What the Evidence Does (and Does Not) Show for the Centers for Disease Control and Prevention Child Development Milestones: An Illustrative Example Using Expressive Vocabulary.

PURPOSE: Child development milestones are a critical tool for pediatricians and caregivers to use for developmental surveillance. Following review and selection by a panel of subject matter experts, the Centers for Disease Control and Prevention (CDC) published a revised list of milestones across multiple domains of development. Using expressive vocabulary, a key indicator of language development, as an illustrative example, the purpose of this brief review is to evaluate the evidence used to establish the CDC developmental milestones and determine whether the samples used to establish these milestones are representative of U.S. children. METHOD: Authors reviewed the methods and evidence cited to determine the CDC milestones. First, authors identified each language/communication milestone that measured expressive vocabulary as number of words, followed by review of the sources cited in support of each extracted milestone. Then, data related to both milestones and sample characteristics were extracted and compiled as well as compared with data from a validated parent report measure of expressive vocabulary, the MacArthur-Bates Communication Development Inventories. RESULTS: Results indicated that evidence was conflicting, misaligned, or missing for the selected CDC expressive vocabulary milestones. This review also indicated that the samples used to determine the selected CDC expressive vocabulary milestones are not representative of U.S. children. CONCLUSION: The striking paucity of evidence supporting the new CDC milestones for expressive vocabulary illustrates the critical need for future research in this area to establish more accurate milestones for U.S. children, with a focus on culturally inclusive large-scale data.

Actualización de áreas de riesgo y perfil epidemiológico de hantavirus en Paraguay (2013-2020)

El síndrome pulmonar por hantavirus (SPH) en el Paraguay es una infección relacionada a extensas áreas geográficas del Chaco o Región Occidental. Sin embargo, en los últimos años se han reportado casos fuera del área endémica conocida. Con el objetivo de describir el perfil epidemiológico de la enfermedad en nuestro país, y actualizar las áreas de transmisión, se realizó una revisión retrospectiva de los casos registrados desde el 2013 al 2020. Fueron confirmados 90 casos de SPH, siendo la Región Occidental la de mayor proporción de casos, con 92% en dicho periodo. La Región Oriental registró el 5,5% de los casos, mientras que en el 2,5% de los casos no fue posible determinar el territorio de ocurrencia del contagio. El perfil de la enfermedad en el país se presenta como una afección principalmente de hombres en la edad adulta - joven, ligados a actividades de campo. Los principales desafíos para el abordaje de esta enfermedad son sensibilizar a la población de las nuevas áreas de riesgo identificadas, fortalecer la vigilancia en dichos lugares a fin de captar en forma oportuna a los casos, y actualizar los conocimientos sobre los virus circulantes y los reservorios zoonóticos de la enfermedad.

Hantavirus Pulmonary Syndrome in Paraguay is an infection related to the Chaco area or Western Region. However, in recent years cases it has been reported outside the known endemic area. In order to describe the epidemiological profile of the disease in our country, and update the transmission areas, a retrospective review of the cases registered from 2013 to 2020. Ninety HPS cases were confirmed, being the Western Region the one that contributed the highest proportion of cases, with 92% in the study period. The Eastern Region registered 5.5% of the cases, while in 2.5% of the cases it was not possible to determine the place. The profile of the disease in the country is presented as a condition mainly of men in adulthood - young, linked to field activities. The main challenges were to sensitize the population of the newly identified risk areas, strengthen the surveillance in these places in order to capture cases in a timely manner and update knowledge about the circulating viruses and zoonotic reservoirs of the disease.

Herbivory makes major contributions to ecosystem carbon and nutrient cycling in tropical forests.

The functional role of herbivores in tropical rainforests remains poorly understood. We quantified the magnitude of, and underlying controls on, carbon, nitrogen and phosphorus cycled by invertebrate herbivory along a 2800 m elevational gradient in the tropical Andes spanning 12°C mean annual temperature. We find, firstly, that leaf area loss is greater at warmer sites with lower foliar phosphorus, and secondly, that the estimated herbivore-mediated flux of foliar nitrogen and phosphorus from plants to soil via leaf area loss is similar to, or greater than, other major sources of these nutrients in tropical forests. Finally, we estimate that herbivores consume a significant portion of plant carbon, potentially causing major shifts in the pattern of plant and soil carbon cycling. We conclude that future shifts in herbivore abundance and activity as a result of environmental change could have major impacts on soil fertility and ecosystem carbon sequestration in tropical forests.