bluuebunny/crossref_metadata_2025 huggingface dataset:
A neurologist’s rhombencephalitis after comirnaty vaccination. A change of perspective
Authors: Walter Alexander , Kraemer Markus
Published: November 2021

Rhombencephalitis is an orphan disease of multiple causes that may manifest with facial palsy, limb ataxia and reduced consciousness. Up to now it is described after COVID-19 infection and in this (personal) case was found up to 8 weeks after Comirnaty vaccination. So far, we do not fully understand the pathophysiological characteristics of encephalitis associated with SARS-CoV-2. In rare cases, vaccination may cause an immunological reaction and delayed inflammation, the consequences of which we have not yet deciphered. Rhombencephalitis should be considered as a rare potential mRNA-associated vaccination side effect.
Διεύθυνση και ηγεσία σχολικών μονάδων: Πώς η βιογραφία επιδρά στη διαμόρφωση της ταυτότητας του ηγέτη
Authors: Λιακοπούλου Μαρία , Αλεξίου Πολυξένη , Ζιώγα Στυλιανή , Μπανάσου Βάϊα , Ράπτη Ειρήνη-Αγλαϊα , Τριανταφύλλου Χαρίκλεια , Φωτίου Κωνσταντίνος , Χίλαϊ Άντζελα
Published: November 2021

Το παρόν άρθρο επιδιώκει να διερευνήσει σε ποιο βαθμό η βιογραφία των διευθυντών διαδραματίζει καθοριστικό ρόλο στη διαμόρφωση της ηγετικής τους φυσιογνωμίας. Η έρευνα εστίασε σε δύο βασικές διαστάσεις της ηγεσίας, την αυτοαντίληψη του ρόλου και το όραμα του ηγέτη. Συγκεκριμένα πραγματοποιήθηκε ποιοτική έρευνα και χρησιμοποιήθηκε η βιογραφική μέθοδος. Μελετήθηκε η βιογραφία επτά διευθυντών σχολικών μονάδων Πρωτοβάθμιας και Δευτεροβάθμιας Εκπαίδευσης. Οι βιογραφικές συνεντεύξεις διεξήχθησαν σε τρεις φάσεις: κύρια αφήγηση από κάθε διευθυντή, διευκρινιστικές ερωτήσεις για σημεία της αφήγησης και ερωτήσεις απολογισμού για την αποτίμηση της συνέντευξης και την κάλυψη όλων των απαραίτητων ζητημάτων για τις θεματικές της έρευνας. Από τα αποτελέσματα της έρευνας, διαφαίνεται ότι οι βιογραφίες των συμμετεχόντων ασκούν ισχυρή επίδραση στον τρόπο που αντιλαμβάνονται και ασκούν τα ηγετικά τους καθήκοντα. Τα ιδιαίτερα χαρακτηριστικά της προσωπικότητάς τους, οι εμπειρίες τους στη διάρκεια της προσωπικής και επαγγελματικής τους πορείας, οι αξίες που πρεσβεύουν και οι προσωπικοί ή οι εκπαιδευτικοί στόχοι που προωθούν, καθώς και οι ιδιαίτερες συνθήκες που καλούνται να αντιμετωπίσουν κατά την επιτέλεση των διοικητικών τους καθηκόντων, καθορίζουν αν είναι ηγέτες, το όραμα τους και τον τρόπο που ασκούν την ηγεσία για τον σχολικό οργανισμό.
DRAINMOD-P: A Model for Simulating Phosphorus Dynamics and Transport in Drained Agricultural Lands: II. Model Testing
Authors: Askar Manal H. , Youssef Mohamed A. , Hesterberg Dean L. , King Kevin W. , Amoozegar Aziz , Skaggs R. Wayne , Chescheir George M , Ghane Ehsan
Published: November 2021

Highlights

DRAINMOD-P was tested using a dataset from a drained field with desiccation cracks.

Surface and subsurface phosphorus losses were mainly in the particulate form.

Surface runoff was a major pathway for phosphorus loss in this field.

The model performance in predicting edge-of-field phosphorus loss is promising.

Abstract. The recently developed phosphorus (P) model DRAINMOD-P was tested using a four-year dataset from a subsurface-drained field in northwest Ohio with significant potential for desiccation cracking or preferential flow. The model satisfactorily predicted subsurface drainage discharge, with a monthly Nash-Sutcliffe efficiency (NSE) of 0.59 and index of agreement (IOA) of 0.89. Lack of annual water budget closure was reported and was likely caused by uncertainty in measured surface runoff and/or modeling approaches representing macropore flow. More than 80% of predicted surface and subsurface P losses were in the particulate form. Surface runoff was the major pathway for P loss, contributing 78% of predicted total P (TP) load. On average, predicted macropore flow represented about 15% of drainage discharge and contributed 21% of DRP loss via subsurface drains. The performance of DRAINMOD-P in predicting monthly dissolved reactive P and TP losses through subsurface drains can be rated as poor (NSE = 0.33 and IOA = 0.60) and very good (NSE = 0.81 and IOA = 0.95), respectively. DRAINMOD-P demonstrated potential for simulating P fate and transport in drained cropland. More testing is needed to further examine newly incorporated hydrological and biogeochemical components of the model. Keywords: Agricultural drainage, Edge-of-field phosphorus load, Macropore flow, Phosphorus model, Sediment yield, Water quality modeling.
Deep learning 2D and 3D optical sectioning microscopy using cross-modality Pix2Pix cGAN image translation
Authors: Zhuge Huimin , Summa Brian , Hamm Jihun , Brown J. Quincy
Published: November 2021

Structured illumination microscopy (SIM) reconstructs optically-sectioned images of a sample from multiple spatially-patterned wide-field images, but the traditional single non-patterned wide-field images are more inexpensively obtained since they do not require generation of specialized illumination patterns. In this work, we translated wide-field fluorescence microscopy images to optically-sectioned SIM images by a Pix2Pix conditional generative adversarial network (cGAN). Our model shows the capability of both 2D cross-modality image translation from wide-field images to optical sections, and further demonstrates potential to recover 3D optically-sectioned volumes from wide-field image stacks. The utility of the model was tested on a variety of samples including fluorescent beads and fresh human tissue samples.
A Call for Expanding the Diversity of Voices in Autism Research Engagement
Authors: Salt Mackenzie
Published: November 2021

Recently, there has been a push to increase research engagement within the autism community. Historically, research engagement has largely focused on childhood disability research and participatory autism research remains rare (den Houting et al., 2021). This gap in the literature can often result in the substitution of parents’ voices for those of their Autistic children within the framework of family-centred services. This article argues that research engagement should be conducted in a way that can represent the wider autism community and cautions against allowing voices of one element of the autism community to speak for the whole.
Philosophical Pedagogy in the Service of Ideology in the Times of the Polish People’s Republic
Authors: Wrońska Katarzyna
Published: November 2021

In my paper, I would like to consider the problem of entanglement of philosophy of education in the communist ideology. I will show it on the example of one Polish concept, created by Karol Kotłowski. He was a disciple of Sergiusz Hessen and developed his own concept of philosophical pedagogy, presenting the philosophy of dialectical materialism, that is Marxism as a perspective in which the entire philosophical thought culminates. Reading Kotłowski, we can see, on the one hand, his rooting in broad philosophical thought, on the other hand – his adherence to the ideology of the socialist state, which demands that education serve the political system and prepare people to be the builders of the system. The theoretical basis for my analysis is Arendt’s concept of totalitarianism and Tischner’s view of homo sovieticus. The analysis is preceded with an historical overview of the situation in Poland in the first decade after World War II with reference to academic pedagogy.
A day of history and hope: A critical discourse analysis of Joe Biden’s Inauguration speech
Authors: Pramadya Teguh Puja , Rahmanhadi Anna Desiyanti
Published: November 2021

This article explores how President-elect Joe Biden used the rhetoric of political language in his inauguration speech as an attempt to showcase his policy plans as well as his political views on the American political scene. This article also looks at how each of the political messages in his inauguration speech shows the ideology and power that Joe Biden believes in. To provide comprehensive details about the elements of Joe Biden’s inauguration speech, the researchers use Norman Fairclough’s idea to view continuing social practice via the prisms of text, discourse practice, and the sociocultural practice that underpins the text, or to view the underlying reality that gave rise to the discourse
TRIAJE Y ÉTICA DE DESASTRES
Authors: Gil Martín Francisco Javier
Published: November 2021

En este artículo se analizan algunas de las implicaciones que tienen las prácticas de triaje para la ética de desastres. Se considera la centralidad técnica de la cuantificación en los modelos algorítmicos y numéricos de triaje y se incide en la prevalencia normativa de los criterios consecuencialistas, incluso cuando éstos hayan de ajustarse a sistemas de múltiples principios. Finalmente se sugiere que una concepción ética de los desastres precisa de una perspectiva compleja y integral de la gestión de los desastres que no se limite a la fase de respuesta inmediata a los mismos y que supere a la par que integre los principios de la bioética y la indispensabilidad de los criterios consecuencialistas en las decisiones de triaje
Composición de los desembarques de la pesca artesanal en los puertos de Boca Parita y El Agallito, Pacífico panameño
Authors: Vergara-Frías Yarkelia Aneth , Robles-Pineda Yolani Aibeth , Vega Ángel Javier
Published: November 2021

Para los puertos de Boca de Parita y El Agallito, en el Pacífico panameño, se contabilizó la biomasa desembarcada entre el 2011 y 2015, adicionalmente, se desarrollaron muestreos de desembarque para identificar, medir y pesar las especies y cuantificar su aporte en número y peso, además de registrar los precios pagados al pescador. Los resultados indican que entre ambos puertos se comercializaron 2 760 toneladas de productos pesqueros, donde el 74.5% correspondió a Boca de Parita y el 25.5% a El Agallito. En los desembarques se identificaron 38 especies, donde las más abundantes: Cynoscion phoxocephalus (Sciaenidae), Scomberomorus sierra (Scombridae) y Lutjanus guttatus (Lujanidae). Más de 90% del producto analizado fue de primera y segunda calidad, según precio de comercialización. La distribución de tallas, en las especies con un tamaño de muestra superior a 100 individuos, y para las cuales se encontró información sobre la media reproductiva (L50), refleja que solo en Caranx vinctus y Centropomus medius, más del 80% de los desembarques estuvo compuesto por ejemplares maduros, en Lutjanus guttatus y Scomberomorus sierra el 49% y 53%, y en Cynoscion phoxocephalus, Caranx caballus, y Cynoscion albus, el porcentaje fue de 19, 5% y 0%, respectivamente. Esto indica que es necesario establecer políticas de manejo, donde se instauren regulaciones de tallas de captura y zonas de pesca que garanticen que la actividad esté dirigida a la captura de individuos que se hayan reproducido, como primer paso para garantizar la sostenibilidad de la pesca artesanal en el golfo de Parita.
Two-point flap blood glucose measurement for monitoring propeller flap perfusion – a case report
Authors: Libondi Klaudia , Libondi Guido , Nessler Michał , Stala Maciej , Śmieszek Jarosław , Chrapusta Anna
Published: November 2021

Monitoring flap perfusion is a helpful method of postoperative care allowing for proper early intervention in and salvage of a flap. The basic means of blood supply monitoring include the assessment of color, warmth, skin tension, and a pin-prick examination. Along with advances in microvascular surgery, methods of flap blood circulation assessment have been also developed. This paper presents the case of a peroneal artery propeller perforator flap for the treatment of a secondary wound resulting from an orthopedic complication of ankle arthrodesis. Blood glucose level (BGL) was used to monitor flap perfusion as an early indicator of possible venous congestion. It is well known that in case of vascular compromise, whether arterial or venous, the flap salvage rate depends on how fast the vascular problem is resolved. Arterial insufficiency is easily detectable, and the arterial flow may be also monitored with minidoppler, however venous insufficiency causes symptoms less dynamically. This fact emphasized the importance of early prediction of venous insufficiency before clinical symptoms appear. It is crucial that the time between pedicle impairment and clinical signs is as short as possible.
Psychometrics Properties of Ways of Coping Questionnaire-Korean among College Students
Authors: Kim Hwa Soon , Seo Eun Ji , You Mi-Ae , Kim Chun-Ja
Published: November 2021

Background: The purpose of this study was to investigate the validity and reliability of the Ways of Coping Questionnaire-Korean (WCQ-K) among college students.Methods: A cross-sectional survey design was employed to validate psychometrics properties of the WCQ-K among 248 students from a university-affiliated health-care center in Suwon, Korea. Structured questionnaires were used for psychometric evaluation. Item analysis, exploratory factor analysis, and known-groups validity were performed for validity. The Cronbach’s alpha coefficient and Intraclass Correlation Coefficient (ICC) were used for reliability.Results: A seven-factor model with 36 items explained 50.8% of the variance. The Cronbach’s alpha was 0.90; the ICC for 2-weeks test-retest reliability was 0.80. Students with stable ways of coping tended to have a lower score on the perceived stress and depressive symptoms than their counterparts (all P<0.05).Conclusions: The findings of this study provide evidence for the adequate psychometric properties of the WCQ-K. The WCQ-K may be used in school or clinical settings to examine the potential role of stress-coping strategies in enhanced stress management among Korean college students.
Care of the Young Athlete
Authors:   American Academy of Pediatrics Council on Sports Medicine,   American Academy of Orthopaedic Surgeons
Published: November 2021

New 2nd edition of this best-selling, award-winning resource gives you an easy-to-use, one-stop guide to all aspects of childhood sports preparation, participation, and injury treatment. The newly enhanced and updated 2nd edition covers safety and risk-management considerations; procedural how-to’s for the pre-participation physical evaluation; the latest treatment recommendations on proper nutrition for athletes; proven injury prevention guidelines; and detailed treatments for dozens of injuries. Topics have been selected to reflect the health and safety issues most likely to be encountered by primary care practitioners. Numerous color photos and illustrations bring the authoritative text to life. The 2nd edition includes all-new chapters on nutrition and weight control, performance-enhancing substances, risks of injury during sports participation, and acute and overuse shoulder injuries. Important new findings on issues specific to the female athlete, a new bonus signs and symptoms poster, and patient education handouts are available through a password-protected Web site.
Caring for Your School-Age Child Ages 5 To 12
Authors:   American Academy of Pediatrics
Published: November 2021

This comprehensive health reference and a complete guide to the complex developmental issues of the middle years includes more than 100 illustrations and offers up-to-date information on: Nutrition, injury prevention, immunizations, physical fitness, and sports participation, School readiness, the gifted, or the student with learning disorders, Depression, aggression, shyness, and running away, Health concerns, Coping with divorce, death, and moving.
Getting It Right for Children
Authors:   American Academy of Pediatrics, Berman Stephen
Published: November 2021

Getting it Right for Children is the story of one pediatrician, determined to make a difference in the lives of children. The book follows the physician as he witness's inequities in the health care system, and involves the reader in his journey to enact legislation for better access to health care for children. Stephen Berman, MD, FAAP, is one pediatrician who made a difference and inspires others to do the same.
Pediatric Dermatology
Authors:   American Academy of Pediatrics Section on Dermatology
Published: November 2021

Here’s the first place to look for practical, concise, abundantly illustrated guidance on the recognition and treatment of more than 100 pediatric and adolescent skin conditions. The second edition of Pediatric Dermatology: A Quick Reference Guide provides the guidance you need to evaluate, diagnose, treat, and manage diverse dermatologic problems occurring from birth through adolescence.
Eating Disorders and the Media
Authors: Hogan Marjorie , Strasburger Victor C.
Published: November 2021

Body self-image is a major concern for teenagers. Pressure to emulate the American body ideal—ultrathin for women, muscular for men—comes from a combination of forces, with teens constructing their ideal body image through messages from family, peers, and the media. But do the media cause eating disorders? As with many aspects of media research, the answer is complicated, and this article discusses ways media may influence body self-image and eating behavior. Given concerns that negative body self-image may contribute to disordered eating, media education presents an opportunity to counter harmful messages and images on large and small screens and in the print media.
Newer Approaches to Acute Nutritional Rehabilitation for Patients With Anorexia Nervosa
Authors: Garber Andrea K. , Kohn Michael
Published: November 2021

Refeeding in the hospital is recommended for patients with malnutrition and medical instability secondary to restrictive eating disorders. For decades, the standard approach to refeeding was lower calorie diets, aimed at minimizing risk for the refeeding syndrome. Emerging data indicate that this approach may be too conservative, and that higher calorie refeeding is feasible. This approach is being rapidly translated into practice with wide variability in routes of delivery and electrolyte correction. This article reviews the current research on refeeding, with particular attention to gaps in the evidence that must be filled before new refeeding recommendations can be developed.
Epidemiology and Social Determinants of Global Health as the Basis for Education and Research
Authors: Laraque Fabienne , Uwemedimo Omolara Thomas
Published: November 2021

This chapter describes the importance of using standard data for decision-making at local and national levels on reportable diseases and conditions of public health significance. In addition, the chapter will provide an overview of the use of data to monitor interventions and detect outbreaks and emerging conditions. Lastly, this chapter will cover the importance of data, data sources, key indicators of childhood health, the role of millennium and sustainable goals, and training needs.

In all health care settings, whether population based or institution specific, the importance of effective use of data for planning and monitoring cannot be overstated. Implementing interventions and programs, even those that are evidence based, without the benefit of a local needs assessment and continuous data monitoring may not succeed due to erroneous targeting and inability to monitor progress. To ensure that public health and clinical programs are targeted to the setting and population in which they will be implemented, standard data collection and analysis is critical. The use of standard indicators allows for comparison across countries or regions.
Global Health Education Faculty Competencies
Authors: Kurbasic Mirzada Pasic
Published: November 2021

In high-income countries, global health has emerged as a core component of medical education across most medical disciplines. Approximately two-thirds of US pediatric residency programs offer the opportunity to complete short-term global health electives in low- and middle-income countries,1 and about one-fifth of residents pursue such an elective.

Internal medicine, emergency medicine, and pediatrics now all offer formal fellowship opportunities in international (ie, global) health. Global health opportunities among Accreditation Council for Graduate Medical Education–accredited pediatric subspecialty fellowship programs are limited but increasing, as noted by its online report.2 Global health has become a branch of science supporting institutionalized education. A rapidly expanding experience indicates that effective global health education should train students to understand global health statuses, to investigate global and local health issues with a global perspective, and to devise interventions to deal with these issues.3
Child Development: The Next Global Health Frontier
Authors: Elansary Mei , Peacock-Chambers Elizabeth , Zuckerman Barry S.
Published: November 2021

Recent improvements in child health have led to substantial decreases in child mortality globally.1 While progress is still needed, especially in regions afflicted by conflict and political instability,2 the next step is to promote young children’s development and early learning so they can remain healthy, take advantage of growing educational opportunities, and contribute to their communities’ economic growth. Every year, approximately 249 million children, mainly from low- and middle- income countries, fail to reach their developmental potential in the context of poverty and related health, nutrition, and social factors.3 Recessions and climate change additionally contribute to loss of developmental potential globally.4–7

While principles of early childhood development are universal, a global perspective must consider exposure to extreme poverty and high prevalence of infectious diseases, cultural context, and availability and type of resources. This chapter will describe biological and social factors that influence brain development and early learning and resilience, their cultural context, and examples of successful child development interventions globally. We also provide recommendations to rapidly accelerate the promotion of early childhood development globally with key strategies, including an emphasis on universal prevention programs rather than universal screening, multigenerational models that emphasize universal support for parents and targeted support for high-risk populations, integration of child development programs into child health and nutrition efforts, and use of technology.
Ethical Research in Global Child Health
Authors: Dewey Deborah , Konje Eveline T. , Nyanza Elias C. , Bernier Francois P. , Manyama Mange
Published: November 2021

Global child health research plays a pivotal role in addressing inequities in children’s health and development worldwide. To achieve this goal, research must be based on sound scientific and ethical principles. This chapter focuses on ethics in child health research in low-, middle-, and high-income countries. It reflects on the key principles underlying ethical research in general and in global health research and child health research in particular. This is followed by a detailed discussion of 3 core principles underlying child health research: respect, benefit, and justice. Research with children poses important and universal ethical issues across world contexts, including establishing consent, protection from harm, privacy, and payment and gifts. Cultural, social, political, and economic factors that can interact to pose particular challenges with regard to these issues in different contexts, especially in low- and middle-income settings, are explored. As methodology and ethics are integrally linked, this chapter also examines the ways in which children have been included in health research studies: research on children, research with children, and research by children. This is followed by a brief discussion of ethical mechanisms that are in place to ensure that ethical standards are met and maintained in research on global child health. The chapter concludes with a discussion of the many positive changes in ethical research involving children in recent years. Emerging ethical challenges in the fields of genetics and genomics are highlighted.
Developing the Agenda for Global Child Health at the American Academy of Pediatrics
Authors: Klein Jonathan D. , Alden Errol R.
Published: November 2021

There are challenges in establishing guidelines for care and in implementing evidence-based recommendations and guidelines in many countries. This is a reflection of nationalistic approaches to governance and, more specifically, national choices governing the social strategies that are deemed acceptable to decision-makers. These challenges are not limited to low- and middle-income countries; within the United States and other high-income countries, individual state and community governmental jurisdictions can be resistant to new evidence or to examples of successes that work in neighboring governmental units.1 But despite these nationalistic tendencies, efforts to share successful models for pediatric education have helped spread innovation and quality improvements in care to many countries over the past several decades. This chapter reviews some of the factors that made this spread possible, including the rapid growth and institutionalization of global health training in US residency programs; addresses the future development of competencies and ethical standards within the current framework of the UN Sustainable Development Goals; and provides a perspective on the role of US pediatric associations in setting and supporting the agenda for global child and adolescent health research, practice, and education.
AM:STARs: Adolescent Contraception: Basics and Beyond
Authors:   American Academy of Pediatrics Section on Adolescent Health
Published: November 2021

AMSTARs: Adolescent Contraception: Basics and Beyond highlights the fundamental aspects of contraception with an overview of contraceptive methods and epidemiology, provides up-to-date guidance on medical eligibility criteria, and reviews critical policy advances supporting contraceptive access.

https://shop.aap.org/amstarsadolescent-contraception-basics-and-beyond-paperback/
Nicotine and Tobacco as Substances of Abuse in Children and Adolescents
Authors: Siqueira Lorena M.
Published: November 2021

Nicotine is the primary pharmacologic component of tobacco, and users of tobacco products seek out its effects. The highly addictive nature of nicotine is responsible for its widespread use and difficulty with quitting. This technical report focuses on nicotine and discusses the stages of use in progression to dependence on nicotine-containing products; the physiologic characteristics, neurobiology, metabolism, pharmacogenetics, and health effects of nicotine; and acute nicotine toxicity. Finally, some newer approaches to cessation are noted.
Firearm-Related Injuries Affecting the Pediatric Population
Authors:   COUNCIL ON INJURY, VIOLENCE, AND POISON PREVENTION EXECUTIVE COMMITTEE
Published: November 2021

The absence of guns from children’s homes and communities is the most reliable and effective measure to prevent firearm-related injuries in children and adolescents. Adolescent suicide risk is strongly associated with firearm availability. Safe gun storage (guns unloaded and locked, ammunition locked separately) reduces children’s risk of injury. Physician counseling of parents about firearm safety appears to be effective, but firearm safety education programs directed at children are ineffective. The American Academy of Pediatrics continues to support a number of specific measures to reduce the destructive effects of guns in the lives of children and adolescents, including the regulation of the manufacture, sale, purchase, ownership, and use of firearms; a ban on semiautomatic assault weapons; and the strongest possible regulations of handguns for civilian use.
Pediatric Firearm-Related Injuries in the United States
Authors: Parikh Kavita , Silver Alyssa , Patel Shilpa J. , Iqbal Sabah F. , Goyal Monika
Published: November 2021

Pediatric firearm-related deaths and injuries are a national public health crisis. In this Special Review Article, we characterize the epidemiology of firearm-related injuries in the United States and discuss public health programs, the role of pediatricians, and legislative efforts to address this health crisis. Firearm-related injuries are leading causes of unintentional injury deaths in children and adolescents. Children are more likely to be victims of unintentional injuries, the majority of which occur in the home, and adolescents are more likely to suffer from intentional injuries due to either assault or suicide attempts. Guns are present in 18% to 64% of US households, with significant variability by geographic region. Almost 40% of parents erroneously believe their children are unaware of the storage location of household guns, and 22% of parents wrongly believe that their children have never handled household guns. Public health interventions to increase firearm safety have demonstrated varying results, but the most effective programs have provided free gun safety devices to families. Pediatricians should continue working to reduce gun violence by asking patients and their families about firearm access, encouraging safe storage, and supporting firearm-related injury prevention research. Pediatricians should also play a role in educating trainees about gun violence. From a legislative perspective, universal background checks have been shown to decrease firearm homicides across all ages, and child safety laws have been shown to decrease unintentional firearm deaths and suicide deaths in youth. A collective, data-driven public health approach is crucial to halt the epidemic of pediatric firearm-related injury.
Weapon Involvement in the Victimization of Children
Authors: Mitchell Kimberly J. , Hamby Sherry L. , Turner Heather A. , Shattuck Anne , Jones Lisa M.
Published: November 2021

OBJECTIVE

To report the prevalence of weapons involved in the victimization of youth with particular emphasis on weapons with a “high lethality risk” and how such exposure fits into the broader victimization and life experiences of children and adolescents.

METHODS

Data were collected as part of the Second National Survey of Children’s Exposure to Violence, a nationally representative telephone survey of youth ages 2 to 17 years and caregivers (N = 4114) conducted in 2011.

RESULTS

Estimates from the Second National Survey of Children’s Exposure to Violence indicate that almost 14 million youth, ages 2–17, in the United States have been exposed to violence involving a weapon in their lifetimes as witnesses or victims, or >1 in 5 children in this age group. More than 2 million youth in the United States (1 in 33) have been directly assaulted in incidents where the high lethality risk weapons of guns and knives were used. Differences were noted between victimizations involving higher and lower lethality risk weapons as well as between any weapon involvement versus none. Poly-victims, youth with 7 or more victimization types, were particularly likely to experience victimization with any weapon, as well as victimization with a highly lethal weapon compared with nonpoly-victims.

CONCLUSIONS

Findings add to the field’s broadening conceptualization of youth victimization highlighting the potentially highly consequential risk factor of weapon exposure as a component of victimization experiences on the mental health of youth. Further work on improving gun safety practices and taking steps to reduce children’s exposure to weapon-involved violence is warranted to reduce this problem.
The Impact of Marijuana Policies on Youth: Clinical, Research, and Legal Update
Authors: Ammerman Seth , Ryan Sheryl , Adelman William P.
Published: November 2021

This technical report updates the 2004 American Academy of Pediatrics technical report on the legalization of marijuana. Current epidemiology of marijuana use is presented, as are definitions and biology of marijuana compounds, side effects of marijuana use, and effects of use on adolescent brain development. Issues concerning medical marijuana specifically are also addressed. Concerning legalization of marijuana, 4 different approaches in the United States are discussed: legalization of marijuana solely for medical purposes, decriminalization of recreational use of marijuana, legalization of recreational use of marijuana, and criminal prosecution of recreational (and medical) use of marijuana. These approaches are compared, and the latest available data are presented to aid in forming public policy. The effects on youth of criminal penalties for marijuana use and possession are also addressed, as are the effects or potential effects of the other 3 policy approaches on adolescent marijuana use. Recommendations are included in the accompanying policy statement.
Prolonged Atrial Fibrillation Precipitated by New-Onset Seizures and Marijuana Abuse
Authors: Singh Dinesh , Huntwork Margaret , Shetty Varun , Sequeira Gina , Akingbola Olugbenga
Published: November 2021

We report a case of prolonged atrial fibrillation (AF) precipitated by new-onset generalized tonic–clonic convulsions and marijuana abuse in a developmentally normal 18-year-old adolescent with a structurally normal heart. Our case highlights an interesting association and a unique pathophysiology between generalized tonic–clonic convulsions, marijuana abuse, and AF. We suggest that seizures and marijuana abuse should be considered in the differential diagnosis of the etiology of AF in children.
Countering Vaccine Hesitancy
Authors: Edwards Kathryn M. , Hackell Jesse M.
Published: November 2021

Immunizations have led to a significant decrease in rates of vaccine-preventable diseases and have made a significant impact on the health of children. However, some parents express concerns about vaccine safety and the necessity of vaccines. The concerns of parents range from hesitancy about some immunizations to refusal of all vaccines. This clinical report provides information about addressing parental concerns about vaccination.
Practical Approaches to Optimize Adolescent Immunization
Authors: Bernstein Henry H. , Bocchini Joseph A.
Published: November 2021

With the expansion of the adolescent immunization schedule during the past decade, immunization rates notably vary by vaccine and by state. Addressing barriers to improving adolescent vaccination rates is a priority. Every visit can be viewed as an opportunity to update and complete an adolescent’s immunizations. It is essential to continue to focus and refine the appropriate techniques in approaching the adolescent patient and parent in the office setting. Health care providers must continuously strive to educate their patients and develop skills that can help parents and adolescents overcome vaccine hesitancy. Research on strategies to achieve higher vaccination rates is ongoing, and it is important to increase the knowledge and implementation of these strategies. This clinical report focuses on increasing adherence to the universally recommended vaccines in the annual adolescent immunization schedule of the American Academy of Pediatrics, the American Academy of Family Physicians, the Centers for Disease Control and Prevention, and the American Congress of Obstetricians and Gynecologists. This will be accomplished by (1) examining strategies that heighten confidence in immunizations and address patient and parental concerns to promote adolescent immunization and (2) exploring how best to approach the adolescent and family to improve immunization rates.
Schedules for Pneumococcal Vaccination of Preterm Infants: An RCT
Authors: Kent Alison , Ladhani Shamez N. , Andrews Nick J. , Scorrer Tim , Pollard Andrew J. , Clarke Paul , Hughes Stephen M. , Heal Carrie , Menson Esse , Chang John , Satodia Prakash , Collinson Andrew C. , Faust Saul N. , Goldblatt David , Miller Elizabeth , Heath Paul T.
Published: November 2021

BACKGROUND AND OBJECTIVE

Premature infants have a higher risk of invasive pneumococcal disease and are more likely to have lower vaccine responses compared with term infants. Increasingly, immunization schedules are including a reduced, 2-dose, pneumococcal conjugate vaccine priming schedule. Our goal was to assess the immunogenicity of 3 commonly used 13-valent pneumococcal conjugate vaccine (PCV13) priming schedules in premature infants and their response to a 12-month booster dose.

METHODS

Premature infants (<35 weeks’ gestation) were randomized to receive PCV13 at 2 and 4 months (reduced schedule); 2, 3, and 4 months (accelerated schedule); or 2, 4, and 6 months (extended schedule). All infants received a 12-month PCV13 booster. Serotype-specific pneumococcal immunoglobulin G (IgG) for PCV13 serotypes was measured by using enzyme-linked immunosorbent assay 1 month after the primary and booster vaccinations.

RESULTS

A total of 210 infants (median birth gestation, 29+6 weeks; range, 23+2–34+6 weeks) were included. After the primary vaccination, 75% (95% confidence interval [CI], 62–85), 88% (95% CI, 76–95), and 97% (95% CI, 87–99) of participants had protective antibody concentrations for at least one-half the PCV13 serotypes for the reduced, accelerated, and extended schedules, respectively. After the booster vaccination, participants receiving the extended schedule had significantly lower (P < .05) geometric mean concentrations compared with reduced (for 9 of 13 serotypes) and accelerated (for 4 of 13 serotypes) schedules, but nearly all participations, regardless of schedule or serotype, had seroprotective IgG concentrations.

CONCLUSIONS

A reduced priming schedule of PCV13 resulted in higher post-booster IgG concentrations but lower post-primary concentrations. The optimum vaccine schedule for preterm infants will therefore depend on when they are most at risk for invasive pneumococcal disease.
Should Pediatric Practices Have Policies to Not Care for Children With Vaccine-Hesitant Parents?
Authors: Alexander Kenneth , Lacy Tomas A. , Myers Angela L. , Lantos John D.
Published: November 2021

One of the most divisive issues in pediatrics today concerns the proper response by pediatricians to parents who refuse routine childhood immunizations for their children. Many pediatricians refuse to care for such families. Others continue to provide care and continue to try to convince parents that the benefits of immunizations far outweigh the risks. Two of the most powerful arguments in favor of dismissing such parents are as follows: (1) their refusal suggests such lack of trust in the physicians’ recommendations that it undermines the basis for a meaningful physician–patient–parent relationship; and (2) unimmunized children present an unacceptable risk to other children in the physicians’ waiting rooms. This article examines those arguments.
Vaccine Education During Pregnancy and Timeliness of Infant Immunization
Authors: Veerasingam Priya , Grant Cameron C. , Chelimo Carol , Philipson Kathryn , Gilchrist Catherine A. , Berry Sarah , Carr Polly Atatoa , Camargo Carlos A. , Morton Susan
Published: November 2021

OBJECTIVES

Pregnant women routinely receive information in support of or opposing infant immunization. We aimed to describe immunization information sources of future mothers’ and determine if receiving immunization information is associated with infant immunization timeliness.

METHODS

We analyzed data from a child cohort born 2009–2010 in New Zealand. Pregnant women (N = 6822) at a median gestation of 39 weeks described sources of information encouraging or discouraging infant immunization. Immunizations received by cohort infants were determined through linkage with the National Immunization Register (n = 6682 of 6853 [98%]). Independent associations of immunization information received with immunization timeliness were described by using adjusted odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

Immunization information sources were described by 6182 of 6822 (91%) women. Of these, 2416 (39%) received information encouraging immunization, 846 (14%) received discouraging information, and 565 (9%) received both encouraging and discouraging information. Compared with infants of women who received no immunization information (71% immunized on-time), infants of women who received discouraging information only (57% immunized on time, OR = 0.49, 95% CI 0.38–0.64) or encouraging and discouraging information (61% immunized on time, OR = 0.51, 95% CI 0.42–0.63) were at decreased odds of receiving all immunizations on time. Receipt of encouraging information only was not associated with infant immunization timeliness (73% immunized on time, OR = 1.00, 95% CI 0.87–1.15).

CONCLUSIONS

Receipt, during pregnancy, of information against immunization was associated with delayed infant immunization regardless of receipt of information supporting immunization. In contrast, receipt of encouraging information is not associated with infant immunization timeliness.
Medication-Assisted Treatment of Adolescents With Opioid Use Disorders
Authors:   COMMITTEE ON SUBSTANCE USE AND PREVENTION
Published: November 2021

Opioid use disorder is a leading cause of morbidity and mortality among US youth. Effective treatments, both medications and substance use disorder counseling, are available but underused, and access to developmentally appropriate treatment is severely restricted for adolescents and young adults. Resources to disseminate available therapies and to develop new treatments specifically for this age group are needed to save and improve lives of youth with opioid addiction.
Duration of Breastfeeding and Risk of SIDS: An Individual Participant Data Meta-analysis
Authors: Thompson John M.D. , Tanabe Kawai , Moon Rachel Y. , Mitchell Edwin A. , McGarvey Cliona , Tappin David , Blair Peter S. , Hauck Fern R.
Published: November 2021

CONTEXT

Sudden infant death syndrome (SIDS) is a leading cause of postneonatal infant mortality. Our previous meta-analyses showed that any breastfeeding is protective against SIDS with exclusive breastfeeding conferring a stronger effect. The duration of breastfeeding required to confer a protective effect is unknown.

OBJECTIVE

To assess the associations between breastfeeding duration and SIDS.

DATA SOURCES

Individual-level data from 8 case-control studies.

STUDY SELECTION

Case-control SIDS studies with breastfeeding data.

DATA EXTRACTION

Breastfeeding variables, demographic factors, and other potential confounders were identified. Individual-study and pooled analyses were performed.

RESULTS

A total of 2267 SIDS cases and 6837 control infants were included. In multivariable pooled analysis, breastfeeding for <2 months was not protective (adjusted odds ratio [aOR]: 0.91, 95% confidence interval [CI]: 0.68–1.22). Any breastfeeding ≥2 months was protective, with greater protection seen with increased duration (2–4 months: aOR: 0.60, 95% CI: 0.44– 0.82; 4–6 months: aOR: 0.40, 95% CI: 0.26–0.63; and >6 months: aOR: 0.36, 95% CI: 0.22– 0.61). Although exclusive breastfeeding for <2 months was not protective (aOR: 0.82, 95% CI: 0.59–1.14), longer periods were protective (2–4 months: aOR: 0.61, 95% CI: 0.42–0.87; 4–6 months: aOR: 0.46, 95% CI: 0.29–0.74).

LIMITATIONS

The variables collected in each study varied slightly, limiting our ability to include all studies in the analysis and control for all confounders.

CONCLUSIONS

Breastfeeding duration of at least 2 months was associated with half the risk of SIDS. Breastfeeding does not need to be exclusive to confer this protection.
Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents
Authors: Rafferty Jason ,   COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH, COMMITTEE ON ADOLESCENCE, SECTION ON LESBIAN, GAY, BISEXUAL, AND TRANSGENDER HEALTH AND WELLNESS
Published: November 2021

As a traditionally underserved population that faces numerous health disparities, youth who identify as transgender and gender diverse (TGD) and their families are increasingly presenting to pediatric providers for education, care, and referrals. The need for more formal training, standardized treatment, and research on safety and medical outcomes often leaves providers feeling ill equipped to support and care for patients that identify as TGD and families. In this policy statement, we review relevant concepts and challenges and provide suggestions for pediatric providers that are focused on promoting the health and positive development of youth that identify as TGD while eliminating discrimination and stigma.
Hepatosplenomegaly in liver cirrhosis is caused by reactive oxygen species formation, an increase in apoptosis and autophagy, and pronounced autoimmune reactions
Authors: Klimova E. M. , Drozdova L. A. , Lavinska O. V. , Bychenko E. A. , Kot Y. H. , Kordon T. I.
Published: November 2021

Various factors of infectious and toxic genesis can lead to the liver cirrhosis, often accompanied by complications such as recurrent bleeding due to portal hypertension against the background of hepatosplenomegaly. Metabolic changes and disturbances in immunoreactivity occur in the liver and spleen. To substantiate the choice of personalized treatment tactics for patients with hepatosplenomegaly, we investigated individual metabolic predictors and immunopathological processes in patients with: liver cirrhosis and hepatitis B (HBV) and/or hepatitis C (HCV) viruses (I group, n = 52); with herpes viruses CMV (cytomegalovirus) and EBV (Epstein-Barr virus) (II group, n = 48), and with splenomegaly and frequent recurrent bleeding associated with hereditary enzymopathies (III group, n = 15). We used the methods of immunoturbidimetry; enzyme immunoassay; light, fluorescence and confocal microscopy. In group I (HBV/HCV), we revealed a decrease in the C4 component; a significant increase in the phagocytic index and phagocytic number, a reduced number of active phagocytes and the digestion index; a decrease in the IL-1β content and an increase in IL-18 and IL-6. In group II (CMV/EBV), we revealed a high activity of the C3 and a low activity of the C4 component against the background of a high level of ROS in neutrophils; the antineutrophil antibodies (ANCA) formation in 85.7% of patients (71.4% –perinuclear antibodies (pANCA) to myeloperoxidase; 14.3% – cytoplasmic antibodies (CANCA) to proteinase 3). Also, in group II, an increased level of pro-inflammatory cytokines IFN-γ, IL-1β, TNF-α, IL-18 and anti-inflammatory IL-6 was detected. Changes in links of immunity in II group led to the formation of autoimmune reactions in 64.7% of patients, which was expressed in the development of a broad range of antinuclear antibodies ANA (11 specificities, including ANA to chromatin and chromatin-associated proteins, to proteins cytoskeleton, enzymes and enzyme complexes). In group III, we revealed a low absorption capacity of neutrophils, a high frequency of antineutrophil antibodies pANCA occurrence and cANCA (in 67.2% of the examined), and low concentration of TNF-α. The developed model of the stepwise change of immunological markers makes it possible to substantiate the choice of a complex targeted treatment, including antiviral and immunotropic therapy.