Analyzing the effect of sibling number on input and output in the first 18 months.

Prior research suggests that across a wide range of cognitive, educational, and health-based measures, first-born children outperform their later-born peers. Expanding on this literature using naturalistic home-recorded data and parental vocabulary reports, we find that early language outcomes vary by number of siblings in a sample of 43 English-learning U.S. children from mid-to-high socioeconomic status homes. More specifically, we find that children in our sample with two or more-but not one-older siblings had smaller productive vocabularies at 18 months, and heard less input from caregivers across several measures than their peers with less than two siblings. We discuss implications regarding what infants experience and learn across a range of family sizes in infancy.

Evaluating fundamental care knowledge to inform educational leadership.

AIM: To explore undergraduate nursing students' understanding of fundamental care and identify educational leadership opportunities to deepen students' understanding of fundamental care concepts. DESIGN: Sequential-explanatory mixed methods study. METHODS: We conducted a cross sectional survey (n = 202) and focus groups (n = 24) to explore undergraduate nursing students' ability to identify fundamental care needs. All data were collected between November 2020 and April 2021. Survey data were analysed using descriptive and inferential statistics and focus group data were thematically analysed. RESULTS: Year One students scored significantly lower in their ability to identify fundamental care needs compared with students in other years, even after controlling for route, gender and age. Post-degree students scored significantly higher than direct entry or transfer students. Students ≤19 years of age had significantly lower scores compared with students ≥25 years of age. Our focus group findings highlighted that students were often unable to define fundamental care, but they identified learning about various components of fundamental care in a variety of ways. While students understood that fundamental care was required in all settings, they were challenged in providing this care in acute and virtual settings. Students shared several suggestions to support fundamental care skills development across the curriculum. CONCLUSIONS: There is a need for a clear definition and description of the fundamentals of care that is used consistently by faculty, students and curriculum documents. It is important to encourage and support educators to share real-world nursing stories, offer students time to share their personal experiences, develop creative learning opportunities and foster student reflection to deepen students' understanding of the fundamentals of care. IMPACT: Educators need support to meaningfully incorporate fundamentals of care learning opportunities across multiple care settings. Educational leaders can use these findings to develop or adapt their curricula to support fundamental care skill development.

The Creation of a Novel Undergraduate Nursing Employee/Student Hybrid Role in the COVID-19 Response: An Alberta Experience.

The COVID-19 pandemic impacted nursing education and health care systems alike. Increases in staff absenteeism along with increased hospitalizations have strained health systems across the globe. Postsecondary institutions (PSIs) were required to remove students from clinical placements, thus delaying nursing students' ability to complete their programs, and in turn, contributing to the nursing workforce challenges. Health care organizations and PSIs had to collaborate innovatively to support the health care response to the pandemic while continuing to educate and graduate students to expand the nursing workforce. In Alberta, the collaboration between the health system and PSIs led to the creation of an undergraduate nursing employee/student hybrid (UNE/Hybrid) role. This role was not only a response to the nursing workforce challenges created by the pandemic, but it provided nursing students with positive learning clinical placements ensuring that they completed their program in a timely manner. This role was designed to assist with the fourth wave of the pandemic (omicron variant), which was expected to be the most severe wave in terms of hospitalizations and increased staff absences. The UNE/Hybrid role allowed nursing students to complete the required learning for their final preceptorships and/or complete leadership placements in a paid role while being integrated into the unit culture and becoming part of the team. The initiative's results, including its successes, challenges, and lessons, are discussed.

Clinical Characteristics of Patients Undergoing Needle Thoracostomy in a Canadian Helicopter Emergency Medical Service.

Objective: Needle thoracostomy (NT) can be a life-saving procedure when used to treat tension pneumothorax. However, there is some question regarding the efficacy of NT in the prehospital setting. Failure to treat tension pneumothorax in a helicopter emergency medical service (HEMS) setting may prove especially deleterious to the patient due to gas expansion with increasing altitude. This study's objective was to identify the characteristics of patients treated with NT in a Canadian HEMS setting and the factors that may influence outcomes following NT use.Methods: This was a retrospective chart review of prehospital records from a Canadian HEMS service. Patients aged 18 years and older who underwent at least one NT attempt using a 14-gauge 8.3 cm needle from 2012 to 2018 were identified. Charts were reviewed to collect demographic data, NT procedural characteristics, vital signs, and clinical response metrics. Descriptive statistics were used to characterize the study sample and overall event characteristics. Binary logistic regression was performed to identify variables associated with a clinical response to the initial NT treatment.Results: 163 patients (1.3%) of 12,407 patients attended received NT. A positive clinical response to NT was recorded in 37% (n = 77) of the total events (n = 208), the most common of which was an improvement in blood pressure (BP) (18.8%, n = 39). Initial NT was associated with a low likelihood of clinical improvement in patients presenting with blunt trauma (OR = 0.18; p = .021; 95% CI [.04, .77]), CPR prior to NT (OR = 0.14; p = .02; 95% CI [.03, .73]), or in those who received bilateral NT treatment (OR = 0.13; p < .01; 95% CI [.05, .37]). A pretreatment BP < 90 mmHg was predictive of a positive clinical response to initial NT (OR = 3.33; p = .04; 95% CI [1.09, 10.20]).Conclusions: Only a small portion of patients in the setting of a Canadian HEMS service were treated with NT. Patients most likely to receive NT were males who had suffered blunt trauma. NT may have questionable benefit for patients presenting with blunt trauma, in cardiac arrest, or requiring bilateral NT.

Exploring Informational Needs of Parents of Children with Intestinal Failure: A Thematic Analysis.

PURPOSE: Information seeking has been observed to be important for the coping and empowerment of parents of children with rare diseases. This study was conducted to understand the education needs of families of children with pediatric intestinal failure (IF) and how technology might be effectively leveraged to address these needs. DESIGN AND METHODS: A qualitative methodology using thematic analysis was utilized. Purposeful sampling was adopted to recruit 10 parents/caregivers of children with IF. Participants participated in a 1:1 semi-structured interview. Interviews were recorded, transcribed and themes identified through open and focused coding. RESULTS: Four themes emerged: (1) reliable electronic or printed information resources relevant to their child's unique needs were lacking; (2) an educational program with in-person and hands-on learning was preferred for transition to home; (3) practical and relatable information was valued over medical knowledge as children's needs evolved; and (4) creation of electronic resources would be useful for information seeking and sharing. CONCLUSION: To cope with the responsibilities of caring for a child with IF, participants sought information beyond what they received. Participants preferred a blended approach of care team discussions and electronic tools for receiving knowledge and skills. Parents' connections with other caregivers was important for practical day-to-day management information, as well as supporting their well-being. PRACTICE IMPLICATIONS: Development and implementation of accessible digital resources with emphasis on practical information is required. Beyond medical and practical informational needs, building resilience and supporting psychologic needs for parents/caregivers of children with IF emerged as important needs to address.

Enduring Cell Lines: Parents' Experiences of Postmortem Tumor Banking in Childhood Cancer.

While cure rates in pediatric oncology have improved over the past 30 years, childhood cancer remains the second leading cause of death in children aged 1 to 14. Developing therapies often require using cancerous tissues, which may come from deceased donors. Tumor banks collect, store, and distribute these donated samples. While tumor banking is more common, factors that contribute to parents' decision and the impact of it on the family are not well understood. The purpose of this hermeneutic study was to understand the meaning and impact of tumor banking for parents of children who have died from cancer. Findings suggest that parents donating their child's tumors unexpectedly found a sense of meaning in their loss. They also found a legacy of their child's life; the living cells in some ways assisted the parents with grief. Aspects of this sensitive conversation and decision are discussed from the perspective of the parents' experiences.

Reducing emergency department utilization for outpatient acute cancer symptoms: An integrative review on the advent of urgent cancer clinics.

The purpose of this integrative literature review was to identify nursing research opportunities related to outpatient acute cancer symptom management within emerging urgent cancer clinics (UCCs). Patients with acute cancer symptoms (e.g., fevers, gastrointestinal disturbances, or uncontrolled pain) from ambulatory settings predominantly rely on emergency departments (EDs) for assessment and treatment. However, this model of care is no longer sustainable and emphasizes healthcare system inefficiencies. Urgent cancer clinics allow patients to have these symptoms treated by oncology experts within ambulatory cancer centres. Unfortunately, limited research on urgent cancer clinics both operationally and experientially makes it difficult for others to adopt this new model of care. The core questions that guided this integrative review were: 1) What is the state of the science regarding UCCs, and what differences exist when compared to EDs in the management of outpatient acute cancer symptoms? and 2) Where do UCCs exist around the world, and what is understood about UCCs related to clinic operations and staffing models?

Thoracic Endotracheal Tube Insertion During Prehospital Thoracostomy: A Case Report.

This case highlights the novel use of endotracheal tubes to maintain patency of simple thoracostomies (STs) performed to relieve a tension pneumothorax after failed needle thoracostomy (NT). Treatment of a tension pneumothorax in the prehospital setting is typically performed using NT because of the minimal equipment required and rapid application. However, the variable efficacy of NT has led to a rise in the use of ST as an alternative procedure to treat a tension pneumothorax. A potential complication of ST is the occlusion of the thoracostomy site, which, left unresolved, may lead to the reoccurrence of tension physiology. In a resource-rich setting, such as in a hospital, the ST would be followed by tube thoracostomy to ensure patency. Unfortunately, this may not be feasible in prehospital environments where constraints exist because of time, equipment, and personnel. A review of the literature surrounding prehospital ST reveals previous reports of endotracheal tubes being used to maintain patency temporarily. However, no cases documenting the successful use of this novel procedure in an air medical setting were found at the time of writing. This case documents the successful use of this novel procedure during the treatment of a polytraumatized adult female resulting from a motorcycle crash.

From babble to words: Infants' early productions match words and objects in their environment.

Infants' early babbling allows them to engage in proto-conversations with caretakers, well before clearly articulated, meaningful words are part of their productive lexicon. Moreover, the well-rehearsed sounds from babble serve as a perceptual 'filter', drawing infants' attention towards words that match the sounds they can reliably produce. Using naturalistic home recordings of 44 10-11-month-olds (an age with high variability in early speech sound production), this study tests whether infants' early consonant productions match words and objects in their environment. We find that infants' babble matches the consonants produced in their caregivers' speech. Infants with a well-established consonant repertoire also match their babble to objects in their environment. Our findings show that infants' early consonant productions are shaped by their input: by 10 months, the sounds of babble match what infants see and hear.

The sustainability of a quality improvement initiative.

Functional decline in seniors admitted to hospital is due in part to lack of mobilization. Many Quality Improvement (QI) initiatives targeting mobilization of the elderly population in acute care exist; however, their long-term effectiveness is not well-documented. Mobilization of Vulnerable Elders (MOVE) was a grant-funded initiative that started in Ontario and spread to Alberta. The primary objective of this project was to ascertain the sustainability of the MOVE project 1 year post implementation at two hospital sites in Alberta, Canada. Qualitative and quantitative cross-sectional data were gathered from multidisciplinary healthcare professionals. Our findings suggest MOVE was not well-sustained one year post implementation. Examination of specific survey questions provided an indication of strengths and weaknesses of the MOVE QI. Sustainable and cost-effective QI targeted at this elderly patient demographic could alleviate some of the demand on the healthcare system. Modifications to improve the sustainability of MOVE are summarized.

Revision of an undergraduate nursing oncology course using the Taylor Curriculum Review Process.

Patients diagnosed with cancer require intensive nursing care and support across all healthcare settings (Canadian Association of Nurses in Oncology [CANO], 2015). Advances in this nursing specialty and the resulting changes to practice add to the complexity of the nursing role. Clinical improvements impact the preparation of nursing students transitioning into this area of practice. The inclusion of an oncology curriculum in undergraduate programs can help to develop fundamental competencies for undergraduates in this specialty (Lockhart et al., 2013). A fourth-year undergraduate nursing oncology course was recently evaluated at the University of Calgary to ensure content was congruent with current practice. Since the course was initially developed in 2011, there have only been minor updates, potentially resulting in out-of-date content. A curriculum review process outlined by the Taylor Institute of Teaching and Learning was used to complete this course revision (Dyjur & Kalu, 2016). The findings of this course revision indicate the need to provide more student-centred learning, to discuss the implementation of recent treatments, and to provide more clinically centered literature on recent developments in oncology.

"Family Is Who They Say They Are"a: Examining the Effects of Cancer on the Romantic Partners of Adolescents and Young Adults.

In this article, we discuss a study we conducted to examine the effects of cancer on romantic partners (i.e., boyfriends and girlfriends, social/romantic/intimate partners) of adolescents and young adults experiencing, or who have experienced, cancer. In this hermeneutic study, we interviewed partners who were involved with an adolescent/young adult with cancer, a cancer survivor who was in a relationship during his treatment, and two healthcare professionals who have worked with these couples and witnessed many other situations of impact, effect, and repercussion. Out of this study, we suggest that partners are affected in many ways that can vary from estrangement, to termination of the relationship, to premature decisions about remaining in the relationship, to family disregard of the partner, and to disregard of the family due to influence of, or relationship with, the partner. We discuss these findings within the context of the larger picture of the psychosocial relational impact of cancer on members beyond those in the immediate and biological family.

A perceptual advantage for onomatopoeia in early word learning: Evidence from eye-tracking.

A perceptual advantage for iconic forms in infant language learning has been widely reported in the literature, termed the "sound symbolism bootstrapping hypothesis" by Imai and Kita (2014). However, empirical research in this area is limited mainly to sound symbolic forms, which are very common in languages such as Japanese but less so in Indo-European languages such as English. In this study, we extended this body of research to onomatopoeia-words that are thought to be present across most of the world's languages and that are known to be dominant in infants' early lexicons. In a picture-mapping task, 10- and 11-month-old infants showed a processing advantage for onomatopoeia (e.g., woof woof) over their conventional counterparts (e.g., doggie). However, further analysis suggests that the input may play a key role in infants' experience and processing of these forms.

Social Return on Investment: A New Approach to Understanding and Advocating for Value in Healthcare.

OBJECTIVE: To determine whether the methodology of social return on investment (SROI) could be a way in which the value of a healthcare-related program (children's cancer camp) could be captured, evaluated, and communicated. BACKGROUND: The value of healthcare goes beyond what can be captured in financial terms; however, this is the most common type of value that is measured. The SROI methodology accounts for a broader concept of value by measuring social, environmental, and economic outcomes and uses monetary values to represent them. METHODS: The steps/stages of an SROI analysis were applied to the context of a children's camp for this article. RESULTS: Applying the SROI methodology to this healthcare-related program was feasible and provided insight and understanding related to the impacts of this program. CONCLUSIONS: Because of SROI's flexibility, it is a tool that has great potential in a healthcare environment and for leaders to evaluate programmatic return on investment.

How salient are onomatopoeia in the early input? A prosodic analysis of infant-directed speech.

Onomatopoeia are frequently identified amongst infants' earliest words (Menn & Vihman, 2011), yet few authors have considered why this might be, and even fewer have explored this phenomenon empirically. Here we analyze mothers' production of onomatopoeia in infant-directed speech (IDS) to provide an input-based perspective on these forms. Twelve mothers were recorded interacting with their 8-month-olds; onomatopoeic words (e.g. quack) were compared acoustically with their corresponding conventional words (duck). Onomatopoeia were more salient than conventional words across all features measured: mean pitch, pitch range, word duration, repetition, and pause length. Furthermore, a systematic pattern was observed in the production of onomatopoeia, suggesting a conventionalized approach to mothers' production of these words in IDS.

Children's cancer camps: a sense of community, a sense of family.

Childhood cancer is a family affair, and each year in Canada, approximately 1,400 children and adolescents under the age of 20 are diagnosed with cancer. Innumerable challenges accompany this diagnosis, and in recognition of the stress of childhood cancer, children's cancer camps arose in the 1970s to help children and their families escape the rigidity and severity of cancer treatment. Very little is known about these cancer camps, and to that end, a philosophical hermeneutic study was conducted to understand the meaning of children's cancer camps for the child with cancer and the family. Six families were interviewed to bring understanding to this topic. While the research included findings related to the concept of play, fit and acceptance, storytelling, and grief, this paper will detail the finding related to the solidarity of the community--the "camp family"--as one that creates intense, healing bonds.

Phonological networks and systematicity in early lexical acquisition.

Infants' early words tend to be phonologically similar. This may reflect a systematic approach to early production, as they adapt newly acquired forms to fit familiar structures in the output. This "rich-get-richer" approach to phonological acquisition, known as preferential attachment in network science, proposes that new words cluster together with existing phonologically similar words in the lexicon (or network). This contrasts with recent work (e.g., Fourtassi et al., 2020) showing that the learning environment is the key predictor of learning (preferential acquisition). This study expands on previous analyses of vocabulary norm data to analyze naturalistic data, namely phonetic transcriptions of nine infants' word productions, from word onset to age 2;6. Network growth models test whether (a) acquisition is best modeled through preferential attachment or preferential acquisition, (b) the trajectory of network growth changes over time, and (c) there are any differences in network growth of adult target forms versus infants' actual productions. Results show that preferential attachment predicts acquisition of new words more convincingly than preferential acquisition: newly acquired words are phonologically similar to existing words in the network. Furthermore, systematicity becomes increasingly apparent over the course of acquisition, and infants produce their early words more systematically than we would expect from looking at target forms alone. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Changing Landscape for Human Absorption, Metabolism, and Excretion: Practical Experiences From a Data Analysis of 500 Studies.

Coincidental with the intensified regulatory and industry focus on the design and conduct of human absorption, metabolism, and excretion (hAME) studies in the past 12 months, we have recently completed our 500th cohort involving radiolabeled test item administration to humans. Here, we build upon a recent industry white paper in this journal1 and share some of our own experiences as a Contract Research Organization based upon collaborations with numerous pharma companies and their differing approaches to design and timing, to add further context to the discussion regarding hAME studies and the pivotal role that drug metabolism and pharmacokinetics plays. In this article, we explore how both changing relationships within the industry and shifting regulatory guidelines are impacting strategies, and compare EU and US pre-study approval requirements, before evaluating the trends from over 500 studies conducted at our global facilities conducted over more than 30 years. We conclude with a review of how improved technical capabilities and strategies are influencing the design and conduct of hAME studies, before speculating on some of the driving factors which may shape the direction they take in the future.