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Most children will experience some type of trauma during childhood, and many children suffer from significant adversities. Research in genetics, neuroscience, and epidemiology all provide evidence that these experiences have effects at the molecular, cellular, and organ level, with consequences on physical, emotional, developmental, and behavioral health across the life span. Trauma-informed care translates that science to inform and improve pediatric care and outcomes. To practically address trauma and promote resilience, pediatric clinicians need tools to assess childhood trauma and adversity experiences as well as practical guidance, resources, and interventions. In this clinical report, we summarize current, practical advice for rendering trauma-informed care across varied medical settings.

Objective To evaluate the characteristics and outcomes of pediatric cochlear implant recipients diagnosed with Usher syndrome (US). Study design Retrospective study of consecutive pediatric cochlear implant recipients (1991-2010). Setting Tertiary care children's hospital. Patients Children who received a cochlear implant who were diagnosed with US either before or after implantation. Main outcome measures Electroretinography and ophthalmologic findings, cochlear anatomy based on preoperative imaging, age of independent ambulation, age at implantation, speech perception level, and communication method. Results Approximately 26 (3.7%) of 712 cochlear implant recipients were diagnosed with US based on the results of electroretinography and/or genetic testing. Preoperative imaging revealed no evidence of cochlear malformations. Average age of independent ambulation was 21.9 months (range, 12-30). Average age at implantation was 3.3 years (range, 6 mo to 11.6 yr). Mean follow-up after implantation was 7.8 years (range, 10 mo to 15.6 yr). Open-set speech perception was present in 92% of children, with use of a primarily oral communication mode in 69.2%. Conclusion In this large series of patients with the diagnosis of US who have undergone cochlear implantation, CT and MRI imaging were normal. Significant delay in independent ambulation was present in this population secondary to abnormal vestibular function associated with US Type I. A majority of children developed significant open-set speech perception and oral communication skills. Implantation of US children provides them with the opportunity to develop useful hearing and oral communication.

The Children's Memorial Hospital cochlear implant team believes an interdisciplinary approach is essential for the implementation of best practices when working with the pediatric cochlear implant population. Over time, we have developed a team model that builds relationships with members of the community to ensure comprehensive care for patients and their families.

Family involvement in planning and choosing services has become a key intervention concept in developmental disability services. This study (N = 547) modeled patterns of family decision making and assessed benefits to persons with developmental disabilities (DDs) and their family members. A latent profile analysis identified 4 classes that were highly involved in decision making (n = 118), involved only in planning (n = 166), involved only in financial decisions (n = 75), and uninvolved (n = 188). Multiple regression analysis indicated that consumers with DD whose family members were highly involved received more services than consumers in other families. A multivariate analysis of covariance indicated that the family members in the highly involved and planning classes experienced more family member satisfaction than others. Findings have implications for practice.

Budding yeast Spc110, a member of γ-tubulin complex receptor family (γ-TuCR), recruits γ-tubulin complexes to microtubule (MT) organizing centers (MTOCs). Biochemical studies suggest that Spc110 facilitates higher-order γ-tubulin complex assembly (Kollman et al., 2010). Nevertheless the molecular basis for this activity and the regulation are unclear. Here we show that Spc110 phosphorylated by Mps1 and Cdk1 activates γ-TuSC oligomerization and MT nucleation in a cell cycle dependent manner. Interaction between the N-terminus of the γ-TuSC subunit Spc98 and Spc110 is important for this activity. Besides the conserved CM1 motif in γ-TuCRs (Sawin et al., 2004), a second motif that we named Spc110/Pcp1 motif (SPM) is also important for MT nucleation. The activating Mps1 and Cdk1 sites lie between SPM and CM1 motifs. Most organisms have both SPM-CM1 (Spc110/Pcp1/PCNT) and CM1-only (Spc72/Mto1/Cnn/CDK5RAP2/myomegalin) types of γ-TuCRs. The two types of γ-TuCRs contain distinct but conserved C-terminal MTOC targeting domains. DOI: http://dx.doi.org/10.7554/eLife.02208.001, eLife digest Microtubules are hollow structures made of proteins that have a central role in cell division and a variety of other important processes within cells. For a cell to divide successfully, the chromosomes containing the genetic information of the cell must be duplicated and then separated so that one copy of each chromosome ends up in each daughter cell. To separate the chromosomes, microtubules extend out from two structures called spindle pole bodies, which are found at either end of the cell, and pull one copy of each chromosome to opposite sides of the cell. Although the individual proteins that make up a microtubule can self-assemble into tubes, this occurs very slowly, so cells employ other molecules to speed up this process. In yeast cells, a protein called gamma-tubulin is recruited to the spindle pole body by the protein Spc110, where it combines with two other proteins to form a complex called the gamma-tubulin small complex. Several of these complexes then join together to form a ring, which probably acts as the platform that microtubules grow from. Recent observations suggested that Spc110 may help to construct this ring, but without revealing how. Now, Lin et al. reveal that Spc110 can regulate microtubule formation by controlling how several gamma-tubulin small complexes bind together, and have identified the exact section of Spc110 that interacts with the complexes. However, the Spc110 must become active before it can perform this role, and it is only activated during certain stages of cell division, through phosphorylation. The structures in Spc110 that bind to the gamma-tubulin small complex in yeast are also found in gamma-tubulin binding receptor proteins in human cells. The work of Lin et al. demonstrates that proteins that are assumed to have passive roles within cells, such as Spc110, often play more active roles instead. DOI: http://dx.doi.org/10.7554/eLife.02208.002

4 Background: Informal caregiving for cancer patients can be both demanding and burdensome – physically, emotionally, and financially – for many caregivers. Cancer caregivers play a large role in advocating for and administering care for their recipients. The current study aimed to explore if cancer caregivers differ from non-cancer caregivers with regard to communicating with healthcare providers, and need for information about end-of-life care. Methods: Data were used from the 2015 Caregiving in the U.S. (CGUS) dataset, a nationally-representative online probability-based panel study of unpaid adult caregivers. The analysis compared cancer and non-cancer caregivers to determine similarities and differences in characteristics and experiences, with a focus on unmet needs in communication with healthcare providers and end-of-life decision-making. Statistical significance was determined at the p < 0.05 level. Results: Approximately 7% (2.8 million) of caregiver participants in the CGUS study indicate cancer as the primary reason for providing care. Cancer caregivers report higher burden than non-cancer caregivers (62% vs. 38%) and significantly more hours per week caregiving (32.9 vs. 23.9 hours per week). Significantly more cancer caregivers indicate interacting with key providers, agencies, and professionals on behalf of their care recipients: 82% report communicating with healthcare professionals (vs. 62%), 76% monitor/adjust care (vs. 66%), and 62% report advocating for care recipient (vs. 49%). Finally, almost twice the number of cancer caregivers than non-cancer caregivers (40% vs. 21%) report needing more help/information with making end-of-life decisions. Conclusions: These findings indicate the burdensome and demanding role of cancer caregiving. These caregivers play a substantial role in directing, monitoring, and advocating for survivor care. Yet, many need more information about end-of-life care. This suggests a gap in preparation despite the roles provided, and suggest a need to explore strategies to engage patient-provider-caregiver communication about care, particularly end of life care.

Consumer choice is a key concept in developmental disability intervention, but relatively little quantitative research has focused on the relationship between choice and quality of life. This study used data from Washington state's Division of Developmental Disabilities 2002 National Core Indicators study (Human Services Research Institute, 2001a, 2001b) to examine the relationship between choice and 3 quality-of-life indicators: community inclusion, rights, and opportunities for relationships. Consumers (N = 224) with mild intellectual disabilities participated in the study. Structural equation modeling was used to assess the influence of type of living arrangement and choice on quality of life. Consumers who lived in the community and made more choices had higher scores on quality-of-life indicators. The findings have implications for disability policy, practice, and future research.