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Introduction: There is a lack of metrics to monitor and evaluate fertility care in adolescents and young adults with cancer. This study evaluated the indicator "proportion of cases attending a fertility consult visit ≤30 days from diagnosis of cancer" using the National Quality Forum (NQF) criteria. Methods: This was a retrospective cohort study using administrative data available through the Institute of Clinical Evaluative Sciences in Ontario, Canada. Cases were included if they were diagnosed with a cancer between January 2005 and December 2019, and aged 15–39 years. Fertility consultations were identified by Ontario Health Insurance Plan Claims Database (OHIP) diagnostic codes 628 and 606.Validity was assessed by examining expected differences in the proportion of fertility consults within clinical and demographic factors using chi-square tests. Reliability was assessed by comparing fertility consult visits identified using OHIP diagnostic codes with consults identified using visits to physicians in a registered specialty, using Pearson's correlation coefficient. Results: The population was composed of 39,977 cases, with 6524 (16.3%) having attended a fertility consult. For diagnostic years 2016–2019, differences in the proportion of cases receiving their first fertility consult within 30 days of diagnosis were observed for sex, age, cancer type, hospital type, Local Health Integration Unit, and region (p < 0.001). There was no correlation between the time from diagnosis to fertility consult and time from diagnosis to the first visit to a fertility-related specialty (r = 0.11; p = 0.002). Conclusion: The indicator examined in this article adhered to the criteria described by the NQF, providing a possible metric for reporting on oncofertility care. [ABSTRACT FROM AUTHOR]

: The primary purpose of this review is to investigate the relationships between cancer and nutrition in children and adolescents living in resource-poor, low- and middle-income countries (LMICs) in order to explore potential opportunities for interventions which could improve clinical outcomes in this population. : The implications of overlapping age groups of children and adolescents with cancer are examined, as are the adverse influences of under-nutrition and socio-economic deprivation on the efficacy of treatment and cancer survival. Evidence suggestive of novel avenues to enhance prospects for cure, based on increased understanding of the dynamic of nutrition and cancer, is evaluated. : Cancer adds to the burden of under-nutrition in disadvantaged populations which is reflective, in large measure, on inadequate governmental expenditure on health which demands public-private partnerships and the use of hospital-based foundations. Structured approaches to the measurement of nutritional status and the design of effective programmes of nutritional supplementation are of proven benefit. Initial results from studies of the perturbed gut microbiome hold considerable promise for further gains. A large minority of children with cancer in LMICs are never diagnosed and the same may be true of adolescents. Investing in the training of nutritionists will have substantial returns as will increasing access to essential medicines. Recognition of these challenges has stimulated WHO and other entities to devise major strategies for comprehensive changes in the care of children and adolescents with cancer in LMICs, offering realistic prospects for improved clinical outcomes. [ABSTRACT FROM AUTHOR]

Cancer represents an important cause of disease-related death in children worldwide. Improved treatment and understanding of the ways in which cancer manifests has allowed for a greater prospect of survival in children of all ages. However, variation in childhood cancer experience exists based on factors at the individual, community and systems levels. Throughout the cancer care continuum these factors may influence the access and timeliness of care a child receives, leading to delays in diagnosis and treatment. The pejorative designation 'delay in diagnosis and treatment' is better characterised as lag time, representing an interval that is thought to influence survival and overall outcome. In recent decades, work has been done to expedite early childhood cancer diagnosis through the creation of screening and education-based programmes. Although systematic cancer screening in children poses risks and fails to achieve the goal of early diagnosis, a case has been made for risk-based surveillance that has been shown to improve outcome and reduce occurrence of advanced stage disease in targeted populations. The components of lag time are examined separately and individually. This review highlights the challenges of early diagnosis in childhood cancers and describes important contributors in the cancer care continuum. [ABSTRACT FROM AUTHOR]

Cancer types in adolescents and young adults form a unique distribution. A system for classifying them is presented. [ABSTRACT FROM AUTHOR]

While meeting conventional thresholds for cost‐effectiveness, the care of children with cancer in low and middle‐income countries is compromised by limited access to affordable medicines of high quality. Survival prospects are constrained further by high rates of abandonment of therapy, which are linked to socioeconomic disadvantage and the financial toxicity experienced by families in the care of their children with malignant disease. [ABSTRACT FROM AUTHOR]

Background: Unwanted intrusive thoughts of intentionally harming one's infant (intrusive harm thoughts) are common distressing experiences among postpartum mothers and fathers. Aim: To understand infant crying as a stimulus for intrusive harm thoughts and associated emotional responses in prepartum and postpartum mothers and fathers in response to infant cry. Method: Following completion of self-report measures of negative mood and anger, prepartum (n = 48) and postpartum (n = 44) samples of mother and father pairs completed 10 minutes of listening to audio-recorded infant crying. Post-test questionnaires assessed harm thoughts, negative emotions, urges to comfort and flee, and thoughts of shaking as a soothing or coping strategy. Results: One quarter of prepartum and 44% of postpartum parents reported intrusive infant-related harm thoughts following crying. Mothers and fathers did not differ in the likelihood of reporting harm thoughts, nor in the number of thoughts reported. Women reported more internalizing emotions compared with men. Hostile emotions were stronger among postpartum parents, and parents reporting harm thoughts. All parents reported strong urges to comfort the infant. Urges to flee were stronger among parents who reported harm thoughts. The likelihood of using infant shaking as a soothing or coping strategy was minimally endorsed, albeit more strongly by fathers and parents who also reported harm thoughts. Conclusions: In response to crying, harm thoughts are common and are associated with hostile emotions, urges to flee, and increased thoughts of using infant shaking. Reassuringly, the number of participants considering infant shaking as a strategy for soothing or for coping with a crying infant was low. [ABSTRACT FROM AUTHOR]

Abstract Low incidence rates and economic recession have hampered interpretation of educational prevention efforts to reduce abusive head trauma (AHT). Our objective was to determine whether the British Columbia experience implementing a province-wide prevention program reduced AHT hospitalization rates. A 3-dose primary, universal education program (the Period of PURPLE Crying ) was implemented through maternal and public health units and assessed by retrospective-prospective surveillance. With parents of all newborn infants born between January 2009 and December 2016 (n = 354,477), nurses discussed crying and shaking while delivering a booklet and DVD during maternity admission (dose 1). Public health nurses reinforced Talking Points by telephone and/or home visits post-discharge (dose 2) and community education was instituted annually (dose 3). During admission, program delivery occurred for 90% of mothers. Fathers were present 74.4% of the time. By 2–4 months, 70.9% of mothers and 50.5% of fathers watched the DVD and/or read the booklet. AHT admissions decreased for <12-month-olds from 10.6 (95% CI: 8.3–13.5) to 7.1 (95% CI: 4.8–10.5) or, for <24-month-olds, from 6.7 (95% CI: 5.4–8.3) to 4.4 (95% CI: 3.1–6.2) cases per 100,000 person-years. Relative risk of admission was 0.67 (95% CI: 0.42–1.07, P = 0.090) and 0.65 (95% CI: 0.43-0.99, P = 0.048) respectively. We conclude that the intervention was associated with a 35% reduction in infant AHT admissions that was significant for <24-month-olds. The results are encouraging that, despite a low initial incidence and economic recession, reductions in AHT may be achievable with a system-wide implementation of a comprehensive parental education prevention program. [ABSTRACT FROM AUTHOR]

The article presents information on the steps in the development of a comprehensive regional program in adolescent and young adult (AYA) oncology that include the identification of a working party, the communication with and participation of potential stakeholders, and the identification and sourcing of capital and running costs.

Background and Aims Malnutrition has been identified as a prognostic factor in children and adolescents with leukemia. Methods A review of the data available on this topic has been carried out. Results and Conclusions In children and adolescents (0–19 years of age), acute lymphoblastic leukemia (ALL) is the commonest form of cancer worldwide and malnutrition is prevalent in this age group, especially in low- and middle-income countries where most of these young people live. Obesity, measured by body mass index, is associated with poorer survival rates in children and adolescents with ALL and acute myelogenous leukemia in high-income countries. In contrast, undernutrition is linked to poorer survival rates among young people with leukemia in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Objective To examine, for essential anti-cancer medicines, the alignment of national lists of essential medicines and national reimbursable medicines lists with the World Health Organization's (WHO's) Model Lists. Methods National medicine lists for 135 countries with per-capita gross national incomes below 25 000 United States dollars in 2015 were compared with WHO's 2013 and 2015 Model Lists of Essential Medicines. Correlations between numbers of anti-cancer medicines included in national lists and gross national income (GNI), government health expenditure and number of physicians per 1000 population were evaluated. Findings Of the 25 anti-cancer medicines on the 2013 Model List and the 16 added via the 2015 revision of the Model List, 0-25 (median: 17) and 0-15 (median: 3) appeared in national lists, respectively. There was considerable variability in these numbers within and between World Bank income groups. Of the 16 new medicines included in the 2015 Model List, for example, 0-10 (median: 1) and 2-15 (median: 10) were included in the national lists of low-income and high-income countries, respectively. The numbers of these new medicines included in national lists were significantly correlated (P ≤ 0.0001) with per-capita GNI (r = 0.45), per-capita annual government health expenditure (r = 0.33) and number of physicians per 1000 population (r = 0.48). Twenty-one countries (16%) included the targeted anti-cancer medicines imatinib, rituximab and trastuzumab in their national lists. Conclusion Substantial numbers of anti-cancer medicines are included in national lists of low- and middle-income countries but the availability, affordability, accessibility and administration feasibility of these medicines, at country-level, need assessment. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this narrative review is to examine the information available on the nutritional status of children with leukemia in low and middle income countries (LMICs), where the great majority of them live and malnutrition is prevalent, in order to identify best practices and remaining deficits in knowledge. Methods: Literature relevant to measurement of nutritional status and the impact of nutritional status on important clinical outcomes in this population, and others of relevance, was reviewed. Results: Arm anthropometry provides more accurate information on nutritional status than measures based on body weight in children with cancer. Both over- and under-nutrition are important determinants of tolerance of chemotherapy, compliance with treatment, relapse of disease, and survival. These relationships are subject to change with nutritional intervention. There are valuable roles for educational tools and ‘ready-to-use-therapeutic-foods’. Discussion: Assessment of nutritional status is mandatory in this population and accomplishable at various levels of sophistication according to available resources. Recognition of the fundamental role of nutritional status in affecting outcomes in children with leukemia is expanding, but knowledge gaps remain. An apparently counter-intuitive strategy of caloric restriction may be worthy of exploration. There is a particular need to establish normative data, including measures of body composition, in children in LMICs. Conclusions: Developing adaptive clinical practice guidelines for the measurement of nutritional status and for nutritional interventions, incorporating assessment of health-related quality of life, are evident priorities in the care of children with leukemia in LMICs. [ABSTRACT FROM PUBLISHER]

Background: Incidence rates and trends of cancers in adolescents and young adults (AYAs) ages 15 to 39 years were reexamined a decade after the US National Cancer Institute AYA Oncology Progress Review Group was established.Methods: Data from the Surveillance, Epidemiology, and End Results program through 2011 were used to ascertain incidence trends since the year 2000 of the 40 most frequent cancers in AYAs, including tumors with nonmalignant/noninvasive behavior.Results: Seven cancers in AYAs exhibited an overall increase in incidence; in 4, the annual percent change (APC) exceeded 3 (kidney, thyroid, uterus [corpus], and prostate cancer); whereas, in 3, the APC was between 0.7 and 1.4 (acute lymphoblastic leukemia and cancers of the colorectum and testis). Eight cancers exhibited statistically significant decreases in incidence among AYAs: Kaposi sarcoma (KS), fibromatous neoplasms, melanoma, and cancers of the anorectum, bladder, uterine cervix, esophagus, and lung, each with an APC less than -1. AYAs had a higher proportion of noninvasive tumors than either older or younger patients.Conclusions: An examination of cancer incidence patterns in AYAs observed over the recent decade reveal a complex pattern. Thyroid cancer by itself accounts for most of the overall increase and is likely caused by overdiagnosis. Reductions in cervix and lung cancer, melanoma, and KS can be attributed to successful national prevention programs. A higher proportion of noninvasive tumors in AYAs than in children and older adults indicates a need to revise the current system of classifying tumors in this population. [ABSTRACT FROM AUTHOR]

Ninety-eight mothers of healthy firstborn infants 0 to 6 months old were randomly assigned to listen to 10-min of infant crying or infant cooing while continuously rating subjective feelings of frustration. Participants completed pre-test measures of depressed mood, empathy, and trait anger and post-test measures of infant-related harm thoughts, negative and positive emotions, and urge to comfort and to flee. Twenty-three (23.5 %) participants endorsed unwanted thoughts of active harm (e.g., throwing, yelling at, shaking the infant). Women in the cry condition were more likely than women in the coo condition to report thoughts of harm. Women in the cry condition who endorsed thoughts of harm reported higher frustration levels over the 10 min of crying, higher levels of post-test negative emotions, and stronger urges to flee the infant but not stronger urges to comfort the infant. Trait anger and personal distress empathy predicted the occurrence of unwanted thoughts of infant harm, whereas negative mood did not. Unwanted, intrusive, infant-related thoughts of harm may be triggered by prolonged infant crying, are predicted by personal distress empathy and a tendency to experience anger, and are associated with higher frustration, negative emotions, and the urge to escape the infant. [ABSTRACT FROM AUTHOR]

The devastating and for the most part irremediable consequences for an infant, his or her family, and society in cases of abusive head trauma have spurred research into ways of preventing it. In the last four or five decades, increasing interest in infant crying and its clinical manifestation of colic has led to a reconceptualization of crying in early infancy, such that most of the characteristics of colic can be understood as manifestations of the crying typical of normal infants. This includes an early increase and then decrease in the amount of crying, the unexpected and unpredictable appearance of prolonged crying bouts, and the presence of inconsolable crying that occurs in the early months of life. When these concepts are merged with anecdotal clinical experiences, perpetrator confessions and epidemiological evidence of abusive head trauma, it is clear that these crying characteristics - and caregiver responses - are the predominant, and potentially modifiable, risk factors for abusive head trauma. This unfortunate but understandable relationship between early crying, shaking and abuse has opened windows of opportunity for primary, universal prevention efforts that are appropriate for - and support - all parents and may be able to prevent at least some of these tragic cases. [ABSTRACT FROM AUTHOR]

Curriculum planning for the development of graphicacy capability has not been systematically included in general education to coincide with the graphicacy needs of human society. In higher education, graphicacy curricula have been developed to meet the needs of certain disciplines, for example medical and teacher training and engineering, among others. A framework for graphicacy curricula, anticipating the graphicacy needs in higher education, has yet to be strategically planned for general education. This is partly a result of lack of research effort in this area, but also a result of lack of systematic curriculum planning in general. This paper discusses these issues in the context of graphicacy curricula for engineering. The paper presents three broad individual case studies spanning Europe and the USA, brought together by the common denominator, graphicacy. The case studies are based on: an analysis of graphicacy within general education curricula, an analysis of graphicacy for engineering education in Europe and an analysis of graphicacy for engineering education in the USA. These three papers were originally presented in a plenary session at the American Society for Engineering Education, Engineering Design Graphics Division at the University of Limerick in November 2012. The case studies demonstrate the potential for strategic curriculum planning in regard to the development of graphicacy in general education and an overview of a methodology to achieve that. It also offers further evidence towards the importance of the systematic classification of graphics capabilities in Engineering and how the lack of a developed theoretical framework in this area undermines the case for the importance of graphics within engineering education. [ABSTRACT FROM PUBLISHER]

Prolonged inconsolable crying bouts in the first months of life are frustrating to parents and may lead to abuse. There is no empirical description of frustration trajectories during prolonged crying, nor of their emotional predictors or emotional and behavioural sequelae. Frustration responses and their relationships were explored in an analogue cry listening paradigm. Without knowing how long it would last, 111 postpartum mothers were randomized to listen to a 10-min audiotape of infant crying or cooing while continuously recording frustration on a visual analogue ‘slider’ scale. The listening bout was preceded by questionnaires on negative mood, trait anger and empathy and followed by questionnaires on the reality of the cry sound, positive and negative emotions, soothing strategies, coping strategies and urges to comfort and flee. Individual frustration trajectories were modelled parametrically and characterized by frustration maximum, rate of rise, inflections and harmonicity parameters. As hypothesized, the modal response was of gradually increasing frustration throughout. However, there were marked individual differences in frustration trajectories. Negative mood, trait anger and empathy did not predict modal or modelled individual trajectories. However, frustration responses were significantly related to post-listening emotions and behavioural ratings. In particular, prolonged crying generated highly ambivalent positive and negative emotional responses. In summary, maternal frustration generally increased as the crying bout progressed; however, frustration trajectories were highly individual and emotional responses were highly ambivalent in terms of positive and negative emotions generated. Some emotional and behavioural responses were associated with specific trajectory parameters of frustration responses. [ABSTRACT FROM AUTHOR]

Newborn infants preferentially orient to familiar over unfamiliar speech sounds. They are also better at remembering unfamiliar speech sounds for short periods of time if learning and retention occur after a feed than before. It is unknown whether short-term memory for speech is enhanced when the sound is familiar (versus unfamiliar) and, if so, whether the effect is further enhanced by feeding. We used a two-factorial design and randomized infants to one of four groups: prefeed-unfamiliar, prefeed-familiar, postfeed-unfamiliar, and postfeed-familiar. Memory for either familiar or unfamiliar speech (the infant's mother saying 'baby' versus a female stranger saying 'beagle') was assessed using head turning to sound in an habituation-recovery paradigm and a retention delay of 85 sec either before or after a typical milk feed. Memory for the familiar speech-voice was enhanced relative to the unfamiliar speech-voice, expressed by significantly less head turning toward the habituated sound stimulus when it was re-presented after the delay. Memory for familiar or unfamiliar speech was not significantly enhanced from pre- to postfeeding, nor was there a significant interaction. This is the first demonstration in newborns that familiarity enhances short-term memory for speech-voice sound. [ABSTRACT FROM AUTHOR]

Washed rat colonic rings were incubated in closed flasks under N2 at physiologic pH and temperature levels. In the absence of an exogenous substrate, negligible H2 but some CH4 concentrations were detected in vitro after one hour of incubation, but high concentrations (H2 > 100 ppm, CH4 > 10 ppm) of both gases were found after 24 hours of culture. Production of H2 and CH4 by the washed colonic rings was stimulated by lactose addition.Maximum H2 production occurred at about pH 7.0, whilemaximum CH4 production occurred between pH 4.0 and 6.0. The increased production of both gases at 24 hours was associated with dramatic increases (104-fold) in anaerobic bacteria colony counts on the colonic rings and in the incubation media, as well as dramatic increases (100-fold) in acetate concentrations in the media, while lactate concentrations first rose and then fell significantly. These results suggest that gas production in colonic ring preparations is subject to quantitative changes in microbiota, pH, and metabolite formation analogous to in vivo conditions. In addition, microbiota firmly attached to colonic tissue appears to utilize colonic tissue to support its growth in the absence of an exogenous substrate. [ABSTRACT FROM AUTHOR]

Head trauma from abuse, including shaken baby syndrome, is a devastating and potentially lethal form of infant physical abuse first recognized in the early 1970s. What has been less recognized is the role of the early increase in crying in otherwise normal infants in the first few months of life as a trigger for the abuse. In part, this is because infant crying, especially prolonged unsoothable crying, has been interpreted clinically as something wrong with the infant, the infant's caregiver, or the interactions between them. Here, we review an alternative developmental interpretation, namely, that the early increase in crying is a typical behavioral development in normal infants and usually does not reflect anything wrong or abnormal. We also review evidence indicating that this normal crying pattern is the most common trigger for abusive head trauma (AHT). Together, these findings point to a conceptualization of AHT as the consequence of a failure in an otherwise common, iterative, and developmentally normal infantcaregiver interaction. They also imply that there is a window of opportunity for prevention of AHT, and potentially other forms of infant abuse, through a public health primary universal prevention strategy aimed at changing knowledge and behaviors of caregivers and society in general concerning normal development of infants and the significance of early increased infant crying. If effective, there may be important implications for prevention of infant abuse nationally and internationally. [ABSTRACT FROM AUTHOR]

Abstract: Passive surveillance using ICD codes for hospital discharges has been used to estimate the incidence of abusive head trauma (AHT) utilizing ICD-9-CM, but not ICD-10, codes. There have been no incidence estimates of AHT in Canada where ICD-10 codes have been used since 2002. The Discharge Abstract Database from the Canadian Institute of Health Information (CIHI) for 2002–2007 was used for analyses conducted in 2011. A case was defined by code combinations that indexed injury specificity (narrow or broad) and degree of certainty (presumptive or probable) that the injury was inflicted. Estimated incidences for the populations at risk in those aged <12 months and 12–23 months from 2002–2007 were determined. For those aged <12 months, the mean incidence for “narrow, presumptive” AHT was 13.0 (95% CIs=11.3, 14.9) per 100,000 person-years; for “broad, probable” it was 15.5 (13.6, 17.6) per 100,000 person-years. For those aged 12–23 months, the “narrow, presumptive” incidence was 2.4 (1.7, 3.3) and the “broad, probable” incidence was 2.8 (2.0, 3.8) per 100,000 person-years, respectively. Month and year of age patterns were similar to previous reports. ICD-10 codes can be used to estimate incidence of AHT. Narrower classifications provide estimates consistent with those from other surveillance programs in Canada and internationally. [Copyright &y& Elsevier]

Hematopoietic stem cell transplantation is a highly expensive clinical intervention with considerable therapeutic benefit but serious adverse effects on health status in some circumstances. Consequently, it is an important target for economic evaluation in which the monetary costs and clinical consequences of optional treatment strategies are compared. The need for such formal assessment is further demanded by the expanded use of hematopoietic stem cell transplantation globally, including its utilization in developing countries. With respect to costs, those incurred by patients and families are often substantial, while those incurred by hospitals may be inadequately reimbursed. Determination of consequences should not be limited to measurements of clinical effectiveness but rather include adjustments for quality of life. Rigorous economic evaluation can provide hard evidence in deliberations of value for money, especially in the context of limited resources for health care. [ABSTRACT FROM AUTHOR]

Cancer in adolescents and young adults is an important public health issue, because there are approximately 1 million new cases annually. The distribution of diseases in this age group varies geographically, contributing to differences in survival rates. Although an overall survival rate exceeding 80 % has been reported in optimal circumstances, emerging knowledge about distinctions in tumor biology and enhanced clinical accrual to clinical trials should lead to further gains. The challenges of cancer survivorship demand further attention with a particular focus on the quality of life of survivors and amelioration of the long-term complications of treatment. Programs in cancer screening and prevention provide potential for considerable benefits in this age group. A renewed perspective on the adolescent and young adult cohort is required; and, in all of these opportunities for change, there are important roles to be played by advocacy groups internationally. Cancer 2011;117(10 suppl):2245-9. © 2011 American Cancer Society. Cancer in adolescents and young adults is a global health concern with opportunities for gains in the areas of tumor biology, clinical trial accrual, screening/prevention, and survivorship. Advocacy groups can play a prominent role as agents of change. [ABSTRACT FROM AUTHOR]

The article reports on the study which compared the correlation of proxy reporting of health-related quality of life (HRQL) by the parents and nurses of children with Hodgkin disease. It indicates that the Canadian children's Pediatric Quality of Life Inventory (PedsQL) generic scores increased at the end of the study except during inpatient chemotherapy. It implies that nurses contributed valuable information as proxy respondents regarding the quality of life for children with Hodgkin disease.

The article presents a cost-effectiveness study which compares amputation to limb salvage. Researchers found that endoprosthetic replacements are expected to gradually fail and that most young and active people will demand the use of a sophisticated artificial limb. It is noted that a successful limb salvage surgery cannot be assumed particularly in young people with bone and soft tissue sarcomas of the lower limb.

Background: Shaken baby syndrome often occurs after shaking in response to crying bouts. We questioned whether the use of the educational materials from the Period of PURPLE Crying program would change maternal knowledge and behaviour related to shaking. Methods: We performed a randomized controlled trial in which 1279 mothers received materials from the Period of PURPLE Crying program or control materials during a home visit by a nurse by 2 weeks after the birth of their child. At 5 weeks, the mothers completed a diary to record their behaviour and their infants' behaviour. Two months after giving birth, the mothers completed a telephone survey to assess their knowledge and behaviour. Results: The mean score (range 0-100 points) for knowledge about infant crying was greater among mothers who received the PURPLE materials (63.8 points) than among mothers who received the control materials (58.4 points) (difference 5.4 points, 95% confidence interval [CI] 4.1 to 6.5 points). The mean scores were similar for both groups for shaking knowledge and reported maternal responses to crying, inconsolable crying and self-talk responses. Compared with mothers who received control materials, mothers who received the PURPLE materials reported sharing information about walking away if frustrated more often (51.5% v. 38.5%, difference 13.0%, 95% CI 6.9% to 19.2%), the dangers of shaking (49.3% v. 36.4%, difference 12.9%, 95% CI 6.8% to 19.0%), and infant crying (67.6% v. 60.0%, difference 7.6%, 95% CI 1.7% to 13.5%). Walking away during inconsolable crying was significantly higher among mothers who received the PURPLE materials than among those who received control materials (0.067 v. 0.039 events per day, rate ratio 1.7, 95% CI 1.1 to 2.6). Interpretation: The receipt of the Period of PURPLE Crying materials led to higher maternal scores for knowledge about infant crying and for some behaviours considered to be important for the prevention of shaking. (Clinical- Trials.gov trial register no. NCT00175422.) [ABSTRACT FROM AUTHOR]

BACKGROUND. Infant crying is an important precipitant for shaken-infant syndrome. OBJECTIVE. To determine if parent education materials (The Period of PURPLE Crying ~PURPLE]) change maternal knowledge and behavior relevant to infant shaking. METHODS. This study was a randomized, controlled trial conducted in prenatal classes, maternity wards, and pediatric practices. There were 1374 mothers of newborns randomly assigned to the PURPLE intervention and 1364 mothers to the control group. Primary outcomes were measured by telephone 2 months after delivery. These included 2 knowledge scales about crying and the dangers of shaking; 3 scales about behavioral responses to crying generally and to unsoothable crying, and caregiver self-talk in response to unsoothable crying; and 3 questions concerning the behaviors of sharing of information with others about crying, walking away if frustrated, and the dangers of shaking. RESULTS. The mean infant crying knowledge score was greater in the intervention group (69.5) compared with controls (63.3). Mean shaking knowledge was greater for intervention subjects (84.8) compared with controls (83.5). For reported maternal behavioral responses to crying generally, responses to unsoothable crying, and for self-talk responses, mean scores for intervention mothers were similar to those for controls. For the behaviors of information sharing, more intervention mothers reported sharing information about walking away if frustrated and the dangers of shaking, but there was little difference in sharing information about infant crying. Intervention mothers also reported increased infant distress. CONCLUSIONS. Use of the PURPLE education materials seem to lead to higher scores in knowledge about early infant crying and the dangers of shaking, and in sharing of information behaviors considered to be important for the prevention of shaking. [ABSTRACT FROM AUTHOR]

One explanation for the relative lack of progress in treating cancer in adolescents and young adults is that the biology of malignant diseases in this age group is different than in younger and older persons, not only in the spectrum of cancers but also within individual cancer types and within the patient (host). Molecular, epidemiological and therapeutic outcome comparisons offer clues to this distinctiveness in most of the common cancers of adolescents and young adults. Translational and clinical research should not assume that the biology of cancers and patients is the same as in other age groups, and treatment strategies should be tailored to the differences. [ABSTRACT FROM AUTHOR]

Acantholytic acanthoma was originally described as a solitary lesion displaying histologic features of acantholysis without dyskeratosis. Solitary, non-genital lesions displaying confluent acantholysis and dyskeratosis have not been well described in the literature, clinically or histologically. We screened cases at our institution over a 6-month period and found 28 such lesions. Lesions were most often found on the trunk as a solitary papule, for which the clinical diagnosis was often basal cell carcinoma. There was a slight female predominance. Confluent acantholysis and dyskeratosis is a histologic pattern that may present as a solitary keratosis. [ABSTRACT FROM AUTHOR]

Background: Assessing health status in survivors of childhood cancer is increasingly important due to improved survival rates. However, there are limited estimates available for this population based on large samples and compared to population controls.Methods: In a retrospective cohort study, 2,152 long-term survivors and 2,432 controls, aged 5-37, who had survived cancer during childhood or adolescence were compared on the Health Utilities Index Mark III (HUI3). Descriptive and logistic regression analyses were used to assess the effect of age at diagnosis, type of cancer and therapy received on HUI3 domains.Major Findings: More survivors than controls showed deficits in dexterity, ambulation, hearing, speech and cognition but not in vision, emotion or pain. The largest numbers of survivors reporting excess impairment was found in the cognition attribute. Survivors of central nervous system tumors were most likely to show impairments across multiple domains. Lastly, impairments in cognition were found most commonly in survivors exposed to cranio-spinal radiation at young ages.Conclusions: Seventy-five percent of childhood cancer survivors and 80% of controls were found to have two or fewer impaired attributes. Those reporting impairments that were most likely to be of clinical relevance were among survivors diagnosed with central nervous system and bone tumours, and those exposed to cranial radiation as young children. Tools assessing health status should be included in prospective trials to more clearly assess the contribution of therapy to reduced long-term health status. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To determine whether there is an age-specific incidence of hospitalized cases of Shaken Baby Syndrome (SBS) that has similar properties to the previously reported “normal crying curve,” as a form of indirect evidence that crying is an important stimulus for SBS. Design and setting: The study analyzed cases of Shaken Baby Syndrome by age at hospitalization from hospital discharge data for California hospitals from October 1996 through December 2000. Patients: All cases of children less than 18 months (78 weeks) of age for whom the diagnostic code for Shaken Baby Syndrome (995.55) in the International Classification of Disease, Ninth Edition, Clinical Modification was assigned. Results: There were 273 hospitalizations for SBS. Like the “normal crying curve,” the curve of age-specific incidence starts at 2–3 weeks, has a clear peak, and declines to baseline by about 36 weeks of age. In contrast to the normal crying curve that peaks at 5–6 weeks, the peak of SBS hospitalizations occurs at 10–13 weeks. Conclusions: The age-specific incidence curve of hospitalized SBS cases has a similar starting point and shape to the previously reported normal crying curve but the peak occurs about 4–6 weeks later. Of the likely predisposing causes, this pattern is only consistent with the properties of early crying. There are numerous explanations for the lag in the peaks between crying and SBS hospitalizations, including the possibility of repeat shakings prior to hospitalization. The importance of crying as a stimulus to SBS may provide an opportunity for preventive intervention. [Copyright &y& Elsevier]

The objectives of this report are to review the assessment of patient-focused outcomes in pediatric orthopedic surgery, to describe a framework for identifying appropriate sets of measures, and to illustrate an application of the framework to a challenging orthopedic problem. A detailed framework of study design and measurement factors is described. The factors are important for selecting appropriate instruments to measure health status and health-related quality of life (HRQL) in a particular context. A study to evaluate treatment alternatives for patients with neurofibromatosis type 1 and congenital tibial dysplasia (NF1-CTD) provides a rich illustration of the application of the framework. The application involves great variability in the instrument selection factors. Furthermore, these patients and their supportive caregivers face numerous complex health challenges with long-term implications for HRQL. Detailed summaries of important generic preference-based multi-attribute measurement systems, pediatric health profile instruments, and pediatric orthopedic-specific instruments are presented. Age-appropriate generic and specific measures are identified for study of NF1-CTD patients. Selected measures include the Activities Scale for Children, Gillette Functional Assessment Questionnaire Walking Scale, Health Utilities Index, and Pediatric Inventory of Quality of Life. Reliable and valid measures for application to pediatric orthopedics are available. There are important differences among measures. The selected measures complement each other. The framework in this report provides a guide for selecting appropriate measures. Application of appropriate sets of measures will enhance the ability to describe the morbidity of pediatric orthopedic patients and to assess the effectiveness of alternative clinical interventions. The framework for measurement of health status and HRQL from a patient perspective has relevance to many other areas of orthopedic practice. [ABSTRACT FROM AUTHOR]

At least 3 dimensions need to be brought to bear on the question of stress and coping in children even in the context of process models. They are the role of physiological regulation in cognitive or emotional appraisals and responses, and of the parents' role in them; the role of early infant experience in later stress and coping responses; and the concept of trade-offs as an element in stress and coping responses. [ABSTRACT FROM AUTHOR]

Treatment of cancer in childhood is an expensive undertaking for the health-care system and for the affected families. As there is a substantial burden of treatment-related morbidity, it is important to determine whether the effects of treatment are worth these monetary costs, especially from a societal perspective. Economic evaluation affords a comparison of the costs and consequences (effects) of relevant therapeutic alternatives. Preference-based measures of health-related quality of life are particularly useful for assessing the effects of treatment, for these tools integrate mortality and morbidity. These measures provide utility scores that can be used as weights on survival data to compute quality-adjusted life years (QALYs). Costs are incurred both within and outside of the health-care system. The former should include those in front-line patient care departments (e.g. nursing); the pro-rated share of the expenses of service departments (e.g. materials management) to those in the front line; and the fully allocated costs for capital invested in lands, building and equipment. The latter are costs borne by families that are both out-of-pocket (e.g. for over-the-counter drugs) as well as related to time spent in providing care, which may involve foregone income. Costs and consequences should be subject to discounting; a process for converting those items incurred in the future into contemporary equivalents. Economic evaluation provides estimates of incremental discounted costs per discounted QALY gained. By almost any interpretative standard this appears attractive with respect to cancer in childhood. Examples are provided with the encouragement that economic evaluation be undertaken in more clinical trials in paediatric oncology. [Copyright &y& Elsevier]

Abstract: Economic evaluation is a comparison of the costs and consequences of alternative healthcare interventions. Consequences are best assessed as utilities; quality-adjusted measures of effectiveness. Although few substantive data are available, it appears that hematopoietic stem cell transplantation is even more cost-effective in children than in adults. [ABSTRACT FROM AUTHOR]

Fifteen hemodialysis patients were recently reported with a new scleromyxedema-like fibrosing disorder thought to be associated with renal dialysis. A case of this new clinicopathological entity is described as well as a limited review of the literature relevant to this disease. The patient was a 31-year-old Hispanic female with firm cutaneous plaques with brawny hyperpigmentation on the thighs and arms, which started 1 month after starting hemodialysis therapy for end-stage renal disease. There was no monoclonal gammopathy or evidence of systemic mucin deposition or other organ system disease. Histopathologically, the skin biopsy samples show haphazardly arranged dermal fibroblasts with associated collagen and small collections of interfibrillar mucin. The skin biopsy was interpreted as scleromyxedema-like fibromucinosis. This represents an additional case of this new renal dialysis-associated disorder. The disease may also occur in nondialysis patients, including those with liver disease. [ABSTRACT FROM AUTHOR]

Reports on a study done on pacifier use in infants and the relationship to early weaning and cry/fuss behavior. Objective to test whether regular pacifier use is related to weaning before three months; Examination of differences in results according to randomized intervention allocation versus observed use or non use of pacifiers; Results; Conclusion that pacifier use is associated with breastfeeding difficulties and reduced motivation to breastfeed.

Background: There is a large spectrum trichoblastoma; of which, several histologic variants have been described including a rippled-pattern variant. Three cases of rippled-pattern trichoblastoma are described which also exhibited definitive foci of sebaceous differentiation. Methods: Three cases were retrieved from the archives of the Dermatopathology Laboratory at the University of California Irvine (Orange, CA, USA). All specimens were stained with hematoxylin and eosin (H&E). In addition, sections were submitted for immunohistochemical studies with epithelial membrane antigen (EMA). Results: All three biopsies were composed of well-circumscribed multiple variously sized tumor lobules present in the upper to deep dermis comprised of with rounded or slightly elongated basaloid cells with scant eosinophilic cytoplasm. The lobules were separated by a slightly hyalinized stroma. The unique finding present in all three specimens was a peculiar arrangement of the basaloid cells in linear rows parallel to one another. This gave the tumors a rippled pattern similar to the palisading of nuclei of Verocay bodies seen in schwannomas. In addition all three biopsies showed definite sebaceous differentiation. Conclusions: Three additional cases of rippled-pattern trichoblastoma are presented. All three were located on the scalp and showed additional features of foci of sebaceous differentiation. No associations with Muir-Torre Syndrome were found in these patients. Because this appears to be a distinct variant within the large spectrum of trichoblastoma, the term rippled-pattern sebaceous trichoblastoma is suggested. [ABSTRACT FROM AUTHOR]

This paper discusses a new freshman course that merges previous topics in the "Introduction to Mechanical Engineering" and "Engineering Design Graphics" courses into a single integrated teaching effort. The main objective of the new course is to introduce students to mechanical engineering education and practice through lectures and laboratory experiences. A major effort in the course is devoted to a reverse engineering team project. The students are divided into four-member teams and are instructed to select a simple mechanical assembly for dissection. They study and disassemble their object into basic constituent components, documenting this process with freehand sketches and notes. They use these sketches and other measured dimensions to construct 3-D solid computer models of each major component. The teams then obtain .STL files of the solid models, which are used to make rapid physical prototypes of their parts. The teams conclude their project activities by generating engineering drawings directly from the 3-D geometric data base. All of these efforts are integrated, documented, and submitted to the instructor as a final team project report. [ABSTRACT FROM AUTHOR]

This article discusses the growing field of adolescent and young adult oncology. The author comments on the clinical needs involved in the care and treatment of youth and young adults with cancer. He also describes the differences in cancers that affect young adults compared with children and the elderly.

There is a substantial difference in observed survival among children with acute lymphoblastic leukemia in high‐income countries versus those in low‐ and middle‐income countries. This gap can be reduced considerably by multilevel investing in health systems and services with innovative frameworks such as implementation science. [ABSTRACT FROM AUTHOR]

In this cross‐sectional study performed in Canada, we evaluated the frustration levels of prepartum and postpartum mother and father couple‐pairs. Our goal was to determine if there were differences in frustration levels between mothers and fathers while listening to prolonged infant crying, and further, how frustration levels might differ between prepartum and postpartum samples. Using two discrete groups, prepartum (Sample 1; N = 48) and postpartum (Sample 2; N = 44) mother and father couple‐pairs completed 600 s of listening to audio‐recorded infant cry sounds. Participants continuously reported their subjective frustration using a computerized Continuous Visual Analog Scale (CVAS). There was no significant difference in frustration responses between mothers and fathers across both prepartum and postpartum samples. Postpartum mothers and fathers experienced greater frustration than their prepartum counterparts, and frustration increased faster in postpartum couples compared to prepartum couples. Informing first‐time parents of the universal experiences of frustration to prolonged crying bouts that are characteristic of their infant's early weeks of life may lead to greater understanding towards their infant, and perhaps decreased instances of harmful responses. [ABSTRACT FROM AUTHOR]

Background: We investigated the effectiveness of Nurse‐Family Partnership (NFP), a prenatal‐to‐age‐two‐years home‐visiting programme, in British Columbia (BC), Canada. Methods: For this randomised controlled trial, we recruited participants from 26 public health settings who were: <25 years, nulliparous, <28 weeks gestation and experiencing socioeconomic disadvantage. We randomly allocated participants (one‐to‐one; computer‐generated) to intervention (NFP plus existing services) or comparison (existing services) groups. Prespecified outcomes were prenatal substance exposure (reported previously); child injuries (primary), language, cognition and mental health (problem behaviour) by age two years; and subsequent pregnancies by 24 months postpartum. Research interviewers were masked. We used intention‐to‐treat analyses. (ClinicalTrials.gov, NCT01672060.) Results: From 2013 to 2016 we enrolled 739 participants (368 NFP, 371 comparison) who had 737 children. Counts for child injury healthcare encounters [rate per 1,000 person‐years or RPY] were similar for NFP (223 [RPY 316.17]) and comparison (223 [RPY 305.43]; rate difference 10.74, 95% CI ‐46.96, 68.44; rate ratio 1.03, 95% CI 0.78, 1.38). Maternal‐reported language scores (mean, M [SD]) were statistically significantly higher for NFP (313.46 [195.96]) than comparison (282.77 [188.15]; mean difference [MD] 31.33, 95% CI 0.96, 61.71). Maternal‐reported problem‐behaviour scores (M [SD]) were statistically significantly lower for NFP (52.18 [9.19]) than comparison (54.42 [9.02]; MD ‐2.19, 95% CI −3.62, −0.75). Subsequent pregnancy counts were similar (NFP 115 [RPY 230.69] and comparison 117 [RPY 227.29]; rate difference 3.40, 95% CI ‐55.54, 62.34; hazard ratio 1.01, 95% CI 0.79, 1.29). We observed no unanticipated adverse events. Conclusions: NFP did not reduce child injuries or subsequent maternal pregnancies but did improve maternal‐reported child language and mental health (problem behaviour) at age two years. Follow‐up of long‐term outcomes is warranted given that further benefits may emerge across childhood and adolescence. [ABSTRACT FROM AUTHOR]

Presents cases of breast-like lesions arising in the skin. Demonstration of the diagnostic difficulties presented by the morphologic and pathologic continuum of the mammary glands, cutaneous mammary-like glands and sweat glands; Provision of perspective in the classification of problematic cases of breast-like cutaneous lesion.

Opinion. Comments on the development of human newborns based on a study by researchers Elliott M. Blass and Vivian Ciaramitaro. Temporal characteristics of responses to sucrose and pacifiers; Causation of state change; Implications for breast feeding; Role of opioid systems in normal caregiving.

Cyclosporine (CSA) is an effective immunosuppressive agent and is used in tissue transplantation. The present investing was undertaken to determine the effect of topical delivers of CSA on allergic contact dermatitis in guinea pigs. Topical 15% CSA in an azone (1-dodecylazacycloheptan 2-one)-containing vehicle blocked local elicitation in previously dinitrochlorohenzene (DNCB) sensitized animals that received a single topical application just prior to elicitation. Elicitation was not blocked at a distant site, indicating a local effect of topical CSA. In contrast, topical CSA when applied twice daily for a total of 5 applications during sensitization only, did not block subsequent elicitation. These experiments suggest that cyclosporine may be beneficial in the therapy of human contact dermatitis, as swell as other T cell medicated dermatoses. [ABSTRACT FROM AUTHOR]

Presents information on study regarding colic in infants. Information on the number of participants in the study; Methodology used in the study; Results of the study.

Abstract. Pain in infants, children, and adolescents warrants study from a developmental, behavioral and physiological perspective because maturation of physical, emotional and cognitive systems influences the way in which pain is experienced and expressed. Pediatric pain is an underdeveloped area ripe for study within the realm of developmental and behavioral pediatrics, as noted by documentation of its undertreatment in children. The focus of this paper is to present issues relevant to the study of pain in children, using the example of the recurrent abdominal pain syndrome to illustrate points regarding epidemiology, assessment, and intervention. It is the opinion of these authors that pediatric pain must be understood from a developmental perspective in both clinical and nonclinical populations of children. Multidisciplinary approaches to research in pain aids in understanding the development of nociceptive transmission and inhibitory systems, the development of pain expression, and the influence of context on pain experience and behavior. The goal of research in pediatric pain is to understand these systems within a developmental context so that preventive and therapeutic intervention strategies can be developed to reduce children's distress and pain-related disability. [ABSTRACT FROM AUTHOR]