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IntroductionThe need for an efficient, low-cost, comprehensive measure to track infant/toddler development and treatment outcomes is critical, given the importance of early detection and monitoring. This manuscript describes the protocol for the development and testing of a novel measure, PediaTrac, that collects longitudinal, prospective, multidomain data from parents/caregivers to characterise infant/toddler developmental trajectories in term and preterm infants. PediaTrac, a web-based measure, has the potential to become the standard method for monitoring development and detecting risk in infancy and toddlerhood.Methods and analysesUsing a multisite, prospective design, primarcaregivers will complete PediaTrac V.3.0, a survey tool that queries core domains of early development, including feeding/eating/elimination, sleep, sensorimotor, social/sensory information processing, social/communication/cognition and early relational health. Information also will be obtained about demographic, medical and environmental factors and embedded response bias indices are being developed as part of the measure. Using an approach that systematically measures infant/toddler developmental domains during a schedule that corresponds to well-child visits (newborn, 2, 4, 6, 9, 12, 15, 18 months), we will assess 360 caregiver/term infant dyads and 240 caregiver/preterm infant dyads (gestational age Ethics and disseminationThis investigation has single Institutional Review Board (IRB) multisite approval from the University of Michigan (IRB HUM00151584). The results will be presented at prominent conferences and published in peer-reviewed scientific journals.

Approximately 5-10% of children exhibit developmental deviations in motor skills or other domains; however, physicians detect less than one-third of these abnormalities. Systematic tracking and early identification of motor deviations are fundamental for timely intervention.Term and preterm neonates were prospectively assessed at the newborn (NB) period in a study of the psychometric properties of the Motor (MOT) domain of PediaTracIn a cohort of 571 caregiver/infant dyads (331 term, 240 preterm), NB MOT domain reliability was high (rho = 0.94). Item discrimination and item difficulty of each of the 15 items could be reliably modeled across the range of motor ability. EFA confirmed that the items constituted a single dimension with second-order factors, accounting for 43.20% of variance.The latent trait, motor ability, could be reliably estimated at the NB period.The caregiver-reported Motor domain of PediaTrac provides a reliable estimate of the latent trait of motor ability during the newborn period. This is the first known caregiver-reported instrument that can assess motor ability in the newborn period with high reliability in term and preterm infants. Item response theory methods were employed that will allow for future characterization of developmental subgroups and motor trajectories. The PediaTrac Motor domain can support early identification of at-risk infants. Including caregivers in digital reporting and child-centered monitoring of motor functioning may improve access to care.

The effect of cumulative biological, psychosocial, and demographic risk and infant sleep on infant social-emotional functioning in 12-month-old infants (46% female) was examined in data from racially (30% Black, 60% White, 10% multiracial/other) and socioeconomically (41% below median income) diverse caregivers (N = 468, M = 30.42 years old, SD = 5.65) recruited from two midwestern states in 2019–2020. Due to the major changes in sleep patterns during infancy and the reported association between sleep and social-emotional functioning, this study also examined whether sleep moderates the association between risk and infant social-emotional functioning and potentially promotes healthy social-emotional functioning despite risk. Greater cumulative risk was associated with poorer sleep efficiency and more social-emotional problems, but was not associated with the general acquisition of social-emotional milestones. Results also suggested that poorer sleep efficiency was associated with more social-emotional problems and poorer social-emotional milestone acquisition. No significant interaction effects were found between cumulative risk and infant sleep. Risk and sleep appear to have unique associations with infant social-emotional problems and development; thus both could be targeted in early intervention to promote social-emotional functioning during infancy and early childhood.

Recent research suggests that traditional grain-based heart-healthy diet recommendations, which replace dietary saturated fat with carbohydrate and reduce total fat intake, may result in unfavorable plasma lipid ratios, with reduced high-density lipoprotein (HDL) and an elevation of low-density lipoprotein (LDL) and triacylglycerols (TG). The current study tested the hypothesis that a grain-free Paleolithic diet would induce weight loss and improve plasma total cholesterol, HDL, LDL, and TG concentrations in nondiabetic adults with hyperlipidemia to a greater extent than a grain-based heart-healthy diet, based on the recommendations of the American Heart Association. Twenty volunteers (10 male and 10 female) aged 40 to 62 years were selected based on diagnosis of hypercholesterolemia. Volunteers were not taking any cholesterol-lowering medications and adhered to a traditional heart-healthy diet for 4 months, followed by a Paleolithic diet for 4 months. Regression analysis was used to determine whether change in body weight contributed to observed changes in plasma lipid concentrations. Differences in dietary intakes and plasma lipid measures were assessed using repeated-measures analysis of variance. Four months of Paleolithic nutrition significantly lowered (P < .001) mean total cholesterol, LDL, and TG and increased (P < .001) HDL, independent of changes in body weight, relative to both baseline and the traditional heart-healthy diet. Paleolithic nutrition offers promising potential for nutritional management of hyperlipidemia in adults whose lipid profiles have not improved after following more traditional heart-healthy dietary recommendations.

Determining what constitutes an anticipatable incidental finding (IF) from clinical research and defining whether, and when, this IF should be returned to the participant have been topics of discussion in the field of human subject protections for the last 10 years. It has been debated that implementing a comprehensive IF-approach that addresses both the responsibility of researchers to return IFs and the expectation of participants to receive them can be logistically challenging. IFs have been debated at different levels, such as the ethical reasoning for considering their disclosure or the need for planning for them during the development of the research study. Some authors have discussed the methods for re-contacting participants for disclosing IFs, as well as the relevance of considering the clinical importance of the IFs. Similarly, other authors have debated about when IFs should be disclosed to participants. However, no author has addressed how the "actionability" of the IFs should be considered, evaluated, or characterized at the participant's research setting level. This paper defines the concept of "Actionability at the Participant's Research Setting Level" (APRSL) for anticipatable IFs from clinical research, discusses some related ethical concepts to justify the APRSL concept, proposes a strategy to incorporate APRSL into the planning and management of IFs, and suggests a strategy for integrating APRSL at each local research setting.

Objective PediaTrac™, a 363-item web-based tool to track infant development, administered in modules of ∼40-items per sampling period, newborn (NB), 2­-, 4­-, 6­-, 9­- and 12­-months was validated. Caregivers answered demographic, medical, and environmental questions, and questions covering the sensorimotor, feeding/eating, sleep, speech/language, cognition, social-emotional, and attachment domains. Methods Expert Panel Reviews and Cognitive Interviews (CI) were conducted to validate the item bank. Classical Test Theory (CTT) and Item Response Theory (IRT) methods were employed to examine the dimensionality and psychometric properties of PediaTrac with pooled longitudinal and cross-sectional cohorts (N = 132). Results Intraclass correlation coefficients (ICC) for the Expert Panel Review revealed moderate agreement at 6 ­months and good reliability at other sampling periods. ICC estimates for CI revealed moderate reliability regarding clarity of the items at NB and 4 months, good reliability at 2-­, 9­- and 12­-months and excellent reliability at 6 ­months. CTT revealed good coefficient alpha estimates (α ≥ 0.77 for five of the six ages) for the Social-Emotional/Communication, Attachment (α ≥ 0.89 for all ages), and Sensorimotor (α ≥ 0.75 at 6-months) domains, revealing the need for better targeting of sensorimotor items. IRT modeling revealed good reliability (r = 0.85–0.95) for three distinct domains (Feeding/Eating, Social-Emotional/Communication and Attachment) and four subdomains (Feeding Breast/Formula, Feeding Solid Food, Social-Emotional Information Processing, Communication/Cognition). Convergent and discriminant construct validity were demonstrated between our IRT-modeled domains and constructs derived from existing developmental, behavioral and caregiver measures. Our Attachment domain was significantly correlated with existing measures at the NB and 2-month periods, while the Social-Emotional/Communication domain was highly correlated with similar constructs at the 6-, 9- and 12-month periods. Conclusion PediaTrac has potential for producing novel and effective estimates of infant development via the Sensorimotor, Feeding/Eating, Social-Emotional/Communication and Attachment domains.

Purpose/objectives This is a report of the results of a pilot project conducted to identify the areas where role confusion/ambiguity exists in the practice of nurse case management. Methodology and sample A convenience sample of 25 registered nurses practicing as case managers in a small east coast medical treatment facility's outpatient clinics. Participants responded to 2 Likert-type surveys designed to evaluate role confusion from an individual and a team membership perspective. Results Analysis indicated that nurse case managers experience role confusion in the specific areas of conflicts between time resources, capabilities, and multiple individual roles. There was no identified role confusion associated with membership on multidisciplinary teams. The application of the Synergy Model as a theoretical framework for nurse case management serves as a benchmark for the implementation of evidence-based practices. Implications for case management practice This project could serve as the starting point for the development of a skill set for nurse case managers, for the standardization of the practice, and for the recognition of nurse case management as a legitimate nursing subspecialty.

In recent years, about one in five American children-some 12 to 14 million-have lived in families in which cash income failed to exceed official poverty thresholds. Another one-fifth live in families whose incomes were no more than twice the poverty threshold.8Today's economically based reorganization of the U.S. society is reshaping family structure through distinctive racial patterns. Families mainly headed by women have become permanent in all racial categories, with the disproportionate effects of change more visible among racial ethnics.9

This study explored whether parents who purchase more fruit/vegetables have preschool-aged children who are able to identify fruit/vegetables and in turn are more likely to consume them. Sixty-two parent-child pairs were recruited during a 4-month period. The data collection included a child interview, a parent/guardian interview, a fruit/vegetable taste test for children, and a month-long food-receipt collection by the parent/guardian. As the percentage of fruit/vegetables purchased by parent increased, the child was more likely to accept all of the fruit/vegetables offered to him/her. A weak correlation was found between the child's ability to name fruit/vegetables and their willingness to try the fruit/vegetables offered. A trend was established between the child's ability to name the 10 fruits/vegetables and parent fruit/vegetable purchases. Parents who purchased the most fruit/vegetables, causing increased exposure, had children who were more willing to taste the fruit/vegetables offered to them.

Concern with the size of poverty in any nation leads to a broader question: What does it mean to be poor in a rich society? More specifically, what does it mean for a family, and particularly its children, to live in a state of poverty within a prosperous society? To begin to answer these questions, we must look at poverty in the context of its opposite, plenty. As members of modern societies, we use a wide range of goods and services to effect our participation in social relations and to create and sustain our sense of social identity. The mainstream standard of living defines the average American's family resources that fall sufficiently short of the mainstream as deprivation, precarious subsistence, exclusion – in short, poverty. Our common cultural understanding is that we cannot play our social roles or participate meaningfully in our communities without the basic material resources necessary to carry out our activities. One way or another, each of us has to “make a living” in order to “have a life.” The roles and activities that define participation are age-graded – child, teenager, young adult, mature adult, senior citizen. For any one age, these common cultural understandings allow people to pass judgment on their own rank and that of others in a continuum from destitution to unseemly affluence, based on what kind of participation they can effect.

Approximately 120 million children under the age of 14 labor full time, according to recent estimates by the International Labor Organization (ILO) (U.S. Department of Labor, 2002, 2001; UNICEF, 2000). If those for whom work is a secondary activity are included, the number of working children rises to 250 million. The majority of child laborers live in Asia, although Africa has a higher rate of child labor. The ILO estimates that 40% of African children between the ages of five and fourteen years of age, work. (U.S. Department of Labor, 2002, 2001) Although the majority of the 120 million full time working children labor in the commercial agricultural sector, child labor is not confined to any particular economic sector. Children work as domestic servants, in mining, as divers in deep-sea fishing, in construction, as prostitutes, in toy, shoe and garment factories, as cigarette makers, as rug weavers, in charcoal making, in glass and ceramics factories, as sports equipment and surgical instrument makers, in the match and fireworks industries and in many other jobs.

We have attempted the prenatal detection of the fra(X) 9 times. Three fra(X) positive fetuses have been diagnosed: 2 males and one female. The diagnosis on the 2 males has been confirmed. The testes of the 2 fra(X) positive fetuses appeared large for gestational age. However, results of anthropometric, bone age, anatomical and neurohistological studies were normal. Normal outcome was confirmed after birth in 2 males and one female on the basis of whole blood fra(X) studies. A presumptively positive female and a presumptively negative female await confirmation. Two presumptively negative males remain unborn. Further experience is needed to establish the reliability of the prenatal detection of fra(X) (q27).

The fragile X chromosome has been identified in specimens from 17 male and 10 female fetuses in 11 laboratories throughout the world, obtained from at least 79 fetuses at increased risk for the fra(X) syndrome. Of these, 19 were confirmed, 6 were pending, 1 was negative and 1 could not be confirmed. Twenty-five of the 79 cases were studied in our laboratory (Institute for Basic Research [IBR]) and resulted in fra(X) demonstration in specimens from 3 male and 5 female fetuses. All 3 males and 2 of the 5 females have been confirmed. When amniocytes from the two confirmed female fetuses were exposed to FUdR after culturing in Chang medium, fra(X) frequencies were virtually negative indicating that Chang medium should not be used in fragile X studies at least when FUdR is used to induce fragility. Finally, amniocytes from a fra(X) male fetus studied in 3 different laboratories exhibited strikingly different frequencies. To date, we have experienced no false-positives or negatives, but the latter case was controversial. It is recommended that laboratories undertaking fra(X) prenatal detection use a combination of at least two different proven induction systems as well as complementary DNA marker studies to prevent false negative diagnosis.

1. Hayes-Allen MC. Obesity and short stature in children with myelomeningocele. Dev Med Child Neurol 1972;14(suppl 27):59-64. 2. Rosenblum MF, Finegold DN, Charney EB. Assessment of stature of children with myelomeningocele and usefulness of arm-span measurement. Dev Med Child Neurol 1983;25:33842. 3. Rimoin DL. Genetic disorders of the pituitary gland. In: Emery AEH, Rimoin DL, eds. Principles and practice of medical genetics. New York: Churchill Livingston, 1983:1134-51. 4. Hamill PVV. NCHS growth curves for children birth to 18 years: United States. Hyattsville, Md.: National Center for Health Statistics, 1977. DHEW publication No. 78-1650. (Vital and health statistics; series 11; No. 165, pp 20-3. 5. Maresh MM. Linear growth of long bones of limbs from infancy through adolescence. Am J Dis Child 1955;89:725-42. 6. Greulich WW, Pyle SI. Radiographic atlas of skeletal development of the hand and wrist. Stanford, Calif.: Stanford University Press, 1959. 7. Tanner JM. Growth at adolescence. Oxford: Blackwell Scientific Publications, 1962:33. 8. Gil-Ad I, Topper E, Laron Z. Oral clonidine as a growth hormone stimulation test. Lancet 1979;2:278-9. 9. Lin T, Kirkland RT, Sherman BM, Kirkland JL. Twentyfour-hour studies of growth hormone secretion in normal and short children and their lack of predictive value in growth hormone therapy [Abstract]. Pediatr Res 1988;23:280A. 10. Belt-Niedbala BJ, Ekval S, Cook C, Oppenheimer S, Wessel J. Linear growth measurement: a comparison of single armlength and arm-span. Dev Med Child Neurol 1986;28:319-24. 11. Reigel DH. Tethered spinal cord. Concepts Pediatr Neurosurg 1983;4:142-64. 12. Leonard CO, Freeman JM. Spina bifida: a new disease. Pediatrics 1981;68:136-7. 13. Greene SA, Frank M, Zachmann M, Prader M. Growth and sexual development in children with meningomyelocele. Eur J Pediatr 1985;144:146-8. 14. Meyer S, Landau H. Precocious puberty in myelomeningocele patients. J Pediatr Orthop 1984;4:28-31. 15. Costin G, Kaufman FR. Growth hormone secretory patterns in children with short stature.. J PEDIATR 1987;110:362-8. 16. Hammock MK, Milhorat TH, Baron IS. Normal pressure hydrocephalus in patients with myelomeningocele. Dev Med Child Neurol 1976;18(suppl 37):55-68. 17. Grumback MM. Growth hormone therapy and the short end of the stick. N Engl J Med 1988;319:238-40.

The main purpose of the present study was to assess the test-retest reliability of a newly devised instrument for measuring optimism and pessimism. In addition, correlations were obtained between the optimism and pessimism scores and two measures of happiness as well as with subjects’ responses to single-item questions about the likelihood of a nuclear encounter and about their religious and political commitment and philosophy of life. The instruments were administered to 106 introductory psychology students on two occasions separated by a 2-week interval. The test-retest reliability for the optimism scale was.75; for pessimism,.84. Both optimism and pessimism were correlated, on both administrations, with both happiness measures in the high.50s to low.60s. Of the remaining items, the strongest relation was between optimism and religious commitment (r =.27), confirming prior results.