How we approach steroid-induced affective disorder in pediatric oncology.

High-dose corticosteroids are an essential component of treatment for pediatric cancers. Yet, these agents often cause psychiatric disturbances including sleep disruption, steroid-induced psychosis, and steroid-induced affective disorder (SIAD). SIAD, identified as a specific form of substance/medication-induced mental disorder, can present with various psychiatric symptoms, including mania, depression, irritability, and inconsolability. SIAD's varied presentation can lead to underdiagnosis and complicates clinical care, research, and identification of best practices. Here we highlight three pediatric oncology cases involving SIAD and discuss recommendations for supporting patients with SIAD, while introducing a tiered intervention framework (modified from Kazak) that stratifies responses based on symptom severity.

Pilot study of parental alienation items in the adverse childhood experiences scale.

BACKGROUND: Adverse Childhood Experiences (ACEs) and Parental Alienation (PA)are forms of adverse events negatively affecting children globally. The current study was to identify a revised ACEs measure that includes a screening item for PA. METHODS: A total of 231 undergraduate students, ages 18 to 37, were surveyed for this analysis. A factor analyses was performed to identify what PA item, out of four, would correlate most strongly with existing ACEs scale items. Convergent and divergent validity was assessed. An exploratory factory analyses was conducted to identify factor structure of scale items and a confirmatory factory analysis of extracted factors was used to assess model fit. RESULTS: Over half (60 %) of the sampled population reported at least one ACEs item. All four PA items were significantly correlated with converging constructs (r = 0.68, p < .01). Out of four PA items, one PA item significantly outperformed the other three items in relation to convergent validity and was used to create a new ACEs-PA scale item (r = 0.33, p < .01). A two factor solution was identified with the new PA item loading, accounting for 35 % of the variance, explaining more variance in both outcomes (R2 = 0.43 and R2 = 0.16) than the original ACEs scale when comparing the adjusted R2 values (R2 = 0.35 and R2 = 0.13). Limitations This study used participant self-reporting methods subjecting it to retrospective bias. CONCLUSION: Within the population, the new PA item factored significantly with existing ACEs, suggesting the capture of an additional adverse childhood experience.

Academic Readiness among Young Children Treated for Brain Tumors: A Multisite, Prospective, Longitudinal Trial.

BACKGROUND: Young children treated for central nervous system (CNS) malignancies are at high risk for difficulties with academic functioning due to increased vulnerability of the developing brain and missed early developmental opportunities. Extant literature examining academics in this population is limited. We investigated academic readiness, its clinical and demographic predictors, and its relationship with distal academic outcomes among patients treated for CNS tumors during early childhood. METHODS: Seventy patients with newly diagnosed CNS tumors were treated on a prospective, longitudinal, multisite study with chemotherapy, with or without photon or proton irradiation. Patients underwent assessments of academic skills at baseline, six months, one year, and then annually for five years. Assessments measured academic readiness and academic achievement in reading and math. RESULTS: Mixed linear models revealed slowed development of academic readiness skills over time. Socioeconomic status (SES) was predictive of academic readiness at all time points. Other demographic (eg, age at treatment) and clinical (eg, shunt status, treatment exposure) variables were not predictive of academic readiness. Distal reading difficulties were proportionally greater than normative expectations while math difficulties did not differ. Academic readiness was predictive of distal academic outcomes in reading and math. CONCLUSIONS: Treatment for CNS malignancies in early childhood appears to slow development of academic readiness skills, with SES predictive of risk. Academic readiness skills were predictive of subsequent academic achievement. A disproportionate number of long-term survivors performed below age-based expectations in reading. These findings suggest the need for monitoring and interventions targeting early academic skills in this population.

Developmental and adaptive functioning of very young children with solid tumors and brain tumors.

PURPOSE: Infancy/toddlerhood is a period of rapid development. All infants/toddlers (0-36 months-of-age) undergoing cancer-directed treatment at one hospital are offered developmental assessments and related services. Yet, literature comparing development of infants/toddlers with brain tumors to those with non-CNS solid tumors is sparse. DESIGN AND METHODS: Developmental assessment data were abstracted from electronic health records of infants/toddlers undergoing treatment for a brain tumor (n = 36; mean age = 21.83 ± 9.96 months) or a solid tumor (n = 40; mean age = 17.35 ± 8.50). Z-scores compared obtained data with age expectations. Chi-square analyses assessed whether a greater proportion of participants scored within the clinical range than normative expectations. Multivariate analysis of variance and chi-square analyses compared developmental outcomes between groups. RESULTS: Compared with age expectations, the overall group demonstrated significantly less well-developed skills. Infants/toddlers with solid tumors demonstrated clinical deficits at rates higher than expected for most domains; the rate of impairment for the solid tumor group did not differ significantly from that of the brain tumor group across most subtests. CONCLUSIONS: Like young patients with brain tumors, the developmental functioning of infants/toddlers with solid tumors should be studied across time to determine the trajectory of functioning for these young patients and to inform future developmental intervention studies. PRACTICE IMPLICATIONS: Infants/toddlers with a malignant solid tumor may be at increased risk for delayed development. These very young patients would likely benefit from developmental assessment, early intervention services during and after treatment, and ongoing monitoring of development across time.

Exploring the interagency collaboration between a pediatric oncology health care setting and community schools.

Globally, approximately 400,000 youth are diagnosed with pediatric cancer each year. Treatment-related side effects, psychosocial challenges, and frequent school absences may adversely impact learning and the education experience among these youth. Efforts to enhance interagency collaboration between health care settings and community schools are imperative to facilitate school reintegration. The Standards for the Psychosocial Care of Children with Cancer and Their Families outline specific guidelines related to the continuity of education for students impacted by pediatric cancer. In particular, the Academic Continuity and School Reentry Support and Monitoring and Assessment of Neuropsychological Outcomes standards of care highlighted within this article align with extant programmatic efforts for transitioning hospitalized school-aged children back into community schools. This article aims to describe systematic programmatic efforts within hospital-based psychosocial programs that are consistent with the Standards for the Psychosocial Care of Children with Cancer and Their Families, as well as interagency collaboration with community schools to support student-centered education for youth impacted by pediatric cancer. Resources for school psychologists, teachers, hospital-based programs, and others involved in student-centered education for pediatric cancer patients and survivors are presented. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

2023 BMC Ecology and Evolution image competition: the winning images.

In 2023, researchers from around the world entered the BMC Ecology and Evolution photography competition. As a result, we received a spectacular collection of photographs that capture the wonder of nature, those looking to understand it and glimpses into long lost worlds. This editorial celebrates the winning images selected by the Editor of BMC Ecology and Evolution and senior members of the journal's editorial board.

Promoting Completion of Cranial Radiation Therapy Without Sedation in Young Patients With Brain Tumors: A Case Series Illustrating Flexible Application of Empirically Supported Intervention.

Repeated anesthesia poses risks to patients but is often utilized to immobilize young children undergoing cranial radiation therapy for brain tumors. To enable young patients to remain still during cranial radiation therapy and thereby avoid sedation, medical and psychosocial clinicians can use behavioral and other supportive interventions. This case series illustrates the utility of behavioral training for motion control in 3 children 6 years old or younger who were treated for brain tumors. We demonstrate the efficacy of flexible, individualized intervention approaches to accommodate patients with brain tumors in the context of emotional dysregulation, significant communication barriers, and profound sensory deficits.

Cellular mechanisms of oligoclonal vascular smooth muscle cell expansion in cardiovascular disease.

AIMS: Quiescent, differentiated adult vascular smooth muscle cells (VSMCs) can be induced to proliferate and switch phenotype. Such plasticity underlies blood vessel homeostasis and contributes to vascular disease development. Oligoclonal VSMC contribution is a hallmark of end-stage vascular disease. Here, we aim to understand cellular mechanisms underpinning generation of this VSMC oligoclonality. METHODS AND RESULTS: We investigate the dynamics of VSMC clone formation using confocal microscopy and single-cell transcriptomics in VSMC-lineage-traced animal models. We find that activation of medial VSMC proliferation occurs at low frequency after vascular injury and that only a subset of expanding clones migrate, which together drives formation of oligoclonal neointimal lesions. VSMC contribution in small atherosclerotic lesions is typically from one or two clones, similar to observations in mature lesions. Low frequency (<0.1%) of clonal VSMC proliferation is also observed in vitro. Single-cell RNA-sequencing revealed progressive cell state changes across a contiguous VSMC population at onset of injury-induced proliferation. Proliferating VSMCs mapped selectively to one of two distinct trajectories and were associated with cells showing extensive phenotypic switching. A proliferation-associated transitory state shared pronounced similarities with atypical SCA1+ VSMCs from uninjured mouse arteries and VSMCs in healthy human aorta. We show functionally that clonal expansion of SCA1+ VSMCs from healthy arteries occurs at higher rate and frequency compared with SCA1- cells. CONCLUSION: Our data suggest that activation of proliferation at low frequency is a general, cell-intrinsic feature of VSMCs. We show that rare VSMCs in healthy arteries display VSMC phenotypic switching akin to that observed in pathological vessel remodelling and that this is a conserved feature of mouse and human healthy arteries. The increased proliferation of modulated VSMCs from healthy arteries suggests that these cells respond more readily to disease-inducing cues and could drive oligoclonal VSMC expansion.

Occupational Therapy: An Essential Component of Support for Young Children With Cancer.

We established a multidisciplinary early childhood clinic to support infants and toddlers receiving cancer treatment. The access to occupational therapy (OT) in this population is unknown. To describe the access to OT for infants and toddlers with cancer. We retrospectively reviewed medical records to determine the frequency and characteristics of children with cancer who were referred to OT. Demographic data, medical information, and frequency of referrals were extracted from September 2015 to September 2018. Of the 134 patients, 112 (83.6%) received an OT evaluation: 88.4% were referred for hospital-based OT services; 42.0% were recommended for services upon returning home. Between-group comparisons revealed significant differences in referrals for home- or community-based OT services based on age and disease. OT is crucial to treatment plans that address the developmental needs of young pediatric oncology patients during hospitalization and thereafter. Recommendations for monitoring this vulnerable population are provided.

Virtual Group Activities as a New Platform for Socialization in Children With Pediatric Cancer: A Case Series From the COVID-19 Pandemic.

Socialization with peers is essential for development yet reduced when children and adolescents are undergoing cancer treatment. Providing opportunity for social experiences is a key role for providers working in the pediatric oncology setting. Traditional in-person socialization activities were significantly impacted by coronavirus disease-2019 restrictions, and psychosocial providers were forced to adapt their practice. This case series illustrates four unique scenarios that highlight virtual social interactions as both feasible and beneficial. While virtual socialization groups were intended to be temporary, the experiences described suggest that ongoing video-based options for some socialization activities are likely prudent for some pediatric populations.

2022 BMC Ecology and Evolution image competition: the winning images.

In 2022, researchers from around the world entered the BMC Ecology and Evolution photography competition. The contest produced a spectacular collection of photographs that capture the wonder of the natural world and the growing need to protect it as the human impact on the planet intensifies. This editorial celebrates the winning images selected by the Editor of BMC Ecology and Evolution and senior members of the journal's editorial board.

Developmental psychology and the scientific status of parental alienation.

Theory and research have described developmental processes leading to damaged parent-child relationships, such as those that occur during a divorce. However, scholars dispute the scientific status of the literature on children who form unhealthy alliances with one parent against the other-termed parental alienation (PA). This comprehensive literature review tests competing descriptions of the PA literature. Accessing four electronic databases, we identified 213 documents with empirical data on PA published in 10 languages through December 2020. The results confirmed that the current state of PA scholarship meets three criteria of a maturing field of scientific inquiry: an expanding literature, a shift toward quantitative studies, and a growing body of research that tests theory-generated hypotheses. Nearly 40% of the PA literature has been published since 2016, establishing that PA research has moved beyond an early stage of scientific development and has produced a scientifically trustworthy knowledge base. This literature review documents the value of multiple research methodologies to this knowledge base. In addition, the growing body of research described in this review enhances our understanding of the association between interparental conflict and the breakdown of parent-child relationships in families where conflict differentially affects children's relationship with and behavior toward each parent. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Losses experienced by children alienated from a parent.

Parental alienation occurs when a child aligns with one parent and unjustifiably rejects the other as a result of parental alienating behaviors. This article provides an overview of current research and theory regarding the losses alienated children endure. Parental alienating behaviors alter the child's beliefs, perceptions, and memories of the alienated parent, triggering a cascade of profound losses for the child. These losses include loss of individual self, childhood experiences, extended family, community, and activities and relationships essential for healthy development. Consequently, alienated children often experience ongoing and ambiguous losses and thereby suffer disenfranchised grief in isolation.

Inaugural BMC Ecology and Evolution image competition: the winning images.

The inaugural BMC Ecology and Evolution image competition attracted entries from talented ecologists and evolutionary biologists worldwide. Together, these photos beautifully capture biodiversity, how it arose and why we should conserve it. This editorial celebrates the winning images as selected by the Editor of BMC Ecology and Evolution and senior members of the journal's editorial board.