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UNLABELLED: Skeletal fragility is a common complication of childhood acute lymphoblastic leukaemia (ALL) but the impact of bisphosphonate therapy on bone mass and fracture is unclear. We aim to conduct a systematic review to evaluate the effects of bisphosphonates on bone mineral density (BMD) and fracture incidence in children with ALL. METHODS: EMBASE, Medline and the Cochrane Library were thoroughly searched by two researchers. Inclusion criteria was any child under the age of 18 years with a diagnosis of ALL, who had received any bisphosphonate treatment and had serial measurements of bone density performed thereafter. All primary research studies of any study design, excluding case reports, were included. RESULTS: Ten full text papers were identified with two exclusively meeting the inclusion criteria. Both studies administered bisphosphonates to children receiving maintenance chemotherapy for varying durations. Bone density was assessed at regular intervals by dual x-ray absorptiometry (DXA). The majority of participants had an improvement in bone density at the end of each study. However, no size adjustment of DXA data was performed. Limited information on fracture occurrence was provided by one study but did not include routine screening for vertebral fractures. CONCLUSIONS: This systematic review identified that there is insufficient evidence to support routine use of prophylactic bisphosphonate therapy in childhood ALL for prevention of fracture and improvement of bone mass. Future well-designed clinical trials in those at highest risk of fractures in ALL are now needed.

The challenge to foster greater creativity in education systems represents a range of diverse and complex affordances and constraints. Creativity research in education spans policy, teaching, learning and assessment, as well as environments within and beyond the school that promote creative encounters. Worldwide, creativity, critical thinking, and problem-solving skills are marked as essential for effective learners and future employees. Creativity is closely linked with the development of flexible thinking and lateral problem-solving. Yet a shift is occurring from interest in creative individuals to creative ecologies in sociocultural formations of digitally networked cultures and collaborative methods of thinking. The value of attending to increasing creative sociality within and between diverse cultures and contexts is growing. Drawing on an international study of creativity in secondary schools across Australia, Canada, Singapore, and the United States, the authors argue that because creativity in education is central to lifelong learning and work satisfaction, schools must radically shift toward a more interdisciplinary whole-school creative ecology approach, and away from siloed disciplinary and individualist learning. The chapter draws on aspects of creative ecologies in education that combine science, technology, arts, culture, and industry, showing creativity as a fundamental aspect of education across all domains.