Informing Clinical Practice Guidelines for Children and Youth With Down Syndrome: A Survey of Key Partners.

PURPOSE: The purpose of this work was to describe input from key partners to inform the scope and priorities for a clinical practice guideline (CPG) pertaining to physical therapy services provided to children and youth with Down syndrome (DS). METHODS: A 68-item survey was completed by interventionists and parents (n = 296) of children and youth with DS. RESULTS: The most prevalent physical therapy interventions currently being performed included tummy time, postural control activities, activity-based interventions, and play-based interventions. Key partners agreed on the importance of specific clinical outcomes, needing guidance on frequency and dosage of interventions, common barriers to physical therapy intervention, and needing information for discharge criteria in a future CPG. CONCLUSIONS: The results of this survey have given the CPG committee the necessary information to inform the CPG process for children and youth with DS.

The relative influence of cross-seasonal and local weather effects on the breeding success of a migratory songbird.

In seasonal environments, fluctuating early-season weather conditions and short breeding windows limit reproductive opportunities such that breeding earlier or later than the optimum may be particularly costly. Given the risk of early-season energy limitations, time- and energy-based carry-over effects stemming from environmental conditions across the annual cycle may have pronounced consequences for breeding phenology and fitness. Generally, when and where environmental conditions are most influential are poorly understood, limiting our ability to predict the future of climate-sensitive populations. For an alpine-breeding, migratory population of horned lark Eremophila alpestris in northern British Columbia, Canada (54.8°N), we assessed how weather conditions across the annual cycle influenced clutch initiation date and offspring development. We also addressed how cross-seasonal effects on breeding parameters combine to influence reproductive fitness. With 12 years of breeding data and 3 years of migration data, we used a sliding window approach to identify points during the annual cycle when weather events most influenced breeding phenology and offspring development. Consequences for breeding success were assessed using nest survival simulations. Average clutch initiation date varied up to 11 days among years but did not advance from 2003 to 2019. Warmer temperatures at stopover and breeding sites advanced clutch initiation, but winter conditions had no effect. Sub-zero stopover temperatures carried over to prolong offspring development independent of clutch initiation date, potentially indicating energy-based carry-over effects acting on parental investment. Nest survival decreased with both later clutch initiation and prolonged offspring development such that females nesting earlier and fledging offspring at a younger age were up to 45% more likely to reproduce successfully. We demonstrate that stronger carry-over effects originated from environmental conditions closer to the breeding site in time and space, as well as the potential for energy-based mechanisms to link pre-breeding conditions to reproductive fitness. We also highlight the importance of extended stopovers for songbirds breeding in seasonal environments, particularly given that climatic conditions are becoming increasingly decoupled across stages of the annual cycle. Understanding the cross-seasonal mechanisms shaping breeding decisions in stochastic environments allows for more accurate predictions of population-level responses to climate change.

Les variations saisonnières de l'environnement, notamment due aux conditions climatiques changeantes en début de saison ainsi que la réduction de la période propice à l'accouplement contraint fortement les possibilités de reproduction. Dans ces conditions, s'accoupler avant ou après le moment optimal peut s'avérer particulièrement coûteux. Les effets de report (temporels et énergétiques) causés par ces variations environnementales peuvent avoir des conséquences notables sur la phénologie de la reproduction, et ultimement sur la valeur sélective des individus. Où et quand les effets des conditions environnementales sont le plus critiques reste encore méconnu, limitant notre capacité à prédire le futur des populations sensibles aux variations climatiques. Ici, nous avons évalué comment des conditions climatiques au cours de l'année influencent la date de ponte et le développement des oisillons dans une population migratrice d'Alouette hausse-col Eremophila alpestris se reproduisant en milieux alpin. Nous tirons profit de données issues de 12 ans de suivit de la reproduction et de 3 ans de suivit migratoire, et utilisons une approche dite de 'sliding window' pour identifier les moments du cycle annuel pour lequel le climat a eu le plus d'influence sur la phénologie de la reproduction et le développement des oisillons. La date moyenne de ponte s'avère variable d'une année à l'autre (certaine différence allant jusqu'à 11 jours), mais ne se décale pas sur la période de 2003 à 2019. Nos résultats montrent que des conditions climatiques plus chaudes lors des haltes migratoires ainsi que sur les sites de reproductions rendent la date de ponte plus précoces. Des températures négatives lors des haltes migratoires aussi ont pour conséquences un temps de développement des oisillons plus long, et ceci indépendamment de la date de ponte. Cela suggère des effets de report, notamment énergétique, affectant l'investissement des parents. Nos résultats montrent que la survie au nid diminue lorsque la date de ponte est plus tardive ou que le temps de développement des oisillons est rallongé. De cette manière, les femelles commençants la nidification plus tôt et pour qui les oisillons quittent le nid plus tôt ont 45% plus de chance de se reproduire avec succès. Nous démontrons que des conditions environnementales proche du site de reproduction (que ce soit dans le temps ou dans l'espace) cause un fort effet de report, et suggérons un possible mécanisme reliant les conditions climatiques pré-reproductives au succès reproducteur. De plus, nous mettons en lumière l'importance des haltes migratoires prolongées pour la reproduction des passereaux en environnement saisonnier, particulièrement du fait que les conditions climatiques sont de plus en plus découplées au cours des les étapes du cycle annuel. Une meilleure compréhension des mécanismes inter-saisonniers influençant les décisions de reproduction en environnement stochastique permettrait de mieux prédire les réponses des populations aux changements climatiques.

Woodpeckers and other excavators maintain the diversity of cavity-nesting vertebrates.

Woodpeckers and other excavators create most of the holes used by secondary cavity nesters (SCNs) in North American temperate mixedwood forests, but the degree to which excavators release SCNs from nest-site limitation is debated. Our goal was to quantify how excavators maintain the diversity and abundance of secondary cavity nesters in a temperate forest through the creation of tree cavities. We examined the short- and long-term (legacy) effects of excavators (principally woodpeckers, but also red-breasted nuthatches and black-capped chickadees) on forest biodiversity using longitudinal monitoring data (1,732 nest cavities, 25 sites, 16 years) in British Columbia, Canada. Sites with higher densities of excavator nests had more cavities available, higher species richness of SCNs and higher nest density of SCNs, indicating the importance of a standing stock of cavities. Years with higher nesting densities of excavators were followed by years with higher SCN diversity, indicating that the creation of nesting opportunities through fresh excavation releases SCNs from community-wide nest-site limitation. We also show that excavators leave a 'legacy' of biodiversity (species richness and abundance) at a site by accumulating cavities at rates faster than they become unusable by decay or destruction. By quantifying site-level effects of cavity excavation on the SCN community, our study highlights the key role of excavators as ecosystem engineers that maintain forest wildlife biodiversity.

Si, dans la forêt mixte tempérée d'Amérique du Nord, les pics et autres excavateurs créent la plupart des cavités utilisées par les cavernicoles secondaires (SCN), la question de savoir s'ils augmentent la disponibilité des sites de nidification des SCN reste ouverte. Notre objectif était d'évaluer et quantifier l'impact qu'ont les excavateurs lorsqu'ils creusent des cavités dans les arbres, sur la diversité et l'abondance de cavernicoles secondaires dans une forêt mixte tempérée. Nous avons examiné les effets des excavateurs (principalement les pics, mais aussi la sittelle à poitrine rousse et la mésange à tête noire) à court et à long terme (survivance), sur la biodiversité de la forêt en Colombie-Britannique, au Canada, en utilisant des données longitudinales de surveillance (1,732 cavités ressource, 25 sites, 16 ans). Les sites à plus fortes densités de nids d'excavateurs avaient une plus grande abondance en cavités disponibles, une richesse en espèce SCN plus élevée, et une plus forte densité de nids de SCN, ce qui montre l'importance des arbres à cavités utilisables, vivants ou morts sur pied. Les années à plus fortes densités de nids d'excavateurs étaient suivies par des années à plus fortes diversités d'espèces SCN, ce qui signifie que la disponibilité de sites de nidification à partir de nouveaux creusements augmente le potentiel de nidification des espèces SCN pour l'ensemble de la communauté qui en dépend. Nous démontrons aussi que, sur un site donné, les excavateurs laissent une 'survivance' de biodiversité (richesse en espèce et abondance) en formant des cavités à un taux plus élevé que le taux avec lequel ces dernières deviennent inutilisables suite à leur décomposition ou destruction. En quantifiant les effets du creusement de cavités au niveau de chaque site par rapport à la communauté des SCN, notre étude met en évidence le rôle clé des excavateurs comme ingénieurs de l'écosystème favorisant la diversité de la faune forestière.

Exploring the potential for online peer support mentorship: Perspectives of pediatric solid organ transplant patients.

OBJECTIVE: Self-management for patients who have undergone solid organ transplantation is demanding and a challenge for adolescents transitioning into adult-oriented healthcare systems. This study explores whether adolescent and young adult solid organ transplant patients support the use of online peer support programs that encourage peer mentorship as an approach to improve disease self-management. METHODS: A qualitative descriptive design comprised of semi-structured interviews with adolescent and young adult transplant patients. Individual interviews were audio-recorded, transcribed verbatim, and subject to content analysis. Emergent categories and themes were refined through member checking and team consensus following saturation. RESULTS: Interviews were conducted across organ groups with 15 participants (60% female) ages 14 to 22 years. Participants expressed unanimous support for an online peer support mentorship program to aid disease self-management in the pediatric transplant patient population. Three themes emerged from the interviews: (a) self-management care can be "taxing"; (b) there would be value in peer mentorship for adolescent transplant patients; and (c) online peer mentorship is the "best" option but still requires relationship building. Logistical preferences of an online peer mentorship program were solicited. The preferred peer "match" was someone of the same organ transplant group and gender who was able to have weekly contact via texting. CONCLUSIONS: Creating tailored, online peer mentorship programs is gaining evidence to justify further development. Findings from this study will support program modifications for adolescent and young adult solid organ transplant patients. Next steps will involve usability and feasibility testing of an adapted online program for this patient group.

Assimilation of the Pediatric Essential Core Competencies by Professional Physical Therapist Education Programs.

PURPOSE: This study examined the degree to which pediatric essential core competencies (ECCs) are meeting their intended purpose to provide guidance to pediatric educators in professional physical therapy (PT) education programs and to determine facilitators, barriers, and recommendations to implementation of ECCs in curricula. METHODS: Pediatric PT educators from professional PT education programs were recruited to participate in a survey. Descriptive statistics were used to analyze close-ended questions for frequency of responses and content analysis to generate themes. RESULTS: Of the 162 completed surveys, most participants were aware of the ECCs (96%) and used them to inform pediatric curriculum (88%). A mean proportion (86%-95%) of participants perceived their program curricula addressed the ECCs very or moderately well. Multiple themes of facilitators/barriers/recommendations to ECC implementation were determined. CONCLUSIONS: Most pediatric educators are aware of and using the ECCs to guide pediatric education to prepare graduates for pediatric patients/clients.

Lifetime productivity of tree cavities used by cavity-nesting animals in temperate and subtropical forests.

Tree cavities are a critical multi-annual resource that can limit populations and structure communities of cavity-nesting vertebrates. We examined the regional and local factors influencing lifetime productivity (number and richness of occupants) of individual tree cavities across two divergent forest ecosystems: temperate mixed forest in Canada and subtropical Atlantic Forest, Argentina. We predicted that (1) species would accumulate more rapidly within cavities in the species-rich system (Argentina: 76 species) than the poorer system (Canada: 31 species), (2) cavity characteristics associated with nest-site selection in short-term studies would predict lifetime cavity productivity, and (3) species would accumulate more rapidly across highly used cavities than across cavities used only once, and in Argentina than in Canada. We monitored and measured nesting cavities used by birds and mammals over 22 breeding seasons (1995-2016) in Canada and 12 breeding seasons (2006-2017) in Argentina. Cavities were used an average of 3.1 times by 1.7 species in Canada and 2.2 times by 1.4 species in Argentina. Species richness within cavities increased with number of nesting events at similar rates in Canada and Argentina, in both cases much slower than expected if within-cavity species assemblages were random, suggesting that lifetime richness of individual cavities is more strongly influenced by local ecological factors (nest site fidelity, nest niche) than by the regional species pool. The major determinant of lifetime cavity productivity was the cavity's life span. We found only weak or inconsistent relationships with cavity characteristics selected by individuals in short-term nest-site selection studies. Turnover among (vs. within) cavities was the primary driver of diversity at the landscape scale. In Canada, as predicted, species accumulation was fastest when sampling across high-use cavities. In Argentina, the rates of species accumulation were similar across high- and low-use cavities, and fastest when both high- and low-use cavities were pooled. These findings imply that biodiversity of cavity nesters is maintained by a mix of long-lived (highly productive, legacy trees) and many high-turnover (single-use, fast decaying) tree cavities. Conservation of both long-lasting and single-use cavities should be incorporated into decisions about stand-level forest management, regional land use policies, and reserve networks.

Minimal Detectable Change for TUG and TUDS Tests for Children With Down Syndrome.

PURPOSE: To determine test-retest reliability and minimal detectable change of the Timed Up and Go (TUG) and Timed Up and Down Stairs (TUDS) for Down syndrome. SUBJECTS: Twelve children with Down syndrome (DS) aged 3 to 17 years. METHODS: Two sessions, 1 week apart, with 3 trials of the TUG and 2 trials of the TUDS. Test-retest reliability was estimated using intraclass correlation coefficients and the standard error of measurement. The minimal detectable changes (MDCs) for both tests were calculated. RESULTS: The TUG and TUDS tests both had high test-retest reliability. The MDC was 1.26 seconds for the TUG and 12.52 seconds for the TUDS test. CONCLUSIONS: Both tests were reliable in this population, but the MDC results suggest only the TUG is clinically useful.

International Olympic Committee consensus statement: harassment and abuse (non-accidental violence) in sport.

Despite the well-recognised benefits of sport, there are also negative influences on athlete health, well-being and integrity caused by non-accidental violence through harassment and abuse. All athletes have a right to engage in 'safe sport', defined as an athletic environment that is respectful, equitable and free from all forms of non-accidental violence to athletes. Yet, these issues represent a blind spot for many sport organisations through fear of reputational damage, ignorance, silence or collusion. This consensus statement extends the 2007 IOC Consensus Statement on Sexual Harassment and Abuse in Sport, presenting additional evidence of several other types of harassment and abuse-psychological, physical and neglect. All ages and types of athletes are susceptible to these problems but science confirms that elite, disabled, child and lesbian/gay/bisexual/trans-sexual (LGBT) athletes are at highest risk, that psychological abuse is at the core of all other forms and that athletes can also be perpetrators. Harassment and abuse arise from prejudices expressed through power differences. Perpetrators use a range of interpersonal mechanisms including contact, non-contact/verbal, cyber-based, negligence, bullying and hazing. Attention is paid to the particular risks facing child athletes, athletes with a disability and LGBT athletes. Impacts on the individual athlete and the organisation are discussed. Sport stakeholders are encouraged to consider the wider social parameters of these issues, including cultures of secrecy and deference that too often facilitate abuse, rather than focusing simply on psychopathological causes. The promotion of safe sport is an urgent task and part of the broader international imperative for good governance in sport. A systematic multiagency approach to prevention is most effective, involving athletes, entourage members, sport managers, medical and therapeutic practitioners, educators and criminal justice agencies. Structural and cultural remedies, as well as practical recommendations, are suggested for sport organisations, athletes, sports medicine and allied disciplines, sport scientists and researchers. The successful prevention and eradication of abuse and harassment against athletes rests on the effectiveness of leadership by the major international and national sport organisations.

Increased rodenticide exposure rate and risk of toxicosis in barn owls (Tyto alba) from southwestern Canada and linkage with demographic but not genetic factors.

Among many anthropogenic drivers of population decline, continual rapid urbanization and industrialization pose major challenges for the survival of wildlife species. Barn owls (Tyto alba) in southwestern British Columbia (BC) face a multitude of threats ranging from habitat fragmentation to vehicle strikes. They are also at risk from secondary poisoning of second-generation anticoagulant rodenticides (SGARs), a suite of toxic compounds which at high doses results in a depletion of blood clotting factors leading to internal bleeding and death. Here, using long-term data (N = 119) for the hepatic residue levels of SGAR, we assessed the risk of toxicosis from SGAR for the BC barn owl population over the past two decades. We also investigated whether sensitivity to SGAR is associated with genetic factors, namely Single Nucleotide Polymorphisms (SNPs) found in the CYP2C45 gene of barn owls. We found that residue concentration for total SGAR was significantly higher in 2006-2013 (141 ng/g) relative to 1992-2003 (57 ng/g). The proportion of owls exposed to multiple SGAR types was also significantly higher in 2006-2013. Those measures accordingly translate directly into an increase in toxicosis risk level. We also detected demographic differences, where adult females showed on average lower concentration of total SGAR (64 ng/g) when compared to adult males (106 ng/g). Juveniles were overall more likely to show signs of toxicosis than adults (33.3 and 6.9 %, respectively), and those symptoms were positively predicted by SGAR concentrations. We found no evidence that SNPs in the CYP2C45 gene of barn owls were associated with intraspecific variation in SGAR sensitivity. We recommend several preventative measures be taken to minimize wildlife exposure to SGAR.

Reliability and Responsiveness of the Timed Up and Go Test in Children With Cerebral Palsy.

PURPOSE: The purpose of this study was to determine the absolute reliability and responsiveness of the Timed Up and Go (TUG) test, as measured using minimal detectable change (MDC) and minimal clinical important difference (MCID) values. METHODS: Prospective observational study of children aged 3 to 10 years with cerebral palsy (CP) in Gross Motor Function Classification System levels I-III who completed the TUG test. Minimal detectable change estimates were calculated using baseline data. MCID estimates for each Gross Motor Function Classification System (GMFCS) level were calculated using distribution- and anchor-based methods. RESULTS: Minimal detectable change values ranged from 1.40 to 8.74 seconds and MCID estimates ranged from 0.22 to 5.31 seconds. CONCLUSIONS: The TUG test is a reliable and responsive measure of balance and mobility for children with CP between 3 and 10 years of age in GMFCS levels I-III. Study results support improved use of the TUG test in clinical and research settings by providing reliability values and estimates of meaningful change. VIDEO ABSTRACT: For more insights from the authors, see Supplemental Digital Content 1, available at http://links.lww.com/PPT/A117.

Temporal dynamics of a commensal network of cavity-nesting vertebrates: increased diversity during an insect outbreak.

Network analysis offers insight into the structure and function of ecological communities, but little is known about how empirical networks change over time during perturbations. "Nest webs" are commensal networks that link secondary cavity-nesting vertebrates (e.g., bluebirds, ducks, and squirrels, which depend on tree cavities for nesting) with the excavators (e.g., woodpeckers) that produce cavities. In central British Columbia, Canada, Northern Flicker (Colaptes auratus) is considered a keystone excavator, providing most cavities for secondary cavity-nesters. However, roles of species in the network, and overall network architecture, are expected to vary with population fluctuations. Many excavator species increased in abundance in association with a pulse of food (adult and larval beetles) during an outbreak of mountain pine beetle (Dendroctonus ponderosae), which peaked in 2003-2004. We studied nest-web dynamics from 1998 to 2011 to determine how network architecture changed during this resource pulse. Cavity availability increased at the onset of the beetle outbreak and peaked in 2005. During and after the outbreak, secondary cavity-nesters increased their use of cavities made by five species of beetle-eating excavators, and decreased their use of flicker cavities. We found low link turnover, with 74% of links conserved from year to year. Nevertheless, the network increased in evenness and diversity of interactions, and declined slightly in nestedness and niche overlap. These patterns remained evident seven years after the beetle outbreak, suggesting a legacy effect. In contrast to previous snapshot studies of nest webs, our dynamic approach reveals how the role of each cavity producer, and thus quantitative network architecture, can vary over time. The increase in interaction diversity with the beetle outbreak adds to growing evidence that insect outbreaks can increase components of biodiversity in forest ecosystems at various temporal scales. The observed changes in (quantitative) network architecture contrast with the relatively stable (qualitative) architecture of empirical mutualistic networks that have been studied to date. However, they are consistent with recent theory on the importance of population fluctuations in driving network architecture. Our results support the view that models should allow for the possibility of rewiring (species switching partners) to avoid overestimation of secondary extinction risk.

Transition to adult care in pediatric solid-organ transplant: development of a practice guideline.

BACKGROUND: Transition to adult-centered care is becoming an increasingly important area of practice in pediatric organ transplant. Standardized, best-practice guidelines are needed to assist transplant practitioners in providing optimal transitional care for this population of patients. OBJECTIVE: To describe the development and implementation of a practice guideline for the transitional care of pediatric transplant recipients. METHODS: A quality improvement project was undertaken in a pediatric multiorgan transplant program setting. Strategies employed included (1) creation of an interdisciplinary working group, (2) survey of transition-related practices and learning needs of transplant practitioners, (3) review of the literature and existing transition-related materials, and (4) creation of transition guidelines. RESULTS: An interdisciplinary survey of transplant practitioners at our institution identified practice strengths related to transitional care and learning needs. Review of relevant literature and other materials revealed limited but emerging research related to the transition of pediatric transplant recipients from pediatric to adult care. Existing transition tools were examined and applicable items identified. A practice guideline for use with pediatric transplant recipients transitioning to adult care was developed. Strategies to educate staff about the guideline and promote ongoing guideline use were implemented. CONCLUSION: Preparing pediatric transplant recipients and their families for transition to adult-centered care is an emerging challenge for transplant teams. These guidelines provide practitioners with a developmentally sensitive overview of important transition-related domains and strategies directed toward patients and their caregivers, who may experience the process of transition differently. Dissemination of the pediatric transplant transition guideline will make transition information more widely available to transplant practitioners.

Innovation in pediatric clinical education: application of the essential competencies.

BACKGROUND: At the Section on Pediatrics Education Summit in July 2012, consensus was achieved on 5 essential core competencies (ECCs) that represent a knowledge base essential to all graduates of professional physical therapist education programs. KEY POINTS: This article offers suggestions for how clinical instructors (CIs) might use the ECCs to identify student needs and guide student learning during a pediatric clinical education experience. Pediatric CIs potentially might choose to use the ECCs as a reference tool in clinical education to help (1) organize and develop general, clinic-specific clinical education objectives, (2) develop and plan individualized student learning experiences, (3) identify student needs, and (4) show progression of student learning from beginner to intermediate to entry level. CONCLUSIONS: The ECCs may offer CIs insights into the role of pediatric clinical education in professional physical therapist education.

Experiential Learning With Children: An Essential Component of Professional Physical Therapy Education.

PURPOSE: The Section on Pediatrics of the American Physical Therapy Association has developed a number of resources to support and improve the consistency of professional pediatric physical therapy education, including a set of core competencies that all graduates must attain. The purpose of this article is to advocate for the inclusion of experiential learning activities with children, including children with participation restrictions, as a necessary component to achieve the core competencies. KEY POINTS: Experiential learning is a form of practice-based education that provides exposures and opportunities for students to explore the work, roles, and identities they will encounter as future professionals. Experiential learning is learning by doing, and occurs within a relevant setting. Six representative curricular exemplars are presented to provide readers with a variety of suggestions for development and integration of experiential learning. SUMMARY: Recommendations for future research are provided and 4 key recommendations are provided.

An empirically based practice perspective on the transition to adulthood for solid organ transplant recipients.

Preparing patients for transitioning to self-managed care and subsequently transferring to the adult healthcare system has become a critical process for clinicians working with pediatric transplant recipients. This paper reviews several barriers to a successful transition. These include patient barriers, caregiver barriers, and considerations within pediatric and adult centers. To date, few approaches for improving the transition process have been empirically tested. This review details studies that have examined possible models including usage of a transition coordinator and transition clinics. Recommendations are offered to promote an optimal transition including the importance and content of preparation, assessing and addressing transition readiness, insuring the involvement of all stakeholders, and finally, at minimum providing services during the transfer period. Future directions are offered aiming to advance this important area of investigation.

Efficacy of orthoses for children with hypotonia: a systematic review.

PURPOSE: The purpose of this systematic review of the literature was to determine the efficacy of orthoses for children with hypotonia and provide a concise summary of the state of the evidence in this area. METHODS: Fifteen search terms were used to find articles addressing children with hypotonia, orthotic use, and physical therapy. RESULTS: Ten articles met the inclusion criteria, but no level I evidence was found. Data were reported for body structure and activity components, but not participation outcomes. Current evidence suggests that foot orthoses and supramalleolar orthoses may benefit children with hypotonia; however, the evidence is low level. CONCLUSION: The evidence for efficacy of orthoses for children with hypotonia continues to have gaps with the following questions still unanswered: When is the optimal time to introduce orthoses? Are foot orthoses or supramalleolar orthoses more efficacious? Should orthoses be combined with physical therapy?

Essential competencies in entry-level pediatric physical therapy education.

BACKGROUND: The Section on Pediatrics (SoP) convened an Education Summit in July 2012 to examine, discuss, and respond to documented inconsistencies and challenges in teaching pediatric physical therapy (PT) content in entry-level professional education programs. Despite previous attempts by the SoP to provide guidance around teaching pediatric PT, variability continued to be extensive across programs. KEY POINTS: This article presents the core competencies developed out of the Summit to inform pediatric content in the entry-level PT curriculum. In addition, the core competencies were linked to teaching strategies, learning activities, assessment outcomes, and curricular structures. STATEMENT OF CONCLUSIONS: Consensus was reached on 5 core competencies that represent a knowledge base essential to all graduates of PT programs. In contrast to prior SoP documents, these competencies were specifically designed to focus on knowledge and skills unique to pediatric practice but essential for all graduates of accredited entry-level PT education programs. VIDEO ABSTRACT: For more insights from the authors, see Supplemental Digital Content 1, at http://links.lww.com/PPT/A50.

Examination of the perception of communication and collaboration in a neonatal intensive care unit: a decade on, has it changed?

OBJECTIVE: The aim of this study was to ascertain the perception of communication and collaboration within and between the groups of medicine and nursing in a neonatal unit. METHODS The study used an analytical cross-sectional design involving both doctors and nursing staff in the neonatal clinical care unit (NCCU). A quantitative questionnaire using a Likert scale format, accompanied by an open-ended question, provided a snapshot of the perception of communication and collaboration within the NCCU. RESULTS Significant differences were noted between the two disciplines. Medical staff were satisfied overall with the communication. They perceived communication was more open, timely and that a mutual understanding existed. They thought teamwork was good. As time of employment in NCCU lengthened, the understanding between the groups lessened. Problems with the handover information emerged for both medical and nursing staff. Both groups felt problems were due to the hierarchical system. CONCLUSION Within the NCCU the perception of communication and collaboration is rated more highly by doctors. This has implications for the overall care of babies and for safety issues. Education is needed in the neonatal unit to identify and bridge gaps in communication and enhance teamwork.