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Abstract Background The National Health Promotion Intervention Program by Student (HPIPS) is a French government educational program introduced in 2018, aiming at developing all health students’ health promotion knowledge and abilities, as well as implementing health promotion interventions for specific subpopulations in the general public. Its pedagogical framework was elaborated in 2018 and then evaluated by the French Council for Public Health in 2022, highlighting certain difficulties for the program to be homogeneously implemented in France. The aim of this study was to explore and describe the experiences and feedback of university lecturers in charge of this HPIPS training. Methods Semi-structured interviews were conducted with HPIPS lecturers from various health fields and from French universities, and a qualitative content analysis was carried out. Results Fourteen interviews were conducted during the autumn of 2022 with HPIPS program university lecturers including five doctors, three dentists, two nurses, two pharmacists, one midwife, and one physiotherapist from eight different towns belonging to six regions. Depending on the professional background, the component, and the local resources available, the teaching experience varied from one lecturer to another. A number of difficulties arose in setting up this educational program and complying with the latter legislation. The work overload was considerable, and the lecturers’ heavy commitments some lecturers to be discouraged, especially since some lecturers were not trained in health promotion abilities. Although interprofessionality was a strength of this HPIPS, it was also its main challenge. Pedagogical innovations were developed, notably through the use of digital technology; cross-disciplinary collaboration was established; and lecturers–students specific boundaries have emerged thanks to this health promotion project. Conclusions In France, setting up the HPIPS rapidly was experienced as a real pedagogical challenge for the interviewed university lecturers. While most of them noted the positive and beneficial contributions made by the introduction of prevention and health promotion intervention skills for health students, they also shared recommendations in order to match the ambitions and increase the HPIPS impact on the development of a culture of prevention and health promotion among health students.

Abstract Throughout their lives, humans seem to learn a variety of rules for things like applying category labels, following procedures, and explaining causal relationships. These rules are often algorithmically rich but are nonetheless acquired with minimal data and computation. Symbolic models based on program learning successfully explain rule-learning in many domains, but performance degrades quickly as program complexity increases. It remains unclear how to scale symbolic rule-learning methods to model human performance in challenging domains. Here we show that symbolic search over the space of metaprograms—programs that revise programs—dramatically improves learning efficiency. On a behavioral benchmark of 100 algorithmically rich rules, this approach fits human learning more accurately than alternative models while also using orders of magnitude less search. The computation required to match median human performance is consistent with conservative estimates of human thinking time. Our results suggest that metaprogram-like representations may help human learners to efficiently acquire rules.

Many technological applications (apps) purport to help children learn academic material. Building on research in developmental and educational psychology, we developed and tested an app to teach biological and physical science content to preschool children. There were 21 children in the control condition (M[subscript age] = 50.30 months, SD = 8.61) and 21 children in the intervention condition (M[subscript age] = 53.21 months old, SD = 6.36). Children were given pre- assessments and post-assessments of their understanding of living things, inheritance, buoyancy, and balance. Half were assigned to play the app for 3 weeks or to a control condition that only completed the assessments. Based on ANCOVA and ANOVA models, children in the app condition increased in their understanding of living things and buoyancy on a near-transfer task from pre-test to post-test assessment, whereas the children in the control condition did not increase their understanding. The findings suggest that drill and tests apps focusing on science content that take account of folk theories of science can support children's science learning.

Objective and Approach At the 2022 IPDLN Conference, we presented work led by the North Carolina Department of Health and Human Services (NCDHSS), in partnership with university-based researchers, to build legal and ethical processes for routine data sharing. This session provides significant updates on the methods, results, and implications of these efforts–namely, that NCDHHS implemented an enterprise-wide data governance process and a legal framework that has enabled timely, impactful use of cross-sector data. We relied on Participatory Action Research and Deliberative Dialogue methods to engage a diverse range of partners in a data landscape overview and the co-creation of new data sharing processes that better enables the enterprise to adapt to a changing world. Results Four key actions were taken as a result of the participatory research process: NCDHHS developed a data strategy, created a data sharing guidebook, staffed their Data Office, and implemented a new legal framework. In addition to describing how these actions support data use across a large US state health and human services agency, we provide three use cases demonstrating the impact of this work. Conclusions Establishing routine data sharing presents legal, technical, and cultural challenges, particularly in large agencies. Through a collaborative, participatory approach, the NCDHHS successfully established enterprise-wide data governance and a legal framework to support data-driven policymaking and, ultimately, improve health outcomes for residents. Implications This research presents a successful, actionable, and replicable framework for developing and implementing processes to support intradepartmental data access, linkage, and use.

The Walter Reed Army Institute of Research holds an annual summer STEM program called Gains in the Education of Mathematics and Science (GEMS) in which rising 7th-12th graders are mentored by undergraduate STEM majors (near-peer mentors - NPMs) who facilitate hands-on, inquiry-centered activities. To make GEMS accessible to underserved and underrepresented populations, we recruit both students and NPMs from local, underserved communities and minority-serving institutions, while additionally broadcasting the opportunities to surrounding counties. We mitigate financial barriers to participation by offering both student and NPM stipends. Although GEMS is traditionally held in person, the COVID-19 pandemic led to the creation of virtual GEMS (eGEMS). We compared NPM and student survey responses for eGEMS to the prior year of in-person GEMS. Despite logistical differences, we maintained similar participant demographics, program elements, and shifts in attitudes towards STEM for all student groups while providing comparable personal and professional growth for NPMs. Going forward, though, eGEMS can be improved by incorporating more group work and use of laboratory tools alongside alleviating technical barriers. Furthermore, both eGEMS and in-person GEMS must increase recruitment amongst FARMS (free and reduced-price meals at school) recipients, English language learners, and potential first-generation college students to align with accessibility goals.

Approximately 30% of autistic children are considered minimally verbal. The field lacks an efficient and reliable measure of communicative capacity among minimally verbal autistic children. Improved methods are needed to determine which children are at greatest risk for minimally verbal outcomes to better target interventions. Here, we present the Low Verbal Investigatory Survey (LVIS), a brief parent-report measure designed to assess communicative capacity among minimally verbal autistic children. The 36-item easy-to-complete LVIS was developed to capture the atypical language trajectories associated specifically with autism. We report pilot results from a sample of 147 children (1-8 years) whose caregivers completed the LVIS as part of other studies. Principal components analysis was used to assess dimensionality of the LVIS; composite scores were compared with existing measures of communicative capacity, all of which take "significantly more time and training" to administer and score. Scores on the LVIS were strongly correlated with existing gold-standard measures of communication. Presence of atypical vocalizations was determined to be particularly relevant for symptoms of autism as well as language and cognitive abilities. These findings provide initial validation of a tool designed to capture multiple dimensions of communicative capacity in children with minimal or low verbal skills.

Two experiments investigated perceived and physiological changes in anxiety in children (7-11 years; N = 222; 98 female) in a performance situation after they observed another child in a similar situation with a negative or neutral outcome. The sample's London, United Kingdom, school catchment areas ranged from low to high socioeconomic statuses with 31% to 49% of children from ethnic minority backgrounds. In Study 1, participants watched one of two films of a child playing a simple musical instrument (a kazoo). In one film, an audience of peers responds negatively to the performance. In the other film, the audience response was neutral. Participants were then filmed playing the instrument themselves and measures of perceived and actual heart rate were taken along with individual differences in trait social anxiety, anxiety sensitivity, and effortful control. To better understand findings from Study 1, Study 2 replicated Study 1 but added a manipulation check and measures of effortful control and self-reported anxiety. Multiple regression analyses found watching a negative performance film, compared with a neutral one, was associated with a blunted heart rate response for children with low effortful control (Study 1 and 2). These findings suggest that children who are low in effortful control may disengage during performance tasks if the situation's social threat is elevated. Hierarchical regression analyses found that, compared to the neutral film, the negative performance film elevated children's self-report anxiety (Study 2). Overall, the findings indicated that anxiety in performance situations can be elevated after observing peers' negative experiences.

To examine the ways that 6- to 11-year-old children's conversation with their parents support their developing understandings of evolution, 49 parent-child dyads participated in a study with two elicited discussion tasks: origins of species and potential species change. Conversational data were transcribed, coded, and qualitatively and quantitatively analyzed to compare the appearance of reasoning in each type of task. Quantitative analyses revealed correlations between tasks in informed naturalistic reasoning as well as differences in the way reasoning was expressed in each task. In addition, parent-child dyads with older children were more likely to use informed naturalistic reasoning than parent-child dyads with younger children. A subset of the data was analyzed qualitatively and showed that irrespective of how much evolution reference was present in the conversation, parents supported their children's learning through scaffolding. However, greater amounts of nonscientific reasoning appeared in the groups with less evolution talk. This study demonstrates that family talk about evolution varies with context both within and between families.

Abstract Background There is a remarkable variability in the frequency of HLA-B27 positivity in patients with spondyloarthritis (SpA), which may be associated with different clinical presentations worldwide. However, there is a lack of data considering ethnicity and sex on the evaluation of the main clinical and prognostic outcomes in mixed-race populations. The aim of this study was to evaluate the frequency of HLA-B27 and its correlation with disease parameters in a large population of patients from the Brazilian Registry of Spondyloarthritis (RBE). Methods The RBE is a multicenter, observational, prospective cohort that enrolled patients with SpA from 46 centers representing all five geographic regions of Brazil. The inclusion criteria were as follow: (1) diagnosis of axSpA by an expert rheumatologist; (2) age ≥18 years; (3) classification according to ASAS axial. The following data were collected via a standardized protocol: demographic data, disease parameters and treatment historical. Results A total of 1096 patients were included, with 73.4% HLA-B27 positivity and a mean age of 44.4 (±13.2) years. Positive HLA-B27 was significantly associated with male sex, earlier age at disease onset and diagnosis, uveitis, and family history of SpA. Conversely, negative HLA-B27 was associated with psoriasis, higher peripheral involvement and disease activity, worse quality of life and mobility. Conclusions Our data showed that HLA-B27 positivity was associated with a classic axSpA pattern quite similar to that of Caucasian axSpA patients around the world. Furthermore, its absence was associated with peripheral manifestations and worse outcomes, suggesting a relevant phenotypic difference in a highly miscegenated population.

Abstract Background Gaucher disease (GD) is a rare autosomal recessive condition associated with clinical features such as splenomegaly, hepatomegaly, anemia, thrombocytopenia, and bone abnormalities. Three clinical forms of GD have been defined based on the absence (type 1, GD1) or presence (types 2 and 3) of neurological signs. Early diagnosis can reduce the likelihood of severe, often irreversible complications. The aim of this study was to validate the ability of factors from the Gaucher Earlier Diagnosis Consensus (GED-C) scoring system to discriminate between patients with GD1 and controls using real-world data from electronic patient medical records from Maccabi Healthcare Services, Israel’s second-largest state-mandated healthcare provider. Methods We applied the GED-C scoring system to 265 confirmed cases of GD and 3445 non-GD controls matched for year of birth, sex, and socioeconomic status identified from 1998 to 2022. The analyses were based on two databases: (1) all available data and (2) all data except free-text notes. Features from the GED-C scoring system applicable to GD1 were extracted for each individual. Patients and controls were compared for the proportion of the specific features and overall GED-C scores. Decision tree and random forest models were trained to identify the main features distinguishing GD from non-GD controls. Results The GED-C scoring distinguished individuals with GD from controls using both databases. Decision tree models for the databases showed good accuracy (0.96 [95% CI 0.95–0.97] for Database 1; 0.95 [95% CI 0.94–0.96] for Database 2), high specificity (0.99 [95% CI 0.99–1]) for Database 1; 1.0 [95% CI 0.99–1] for Database 2), but relatively low sensitivity (0.53 [95% CI 0.46–0.59] for Database 1; 0.32 [95% CI 0.25–0.38]) for Database 2). The clinical features of splenomegaly, thrombocytopenia (

Abstract Parkinson’s disease is characterized by a progressive accumulation of alpha-Synuclein (αSyn) neuronal inclusions called Lewy bodies in the nervous system. Lewy bodies can arise from the cell-to-cell propagation of αSyn, which can occur via sequential steps of secretion and uptake. Here, by fusing a removable short signal peptide to the N-terminus of αSyn, we developed a novel mouse model with enhanced αSyn secretion and cell-to-cell transmission. Expression of the secreted αSyn in the mouse brain was under the control of a novel hybrid promoter in combination with adeno-associated virus serotype 9 (AAV9). This combination of promoter and viral vector induced a robust expression in neurons but not in the glia of injected mice. Biochemical characterization of the secreted αSyn revealed that, in cultured cells, this protein is released to the extracellular milieu via conventional secretion. The released αSyn is then internalized and processed by acceptor cells via the endosome–lysosome pathway indicating that the secreted αSyn is cell-to-cell transmitted. The secreted αSyn is aggregation-prone and amyloidogenic, and when expressed in the brain of wild-type non-transgenic mice, it induces a Parkinson’s disease-like phenotype that includes a robust αSyn pathology in the substantia nigra, neuronal loss, neuroinflammation, and motor deficits, all the key features of experimental animal models of Parkinson’s disease. In summary, a novel animal model of Parkinson’s disease based on enhanced cell-to-cell transmission of αSyn was developed. The neuron-produced cell-to-cell transmitted αSyn triggers all phenotypic features of experimental Parkinson’s disease in mice.

Abstract By means of a nationwide, prospective, multicenter, observational cohort registry collecting data on 7375 patients with laboratory-confirmed SARS-CoV-2 admitted to children's hospitals in Germany, March 2020–November 2022, our study assessed the clinical features of children and adolescents hospitalized due to SARS-CoV-2, evaluated which of these patients might be at highest risk for severe COVID-19, and identified underlying risk factors. Outcomes tracked included: symptomatic infection, case fatality, sequelae at discharge and severe disease. Among reported cases, median age was one year, with 42% being infants. Half were admitted for reasons other than SARS-CoV-2. In 27%, preexisting comorbidities were present, most frequently obesity, neurological/neuromuscular disorders, premature birth, and respiratory, cardiovascular or gastrointestinal diseases. 3.0% of cases were admitted to ICU, but ICU admission rates varied as different SARS-CoV-2 variants gained prevalence. Main risk factors linked to ICU admission due to COVID-19 were: patient age (> 12 and 1–4 years old), obesity, neurological/neuromuscular diseases, Trisomy 21 or other genetic syndromes, and coinfections at time of hospitalization. With Omicron, the group at highest risk shifted to 1–4-year-olds. For both health care providers and the general public, understanding risk factors for severe disease is critical to informing decisions about risk-reduction measures, including vaccination and masking guidelines.

Abordamos o problema da língua na psicanálise, apontando como esta lida com os limites nos quais esbarra em seu exercício linguageiro. Mostramos a relação entre letra, lugar e as fronteiras da língua. A partir da abordagem do exílio e do desarraigamento no campo da arte e da literatura, problematizamos o monolinguismo e situamos a importância do ato de recepção do testemunho em psicanálise. Como escutar o que escapa à representação? Apontamos a dimensão política da prática d'alíngua como via de reabitar a língua, recurso cuja escrita viabiliza novas leituras do mundo. A psicanálise encontra, assim, o desafio de fazer surgir/emergir aquilo que foi apagado/silenciado, contribuindo para a produção de novos territórios linguísticos que sejam respeitosos com a diferença e viabilizem o trânsito entre línguas. Ler com o translinguístico é uma maneira de grifar o movimento daqueles que estão à margem e fornece pistas para a reinvenção necessária do lugar de escuta.

Background. Studies have suggested a correlation between periodontitis and reduced male fertility. Inflammation has been described as the link between these ailments. Oral inflammatory load (OIL) can be measured through oral polymorphonuclear neutrophil (oPMN) count, which is associated with periodontal diseases. This cross-sectional study assessed the possible correlation between OIL and the functional parameters of sperm cells. Methods. In 229 volunteers, oral rinse and semen samples were assessed for oPMN, semen polymorphonuclears (sPMNs), sperm concentration, total sperm count, motility, morphology, and sperm DNA fragmentation index (SDFi). A multiple linear regression model was conducted to evaluate the relationships between oPMN and semen parameters. Results. The effect of elevated oPMN counts on total motility rate, progressive rate, and percentage of sperm cells with normal morphology was significant (P

The aim of the Foundation Year of university is to prepare students for their undergraduate study. Part of this preparation is enculturation into ways of speaking. Undergraduate study involves small group interaction in which students are expected to use educational dialogue to co-construct conceptual understanding and engage in critical thinking. In this study, we were interested in whether and to what extent Foundation Year Bioscience students used educational dialogue in problem-solving tasks. Seven groups were audio recorded during online group discussions at three points during the semester. Transcripts were analysed according to a framework of educational dialogue codes. While some groups engaged in educational dialogue, there was variability amongst group members, within the session and across sessions. Based on this small case study, we argue that Foundation Year teachers can support the development of students' educational dialogue by raising metacognitive awareness of language and providing opportunities through task design. We conclude the paper with specific suggestions for classroom practice which are not restricted to Biosciences Foundation Year and relevant to all stages of university study and across disciplines.

This pilot study is the first to examine whether a novel curriculum based on the Reference Framework of Competences for Democratic Culture (RFCDC) could increase children's endorsement and knowledge of children's rights. We conducted a pre-test-post-test design with an intervention and a comparison school. Pupils (n = 172) from Bulgaria, Italy, Norway, Romania, and Spain attended schools in which the curriculum was taught, whereas pupils in the comparison group (n = 120) attended schools in the same city where the curriculum was not taught. Both groups were tested on their endorsement and knowledge of rights before and at the end of the intervention. Children in the intervention group increased in endorsing children's rights at post-test more than did children in the intervention group. Most children believed that children had rights. Children in the intervention group showed modest increases in their knowledge of rights. Future ways of implementing the RFCDC are suggested.

Educational inequity is widely prevalent in United States (U.S.) public schools and creates barriers to STEM education for underserved and underrepresented populations, including racial minority, low-income, and first-generation college students. Scientists at the Walter Reed Army Institute of Research (WRAIR) recognized a need in its community, the greater Washington, DC metropolitan area, to improve access to high-quality STEM education, and founded the WRAIR Gains in the Education of Mathematics and Science (GEMS) program for this purpose. In pursuit of this goal, the GEMS program engages students using innovative learning strategies and authentic STEM experiences with the hopes of fostering interest in STEM and motivating more underserved and underrepresented students to persist in STEM education and career pathways. By 1995, WRAIR scientists began investigating how to bring science-enthusiastic but novice high school (HS) students into their laboratories where they could be mentored, along with providing a stipend to mitigate financial barriers; importantly, this process was funded by two Science Education Partnership Awards from 2001-2006. Each year, WRAIR's GEMS program now guides about 600-700 local middle and HS students to take part in hands-on, inquiry-based STEM laboratory investigations led by undergraduate "near peer mentors" (NPMs), so named due to their close age to participants. GEMS is now sustained at 14 sites nationwide through the U.S. Army Educational Outreach Program, and serve about 4,000 students and near-peer mentors annually. Recent evaluations of the program explore service to underrepresented groups in STEM and growth of the local program. Further evaluation of the nationwide programs reveals positive student feedback, especially regarding working with NPMs and hands-on learning.

Background: Parental support plays an important role in children's schoolwork motivation and may have been even more important during the first UK COVID-19 pandemic lockdown because all schoolwork was completed at home. When examining the effect of parental support on children's schoolwork motivation, research has typically focused on comparing families with each other (i.e., difference between families). In reality, however, the effect unfolds as a transactional, bidirectional process between parents and children over time (i.e., a within family process). This research trend can result in imprecise conclusions about the association between parental support and schoolwork motivation. Objectives: We examined bidirectional effects of parental schoolwork support and children's schoolwork motivation at both the between-family and within-family level. Methods: This study reports findings from a weekly-diary study conducted during the first UK COVID-19 school lockdown. Cross-lagged within and between multilevel modelling was used to analyse data from UK secondary school students (N = 98) in Years 7-9. Results: Between-family results show no evidence of association between motivation and parental support. Within-family results indicate that higher motivation (assessed as higher expectations of success) predicted more support from parents. However, in contrast with predictions, weekly levels of parental support did not predict children's weekly fluctuations in motivation. Conclusions: Within-family results were not consistent with between-family results. This study is novel in showing that child-driven effects appear to be important in eliciting parental support within families over time.

The rise of feminist and LGBTQIA+ movements paved the way for many equality reforms. These include language reforms, which facilitate inclusion of multiple groups in society. For example, the shift from the generic “he” to “he or she” and “they” allows for the inclusion of women, transgender, and non-binary individuals in many narratives. For this reason, many institutions worldwide encourage neutral language. It remains unclear how individuals interpret neutral language. One case of neutral language is the pronoun “they,” which has been assigned multiple definitions from the 1970s to 2022. We examine how the pronoun “they” has been interpreted, used, and accepted over time. We discuss trends in the findings and make suggestions for future research directions, including the need for better methods to investigate pronouns and clarification on what the focus of neutral language should be. This timely commentary has implications for action on equality, diversity, and inclusion.

Photo ID 129550171© Katarzyna Bialasiewicz|Dreamstime.com INTRODUCTION One night in 2016, I fell sound asleep, then awoke to painkiller-induced, nightmarish hallucinations in the ICU. Despite being unable to identify myself or surroundings, I can clearly remember the discordant beeping of hospital monitors, acrid smell of saline wash, and taste of sickly sweet orange amoxicillin syrup. I was unaware that, the morning after I’d fallen asleep, I’d skied off an unmarked 30-foot cliff, breaking my legs, jaw, eye socket and nose, rupturing my right ear canal, and shattering nearly all of my teeth. Over the years that followed, I was fortunate enough to receive care from skilled, compassionate physicians. This not only allowed me to return to ski racing, but to dream of becoming a surgeon. Having grown older and thus more aware throughout my years as a pediatric patient, I’ve developed a nuanced understanding of what treatment made me feel heard. In fact, I found the most radically varying aspect of my care to be the degree to which I was addressed as a conscious, capable individual versus an extension of my parents. This is unsurprising as the proper amount of authority lended to pediatric patients persists as highly disputed in bioethics. Over the course of this paper, several perspectives will be considered in order to evaluate the current position of the pediatric patient in medical decision-making. First, the ambiguity of maturity and reactions to pediatric autonomy will be considered through the Mature Minor Doctrine, especially important in the refusal of life-saving therapies. Next, the need for improved pain management, rooted in the misalignment of experienced and perceived pain in pediatric patients. Finally, this paper will prove, through the lenses of communitarianism and mosaic decision-making, the need for a more nuanced approach to pediatric care that structurally accounts for the patient’s voice without neglecting their place within a greater network. Therefore, there exists a great need for a more direct, balanced integration of pediatric patients’ as well as revisiting prevailing notions of where pediatric patients stand in relation to reason and experience. ANALYSIS To begin, Fleischman’s Pediatric Ethics opens with an exploration of what makes pediatric bioethics distinct.[1] Fleischman quickly runs into the most problematic of principles in the treatment of pediatric patients– autonomy. The ethical ambiguity of the degree of autonomy to offer pediatric patients and at what point in their lives is a central point of conflict. Many in favor of expanded authority point to the neurobiological similarity between young adults and late teenagers.[2] Furthermore, while parents are treated as natural decision-makers for their children, there are several cases of minors facing pressure to undergo medical treatment against their wishes.[3],[4] In response to these concerns, the Mature Minor Doctrine was created, a common law exception to the parental consent requirement. The doctrine allows a minor “to refuse or consent to medical treatment if [they possess] sufficient maturity to understand and appreciate the benefits and risks of the proposed medical treatment.”[5] The doctrine has spurred extensive and impassioned bioethical discourse, especially in relation to the refusal of life-saving therapies. In “Health Care Decisionmaking by Children'', Ross draws a clear distinction between the notion of competence, often cited in psychological justifications of the Mature Minor Doctrine, and sound judgment.[6] Her points against child liberationists can be simplified as follows: (a) children need time to develop virtues that preserve their life-time autonomy versus their present-day autonomy, (b) pediatric patients possess “limited world experience and so [their] decisions are not part of a well-conceived life plan,”[7] and (c) it serves parents and children alike for parents to make decisions in line with their view of a good life. I find all three points convincing, but each of them to be uniquely rooted in this same, critical lack of experience possessed by pediatric patients. I can attest to this. There were times where I suffered so desperately that I longed for relief by any means. I even told my mother that I was content only hearing out of one ear, willing to do anything to prevent another surgery. Now, I am fearful to imagine a world where, at my lowest, I had full autonomy. Hence, the broad aversion to expanded pediatric autonomy is largely rooted in potential misuse, especially in the possibility of a unilateral, misinformed decision in favor of death via refusal of life-sustaining therapy.[8],[9] Yet, one might argue, the desire for death has concrete rationale beyond lack of life experience— pain and suffering. As Foley describes, “The public's fear of pain and the media's portrayal that physician-assisted suicide and euthanasia are the only reliable options for pain relief… demand that health care delivery systems commit their efforts to improve pain relief at an institutional level.”[10] Indeed, the issue of insufficient pain management is all too common in pediatrics. One study comparing postoperative pain assessments surveyed 307 patients, 207 of whom were verbal. Across the board, nurses’ pain estimations produced significantly lower pain scores than parents and children, and were consistently closer to estimated pain scores of independent observers.[11] In another study, a total of 356 nurses across 22 Japanese PICUs were surveyed, and despite possessing a median of 4 years of experience, a mere 32.6% expressed confidence in their ability to accurately assess pain.[12] It is alarming and telling that even in verbal pediatric patients, pain is significantly underestimated by medical personnel, reflecting a real gap in pediatric patient-professional communication. I can, again, personally attest to this. In the children’s ward, I was offered only Tylenol for severe nerve pain in my legs that kept me awake most nights. Relatedly, the spirited debate in response to the Mature Minor Doctrine is somewhat disproportionate. Despite the suggestion of various commentators that the law broadly recognizes the doctrine or that states are trending in its direction, only eight states have adopted a mature minor exception, and even these states condition this authority greatly.[13] With this in mind, a crucial issue is illuminated– an aversion to the pediatric patient voice altogether. As Flesichman writes, “Children should be informed about the nature of their condition, the proposed treatment plan, and the expected outcome… appropriate to their developmental levels.”[14] Hence, it is vital to curtail pediatric autonomy in complex and life-threatening choices, but it is worth seriously considering that the current landscape might excessively minimize or avoid pediatric patients’ expression, merely serving to inform them rather than account for their voice. The experience that pediatric patients do possess, in the form of knowing their body, past medical experiences, and thus present pain-related needs, is systemically underrepresented. This is a pressing issue. Before considering expansion of the pediatric voice, though, it is first important to consider the manner in which the patient’s capacity is further complicated by their role within a larger community. It is worthwhile explicitly mentioning communitarianism, a prevailing school of thought in modern bioethics, defined by Callahan as “a way of… assum[ing] that human beings are social animals… and whose lives are lived out within deeply penetrating social, political, and cultural institutions and practices.”[15] Pediatric patients present a uniquely communitarian case as the perspectives of parents and the needs of patients’ families are vital considerations in offering care. The pediatric patient’s role in a larger family unit and community should be kept in focus so long as the well-being of the patient isn’t compromised, such as in potentially life-threatening religious preferences, as the obligation of the physician is, first and foremost, to the patient. Nonetheless, the status quo demands a more thoughtful and structural accounting of the pediatric voice to ensure that they feel heard and empowered in complex decision-making and regular care alike. Hence, it is necessary to develop and evaluate clinical models and frameworks that directly account for the pediatric voice, that integrate pediatric patients’ input as continuous, regular, and required elements of treatment. For instance, there may be promise in a model similar to that of mosaic decision-making, a means of restoring the capacity of reemergent patients following brain injury. Rather than enabling complete surrogate authority, the model would enable a pediatric patient’s emergent voice to be accommodated but to not “speak beyond its range and capabilities” via group deliberation between surrogate and patient, a medical professional, and a patient advocate.[16] Opting for such a model would enable the active involvement of pediatric input without excessively empowering the patient in a manner that neglects their communitarian role and lack of experience. CONCLUSION In the heated response to the largely unenforced mature minor doctrine, one finds the invaluable and lacking factor of experience in pediatric patients, especially in decisions to withdraw or refuse life-sustaining medical treatments. In this same response, however, one finds a sharp aversion to the pediatric voice, reflected in pervasive under-medication. Deficits in pain management must be addressed to more effectively treat discomfort, an effort bolstered by a more structural accounting of the pediatric voice and thus pain-related needs. Finally, frameworks that regularly involve the pediatric patient perspective while valuing their communitarian importance and lacking experience, such as the mosaic model, hold real promise moving forward. - [1] Fleischman, Alan. Pediatric Ethics: Protecting the Interests of Children. (Oxford: Oxford University Press, September, 2016), p. 1-16. [2] Coleman, Doriane & Rosoff, Philip. “The Legal Authority of Mature Minors to Consent to General Medical Treatment.” (Itasca: American Journal of Pediatrics, March 2013), p. 1. [3] Hawkins, Susan. “Protecting the Rights and Interests of Competent Minors in Litigated Medical Treatment Disputes.” (New York: Fordham Law Review, March 1996), p. 1. [4] Derish, Melinda & Heuvel, Kathleen. “Mature Minors Should Have the Right to Refuse Life-Sustaining Medical Treatment.” (Boston: The Journal of Law, Medicine & Ethics, January 2021), p. 1-14. [5] Derish, Melinda & Heuvel, Kathleen. “Mature Minors Should Have the Right to Refuse Life-Sustaining Medical Treatment.” p. 7. [6] Ross, Lainie. “Health Care Decisionmaking by Children. Is It in Their Best Interest?” (Garrison: The Hastings Center Report, November-December 1997), p. 1-5. [7] Ross. “Health Care Decisionmaking by Children''. p. 5. [8] Penkower, Jessica. “The Potential Right of Chronically Ill Adolescents to Refuse Life-Saving Medical Treatment - Fatal Misuse of the Mature Minor Doctrine.” (Chicago: DePaul Law Review, 1996), p. 1-8. [9] Burk, Josh. “Mature Minors, Medical Choice, and the Constitutional Right to Martyrdom.” (Charlottesville: Virginia Law Review, September 2016), p. 1-15. [10] Foley, Kathleen. “Pain Relief Into Practice: Rhetoric Without Reform.” (Alexandria: Journal of Clinical Oncology, 1995), p. 1-3 [11] Hla et. al. “Perception of Pediatric Pain: A Comparison of Postoperative Pain Assessments Between Child, Parent, Nurse, and Independent Observer.” (Melbourne: Pediatric Anesthesia. 2014) p. 1-5. [12] Tsuboi et. al. “Nurses' perception of pediatric pain and pain assessment in the Japanese PICU.” (Tokyo: Pediatrics International, February 2023), p. 1-3, 10-12. [13] Coleman, Doriane & Rosoff, Philip. “The Legal Authority of Mature Minors”. p. 1-3. [14] Fleischman, Alan. Pediatric Ethics. p. 115. [15] Callahan, Daniel. “Principlism and communitarianism.” (Garrison: The Hastings Center Report, October 2003), p. 2. [16] Fins, Joseph. “Mosaic Decisionmaking and Reemergent Agency after Severe Brain Injury”. (Cambridge: Cambridge University Press, September 2017), p. 6.

Simulation of high-definition binaural room impulse responses using conventional approaches involves a significant amount of computational resources, resulting in high computational time, making these approaches incapable of performing real-time high quality acoustic virtual reality. This research implemented a methodology for the rapid impulse response generation using the position of a moving listener inside a fixed sound field. The rapid generation of the impulse response is performed using its representative compressed dimension, with a smaller dimension than the original impulse response, learned by variational autoencoders and long short-term memory neural networks. First, the methodology selects a representative number of impulse responses covering the area of interest using a reliable room acoustic simulator. Second, it generates a dataset with sufficient impulse responses uniformly distributed through a data augmentation approach using a modified bilinear interpolation from the impulse responses previously simulated. Third, it applies an unsupervised model to positionally cluster the impulse responses to reduce the variability of the impulse responses in the given environment. Fourth, it splits the impulse response into time segments and generates a dataset per segment and cluster. Fifth, it trains a variational autocoder with a long short-term memory neural network model for each time segment cluster of impulse responses to infer the correspondent compressed impulse response part. In summary, the impulse response is generated by assigning the current listener position to the corresponding cluster and executing the decoders of the variational autoencoders with long short-term memory, trained previously. The findings are encouraging; the normalized mean absolute error of the impulse responses gathered by the interpolator and the impulse responses generated by the proposed model is less than 15% in the 88% of impulse responses reserved for testing. Moreover, the average of the absolute error of the interaural cross-correlation coefficient between the impulse responses obtained from the simulator and the proposed model is around 16%, implying that most acoustic characteristics of the real impulse are preserved. In addition, the computational time for generating the impulse response segment of 300 ms is approximately 65 ms, which is almost haft than the total system latency for a realistic auralization, 112 ms.

Prior eye-tracking studies involving autistic individuals have focused on total looking time or proportion of looking time to key regions of interest. These studies have not examined another important feature, the ability to sustain attention to stimuli. In particular, the ability to sustain attention to a dynamic social stimulus might reflect more advanced self-regulatory skills that may enhance engagement with and comprehension of social information. In a sample of 155 autistic children (2--8 years of age), we examined children's average look duration while they viewed a complex, dynamic stimulus containing both social and nonsocial elements. After accounting for children's age and intelligence quotient, we found that shorter average look duration was associated with increased autism spectrum disorder severity across multiple clinical measures. To calculate average look duration, we divided the length of total looking time in seconds by the total number of uninterrupted looks to the video media. Thus, the ability to sustain attention while viewing complex dynamic information could be important for comprehending dynamic social information.

AbstractInhalation or swallowing of foreign bodies (FBs) are relatively common in the pediatric population, with a male predominance. Obtaining relevant clinical history, in these situations, may be a challenge, due to the fact that young children cannot give a detailed account of what happened and in some cases an adult caretaker may not have been present. In order to complicate even further, many aspirated or swallowed FBs in children tend to be small and radiolucent, making the radiological diagnosis even more challenging. A 16-year-old healthy male presented to the emergency room with the chief complaint of a swollen mass in the left midjugular area of his neck, off-midline. He recalled, that 3 months prior to the incident, he accidentally swallowed a grain of wheat while picking his teeth. One month later, he started complaining of intermittent dysphagia as well as localized edema and erythema in his neck, without pyrexia. Two months later, a neck ultrasound demonstrated a 7 mm hyper echogenic linear mass in a small fluid collection. A contrast enhanced computed tomographic (CT) scan of the soft tissues of the neck revealed an abscess measuring 0.8*2.36*2.0 cm, superficial to the sternocleidomastoid (SCM) muscle. Due to the fact that a superficial collection was diagnosed, the patient underwent incision and drainage during which a splinter of a grain of wheat, measuring 1 cm in length, was surgically extracted. In cases of localized neck masses, FBs should be considered as a possible cause, especially in children.