White children's prosocial behavior toward White versus Black peers: The role of children's effortful control and parents' implicit racial attitudes.

White children's effortful control (EC), parents' implicit racial attitudes, and their interaction were examined as predictors of children's prosocial behavior toward White versus Black recipients. Data were collected from 171 White children (55% male, Mage = 7.13 years, SD = 0.92) and their parent in 2017. Prosocial behavior toward White peers was predicted by children's higher EC. When predicting prosocial behavior toward Black peers and prosocial disparity (the difference between White and Black recipients), parents' implicit racial attitudes moderated the relation between children's EC and children's prosocial behavior. Specifically, children's EC was positively associated with prosocial behavior toward Black peers (and negatively related to inequity in prosocial behavior) only when parents exhibited less implicit racial bias.

White children's empathy-related responding and prosocial behavior toward White and Black children.

Relations among White (non-Latinx) children's empathy-related responding, prosocial behaviors, and racial attitudes toward White and Black peers were examined. In 2017, 190 (54% boys) White 5- to 9-year-old children (M = 7.09 years, SD = 0.94) watched a series of videos that depicted social rejection of either a White or Black child. Empathy-related responses, prosocial behaviors, and racial attitudes were measured using multiple methods. Results showed that younger children showed less facial concern toward Black than White peers and greater increases with age in concern and prosocial behaviors (sharing a desirable prize) for Black, compared to White, targets. Children's facial anger increased with age for White but not Black targets. The findings can extend our understanding children's anti-racism development.

Compassion fatigue in pediatric hematology, oncology, and bone marrow transplant healthcare providers: An integrative review.

OBJECTIVE: Compassion fatigue (CF), which includes burnout and secondary traumatic stress, is highly prevalent among healthcare providers (HCPs). Ultimately, if left untreated, CF is often associated with absenteeism, decreased work performance, poor job satisfaction, and providers leaving their positions. To identify risk factors for developing CF and interventions to combat it in pediatric hematology, oncology, and bone marrow transplant (PHOB) HCPs. METHODS: An integrative review was conducted. Controlled vocabulary relevant to neoplasms, CF, pediatrics, and HCPs was used to search PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Web of Science MEDLINE. Inclusion criteria were the following: English language and PHOB population. Exclusion criteria were the following: did not address question, wrong study population, mixed study population where PHOB HCPs were only part of the population, articles about moral distress as this is a similar but not the same topic as CF, conference abstracts, and book chapters. RESULTS: A total of 16 articles were reviewed: 3 qualitative, 6 quantitative, 3 mixed methods, and 4 non research. Three themes were explored: (1) high-risk populations for developing CF, (2) sources of stress in PHOB HCPs, and (3) workplace interventions to decrease CF. SIGNIFICANCE OF RESULTS: PHOB HCPs are at high risk of developing CF due to high morbidity and mortality in their patient population. Various interventions, including the use of a clinical support nurse, debriefing, support groups, respite rooms, and retreats, have varying degrees of efficacy to decrease CF in this population.

Effortful Control and Extensive Observations of Negative Emotion as Joint Predictors of Teacher-Student Conflict in Childhood.

Studies with extensive observations of real-life emotions at school are rare but might be especially useful for predicting school-related outcomes. This study evaluated observations of negative emotion expressivity in lunch and recreation settings across kindergarten, first grade, and second grade (N = 301), kindergarten teachers' reports of children's effortful control, and kindergarten and second grade teachers' reports of their perceived conflict with children. In latent growth curve analyses, we tested whether individual trajectories of negative expressivity from kindergarten to second grade, based on estimated slopes, predicted teacher-student conflict in second grade, and whether effortful control in kindergarten moderated this association. RESEARCH FINDINGS: Negative expressivity levels in kindergarten significantly predicted higher levels of teacher-student conflict in second grade, controlling prior teacher-student conflict. Furthermore, greater increases in negative expressivity from kindergarten to second grade were associated with higher teacher-student conflict in second grade especially for children who had difficulties with effortful control in kindergarten. PRACTICE OR POLICY: Results from this study have the potential to inform programs focused on reducing teacher-student conflict. The findings highlight the possibility of targeting both effortful control and negative emotion in the early elementary school transition as a means to improve teacher-student relationships.

The Virtual Hospitalist: a Critical Innovation During the COVID-19 Crisis.

A virtual hospitalist program expanded our ability to confront the challenges of the COVID-19 crisis at the epicenter of the pandemic in New York City. In concert with on-site hospitalists and redeployed physicians, virtual hospitalists aimed to expand capacity while maintaining high-quality care and communication. The program addressed multiple challenges created by our first COVID-19 surge: high patient census and acuity; limitations of and due to personal protective equipment; increased communication needs due to visitor restrictions and the uncertain nature of the novel disease, and limitations to in-person work for some physicians. The program created a mechanism to train and support new hospitalists and provide and expand palliative care services. We describe how our virtual hospitalist program operated during our COVID-19 surge in April and May 2020 and reflect on potential roles of virtual hospitalists after the COVID-19 crisis passes.

Instituting a New Central Line Policy to Decrease Central Line-associated Blood Stream Infection Rates During Induction Therapy in Pediatric Acute Lymphoblastic Leukemia Patients.

BACKGROUND: Children with acute lymphoblastic leukemia (ALL) require central lines to facilitate their care. Peripherally inserted central catheters (PICCs) may have lower rates of central line-associated bloodstream infections (CLABSIs) versus other central lines. OBJECTIVES: The objective of this study was to compare the CLABSI rate in the first month of therapy after initiating a policy to place PICCs in new patients with severe neutropenia (SN) and Mediports in those with moderate-to-no neutropenia. We also examined thrombosis rates. DESIGN/METHOD: We prospectively gathered data on new patients for 2.5 years following the policy change and retrospectively for the 2 years prior and compared rates of CLABSIs and thrombosis. RESULTS: CLABSIs decreased in SN patients from 7.52/1000 to 3.11/1000 line days (P=0.33). The CLABSI rate for all patients with SN who had a Mediport was 13.39/1000 versus 4.08/1000 line days for those that received PICCs (P=0.15). The thrombosis rate for Mediport patients was 3.13 clots/1000 versus 7.65/1000 line days for PICC patients, but the difference was not significant (P= 0.11). CONCLUSION: The differences observed suggest that placing PICCs versus Mediports in new ALL patients with SN may result in a lower incidence of CLABSIs in the first month of therapy without a significant increase in thrombosis.

The relations of White parents' implicit racial attitudes to their children's differential empathic concern toward White and Black victims.

The goal of this study was to investigate the relations between White parents' implicit racial attitudes and their children's racially based bias in empathic concern toward White and Black victims of injustice as well as the moderating role of children's age in this relation. Children aged 5-9 years (N = 190) reported how sorry (i.e., sympathy) and nervous (i.e., personal distress) they felt after watching sympathy-inducing videos in which either a White (non-Hispanic) child or a Black child was teased by peers. Participants' primary caregivers (mostly mothers) completed a computerized Implicit Association Test to assess their implicit racial attitudes. Parents' implicit race bias was associated with their children's reported sympathy toward Black victims and their sympathetic bias (i.e., relative sympathy toward White vs. Black victims); however, results were moderated by children's age. Specifically, parents with higher implicit race bias tended to have children with lower levels of sympathy toward Black victims for younger children and higher levels of sympathetic bias for younger and average-aged children but not for older children. Older children tended to report relatively high levels of sympathy toward Black victims and low levels of sympathetic bias regardless of their parents' implicit attitudes. The importance of parents' implicit attitudes in understanding young children's race-based moral emotional responses and the implications for intervention work are discussed.

Supporting Infant Emotion Regulation Through Attachment-Based Intervention: a Randomized Controlled Trial.

Infant emotion regulation has long-term implications for human development, highlighting the need for preventive interventions that support emotion regulation early in life. Such interventions may be especially important for infants higher in emotional reactivity who need to regulate their emotions more frequently and intensely than infants lower in emotional reactivity. The current randomized trial examined main and moderated effects of an attachment-based intervention on (a) infants' use of mother-oriented and self-soothing emotion regulation strategies and (b) infant emotion dysregulation in 186 low-income, predominantly Latino infants. We tested the brief (10-session) Attachment and Biobehavioral Catch-up (ABC) intervention in the context of home-based federal Early Head Start (EHS) services. Control participants received home-based EHS plus 10 weekly books. Intent-to-treat analyses with covariates revealed main effects of the intervention on infants' use of mother-oriented emotion regulation strategies during a brief (40-s) novel and potentially fear-inducing procedure (d = 0.31). Infant emotional reactivity moderated intervention impacts on mother-oriented emotion regulation strategies and on infant emotion dysregulation: We found stronger effects of the intervention for infants relatively higher in emotional reactivity. Findings are discussed in terms of the preventive value of attachment-based interventions for supporting early emotion regulation.

Prediction of Children's Early Academic Adjustment from Their Temperament: The Moderating Role of Peer Temperament.

The goal of the study was to examine whether target children's temperamental negative emotional expressivity (NEE) and effortful control in the fall of kindergarten predicted academic adjustment in the spring and whether a classmate's NEE and effortful control moderated these relations. Target children's NEE and effortful control were measured in the fall via multiple methods, academic adjustment was measured via reading and math standardized tests in the spring, and observations of engagement in the classroom were conducted throughout the year. In the fall, teachers nominated a peer with whom each target child spent the most time and rated that peer's temperament. Target children with high effortful control had high reading and math achievement (ps = .04 and < .001, respectively), and children with low NEE increased in engagement during the year (p < .001). Peers' temperament did not have a direct relation to target children's academic adjustment. Peers' negative emotion, however, moderated the relation between target children's effortful control, as well as NEE, and changes in engagement (ps = .03 and .05, respectively). Further, peers' effortful control moderated the relations between target children's NEE and reading and changes in engagement (ps = .02 and .04, respectively). In each case, target children's temperament predicted the outcome in expected directions more strongly when peers had low NEE or high effortful control. Results are discussed in terms of how children's temperamental qualities relate to academic adjustment, and how the relation between NEE and changes in engagement, in particular, depends on peers' temperament.

Emotions in school and symptoms of psychological maladjustment from kindergarten to first grade.

The associations between children's (N = 301) observed expression of positive and negative emotion in school and symptoms of psychological maladjustment (i.e., depressive and externalizing symptoms) were examined from kindergarten to first grade. Positive and negative emotional expressivity levels were observed in school settings, and teachers reported on measures of children's externalizing and depressive symptoms. In longitudinal panel models testing bidirectional paths, depressive symptoms in kindergarten were negatively associated with positive expressivity in first grade but not vice versa. Children's externalizing symptoms in kindergarten predicted higher negative expressivity in school in first grade. There was also significant prediction of externalizing in first grade by negative expressivity during kindergarten. Implications about child psychological maladjustment in early schooling are discussed.

Bidirectional associations between emotions and school adjustment.

OBJECTIVE: We examined the relations of children's (N = 301) observed expression of negative and positive emotion in classes or nonclassroom school contexts (i.e., lunch and recess) to school adjustment from kindergarten to first grade. METHOD: Naturalistic observations of children's emotional expressivity were collected, as were teachers' reports of children's school engagement and relationship quality with teachers and peers. RESULTS: In longitudinal panel models, greater teacher-student conflict and lower student engagement in kindergarten predicted greater negative expressivity in both school contexts. School engagement and peer acceptance in kindergarten positively predicted first grade positive emotion in the classroom. Suggestive of possible bidirectional relations, there was also small unique prediction (near significant) from negative expressivity at lunch and recess to higher teacher-student conflict, from negative expressivity in the classroom to low peer acceptance, and from positive expressivity in the classroom to higher peer acceptance. CONCLUSIONS: The pattern of findings suggests that the quality of experience at school uniquely predicts children's emotional expressivity at school more consistently than vice versa-a finding that highlights the important role of school context in young children's emotionality at school.

Trajectories of the Expression of Negative Emotion from Kindergarten to First Grade: Associations with Academic Outcomes.

We examined individual trajectories, across four time points, of children's (N = 301) expression of negative emotion in classroom settings and whether these trajectories predicted their observed school engagement, teacher-reported academic skills, and passage comprehension assessed with a standardized measure in first grade. In latent growth curve analyses, negative expressivity declined from kindergarten to first grade with significant individual differences in trajectories. Negative expressivity in kindergarten inversely predicted first grade school engagement and teacher-reported academic skills, and the slope of negative expressivity from kindergarten to first grade inversely predicted school engagement (e.g., increasing negative expressivity was associated with lower school engagement). In addition, we examined if prior academic functioning in kindergarten moderated the association between negative expressivity (level in kindergarten and change over time) and academic functioning in first grade. The slope of negative expressivity was negatively associated with first grade school engagement and passage comprehension for children who had lower kindergarten school engagement and passage comprehension, respectively, but was unrelated for those with higher academic functioning in kindergarten. That is, for children who had lower kindergarten school engagement and passage comprehension, greater declines in negative expressivity were associated with higher first grade school engagement and passage comprehension, respectively. The findings suggest that negative emotional expressivity in school is associated with academic outcomes in first grade and, in some cases, this association is more pronounced for children who had lower kindergarten academic functioning.

Sleep duration moderates the association between children's temperament and academic achievement.

The primary goal of this study was to determine whether sleep duration moderated the relations of two dimensions of children's temperament, shyness and negative emotion, to academic achievement. In the autumn, parents and teachers reported on kindergarteners' and first graders' (N = 103) shyness and negative emotion and research assistants observed negative emotion in the classroom. In the spring, children wore actigraphs that measured their sleep for five consecutive school nights, and they completed the Woodcock Johnson-III standardized tests of achievement. Interactions between temperament and sleep duration predicting academic achievement were computed. Interactions of sleep duration with parent-reported shyness, teacher-reported negative emotion, and observed negative emotion indicated that the negative relations of shyness or negative emotion to academic achievement were strongest when children slept less. Results suggest that sleep duration may be an important bio-regulatory factor to consider in young children's early academic achievement.

Balance in Positive Emotional Expressivity Across School Contexts Relates to Kindergarteners' Adjustment.

Positive emotional expressivity has been associated with increased social competence and decreased maladjustment in childhood. However, a few researchers have found null or even positive associations between positive emotional expressivity and maladjustment, which suggests that there may be nuanced associations of positive expressivity, perhaps as a function of the social context in which it is expressed. We examined whether observed positive emotional expressivity balance across peer-oriented/recreational and learning contexts predicted kindergarten children's adjustment (N = 301). RESEARCH FINDINGS: Higher positive expressivity during lunch/recess compared to positive expressivity in the classroom was associated with lower teacher-student conflict, externalizing behaviors, and depressive symptoms. In addition, overall positive emotional expressivity predicted lower externalizing behaviors as well as lower depressive and anxiety symptoms. PRACTICE OR POLICY: The results suggest the importance of assessing observed positive emotional expressivity in context as a potential indicator of children's maladjustment risk and the need for children to adapt their emotions to different contexts. Implications for assessing and supporting positive emotional expression balance and training emotional regulation in school are discussed.

Self-Regulation and Academic Measures Across the Early Elementary School Grades: Examining Longitudinal and Bidirectional Associations.

This study evaluated the association between children's (N = 301) self-regulation and math and reading achievement in kindergarten, first grade, and second grade. Children's self-regulation was assessed using the Head-Toes-Knees-Shoulders (HTKS) task (involving control of gross body movements) and a computerized continuous performance task (CPT; assessing primarily inhibitory control) in kindergarten, first grade, and second grade. Research findings: Based on cross-lagged structural equation panel models, HTKS task performance positively predicted later math and reading achievement. Math achievement significantly and positively predicted later HTKS and CPT scores. Earlier math and reading achievement moderated the association between CPT scores and later math and reading achievement; inhibitory control-based self-regulation assessed with the CPT predicted higher math or reading achievement in subsequent grades for children with lower math or reading achievement in prior grades. Performance on the CPT moderated the paths from HTKS scores to later reading achievement; behavioral self-regulation assessed with the HTKS task predicted higher reading achievement in subsequent grades for children with low or average CPT performance in prior grades. Practice: Results from this study have the potential to inform targeted academic interventions focused on enhancing self-regulation in school contexts. The findings highlight the utility of assessing multiple measures of self-regulation.

Effortful control and school adjustment: The moderating role of classroom chaos.

Guided by the person by environment framework, the primary goal of this study was to determine whether classroom chaos moderated the relation between effortful control and kindergarteners' school adjustment. Classroom observers reported on children's (N = 301) effortful control in the fall. In the spring, teachers reported on classroom chaos and school adjustment outcomes (teacher-student relationship closeness and conflict, and school liking and avoidance). Cross-level interactions between effortful control and classroom chaos predicting school adjustment outcomes were assessed. A consistent pattern of interactions between effortful control and classroom chaos indicated that the relations between effortful control and the school adjustment outcomes were strongest in high chaos classrooms. Post-hoc analyses indicated that classroom chaos was associated with poor school adjustment when effortful control was low, suggesting that the combination of high chaos and low effortful control was associated with the poorest school outcomes.

Elementary Students' Effortful Control and Academic Achievement: The Mediating Role of Teacher-Student Relationship Quality.

This study evaluated the association between effortful control in kindergarten and academic achievement one year later (N = 301), and whether teacher-student closeness and conflict in kindergarten mediated the association. Parents, teachers, and observers reported on children's effortful control, and teachers reported on their perceived levels of closeness and conflict with students. Students completed the passage comprehension and applied problems subtests of the Woodcock-Johnson tests of achievement, as well as a behavioral measure of effortful control. Analytical models predicting academic achievement were estimated using a structural equation model framework. Effortful control positively predicted academic achievement even when controlling for prior achievement and other covariates. Mediation hypotheses were tested in a separate model; effortful control positively predicted teacher-student closeness and strongly, negatively predicted teacher-student conflict. Teacher-student closeness and effortful control, but not teacher-student conflict, had small, positive associations with academic achievement. Effortful control also indirectly predicted higher academic achievement through its positive effect on teacher-student closeness and via its positive relation to early academic achievement. The findings suggest that teacher-student closeness is one mechanism by which effortful control is associated with academic achievement. Effortful control was also a consistent predictor of academic achievement, beyond prior achievement levels and controlling for teacher-student closeness and conflict, with implications for intervention programs on fostering regulation and achievement concurrently.

Selective Retinoic Acid Receptor γ Agonists Promote Repair of Injured Skeletal Muscle in Mouse.

Retinoic acid signaling regulates several biological events, including myogenesis. We previously found that retinoic acid receptor γ (RARγ) agonist blocks heterotopic ossification, a pathological bone formation that mostly occurs in the skeletal muscle. Interestingly, RARγ agonist also weakened deterioration of muscle architecture adjacent to the heterotopic ossification lesion, suggesting that RARγ agonist may oppose skeletal muscle damage. To test this hypothesis, we generated a critical defect in the tibialis anterior muscle of 7-week-old mice with a cautery, treated them with RARγ agonist or vehicle corn oil, and examined the effects of RARγ agonist on muscle repair. The muscle defects were partially repaired with newly regenerating muscle cells, but also filled with adipose and fibrous scar tissue in both RARγ-treated and control groups. The fibrous or adipose area was smaller in RARγ agonist-treated mice than in the control. In addition, muscle repair was remarkably delayed in RARγ-null mice in both critical defect and cardiotoxin injury models. Furthermore, we found a rapid increase in retinoid signaling in lacerated muscle, as monitored by retinoid signaling reporter mice. Together, our results indicate that endogenous RARγ signaling is involved in muscle repair and that selective RARγ agonists may be beneficial to promote repair in various types of muscle injuries.