We found a clarity of vision and purpose of integration throughout the partnership, but there were challenges related to the introduction of devolved leadership. There were widespread concerns that the specified outcome measures did not capture the complexities of integration. Organisational challenges included a lack of detail around clinical and service delivery planning, tensions around variable human resource practices and barriers to data sharing. A lack of understanding and trust meant professional workforce integration remained a key challenge, although integration was also seen as a potential solution to engender relationship building., Conclusions: Given the long-term national policy focus on integration this ambitious approach to integrate community health and social care has highlighted implications for leadership, organisational design and inter-professional working. Given the ethos of valuing the local assets of individuals and networks within the new partnership we found the integrated neighbourhood teams could all learn from each other. Many of the challenges of integration could benefit from embracing the inherent capabilities across the integrated neighbourhood teams and localities of this city.

Background: Growth in early self-regulation skills has been linked to positive health, wellbeing, and achievement trajectories across the lifespan. While individual studies have documented specific influences on self-regulation competencies in early childhood, few have modelled a comprehensive range of predictors of self-regulation change across health, development, and environment simultaneously. This study aimed to examine the concurrent associations among a range of proximal and distal influences on change in children's self-regulation skills over 2 years from age 4-5 years., Methods: Data from the Longitudinal Study of Australian Children (N = 4983) were used in a structural equation model, predicting a multi-source composite measure of self-regulation at each of 4-5 years and 6-7 years. By controlling for earlier self-regulation and covariates, the model examined the relative contributions of a comprehensive range of variables to self-regulation change including health, development, educational, home environment, time-use, and neighbourhood characteristics., Results: The significant predictors of children's self-regulation growth across 4 to 7 years were fewer behavioural sleep problems, higher gross motor and pre-academic skills, lower levels of maternal and paternal angry parenting, and lower levels of financial hardship. There were also marginal effects for high-quality home learning environments and child-educator relationships., Conclusion: Findings suggest that if we are to successfully foster children's self-regulation skills, interventionists would do well to operate not only on children's current capacities but also key aspects of their surrounding context.

This meta-analysis explores whether self-regulation in childhood relates to concurrent and subsequent levels of achievement, interpersonal behaviors, mental health, and healthy living. A comprehensive literature search identified 150 studies that met inclusion criteria (745 effect sizes; total n = 215,212). Data were analyzed using inverse-variance weighted random effects meta-analysis. Mean effect sizes from 55 meta-analyses provided evidence that self-regulation relates to 25 discrete outcomes. Results showed that self-regulation in preschool (∼age 4) was positively associated with social competency, school engagement, and academic performance, and negatively associated with internalizing problems, peer victimization, and externalizing problems, in early school years (∼age 8). Self-regulation in early school years was positively related to academic achievement (math and literacy), and negatively related to externalizing problems (aggressive and criminal behavior), depressive symptoms, obesity, cigarette smoking and illicit drug use, in later school years (∼age 13). Results also showed that self-regulation in early school years was negatively related to unemployment, aggressive and criminal behavior, depression and anxiety, obesity, cigarette smoking, alcohol and substance abuse, and symptoms of physical illness in adulthood (∼age 38). Random effects metaregression identified self-regulation measurement as the most important moderator of pooled mean effects, with task-based assessments and teacher-report assessments often showing stronger associations than parent-report assessments. Overall, findings from this meta-analysis provide evidence that self-regulation in childhood can predict achievement, interpersonal behaviors, mental health, and healthy living in later life. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

The Preschool Situational Self-Regulation Toolkit (PRSIST) Program was developed as a low-cost and embedded approach for educators to foster pre-schoolers' self-regulation and related abilities (e.g., executive function, school readiness). This study reports on a cluster RCT study with 50 Australian pre-school services to evaluate the effectiveness of the PRSIST Program for improving children's self-regulation, executive function and school readiness, compared to current routine practice. Pre-school centers were recruited to reflect the breadth of geography, pedagogical quality, and socio-economic catchment areas across the early childhood education and care sector. All children identified as in their final year of pre-school education at these centers were invited to participate, resulting in a sample of 473 3-5-year-old children at baseline. Centers were randomly assigned to groups after baseline data collection, and data collectors were blinded to group assignment throughout the study. It was hypothesized that engagement in the PRSIST Program would improve children's self-regulation, executive function and school readiness, over and above normal age-related rates of development. Results indicated small but significant improvements in executive functioning for the intervention group, after adjusting for cluster, baseline results and key covariates. All other outcomes were descriptively in favor of the intervention group but failed to reach significance. Levels of use of the program remained high by most educators throughout the intervention period, suggesting its acceptability and sustainability within these contexts. Together, results show promise for this approach to self-regulation development. Opportunities that might further strengthen this approach are discussed. This study was registered with the Australia and New Zealand Clinical Trials Registry (ACTRN12617001568303) and study protocols published in advance of commencement. Funding for this study was provided by the Australian Research Council's Discovery Early Career Researcher Award research grant scheme., (Copyright © 2020 Howard, Vasseleu, Batterham and Neilsen-Hewett.)