Young Children's Mathematical Learning From Intelligent Characters.

Children's math learning (N = 217; Mage  = 4.87 years; 63% European American, 96% college-educated families) from an intelligent character game was examined via social meaningfulness (parasocial relationships [PSRs]) and social contingency (parasocial interactions, e.g., math talk). In three studies (data collected in the DC area: 12/2015-10/2017), children's parasocial relationships and math talk with the intelligent character predicted quicker, more accurate math responses during virtual game play. Children performed better on a math transfer task with physical objects when exposed to an embodied character (Study 2), and when the character used socially contingent replies, which was mediated by math talk (Study 3). Results suggest that children's parasocial relationships and parasocial interactions with intelligent characters provide new frontiers for 21st century learning.

2 year neurodevelopmental and intermediate perinatal outcomes in infants with very preterm fetal growth restriction (TRUFFLE): a randomised trial.

BACKGROUND: No consensus exists for the best way to monitor and when to trigger delivery in mothers of babies with fetal growth restriction. We aimed to assess whether changes in the fetal ductus venosus Doppler waveform (DV) could be used as indications for delivery instead of cardiotocography short-term variation (STV). METHODS: In this prospective, European multicentre, unblinded, randomised study, we included women with singleton fetuses at 26-32 weeks of gestation who had very preterm fetal growth restriction (ie, low abdominal circumference [<10th percentile] and a high umbilical artery Doppler pulsatility index [>95th percentile]). We randomly allocated women 1:1:1, with randomly sized blocks and stratified by participating centre and gestational age (<29 weeks vs ≥29 weeks), to three timing of delivery plans, which differed according to antenatal monitoring strategies: reduced cardiotocograph fetal heart rate STV (CTG STV), early DV changes (pulsatility index >95th percentile; DV p95), or late DV changes (A wave [the deflection within the venous waveform signifying atrial contraction] at or below baseline; DV no A). The primary outcome was survival without cerebral palsy or neurosensory impairment, or a Bayley III developmental score of less than 85, at 2 years of age. We assessed outcomes in surviving infants with known outcomes at 2 years. We did an intention to treat study for all participants for whom we had data. Safety outcomes were deaths in utero and neonatal deaths and were assessed in all randomly allocated women. This study is registered with ISRCTN, number 56204499. FINDINGS: Between Jan 1, 2005 and Oct 1, 2010, 503 of 542 eligible women were randomly allocated to monitoring groups (166 to CTG STV, 167 to DV p95, and 170 to DV no A). The median gestational age at delivery was 30·7 weeks (IQR 29·1-32·1) and mean birthweight was 1019 g (SD 322). The proportion of infants surviving without neuroimpairment did not differ between the CTG STV (111 [77%] of 144 infants with known outcome), DV p95 (119 [84%] of 142), and DV no A (133 [85%] of 157) groups (ptrend=0·09). 12 fetuses (2%) died in utero and 27 (6%) neonatal deaths occurred. Of survivors, more infants where women were randomly assigned to delivery according to late ductus changes (133 [95%] of 140, 95%, 95% CI 90-98) were free of neuroimpairment when compared with those randomly assigned to CTG (111 [85%] of 131, 95% CI 78-90; p=0.005), but this was accompanied by a non-significant increase in perinatal and infant mortality. INTERPRETATION: Although the difference in the proportion of infants surviving without neuroimpairment was non-significant at the primary endpoint, timing of delivery based on the study protocol using late changes in the DV waveform might produce an improvement in developmental outcomes at 2 years of age. FUNDING: ZonMw, The Netherlands and Dr Hans Ludwig Geisenhofer Foundation, Germany.

Respiratory morbidity at follow-up of small-for-gestational-age infants born very prematurely.

BACKGROUND: The aim of this study was to determine whether small-for-gestational-age (SGA) infants born very prematurely had increased respiratory morbidity in the neonatal period and at follow-up. METHODS: Data were examined from infants recruited into the United Kingdom Oscillation Study (UKOS). Of the 797 infants who were born at <29 wk of gestational age, 174 infants were SGA. Overall, 92% were exposed to antenatal corticosteroids and 97% received surfactant; follow-up data at 22-28 mo were available for 367 infants. RESULTS: After adjustment for gestational age and sex, SGA infants had higher rates of supplementary oxygen dependency at 36 wk postmenstrual age (odds ratio (OR): 3.23; 95% confidence interval: 2.03, 5.13), pulmonary hemorrhage (OR: 3.07; 95% CI: 1.82, 5.18), death (OR: 3.32; 95% CI: 2.13, 5.17), and postnatal corticosteroid requirement (OR: 2.09; 95% CI: 1.35, 3.23). After adjustment for infant and respiratory morbidity risk factors, a lower mean birth weight z-score was associated with a higher prevalence of respiratory admissions (OR: 1.40; 95% CI: 1.03, 1.88 for 1 SD change in z-score), cough (OR: 1.28; 95% CI: 1.00, 1.65), and use of chest medicines (OR: 1.32; 95% CI: 1.01, 1.73). CONCLUSION: SGA infants who were born very prematurely, despite routine use of antenatal corticosteroids and postnatal surfactant, had increased respiratory morbidity at follow-up, which was not due to poor neonatal outcome.

Clinical prediction models for bronchopulmonary dysplasia: a systematic review and external validation study.

BACKGROUND: Bronchopulmonary dysplasia (BPD) is a common complication of preterm birth. Very different models using clinical parameters at an early postnatal age to predict BPD have been developed with little extensive quantitative validation. The objective of this study is to review and validate clinical prediction models for BPD. METHODS: We searched the main electronic databases and abstracts from annual meetings. The STROBE instrument was used to assess the methodological quality. External validation of the retrieved models was performed using an individual patient dataset of 3229 patients at risk for BPD. Receiver operating characteristic curves were used to assess discrimination for each model by calculating the area under the curve (AUC). Calibration was assessed for the best discriminating models by visually comparing predicted and observed BPD probabilities. RESULTS: We identified 26 clinical prediction models for BPD. Although the STROBE instrument judged the quality from moderate to excellent, only four models utilised external validation and none presented calibration of the predictive value. For 19 prediction models with variables matched to our dataset, the AUCs ranged from 0.50 to 0.76 for the outcome BPD. Only two of the five best discriminating models showed good calibration. CONCLUSIONS: External validation demonstrates that, except for two promising models, most existing clinical prediction models are poor to moderate predictors for BPD. To improve the predictive accuracy and identify preterm infants for future intervention studies aiming to reduce the risk of BPD, additional variables are required. Subsequently, that model should be externally validated using a proper impact analysis before its clinical implementation.

Electronic gaming and the obesity crisis.

Children and adolescents in the United States and in many countries are projected to have shorter life spans than their parents, partly because of the obesity crisis engulfing the developed world. Exposure to electronic media is often implicated in this crisis because media use, including electronic game play, may promote sedentary behavior and increase consumption of high-calorie foods and beverages that are low in nutritional value. Electronic games, however, may increase children's physical activity and expose them to healthier foods. We examine the role of electronic games in the pediatric obesity crisis and their contribution to more favorable health outcomes.

Neonatal and infant outcome in boys and girls born very prematurely.

INTRODUCTION: Although important new strategies have improved outcomes for very preterm infants, males have greater mortality/morbidity than females. We investigated whether the excess of adverse later effects in males operated through poorer neonatal profile or if there was an intrinsic male effect. RESULTS: Male sex was significantly associated with higher birth weight, death or oxygen dependency (72% vs. 61%, boys vs. girls), hospital stay (97 vs. 86 days), pulmonary hemorrhage (15% vs. 10%), postnatal steroids (37% vs. 21%), and major cranial ultrasound abnormality (20% vs. 12%). Differences remained significant after adjusting for birth weight and gestation. At follow-up, disability, cognitive delay, and use of inhalers remained significant after further adjustment. DISCUSSION: We conclude that in very preterm infants, male sex is an important risk factor for poor neonatal outcome and poor neurological and respiratory outcome at follow-up. The increased risks at follow-up are not explained by neonatal factors and lend support to the concept of male vulnerability following preterm birth. METHODS: Data came from the United Kingdom Oscillation Study, with 797 infants (428 boys) born at 23-28 wk gestational age. Thirteen maternal factors, 8 infant factors, 11 acute outcomes, and neurological and respiratory outcomes at follow-up were analyzed. Follow-up outcomes were adjusted for birth and neonatal factors sequentially to explore mechanisms for differences by sex.

Dietary Digital Diaries: Documenting Adolescents' Obesogenic Environment.

Obesogenic built environments may contribute to excessive eating and obesity. Twenty-three 12- to 17-year-old low-income African American adolescents created digital diaries by photographing their lunchtime food environment in a summer academic program. Digitally depicted foods were classified as appearing on the platescape (student's or others' plate) or the tablescape (food buffet). Height, weight, BMI percentile, and waist-to-hip ratio were calculated at baseline and week 4. Adolescents digitally depicted high caloric, high fat foods on the platescape and tablescape, particularly adolescents with a higher waist-to-hip ratio. Weight gain during the 4-week program was significantly predicted by the number of calories and the amount of fat content depicted on the student's plates. Digital diaries, then, can document adolescents' perspectives of their food environments that promote their overconsumption of high caloric and high fat foods that contribute to weight gain and put them at risk for obesity.

Elective high-frequency oscillatory versus conventional ventilation in preterm infants: a systematic review and meta-analysis of individual patients' data.

BACKGROUND: Population and study design heterogeneity has confounded previous meta-analyses, leading to uncertainty about effectiveness and safety of elective high-frequency oscillatory ventilation (HFOV) in preterm infants. We assessed effectiveness of elective HFOV versus conventional ventilation in this group. METHODS: We did a systematic review and meta-analysis of individual patients' data from 3229 participants in ten randomised controlled trials, with the primary outcomes of death or bronchopulmonary dysplasia at 36 weeks' postmenstrual age, death or severe adverse neurological event, or any of these outcomes. FINDINGS: For infants ventilated with HFOV, the relative risk of death or bronchopulmonary dysplasia at 36 weeks' postmenstrual age was 0.95 (95% CI 0.88-1.03), of death or severe adverse neurological event 1.00 (0.88-1.13), or any of these outcomes 0.98 (0.91-1.05). No subgroup of infants (eg, gestational age, birthweight for gestation, initial lung disease severity, or exposure to antenatal corticosteroids) benefited more or less from HFOV. Ventilator type or ventilation strategy did not change the overall treatment effect. INTERPRETATION: HFOV seems equally effective to conventional ventilation in preterm infants. Our results do not support selection of preterm infants for HFOV on the basis of gestational age, birthweight for gestation, initial lung disease severity, or exposure to antenatal corticosteroids. FUNDING: Nestlé Belgium, Belgian Red Cross, and Dräger International.

Prenatal diagnosis of non-immune hydrops fetalis: what do we tell the parents?

OBJECTIVE: The aim of this study is to outline the aetiology and outcome of a series of fetuses with non-immune hydrops (NIH), detected prenatally. The findings are compared with a comprehensive review of recent reports. METHODS: This is a retrospective study reviewing all pregnancies complicated by NIH in the fetus and continued after 20 weeks of pregnancy over a period of 10 years. Outcome was obtained from postmortem reports, discharge summaries, communication with the clinicians or information from the parents. A literature search was also performed to identify all reports on NIH in the last 10 years. RESULTS: Seventy-one fetuses affected by NIH were included in this study. The aetiology of the NIH was identified prenatally in 40 cases. The most common causes of NIH were thoracic disorders, infections and cardiovascular disorders. Forty-four of the 71 (62%) fetuses were live-born. There were 10 neonatal deaths. Of the remaining 34 babies, 17 infants survived without morbidity. CONCLUSION: The survival rate of NIH is at least 48% in this study. Prenatal identification of the cause is possible in 56% of cases. The risk of neurodevelopmental delay in those that survive is 3 of 28 (11%).

Infants' Visual Attention to Baby DVDs as a Function of Program Pacing.

This study examined the effects of program pacing, defined as the rate of scene and character change per minute, on infants' visual attention to video presentations. Seventy-two infants (twenty-four 6-month-olds, twenty-four 9-month-olds, twenty-four 12-month-olds) were exposed to one of two sets of high- and low-paced commercial infant DVDs. Each DVD was approximately 5-min long, and the order the DVDs were viewed was counterbalanced for pace. Attention was higher during rapidly than slowly paced DVDs, particularly for the 6- and 9-month-old infants. These results support previous research documenting that attention is initially controlled by exogenous qualities (e.g., rapid pace), but with development and experience becomes more influenced by endogenous factors.

Digital expression among urban, low-income African American adolescents.

Digital production is a means through which African American adolescents communicate and express their experiences with peers. This study examined the content and the form of the digital productions of 24 urban, low-income African American adolescents who attended a summer academic program. The content of student digital productions focused on academic experiences and friendships. Their production styles revealed that youth used perceptually salient production features, such as rapid scene changes and loud rap music. The results suggest that when placed in a supportive, academic environment and provided with digital production resources, students who traditionally face barriers due to cultural and economic inequalities digitally express to their peers an interest in academics and positive peer relationships, and that these youth communicate their experiences through a shared production style that reflects their broader cultural experiences.

Comparing methods of analysing datasets with small clusters: case studies using four paediatric datasets.

Studies of prematurely born infants contain a relatively large percentage of multiple births, so the resulting data have a hierarchical structure with small clusters of size 1, 2 or 3. Ignoring the clustering may lead to incorrect inferences. The aim of this study was to compare statistical methods which can be used to analyse such data: generalised estimating equations, multilevel models, multiple linear regression and logistic regression. Four datasets which differed in total size and in percentage of multiple births (n = 254, multiple 18%; n = 176, multiple 9%; n = 10 098, multiple 3%; n = 1585, multiple 8%) were analysed. With the continuous outcome, two-level models produced similar results in the larger dataset, while generalised least squares multilevel modelling (ML GLS 'xtreg' in Stata) and maximum likelihood multilevel modelling (ML MLE 'xtmixed' in Stata) produced divergent estimates using the smaller dataset. For the dichotomous outcome, most methods, except generalised least squares multilevel modelling (ML GH 'xtlogit' in Stata) gave similar odds ratios and 95% confidence intervals within datasets. For the continuous outcome, our results suggest using multilevel modelling. We conclude that generalised least squares multilevel modelling (ML GLS 'xtreg' in Stata) and maximum likelihood multilevel modelling (ML MLE 'xtmixed' in Stata) should be used with caution when the dataset is small. Where the outcome is dichotomous and there is a relatively large percentage of non-independent data, it is recommended that these are accounted for in analyses using logistic regression with adjusted standard errors or multilevel modelling. If, however, the dataset has a small percentage of clusters greater than size 1 (e.g. a population dataset of children where there are few multiples) there appears to be less need to adjust for clustering.

Food marketing on popular children's web sites: a content analysis.

In 2006 the Institute of Medicine (IOM) concluded that food marketing was a contributor to childhood obesity in the United States. One recommendation of the IOM committee was for research on newer marketing venues, such as Internet Web sites. The purpose of this cross-sectional study was to answer the IOM's call by examining food marketing on popular children's Web sites. Ten Web sites were selected based on market research conducted by KidSay, which identified favorite sites of children aged 8 to 11 years during February 2005. Using a standardized coding form, these sites were examined page by page for the existence, type, and features of food marketing. Web sites were compared using chi2 analyses. Although food marketing was not pervasive on the majority of the sites, seven of the 10 Web sites contained food marketing. The products marketed were primarily candy, cereal, quick serve restaurants, and snacks. Candystand.com, a food product site, contained a significantly greater amount of food marketing than the other popular children's Web sites. Because the foods marketed to children are not consistent with a healthful diet, nutrition professionals should consider joining advocacy groups to pressure industry to reduce online food marketing directed at youth.

Character Apps for Children's Snacks: Effects of Character Awareness on Snack Selection and Consumption Patterns.

OBJECTIVE: Media characters are used to market snacks that are typically of poor nutritional value, which has been linked to childhood obesity. This study examines whether children's snack selections and consumption patterns are influenced by an app depicting a popular children's media character, as well as the role that children's awareness of the character plays. The results can increase our understanding of how to encourage healthier snack selection and consumption in newer game-based marketing venues, such as apps. MATERIALS AND METHODS: Four- and 5-year-old children (N = 132) played a bowling game on an iPad with no character or with a character holding either healthier or unhealthy snacks. After app-play, children selected and consumed healthier or unhealthy snacks. Children's awareness of the character was measured by children's verbalizations of the character's name during or after app-play. RESULTS: An ordered logistic regression found no significant effect of treatment conditions compared with the control group. Within treatment conditions, awareness of the character led to selection and consumption of more healthy snacks in the healthier condition (odds ratio ß = 10.340, P = 0.008), and of unhealthy snacks in the unhealthy condition (odds ratio ß = 0.228, P = 0.033), but children were unaware that the character influenced their decisions. CONCLUSIONS: Results suggest that young children will choose and consume healthier, not just unhealthy, products when they are aware that a popular character in an app is associated with the snack, potentially leading to healthier eating patterns.

Influence of a Character-Based App on Children's Learning of Nutritional Information: Should Apps Be Served with a Side of Media Characters?

OBJECTIVE: Childhood obesity is a health issue in the United States, associated with marketing practices in which media characters are often used to sell unhealthy products. This study examined exposure to a socially contingent touch-screen gaming app, which replied immediately, reliably, and accurately to children's actions. Children's recall of nutritional content and their liking of the character were assessed. MATERIALS AND METHODS: Four- and five-year-old children (N = 114) received no-exposure, single-exposure, or repeated-exposure to a character-based iPad app rewarding healthy and penalizing unhealthy behaviors. Children reported how much they liked the character and recalled healthy and unhealthy items from the app. An ordinary least squares regression was conducted on how much children liked the character by condition. Poisson regressions were conducted on the number of items recalled by condition alone, and in an interacted model of treatment condition by liking the character. RESULTS: Children liked the character more in the repeated app-exposure condition than in the control group (P = 0.018). Children in the repeated and single app-exposure conditions recalled more healthy (P < 0.001) and unhealthy (P < 0.001) items than the control group. Within treatment conditions, liking the character increased recall of healthy items in the single app-exposure compared to the repeated app-exposure condition (P = 0.005). CONCLUSIONS: Results revealed that repeated exposure increased children's learning of nutritional information and liking of the character. The results contribute to our understanding of how to deliver effective nutrition information to young children in a new venue, a gaming app.

The Influence of Active Gaming on Cardiorespiratory Fitness in Black and Hispanic Youth.

BACKGROUND: Youth in the United States have low levels of cardiorespiratory fitness, a risk factor for childhood obesity. Lower levels of physical fitness for black and Hispanic youth contribute to health disparities. In this feasibility study, we examined active video games (AVGs) as a tool to improve fitness and attitudes toward physical activity during early adolescence. METHOD: A 6-week AVG program took place in a youth development program in a high-poverty neighborhood in New York City. Youth aged 10 to 15 years (50% overweight or obese) participated in 2 fitness tests and completed surveys that captured barriers to physical activity pre- and postintervention. Each week, participants played Wii Fit games for 30 minutes. RESULTS: Participants improved the number of sit-ups and step-ups they completed from pre- to postintervention (p < .05). Participants also increased their self-efficacy, intention to exercise and perceived social support to exercise (p < .05). Youth reported a high level of enjoyment and perceived Wii Fit as ways to increase physical fitness and increase their physical activity. CONCLUSION: AVGs may be a viable alternative exercise program to increase physical activity for black and Hispanic youth living in poverty-impacted neighborhoods.

High-frequency oscillatory ventilation for the prevention of chronic lung disease of prematurity.

BACKGROUND: There remains uncertainty concerning the safety and efficacy of high-frequency oscillatory ventilation as compared with those of conventional ventilation for the respiratory support of very preterm infants. We conducted a multicenter trial to determine whether early intervention with high-frequency oscillatory ventilation reduced mortality and the incidence of chronic lung disease among newborns with a gestational age of 28 weeks or less. METHODS: We randomly assigned preterm infants with a gestational age of 23 to 28 weeks to either conventional ventilation or high-frequency oscillatory ventilation within one hour after birth. Randomization was stratified according to center and gestational age (23 to 25 weeks or 26 to 28 weeks). RESULTS: A total of 400 infants were assigned to high-frequency oscillatory ventilation, and 397 were assigned to conventional ventilation. The composite primary outcome (death or chronic lung disease, diagnosed at 36 weeks of postmenstrual age) occurred in 66 percent of the infants assigned to receive high-frequency oscillatory ventilation and 68 percent of those in the conventional-ventilation group (relative risk in the group assigned to high-frequency oscillatory ventilation, 0.98; 95 percent confidence interval, 0.89 to 1.08). Similar proportions of infants died or had chronic lung disease in each gestational-age group. In both treatment groups treatment failure occurred in 10 percent of infants (relative risk in the group assigned to high-frequency oscillatory ventilation, 0.99; 95 percent confidence interval, 0.66 to 1.50). There were no significant differences between the groups in a range of other secondary outcome measures, including serious brain injury and air leak. CONCLUSIONS: The results obtained with high-frequency oscillatory ventilation and conventional ventilation do not differ significantly in the early treatment of respiratory disease in very preterm infants. Assessment of long-term effects will require additional follow-up.

The American Psychological Association Task Force assessment of violent video games: Science in the service of public interest.

A task force of experts was convened by the American Psychological Association (APA) to update the knowledge and policy about the impact of violent video game use on potential adverse outcomes. This APA Task Force on Media Violence examined the existing literature, including the meta-analyses in the field, since the last APA report on media violence in 2005. Because the most recent meta-analyses were published in 2010 and reflected work through 2009, the task force conducted a search of the published studies from 2009-2013. These recently published articles were scored and assessed by a systematic evidentiary review, followed by a meta-analysis of the high utility studies, as documented in the evidentiary review. Consistent with the literature that we reviewed, we found that violent video game exposure was associated with: an increased composite aggression score; increased aggressive behavior; increased aggressive cognitions; increased aggressive affect, increased desensitization, and decreased empathy; and increased physiological arousal. The size of the effects was similar to that in prior meta-analyses, suggesting a stable result. Our task force concluded that violent video game use is a risk factor for adverse outcomes, but found insufficient studies to examine any potential link between violent video game use and delinquency or criminal behavior. Our technical report is the basis of this article. (PsycINFO Database Record

Screen Media Exposure and Obesity in Children and Adolescents.

Obesity is one of the best-documented outcomes of screen media exposure. Many observational studies find relationships between screen media exposure and increased risks of obesity. Randomized controlled trials of reducing screen time in community settings have reduced weight gain in children, demonstrating a cause and effect relationship. Current evidence suggests that screen media exposure leads to obesity in children and adolescents through increased eating while viewing; exposure to high-calorie, low-nutrient food and beverage marketing that influences children's preferences, purchase requests, consumption habits; and reduced sleep duration. Some evidence also suggests promise for using interactive media to improve eating and physical activity behaviors to prevent or reduce obesity. Future interdisciplinary research is needed to examine the effects of newer mobile and other digital media exposures on obesity; to examine the effectiveness of additional interventions to mitigate the adverse effects of media exposures on obesity and possible moderators and mediators of intervention effects; to effectively use digital media interventions to prevent and reduce obesity; and to uncover the mechanisms underlying the causal relationships and interactions between obesity-related outcomes and media content, characteristics, and context.

Toddler learning from video: Effect of matched pedagogical cues.

Toddlers learn about their social world by following visual and verbal cues from adults, but they have difficulty transferring what they see in one context to another (e.g., from a screen to real life). Therefore, it is important to understand how the use of matched pedagogical cues, specifically adult eye gaze and language, influence toddlers' imitation from live and digital presentations. Fifteen- and 18-month-old toddlers (N=123) were randomly assigned to one of four experimental conditions or a baseline control condition. The four experimental conditions differed as a function of the interactive cues (audience gaze with interactive language or object gaze with non-interactive language) and presentation type (live or video). Results indicate that toddlers' successfully imitate a task when eye gaze was directed at the object or at the audience and equally well when the task was demonstrated live or via video. All four experimental conditions performed significantly better than the baseline control, indicating learned behavior. Additionally, results demonstrate that girls attended more to the demonstrations and outperformed the boys on the imitation task. In sum, this study demonstrates that young toddlers can learn from video when the models use matched eye gaze and verbal cues, providing additional evidence for ways in which the transfer deficit effect can be ameliorated.