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Developing valid tools that assess key determinants of canine healthspan such as frailty and health-related quality of life (HRQL) is essential to characterizing and understanding aging in dogs. Additionally, because the companion dog is an excellent translational model for humans, such tools can be applied to evaluate gerotherapeutics and investigate mechanisms underlying longevity in both dogs and humans. In this multi-center, cross sectional study, we investigated the use of a clinical questionnaire (Canine Frailty Index; CFI; Banzato et al., 2019) to assess frailty and an owner assessment tool (VetMetrica HRQL) to evaluate HRQL in 451 adult companion dogs. Results demonstrated validity of the tools by confirming expectations that frailty and HRQL deteriorate with age. CFI scores were significantly higher (higher frailty) and HRQL scores significantly lower (worse HRQL) in old dogs (≥ 7 years of age) compared to young dogs (≥ 2 and < 6 years of age). Body size (small < 25lbs or large > 50lbs) was not associated with CFI or total HRQL score. However, older, larger dogs showed faster age-related decline in HRQL scores specific to owner-reported activity and comfort. Findings suggest that the clinician-assessed CFI and owner-reported VetMetrica HRQL are useful tools to evaluate two determinants of healthspan in dogs: the accumulation of frailty and the progressive decline in quality of life. Establishing validated tools that operationalize the assessment of canine healthspan is critical for the advancement of geroscience and the development of gerotherapeutics that benefit both human and veterinary medicine.Graphical abstractGraphical summary of the design, results, and conclusions of the study.

In this commentary we first examine psychometric issues in the ambitious enterprise of cross-cultural application of the Parental Burnout Assessment (PBA). The present reports span a wide range of cultural places. Overall, the PBA presents good face validity and a strong replication of factor structure; future multi-group confirmatory factor analysis will enable quantitative comparisons not currently possible. Content validity is not fully addressed in these reports, so nuanced differences in the nature of parental burnout remain an interesting possibility. Variation the PBA's correlations with other measures, such as education and household type, suggests cultural mediation in the causes and dynamics of parental burnout. In the second part of our commentary, we address more directly whether parental burnout is influenced by the sociocultural context in which it is manifest. We propose that future research will benefit from more precise description of the particular cultural community involved, including the settings, customs, and ethnotheories of parenting. Gaining a global understanding of parental burnout, in other words, rests on building firmer and more differentiated pictures at the local level. The papers in this volume nevertheless present an important step forward in what promises to be an exciting journey of discovery.

Culture and human development blossomed as a research enterprise in the last quarter of the 20th century; the energy and innovation of that enterprise are less evident now. Where did it go, and where is it going? In this essay, we examine the shifting fields of cross-cultural psychology, psychological anthropology, cultural psychology, indigenous psychology, and the surge of research on Individualism/Collectivism. Offering both academic and personal perspectives, we reflect on the importance of "culture" as a construct, and the value of focusing on individual development in that context. The way forward now, we suggest, is international and intercultural collaboration of scientists. The challenge for training new researchers from diverse backgrounds, however, is to equip them with the knowledge and insights gained from cross-cultural psychology, psychological anthropology, and their own cultures, rather than simply making the next generation of scholars into new representatives of Western theories of development.

Understanding culture is essential for understanding child development, and thus for designing and evaluating interventions to improve children’s physical and mental health. We outline seven key as...

The seven papers in this issue address a variety of challenges that parents in several different cultural places encounter as they do their best to ensure their children's safe, happy, and successful development from infancy through middle childhood: infant sleep, developmental agendas, temperament, preschools, academic success, and learning to be a parent in a new cultural environment. The authors use a varied of methods - qualitative and quantitative - to understand how parental figures in Botswana, China, Italy, the Netherlands, Poland, Spain, Sweden and the United States think about the needs of their children, their own role as parents, and the caretaking practices that follow. A final Commentary focuses on the power of parental ethnotheories in changing societies, and on the complexities and importance of cross-cultural research.

Urban and rural grandmothers (n = 20) in Botswana participated in focus groups to learn their expectations for the acquisition of skills by preschool children. Their expectations for self-care, traditional politeness, and participation in household chores were dramatically earlier than developmental timetables reported for Western middle-class populations. There are some differences, however, in the urban and rural grandmothers' expectations. Rural grandmothers had earlier expectations for self-care skills and participation in household chores, and they had more specific expectations for mastering Setswana cultural customs. In addition, some urban grandmothers, who were generally more educated, described using more reciprocal communication, and they believed in playing with their grandchildren, whereas the rural grandmothers' communication was more instructional, and they insisted that children should play away from adults. Strikingly, there was no mention of school readiness goals or activities by either group, suggesting a "cultural misfit" between the standard early childhood curriculum, largely imported from the United States and other Western countries, and the cultural backgrounds of Batswana families. To create a more workable partnership between preschool teachers and grandparents-important caretakers of young children, both traditionally and currently-will require efforts to acknowledge and promote the values and expectations of both groups.

Posterior reversible encephalopathy syndrome (PRES) is an increasingly recognized entity with certain identified predisposing factors in children. However, the actual incidence, comorbidities, outcomes, and hospitalization charges among children (aged less than 20 years) in the United States are largely unknown.We analyzed the Kids' Inpatient Database for incidence of PRES-related hospitalizations, associated diagnoses, in-hospital outcomes, and charges for children in the United States in 2016. We report demographics, risk factors, discharge status, mortality, length of stay, and hospitalization charges.In 2016, 825 pediatric hospitalizations related to PRES were captured in the Kids' Inpatient Database. Hospital discharges including solid organ transplant, bone marrow transplant, hypertension, renal disorder, primary immunodeficiency, malignancy, sepsis, severe sepsis, systemic connective tissue disorder, blood transfusion, hypomagnesemia, and sickle cell anemia were queried for presence of PRES. The majority of patients were discharged home. We found that PRES-related hospitalizations were significantly associated with increased length of stay and hospitalization charges in 2016 (P 0.001). A mortality rate of 3.2% was found in PRES-related hospitalizations when compared with 0.4% in non-PRES hospitalizations (P 0.001).PRES accounted for 0.04% of the hospitalizations in this database. Hypertension and the presence of a renal disorder are the most significant risk factors found to be associated with PRES. The presence of PRES was associated with a significant increase in hospitalization charges and increased length of stay.

This study investigates differences in the amount and structure of infant sleep in two cultural places with previously documented, divergent parental beliefs and practices. Eight-month-old infants (n=24 per site) were recruited from towns in the Netherlands and the eastern U.S.A. To evaluate sleep, infants’ physical activity was recorded at home for 24 hours using a miniature actigraph, while parents kept a diary of infant activities. Measures derived from actigraphy include total sleep, longest sleep episode, longest wake episode, number of sleep episodes, and percent of sleep during nighttime, as well as time in the stages of Quiet and Active Sleep. Measures based on the parental diaries include most of these aspects as well, except those related to sleep stages. Results based on the more precise actigraphy method indicate that (1) the Dutch infants averaged 13.65 hours of sleep per 24 hours, 1.67 hours more than the U.S. infants; this difference was mostly due to daytime sleep; (2) The Dutch infants’ longest wake episode averaged less than that of the U.S. infants, while their longest sleep episode appeared slightly longer. (3) The Dutch infants, compared to the U.S. sample, spent more time in the Quiet, rather than the Active phase of sleep; (4) They began their Quiet sleep earlier in the evening than did their U.S. counterparts. Measures derived from parental diaries are largely in agreement with the actigraph findings. These results are consistent with reported and observed practices and beliefs in the two communities. The pattern of differences – less apparent maturity among the Dutch in the amount of sleep, but greater apparent maturity in the structure of sleep -- illustrates that behavioral and neurological maturity can be assessed only in the context of the developing child’s adaptation to the specific demands and affordances of the culturally structured developmental niche.

High levels of work-related stress have been frequently documented among front-line family service providers including social workers, home visitors, and agency staff members. Left unaddressed, such stress contributes to burn-out and job turnover, with negative effects on client families as well as agencies and the workers themselves. In response to this problem, some child and family service organizations have encouraged the use of self-care practices to counteract the inherent stresses of these jobs. The present study reports on descriptions of stress and self-care contained in written portfolios of 99 family workers enrolled in a strength-based training program, the Family Development Credential®. As found in other research, virtually all study participants reported an over-arching sense of stress and anxiety, with specific issues of workload, client problems, and work/family imbalance most frequently mentioned. To deal with their stress, workers described a variety of self-care practices: most common were mindfulness, exercise, social connections, changing self-expectations, and time management. Results show a significant curvilinear relationship between the number of stresses and the number of self-care practices mentioned, such that workers discussing both the lowest and the highest number of stresses discussed fewer self-care practices than workers naming a moderate number of stresses. Although a similar relationship between the level of stress and individuals' ability to take advantage of available resources has been demonstrated for low-income families, to our knowledge the present study is the first empirical demonstration of this principle for people who serve such families. These findings illustrate the limits of individual self-care for dealing with high levels of stress, and suggest the importance of strengthening worker support at the agency level, as well as tailoring stress management programs to the needs of individual workers.

The behavior of newborns is ambiguous. Cultural models-representations shared by members of a community-provide new parents and others with a cognitive and motivational structure to understand them. This study asks members of several cultural groups (total n = 100) to judge the "similarity" of behavioral items in the Neonatal Behavioral Assessment Scale (NBAS). Data were obtained from NBAS experts, mothers, and undergraduates in Massachusetts, and mothers and high-school students in rural Kenya. Multidimensional scaling of their judgments reveals that NBAS experts were especially attentive to a dimension of State Control-exactly as the scale emphasizes. Kenyan mothers focused on a dimension of motor responsiveness-in accord with their concern and practices regarding motor development, and the Massachusetts mothers organized their judgments around cognitive competence-abilities emphasized in contemporary discussions of early development. The US students appear to be more similar to US mothers than did the Kenya students to the Kenyan mothers. Each adult group's representation reflects their cultural values and goals, and helps them understand the newborn child in local terms.

Research by Xinyin Chen and others has documented that in past decades, shyness in Chinese children was associated with leadership, peer-acceptance, and academic achievement. In contemporary China, shyness predicts maladaptive youth outcomes. Although social, political, and economic transitions are presumed to be responsible for this shift, little is known about how societal change mediates parents' beliefs and the socialization of shy children. This qualitative study explored implicit parenting cognitions and attitudes about shyness in a Chinese urban middle-class group of mothers (N = 20). Thematic analyses revealed mothers' beliefs about the role of family socialization in the development/maintenance of shyness and the complexities between shyness and introversion. Mothers spoke of increased use of child-centered parenting practices and the promotion of assertive and self-assured traits. These findings highlight how Chinese parenting has contributed to the decline in the adaptive value of shyness, and inform the development of parenting interventions for shy Chinese children.

Despite improvements in nutritional management, preterm infants continue to face high rates of postnatal growth restriction. Because variability in breast milk composition may result in protein and energy deficits, targeted fortification has been advocated. We conducted an interventional study to compare body composition and growth outcomes of very low birth weight infants fed targeted protein-fortified human milk (HM) with those fed standard fortified HM. If mother&rsquo, s own milk was not available, donor milk was used. Weekly analysis of HM with mid-infrared spectroscopy was conducted and additional protein was added to the fortified HM to ensure a protein intake of 4 g/kg/day. Weekly anthropometric measurements were done. Prior to discharge or at 37 weeks, corrected age skinfold thickness (SFT) measurements as well as body composition measurement using air displacement plethysmography were done. Among 36 preterm infants enrolled, those in the targeted group (n = 17) received more protein and had a larger flank SFT at study end than those in the standard group (n = 19). A pilot post-hoc analysis of subjects having at least 30 intervention days showed a 3% higher fat-free mass in the targeted group. Use of a targeted fortification strategy resulted in a higher protein intake and fat-free mass among those receiving longer intervention.

Although children's school success is a parental goal in most cultures, there is wide cultural variation in the qualities that parents most wish their children to develop for that purpose. A questionnaire contained forty-one child qualities was administered to 757 parents in seven cultural communities in Australia, Italy, the Netherlands, Poland, Spain, Sweden, and the United States. Exploratory factor analysis was conducted separately within each sample and results revealed both similarities and differences across the seven samples. The factor structures showed considerable similarity: four domains of characteristics (Cognitive Qualities, Social Qualities, Negative temperament, and Good Characters) were identified in each sample as strongly influencing children's success in school. However, parents differed across the seven cultural communities in the importance they attributed to these factors. The results also reveal some culturally unique patterns in parents' concepts of the successful schoolchild; the seven samples were differentiated by distinctive associations of individual qualities around the four common domains. These results offer new insights for incorporating perspectives from other cultures into our own concepts of what qualities are most important for children's success in school, and how educators can be cognizant of differing cultural perspectives represented by the families whose children are their students.

Contains fulltext : 227081.pdf (Publisher’s version ) (Closed access) Recent years have witnessed increasing attention to early childhood education and care as a foundation for children's successful development in school and beyond. The great majority of children in postindustrial societies now attend preschools or daycare, making this setting a major part of their culturally constructed developmental niches. Although an extensive literature demonstrates the importance of parental involvement or engagement in their children's schools, relationships between parents and their children's preschools have received scant attention in the research literature. This paper aims to address that gap through a mixed-methods cross-cultural study of parents and preschools in four Western countries: Italy, Spain, the Netherlands, and the United States. Following an introduction to national systems of preschool in each country, parents’ involvement and ideas about the family-school relationship are presented, drawing from parental diaries and from semistructured interviews (n = 110). Results indicate areas of cross-cultural similarity but also some differences, especially between the U.S. sample and the three European samples. Discussion addresses the question of how preschools and parents can work together to create optimal developmental niches for their young children. The authors also suggest that parent-preschool relationships deserve greater attention by both researchers and program developers 29 p.

This study explores the cultural construction of "difficult" temperament in the first 2 years of life, as well as the logistical and thematic continuity across infancy and childhood in what mothers perceive as difficult. It extends earlier work regarding older children in six cultural sites: Italy, the Netherlands, Poland, Spain, Sweden, and the United States. In order to compare temperament profiles across sites, a "derived etic" version of standard temperament scales is constructed, and then examined in relation to mothers' global ratings of how "difficult" the child is to manage. Results are compared to the earlier report. Negative Mood and low Adaptability tend to be problematic in most sites in both age groups. High Activity and Intensity increase in their relevance to difficulty from the first 2 years to early childhood. In some sites, dispositions such as low Approach become less difficult to manage. Of particular note are culturally unique patterns of continuity that appear to be related to larger cultural themes. These results have implications for our theoretical understanding of parenting, as well as for educational and clinical practice.

Although developmental science has always been evolving, these times of fast-paced and profound social and scientific changes easily lead to disorienting fragmentation rather than coherent scientific advances. What directions should developmental science pursue to meaningfully address real- world problems that impact human development throughout the lifespan? What conceptual or policy shifts are needed to steer the field in these directions? The present manifesto is proposed by a group of scholars from various disciplines and perspectives within developmental science to spark conversations and action plans in response to these questions. After highlighting four critical content domains that merit concentrated and often urgent research efforts, two issues regarding “how” we do developmental science and “what for” are out- lined. This manifesto concludes with five proposals, calling for integrative, inclusive, transdisciplinary, transparent, and actionable developmental science. Specific recommendations, prospects, pitfalls, and challenges to reach this goal are discussed.

OBJECT Decompressive craniectomy (DC) for the management of severe traumatic brain injury (TBI) is controversial. The authors sought to determine if DC improves the outcome of children with severe TBI. METHODS In a retrospective, case-control study, medical records of all patients admitted to the pediatric ICU between May 1998 and May 2008 with severe TBI and treated with DC were identified and matched to patients who were treated medically without DC. Medical records were reviewed for patients’ demographic data and baseline characteristics. RESULTS During the study period, 17 patients with severe TBI treated with DC at a median of 2 hours (interquartile range [IQR] 1–14 hours) after admission were identified and matched to 17 contemporary controls. On admission, there were no differences between DC and control patients regarding age (10.2 ± 5.9 years vs 12.4 ± 5.4 years, respectively [mean ± SD]), sex, weight, Glasgow Coma Scale score (median 5 [IQR 3–7] vs 4 [IQR 3–6], respectively; p = 0.14), or the highest intracranial pressure (median 42 [IQR 22–54] vs 30 [IQR 21–36], respectively; p = 0.77). However, CT findings were significant for a higher rate of herniation and cerebral edema among patients with DC versus controls (7/17 vs 2/17, respectively, had herniation [p = 0.05] and 14/17 vs 6/17, respectively, had cerebral edema [p = 0.006]). Overall there were no significant differences in survival between patients with DC and controls (71% [12/17] vs 82% [14/17], respectively; p = 0.34). However, among survivors, at 4 years (IQR 1–6 years) after the TBI, 42% (5/12) of the DC patients had mild disability or a Glasgow Outcome Scale score of 5 vs none (0/14) of the controls (p = 0.012). CONCLUSIONS In this retrospective, small case-control study, the authors have shown that early DC in pediatric patients with severe TBI improves outcome in survivors. Future prospective randomized controlled studies are needed to confirm these findings.

The composition of human milk is known to vary with length of gestation, stage of lactation, and other factors. Human milk contains all nutrients required for infant health but requires fortification to meet the needs of low-birth-weight infants. Without a known nutrient profile of the mother's milk or donor milk fed to a baby, the composition of the fortified product is only an estimate. Human milk analysis has the potential to improve the nutrition care of high-risk newborns by increasing the information about human milk composition. Equipment to analyze human milk is available, and the technology is rapidly evolving. This pilot study compares mid-infrared (MIR) spectroscopy to reference laboratory milk analysis.After obtaining informed consent, we collected human milk samples from mothers of infants weighing2 kg at birth. Duplicate samples were analyzed for macronutrients by MIR and by reference laboratory analysis including Kjeldahl for protein, Mojonnier for fat, and high-pressure liquid chromatography for lactose. Intraclass correlation coefficients, Bland-Altman scatter plots, and paired t tests were used to compare the two methods.No significant differences were detected between the macronutrient content of human milk obtained by MIR vs reference laboratory analysis.MIR analysis appears to provide an accurate assessment of macronutrient content in expressed human milk from mothers of preterm infants. The small sample size of this study limits confidence in the results. Measurement of lactose is confounded by the presence of oligosaccharides. Human milk analysis is a potentially useful tool for establishing an individualized fortification plan.

The idea of non-alignment has remained a central component of Indian identity in global politics that is manifest in continuities: since independence in 1947 India has been in pursuit of strategic autonomy, a quest that in practice has led to semi-alliances fashioned under the cover of non-alignment and shaped by regional dynamics. In this setting, the rise of China now raises an interesting conundrum for Indian policy-makers as New Delhi seeks to balance the benefits and risks of an increasingly assertive neighbour and a network of alliances with like-minded countries. This article approaches this enigma by delineating continuities of non-alignment from the early roots of the policy, through the Cold War-era and into the modern-day international system. Though domestic factors have had a significant influence on the trajectory of Indian foreign policy, the continuities of non-alignment have prevailed through changes in leadership and domestic vicissitudes. By exploring the foundation of non-alignment and how India has operationalized the policy, this article maintains that to some extent continuity will persist: India will likely continue its rhetoric in favour of strategic autonomy while moving closer to the West and its allies in practice. Yet in order to effectively balance China's growing influence, India will need to be more assertive in building these alliances, as the success of its modern-day pursuit of strategic autonomy may well rest on a strong foundation of strategic partnerships. The coming to office in May 2014 of the National Democratic Alliance government led by Narendra Modi has signalled a move away from even the rhetoric of non-alignment, with significant implications for the future of Indian foreign policy

This chapter presents the data primarily from two communities: the village of Kokwet in rural Kenya and the town of Duxbury in metropolitan America. Traditional studies of clustering in American children, for reasons that probably have more to do with logistics and economics than a failure of theory, have not examined year-to-year changes in clustering strategy. Changes in elementary visual analysis and construction, in the clustering of items in free recall, and in the rate and type of illusions in the Verbal Transformation Effect are highly canalized growth patterns of middle childhood. Psychological theories of cognitive development are generally vertical. By examining the way subjects of different ages deal with a particular set of tasks, psychologists have derived generalizations about how thinking changes as children mature. A central theme in psychological theories about thinking contrasts organization based on abstracted structural categories with organization based on physical features or function.

Prognosis in patients with Duchenne muscular dystrophy (DMD) is guarded and most deaths are due to cardiac or respiratory causes. It is unclear if some DMD gene mutations might be predictive of either mild or severe cardiac dysfunction. We studied 75 patients with DMD followed at our institution. Cardiac function, as assessed by yearly echocardiography, showed marked variability in left ventricular (LV) function. Some patients in their 3rd decade had no or minimal dysfunction whereas others in their 2nd decade had very severe dysfunction. Therefore, 4 Severity Groups were defined ranging from no/mild LV dysfunction to severe LV dysfunction using patient age at first abnormal echocardiogram and degree of LV dysfunction. Genetic data were collected for all patients. The majority of patients had mutations between exon 1 – 20 and exon 41 – 55. The distribution of the 4 Severity Groups of LV dysfunction did not significantly differ among these two mutation groups. An analysis based on the number of exons involved (< 5 exons versus ≥ 5 exons) also found no significant difference in cardiac severity. When patients having identical mutations were compared as to their cardiac course, concordance was often not evident. Steroid therapy had no apparent protection for the development of cardiomyopathy. In conclusion, 75 patients with DMD showed marked variability in the severity of LV dysfunction. Neither age of onset nor severity of cardiomyopathy correlated with any of the mutation groups.

This study examined the process of adjustment in shy and nonshy children during the transition to school in a Chinese community. Children (35 shy and 19 nonshy) were assessed three times before and after they entered the first grade. Shy and nonshy children’s interactions with peers and teachers, perceived peer acceptance, and anxious behaviour were measured using multiple methods, including naturalistic observations, self-report, and teacher report. Results indicated that shy and nonshy children showed consistently different behavioural profiles in free play settings and structured classes during the transition. However, teacher ratings of and peer responses to shy and nonshy children were not consistently different. Results are discussed in relation to the cultural context where the study was conducted. Copyright © 2014 John Wiley & Sons, Ltd.

Metabolic bone disease (MBD) is an important prematurity-related morbidity, but remains inadequately investigated in extremely low birth weight (ELBW) infants, the group most at risk. The objective was to describe the incidence and associated risk factors of MBD in ELBW infants.Retrospective analysis of all ELBW infants admitted between January 2005 and December 2010 who survived8 weeks. MBD was defined as the presence of osteopenia or rickets in radiographs.Of the 230 infants included in the study, 71 (30.9%) developed radiological evidence of MBD (cases) of which 24/71 (33.8%) developed spontaneous fractures. MBD and fractures were noted at mean postnatal ages of 58.2 ± 28 and 100.0 ± 61 days, respectively. Compared with controls, cases were smaller at birth (664.6 ± 146 g vs 798.1 ± 129 g), more premature (25.0 ± 1.8 vs 26.4 ± 1.9 weeks), more frequently associated with mechanical ventilation, chronic lung disease, parenteral nutrition days, cholestasis, furosemide, postnatal steroids, and antibiotics use (all P.01). Cases had lower average weekly intake of calcium, phosphorous, vitamin D, protein, and calories during the first 8 weeks of life compared with controls. Cases with MBD, compared with controls, had higher mortality (14.1 vs 4.4%) and longer hospital stay (140.2 ± 51 vs 101.0 ± 42 days; P.01).MBD remains an important morbidity in ELBW infants despite advances in neonatal nutrition. Further research is needed to optimize the management of chronic lung disease and early nutrition in ELBW infants.

This article examines India's bilateral relations with the U.S. and Iran and argues that Indian interests, rather than increased pressure from the U.S., will continue to shape New Delhi's policies toward Iran.

Introduction: Recent evidence suggests that preterm birth is a possible risk factor for high blood pressure (BP) in later life. The most widely quoted blood pressure centiles for very low birth weight (VLBW, ≤1500 g birth weight) infants at corrected term gestation is based on a cohort with mostly late preterm or term infants (Zubrow curves). Objectives: The objective of this study was to determine the clinical utility of the Zubrow curves in diagnosis of hypertension in VLBW infants at their term corrected gestational age (CGA). Patients and Methods: In a case-control study, we compared BP in 75 VLBW infants at 40 weeks CGA (cases) to 69 full term infants admitted to neonatal intensive care unit (NICU) (controls). Results: In spite of having lower weights, VLBW infants compared to term infants (2612.8 ± 546 vs. 3308.2 ± 373 g, P ≤ 0.001) had higher average systolic (88.8 ± 7.6 vs. 82.33 ± 8.5 mm Hg; P ≤ 0.001) and mean BP (61.2 ± 6.6 vs. 57.61 ± 6.9, P = 0.01). Although 41% (31/75) VLBW infants would have met the criteria for hypertension according to Zubrow curves only 4% (3/75) were diagnosed with hypertension. Conclusion: Since Zubrow BP centiles were based on a heterogeneous population of infants including preterm and term infants, new BP centiles based on chronological data from VLBW infants would allow a better definition of hypertension in these infants and identify the threshold BP for initiating treatment.

The response of 185 infants to their mothers’ departure was assessed in a rural area of Bangladesh. Despite their poor health and nutritional status, this group of infants showed the same peak in separation protest around the end of the first year that has been documented for healthier samples in several cultural contexts; correlational analysis suggests that the healthier infants were more likely to display protest. In addition, there was an earlier rise and decline in distress at maternal departure in the first half year of life, not seen in other reports. In this case, poor health appeared to dispose toward upset, indicating that the most fragile infants were least able to cope with the regulatory demands imposed by maternal departure. Overall, the results are evidence for a very strongly canalized transformation of cognitive and emotional functioning toward the end of the first year of life.

BACKGROUND The stress response has been well documented in past music therapy literature. However, hypometabolism, or the relaxation response, has received much less attention. Music therapists have long utilized various music-assisted relaxation techniques with both live and recorded music to elicit such a response. The ongoing proliferations of relaxation music through commercial media and the dire lack of evidence to support such claims warrant attention from healthcare professionals and music therapists. OBJECTIVE The purpose of these 3 studies was to investigate the correlational relationships between 12 psychophysical properties of music, preference, familiarity, and degree of perceived relaxation in music. METHODS Fourteen music therapists recommended and analyzed 30 selections of relaxation music. A group of 80 healthy adults then rated their familiarity, preference, and degree of perceived relaxation in the music. RESULTS The analysis provided a detailed description of the intrinsic properties in music that were perceived to be relaxing by listeners. These properties included tempo, mode, harmonic, rhythmic, instrumental, and melodic complexities, timbre, vocalization/lyrics, pitch range, dynamic variations, and contour. In addition, music preference was highly correlated with listeners' perception of relaxation in music for both music therapists and healthy adults. The correlation between familiarity and degree of relaxation reached significance in the healthy adult group. CONCLUSIONS Results from this study provided an in-depth operational definition of the intrinsic parameters in relaxation music and also highlighted the importance of preference and familiarity in eliciting the relaxation response.

Objective To reduce airway injury secondary to high suction pressures, the American Academy of Pediatrics Neonatal Resuscitation Program (NPR) recommends that suction pressures be less than 100 mm Hg. This study was conducted to determine if suction bulbs conform to these recommendations. Study design In this prospective in vitro study, 25 personnel involved in neonatal resuscitation squeezed a new bulb three times for each of six commercially available bulbs using their delivery suite technique. A calibrated, pneumatic transducer measured the pressure of each squeeze. Results Only one bulb met the NRP guidelines with none of the participants exceeding 100 mm Hg (p Conclusions Only one bulb met the NRP guidelines of generating pressures less than 100 mm Hg. This bulb's large size (3 oz) may preclude its use in premature infants. Individuals involved in resuscitating newborns need to be aware of the pressures generated to avoid injuring the delicate oral airway.

We sought to investigate the risk factors and outcome of Ventilator Associated Tracheitis (VAT) according to the Center for Disease Control (CDC) definition in pediatric trauma patients who were ventilated for ≥48 hr. In a retrospective cohort study, medical records of all pediatric trauma patients admitted to our Pediatric Intensive Care Unit (PICU) between April 2002 and April 2007 were reviewed. Medical records were reviewed for patients' demographics, Trauma Injury Severity Score (TISS), Glasgow Coma Scale (GCS), type of trauma, and other potential risk factors prior to the development of VAT (such as hyperglycemia, rate of re-intubation and tracheotomy, presence of chest tubes and central lines, urinary tract infection, seizures, need for cardiopulmonary resuscitation, use of total parental nutrition, transfusion, use of H(2) blockers, steroids, and pressors/inotropes). Medical records were also reviewed for days of mechanical ventilation, PICU length of stay, and PICU mortality. During the study period, 217 trauma patients were admitted to the PICU, 113 patients met our inclusion criteria and 21.2% (24/113) developed VAT. On average patients with VAT (in comparison to patients without VAT), had a higher TISS score on admission [38.6 ± 16.9 vs. 24.2 ± 10.6; respectively (P 0.01)], longer days of ventilation and PICU length of stay [11.5 ± 6.2 vs. 3.7 ± 2.3 days (P 0.001) and 16.4 ± 8.3 vs. 5.4 ± 2.8 days (P 0.001), respectively]. There was no difference in mortality between the two groups. In a logistic regression model adjusting for possible confounders, the TISS score (adjusted OR 7.53; CI: 2.01-28.14; P = 0.03 and use of pressors/inotropes (adjusted OR 4.64; CI: 1.28-16.86; P = 0.01) were the only independent risk factors associated with VAT. We conclude that the severity of illness and use of pressors/inotropes are associated with VAT in pediatric trauma patients. We also conclude that VAT is associated with an increase in days of mechanical ventilation and PICU length of stay in pediatric trauma patients.

Objective To determine epidemiology and clinical characteristics of infants with methicillin-susceptible (MSSA) and -resistant Staphylococcus aureus (MRSA) in a level III neonatal intensive care unit (NICU). Study Design All NICU admissions (2001 to 2008) with any positive S. aureus culture were included as cases. Cases were further characterized as either colonized or infected with invasive disease. Results Four thousand three hundred four infants were admitted; 273 (6.3%) had at least one culture positive for S. aureus , including 198 with MSSA and 75 with MRSA. Invasive disease occurred in 23.2% of MSSA cases versus 29.3% MRSA ( p = 0.298). Between the study periods 2001 to 2005 versus 2006 to 2008, the incidence of all MSSA cultures (colonization and invasive disease) decreased from 53.6 to 38.9/1000 admissions ( p = 0.044), and that of MRSA increased from 13.7 to 24.77/1000 admissions ( p = 0.010). The incidence of invasive MSSA ( p = 0.49) and MRSA ( p = 0.38) disease between the two periods remained similar. Infants with invasive MRSA versus MSSA had a longer duration of positive cultures (55 versus 19 days, p = 0.009). None of five available isolates collected prior to 2006 was characterized as USA300, but 11/21 isolates collected subsequently were USA300 ( p = 0.053). Conclusion The incidence of MRSA (colonization and infection) nearly doubled during the study period coinciding with emergence of community-acquired MRSA USA300.

In this work, we demonstrate an impedance approach to detect pathogens bound to magnetic beads. The approach was demonstrated with C-Albicans. We show that when an appropriate frequency is applied to two electrodes present in a microfluidic channel the impedance change in the detection volume can be used to distinguish between unbound beads and beads bound to pathogens. Furthermore, we present a model to relate measured impedance changes to an effective particle diameter.

— Research on African children has made key contributions to the emergence of a more globalized developmental science, advancing theory and providing illuminating examples in the domains of motor development, cognitive growth, attachment, and socially responsible intelligence. Because the environments for children’s development are culturally structured, local knowledge is necessary to understand development and to devise social programs to promote healthy outcomes, as illustrated in this article by a case study in Senegal. This argues for advancing the research activities of local scholars. At the same time, action at the global level is necessary to weave such local knowledge into a global science of human development.

Cross-cultural research is inherently limited by the difficulty of disentangling cultural effects on children’s development from other environmental features that covary with culture. The growing presence of immigrant populations in the United States offers an opportunity to study parents’ cultural belief systems, or “parental ethnotheories,” as they influence children’s settings and activities in the absence of other environmental supports. This study examined Asian Indian immigrant mothers’ ( n = 10) and matched Euro-American mothers’ ( n = 10) ethnotheories about their daughters by means of analysis of the mothers’ discourse in the context of semistructured interviews, multidimensional scaling and cluster analysis of the descriptors, and consensus analysis. The mothers’ ethnotheories are reflected in differences between the settings and daily activities of their daughters. The Indian immigrant mothers’ ideas and practices are compared to findings in the Whitings’ comparative field studies and discussed in relation to several concepts of culture.

Background Better risk stratification of patients receiving an implantable cardioverter-defibrillator (ICD) for primary prevention of sudden cardiac death (SCD) is needed. Although microvolt T-wave alternans (MTWA) and electrophysiologic study (EPS) are independent markers for SCD, the Alternans Before Cardioverter Defibrillator (ABCD) trial found the combination to be more predictive than either test alone. Objective The purpose of this study was to test the hypothesis that EPS and MTWA measure different elements of the arrhythmogenic substrate and, therefore, predict distinct arrhythmia outcomes. Methods The ABCD trial enrolled 566 patients with ischemic cardiomyopathy, left ventricular ejection fraction (LVEF) ≤0.40, and nonsustained ventricular tachycardia. All patients underwent both MTWA test and EPS. The performance of MTWA and EPS in predicting stable ventricular tachyarrhythmic events (S-VTEs) versus unstable ventricular tachyarrhythmic events (U-VTEs), defined as either polymorphic ventricular tachycardia or ventricular fibrillation, was analyzed using Kaplan-Meier event rates and the log rank test. Results MTWA and EPS were abnormal in 71% and 39% of patients, respectively. There were 28 S-VTEs and 10 U-VTEs. MTWA was predictive of U-VTEs (event rate 2.7% in abnormals vs 0% in normals, P = .04), whereas EPS was not (1.5% vs 3.2%, P = .55). In contrast, EPS predicted S-VTEs (9.7% vs 2.2%, P P = .57). Whereas the extent of left ventricular contractile dysfunction alone (LVEF ≤0.30 vs LVEF 0.31–0.40) did not predict events, MTWA predicted events better than did EPS in subjects with LVEF ≤0.30. In contrast, EPS predicted events better than did MTWA test in subjects with LVEF >0.30. Conclusion The study data suggest that EPS and MTWA identify distinct arrhythmogenic substrates and, when used in combination, may better predict the complex electroanatomic substrates that underlie the risk for SCD.

Objective To describe the natural history of cardiomyopathy in patients with Duchenne muscular dystrophy (DMD) who are receiving contemporary therapies. Methods This is a single-institution retrospective cohort study of 57 patients aged >15 years with DMD. Serial digital echocardiograms were performed over a median follow-up of 8 years. Left ventricular dysfunction (LVD) was defined as shortening fraction (SF)

Functional coronary ischemia testing is frequently utilized to stratify unstable angina (UA) in emergency department, which is time and resource consuming. We propose that an efficient biomarker based approach including N-terminal pro b-type natriuretic peptide (NT-pro BNP) could supplement

Stress testing to identify obstructive coronary artery disease (CAD) in chest pain (CP) is time-consuming and expensive. We propose a biomarker based approach including N-terminal pro-B-natriuretic peptide (NT-pro BNP) to complement stress testing. ROBUST (Role of Biomarkers in Unstable Angina) was

Objective Increased intrathoracic pressures during airway pressure release ventilation (APRV) may compromise systemic venous return resulting in decreased cardiac output and renal perfusion. We sought to study the short-term effect of APRV on blood pressure (BP) and urine output (UO) in children with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). Design Retrospective cohort study. Patients All patients with ALI/ARDS who were admitted to our Pediatric Intensive Care Unit (PICU) between 1/00 and 06/04, and who were ventilated with APRV (for at least 12 hr) for worsening oxygenation while on conventional ventilation (CV). Measurements and Results Medical records were reviewed for patients' demographics, Pediatric Risk of Mortality (PRISM III) score, admitting diagnosis, ventilator settings, gas exchange data, heart rate (HR), central venous pressure (CVP), blood pressure (BP), UO, and use of other therapies [sedatives, pressors, inotropes, and intravenous fluid (IVF)]. Eleven patients met our inclusion and exclusion criteria with a mean age of 6.2 ± 4.8 years (range: 1–15 years), a weight of 35.5 ± 29.5 kg (range: 12–90 kg), and a PRISM score of 18.4 ± 9.6 (range: 2–36). Within 10 hrs of APRV, patients' mean airway pressure (Paw) increased from 16.1 ± 6.6 to 21.1 ± 5.5 cm of H2O (P = 0.04). Despite a higher Paw there were no differences in HR, CVP, BP, UO, IVF and use of other therapies while on CV or APRV (P > 0.10). Conclusion In children with ALI/ARDS, despite a higher Paw, APRV does not affect BP or UO. Pediatr Pulmonol. 2010; 45:48–54. © 2009 Wiley-Liss, Inc.

The three contributions to this Special Section on Culture and Human Development are summarized and critiqued. In considering the nature of contemporary psychological science, as well as applications to early childhood care and development, education to prevent HIV/AIDS, and formal academic education, the various authors are in general agreement on the limitations of current knowledge as it applies to African populations. There is also a common focus on the promise of scientific procedures that take seriously the importance of local understandings, institutions, and social settings. Les trois contributions de cette section speciale sur la culture et sur le developpement humain sont resumees et critiquees. En considerant la nature de la science psychologique contemporaine ainsi que les applications aux soins a la petite enfance et au developpement, a l'education pour prevenir le VIH/SIDA, et a l'education academique formelle, les divers auteurs sont globalement en accord sur les limites des connaissances a...

Parents often arrange activities for their children either by providing them with opportunities or restricting their participation. The way children spend their time affects their cognitive and social development. This study compares the involvement of Asian immigrant and Euro-American parents in their young children's daily activities, with particular attention to two contrasting roles: teacher and playmate. Parents of children aged 3 to 6 years (n = 24 children in each group) kept daily logs of their children's activities and companions for a week. Results show that parents in both groups spent similar amounts of time in play activities with their children, although the Euro-American parents did more pretend play and the Asian parents did more constructive play. However, Asian parents spent far more time on preacademic activities with their children such as learning letters and numbers, playing math games, and working with the computer. The cultural differences among parents are mirrored to a lesser extent by patterns of participation of siblings, friends, and babysitters with the target children. These results are discussed in relation to universality and cultural specificity of parenting beliefs and practices.

The outcome of carotid artery occlusion was studied through the retrospective identification of 115 affected patients. The majority were white (77%) males (61%) with multiple atherogenic risk factors and suffering ipsilateral stroke (57%). Those patients presenting with stroke were not distinguished by demographic features, risk factors, lipid profile, medical regimen, or subsequent mortality when compared with those without. Overall, 36 patients (31%) required contralateral carotid endarterectomy (CEA), with one (2.8%) perioperative stroke, whereas 4 (3%) underwent ipsilateral external CEA without incident. With 81% follow-up (mean 3.9 years), the overall mortality of the group was 46%; the annualized risk of ipsilateral stroke was 1.6%. This study documents a significant risk of stroke and contralateral occlusive disease with ipsilateral carotid artery occlusion, which cannot be reliably predicted by clinical criteria. Duplex surveillance is valuable, but flow velocity measurements alone may be misleading. Surgical endarterectomy can be performed with an acceptable rate of perioperative stroke.

The developmental niche, a theoretical construct for the study of the child in cultural context, has been usefully applied to the analysis of environments of disabled individuals. In this article, the authors review the three components of the niche (settings of daily life, customs of care, and the psychology of the caretakers), with particular reference to issues of disability. Two case studies are presented as illustrations of the importance of parents' culturally constructed ideas, or ethnotheories, as either challenges or supports to the work of the occupational therapist. The article concludes with a consideration of cultural variability in parents' ideas of “successful development,” with illustrations from research in Italy, the Netherlands, and the United States. The developmental niche framework is relevant to concepts of “habit” as used in occupational therapy. It is also helpful for considering how the environment of the disabled individual—including cultural assumptions about what constitutes an agenda for successful development—may be modified to promote full participation in meaningful activities in the community.