"I Missed School to Take Care of Someone Else": Middle and High School Students' Caregiving Responsibilities as a Reason for Absenteeism.

BACKGROUND: Middle and high school students who are involved in caregiving for aging, chronically ill, and/or disabled family members report more learning challenges compared to their non-caregiving peers. However, little is known about how many students miss school to take care of someone else, and which students are most likely to have this experience. Such knowledge could reveal an important, largely unrecognized reason for school absences and educational disparities. METHODS: Our research-practice partnership surveyed middle-and-high schoolers across Rhode Island public schools in 2022. RESULTS: Among 55,746 students (45% White non-Latinx; 21% Latinx; 45% girls), 13.80% reported they had missed school to take care of someone else, with up to 35% in some districts. Students who missed school for caregiving were disproportionately girls, non-binary, transgender, or preferred not to report gender, older youth, and from historically marginalized racial and ethnic groups, and from urban districts. CONCLUSIONS: Children's experiences caregiving for others may be an important and overlooked contributor to absenteeism and achievement gaps, especially in urban areas. We suggest school policies to better serve these students.

Links Between Objectively-Measured Hourly Smartphone Use and Adolescent Wake Events Across Two Weeks.

PURPOSE: Psychosocial and bioregulatory pressures threaten sleep during adolescence. Although recent work suggests that the ubiquity of smartphone use throughout adolescence may also relate to poorer sleep outcomes, most existing research relies upon self-report and retrospective measures. This study drew upon objective measures of smartphone use and sleep at the hourly level to understand how smartphone use was associated with the duration of wake events during sleeping hours. METHODS: Across a 14-day daily study, 59 racially and ethnically diverse adolescents ages 15 to 18 had their sleep assessed via Fitbit Inspire 2 devices and uploaded screenshots of their screen time, pickups, and notifications as logged by their iPhone's iOS. Multi-level modeling was performed to assess hourly level associations between adolescent smartphone use and wake-events during their sleep sessions (N = 4,287 hourly cases). RESULTS: In hours during adolescents' sleep session with more screen time or pickups, adolescents had longer wake event duration. More notifications in a given hour were not associated with wake event duration in the same hour. CONCLUSIONS: Using objectively measured smartphone and sleep data collected at the hourly level, we found that during sleeping hours, when adolescents are actively engaging with their smartphones, their sleep is disrupted, such that their wake events are longer in that hour.

Nitrofurantoin resistance as an indicator for multidrug resistance: an assessment of Escherichia coli urinary tract specimens in England, 2015-19.

Objectives: To determine whether MDR occurs more frequently in nitrofurantoin-resistant Escherichia coli urinary isolates in England, compared with nitrofurantoin-susceptible isolates. Methods: Using routine E. coli urine isolate antibiotic susceptibility laboratory surveillance data for England, 2015-19 inclusive, the percentage of MDR or XDR phenotype was estimated for nitrofurantoin-susceptible and nitrofurantoin-resistant laboratory-reported urinary tract samples by region, patient sex and age group. Results: Resistance to nitrofurantoin among E. coli urinary samples decreased slightly year on year from 2.9% in 2015 to 2.3% in 2019. Among E. coli UTIs tested for nitrofurantoin susceptibility and  ≥3 additional antibiotics, the percentage that were MDR was consistently 15%-20% percentage points higher for nitrofurantoin-resistant isolates compared with nitrofurantoin-susceptible isolates. Similarly, the percentage of isolates with an XDR phenotype was higher among nitrofurantoin-resistant versus -susceptible isolates (8.7% versus 1.4%, respectively, in 2019); this disparity was greater in male patients, although variation was seen by age group in both sexes. Regional variation was also noted, with the highest MDR percentage amongst nitrofurantoin-resistant E. coli urinary samples in the London region (36.7% in 2019); the lowest was in the North East (2019: 16.9%). Conclusions: MDR and XDR phenotypes occur more frequently in nitrofurantoin-resistant E. coli urinary isolates in England, compared with nitrofurantoin-susceptible isolates. However, nitrofurantoin resistance is low (<3%) overall. This latest study provides important insights into trends in nitrofurantoin resistance and MDR, which is of particular concern for patients ≥75 years old and those who are male. It also emphasises geographical heterogeneities within England in nitrofurantoin resistance and MDR.

May-Thurner Syndrome: An Interesting Presentation of Recurrent, Unprovoked Deep Vein Thrombosis.

May-Thurner Syndrome (MTS) is a unique condition characterized by the compression of the left iliac vein by the right common iliac artery, which causes venous outflow obstruction and a high risk of venous sequelae. May-Thurner Syndrome is a condition that is primarily observed in females and is an uncommon cause of deep vein thrombosis (DVT). The more common presentation of DVT is in the lower left extremity, although there have been cases of right-sided formation. In this case report, we present a patient with unprovoked, recurrent, left-sided deep vein thrombosis in a 70-year-old woman. The aim of this case report is to highlight this uncommon condition and to suggest consideration of MTS in the setting of a patient with recurrent unprovoked DVTs of the same extremity.

Linking video chatting, phone calling, text messaging, and social media with peers to adolescent connectedness.

For 14 days three times per day (6072 observations), adolescents (N = 207, Mage = 15.45 years) reported their digital (i.e., video chatting, texting, social media, and phone calling) communication with peers and their social connectedness. Controlling for in-person interactions, adolescents felt more connected in hours when they had communicated with peers by video chatting, texting, or social media, but not phone calling. Girls communicated with peers via text and social media more than boys, and boys talked on the phone more than girls. Boys who talked, texted, or video chatted more on average reported higher connectedness on average, whereas girls did not. As the links with connectedness were only found at the hourly- and not the daily level, results highlight that a sense of connectedness from digital media may be fleeting in nature.

Surveillance towards preventing paediatric incidence of respiratory syncytial virus attributable respiratory tract infection in primary and secondary/tertiary healthcare settings in Merseyside, Cheshire and Bristol, UK.

INTRODUCTION: Respiratory syncytial virus (RSV) is a common respiratory virus, particularly affecting children, and can cause respiratory infections such as croup and bronchiolitis. The latter is a leading cause of paediatric hospitalisation within the UK. Children <3 years of age and/or with underlying health conditions are more vulnerable to severe RSV infection.There are currently limited data on the incidence of laboratory-confirmed RSV, particularly within primary care settings and outside the typical 'RSV season', which in the Northern hemisphere tends to coincide with winter months. There is also a lack of data on the health economic impact of RSV infection on families and healthcare systems.This observational surveillance study aims to collect data on the incidence of laboratory-confirmed RSV-attributable respiratory tract infection (RTI) in children aged <3 years presenting to primary, secondary or tertiary care; it also aims to estimate the health economic and quality of life impact of RSV-attributable infection in this cohort. Such data will contribute to informing public health strategies to prevent RSV-associated infection, including use of preventative medications. METHODS AND ANALYSIS: Parents/carers of children <3 years of age with RTI symptoms will consent for a respiratory sample (nasal swab) to be taken. Laboratory PCR testing will assess for the presence of RSV and/or other pathogens. Data will be obtained from medical records on demographics, comorbidities, severity of infection and hospitalisation outcomes. Parents will complete questionnaires on the impact of ongoing infection symptoms at day 14 and 28 following enrolment. The primary outcome is incidence of laboratory-confirmed RSV in children <3 years presenting to primary, secondary or tertiary care with RTI symptoms leading to health-seeking behaviours. Recruitment will be carried out from December 2021 to March 2023, encompassing two UK winter seasons and intervening months. ETHICS AND DISSEMINATION: Ethical approval has been granted (21/WS/0142), and study findings will be published as per International Committee of Medical Journal Editors' guidelines.

Changes in perceptions of teaching quality in secondary schools in Rwanda during the COVID-19 global pandemic and the subsequent closing and reopening of schools.

The stability of measures of teaching quality is essential for making generalizations of results stemming from these measures to other teaching situations. However, no research has examined the effects of unexpected situational factors on the stability of these measures. Therefore, the purpose of this two-phase quantitative research study was to examine the following aspects among secondary school teachers in Rwanda, using a score-validated, multiple-dimension measure: (a) perceptions of teaching quality (PTQ) prior to the onset of the COVID-19 context (Phase 1; descriptive and correlational design); and (b) the extent to which COVID-19 and the subsequent closing and reopening of secondary schools affected PTQ among STEM teachers in Rwanda, and the associations between these changes in PTQ and selected socio-demographic/locational variables (Phase 2; descriptive and correlational research design). Phase 1 findings revealed that two measures of cultural values (i.e., Attitudes Towards Cultural Values Scale, Inculcating Cultural Values Scale, respectively) generated the most positive attitudes, whereas the Satisfaction with Resources and Material Subscale yielded the least positive attitudes. Phase 2 findings revealed that for four of the nine PTQ scales/subscales, the COVID-19 context negatively affected PTQ. These findings provide compelling evidence of the importance of monitoring PTQ, especially during times of crises. Moreover, these findings have implications for Rwandan educational policymakers, Rwandan administrators, teacher training administrators, and, above all, the teachers themselves, as they all seek to maximize teaching quality in Rwandan secondary schools.

Cortisol response marks biological sensitivity to kindergartners' social hierarchies for emerging school engagement.

This longitudinal study investigated how kindergartners' position in the classroom social hierarchy and cortisol response relate to their change in school engagement across the first year of kindergarten (N = 332, M = 5.3 years, 51% boys, 41% White, 18% Black). We used naturalistic classroom observations of social hierarchy positions, laboratory-based challenges to elicit salivary cortisol response, and teacher, parent, and child reports of emotional engagement with school. Robust, clustered regression models revealed that in the fall, lower cortisol response (but not social hierarchy position) was associated with greater school engagement. However, by spring, significant interactions emerged. Highly reactive, subordinate children showed increases in school engagement from fall to spring of the kindergarten year, whereas highly reactive, dominant children showed decreases in school engagement. This is some of the first evidence that higher cortisol response marks biological sensitivity to early peer-based social contexts.

Adolescents' Perceptions of Social Risk and Prosocial Tendencies: Developmental Change and Individual Differences.

Many prosocial behaviors involve social risks such as speaking out against a popular opinion, bias, group norm, or authority. However, little is known about whether adolescents' prosocial tendencies develop over time with their perceptions of social risks. This accelerated longitudinal study used within-subject growth-curve analyses to test the link between prosocial tendencies and social risk perceptions, in a sample of adolescents who completed self-reports annually for three years (N = 893; M age = 12.30 years, 10 - 14 years at Wave 1, and 10 - 17 years across the full study period; 50% Girls, 33% White non-Latinx, 27% Latinx, 20% African American, 20% Mixed/Other Race). The association between social risk tolerance and prosocial tendencies changed significantly across adolescence, such that at for younger adolescents, more prosocial tendencies were associated with less social risk tolerance, whereas for relatively older adolescents, more prosocial tendencies were associated marginally with more social risk tolerance. Additional individual differences by empathy (but not sensation seeking) emerged. These findings suggest that prosocial development across adolescence may be associated with an underlying ability to tolerate social risks.

Momentary links between adolescents' social media use and social experiences and motivations: Individual differences by peer susceptibility.

This longitudinal ecological momentary assessment study examined whether adolescents' use of social media to interact with peers relates to their experiences of social connectedness, social craving, and sensation seeking on an hourly level. Further, we investigated whether these associations differ for adolescents who were nominated by their peers as more or less susceptible to social influences, because highly susceptible youth may be more strongly impacted by social media due to heightened focus on peer behaviors and social feedback. The sample was 212 adolescents in the southeastern United States (Mage = 15 years; range 14 to 17; 56.2% female; 40% White, 28% Latinx, 26% African American, 15% mixed/other race). Controlling for both daily and between-subjects effects, we found a consistent pattern of hourly-level results that were robust to sensitivity analyses. When highly susceptible adolescents used social media to interact with peers in the last hour, they felt less socially connected to others and more strongly craved social connections and novel sensations. Youth who are particularly sensitive to social input from peers may feel less connected to others and crave more connections and exciting stimuli within 1 hr after using social media to interact with peers. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A meta-analysis of mother-child synchrony in respiratory sinus arrhythmia and contextual risk.

Biobehavioral frameworks of attachment posit that mother-child dyads engage in physiological synchrony that is uniquely formative for children's neurobiological, social, and emotional development. Much of the work on mother-child physiological synchrony has focused on respiratory sinus arrhythmia (RSA). However, the strength of the existing evidence for mother-child RSA synchrony during interaction is unclear. Using meta-analysis, we summarized results from 12 eligible studies comprising 14 samples and 1201 children ranging from infancy to adolescence (Mage  = 5.68 years, SD = 4.13, range = 0.4-17 years) and their mothers. We found that there was a statistically significant, albeit modest, positive within-dyad association between mother and child fluctuations in RSA. There also was evidence for significant heterogeneity across studies. Less mother-child RSA synchrony was observed in high-risk samples characterized by clinical difficulties, history of maltreatment, or socioeconomic disadvantage. We did not find that mother-child RSA synchrony significantly differed by task context, mean child age, or by epoch length for computing RSA. Collectively, these findings suggest that mother-child dyads show correspondence in their fluctuations in RSA, and that RSA synchrony is disrupted in high-risk contexts. Future directions and implications for the study of parent-child physiological synchrony are discussed.

Pakistani preschoolers' number of older siblings and cognitive skills: Moderations by home stimulation and gender.

The present study examines the link between children's number of older siblings and their cognitive development, as measured by executive function (EFs) skills and verbal skills (VIQ) in a sample of 1,302 4-year-old children (54% boys) living in rural Pakistan. Specifically, we investigate whether the links between the number of older siblings and preschoolers' EFs and VIQ are moderated by preschoolers' quality of home stimulation and gender. Multivariate regressions revealed that the number of older siblings was positively associated with EFs for boys in homes with both higher and lower levels of stimulation, and for girls in homes with lower levels of stimulation (p < .05). However, the number of older siblings was negatively associated with EFs for girls from homes with higher levels of stimulation (p = .03). Further, the number of older siblings was positively associated with VIQ in homes with lower stimulation (p < .05), but not for higher stimulation homes. Gender was not a statistically significant moderator of the association between the number of older siblings and VIQ. Findings suggest that living with more older siblings may promote emerging EFs and VIQ among boys and girls with fewer opportunities for cognitive stimulation. However, more older siblings may hinder EF development for girls in the context of adequate home stimulation, perhaps due to inequitable allocation of resources among boys and girls in more affluent, larger families. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The management of acute meningitis: an update.

Meningitis remains an important cause of mortality and morbidity. Clinicians should be alert to this diagnosis and have a low threshold for investigation and treatment of meningitis. This article provides an update of current evidence and existing guidelines for the management of suspected acute meningitis in adults in the UK.

A 28-day, 2-year study reveals that adolescents are more fatigued and distressed on days with greater NO2 and CO air pollution.

This 2-year, 28-day study examined whether adolescents felt greater fatigue and emotional distress the same day and the day after air quality was worse. We linked objective daily air quality measurements to daily self-reports from 422 Mexican-American adolescents in Los Angeles County, California from 2009 to 2011 (50% girls, MAge = 15 years). A robust, within-subject analysis of 9696 observations revealed that adolescents with ongoing physical complaints reported greater fatigue and emotional distress on days that the air contained higher levels of nitrogen dioxide (NO2) and carbon monoxide (CO). Regardless of physical complaints, adolescents on average also reported greater fatigue the day after NO2 levels were higher. The same-day and next-day associations between air pollution and distress were mediated via daily increases in fatigue. Results were robust when controlling for day of the week, and daily temperature and humidity. Sulfur dioxide (SO2), ozone (O3), PM2.5 and PM10 were not related to daily fatigue or distress.

Estimating effects of parents' cognitive and non-cognitive skills on offspring education using polygenic scores.

Understanding how parents' cognitive and non-cognitive skills influence offspring education is essential for educational, family and economic policy. We use genetics (GWAS-by-subtraction) to assess a latent, broad non-cognitive skills dimension. To index parental effects controlling for genetic transmission, we estimate indirect parental genetic effects of polygenic scores on childhood and adulthood educational outcomes, using siblings (N = 47,459), adoptees (N = 6407), and parent-offspring trios (N = 2534) in three UK and Dutch cohorts. We find that parental cognitive and non-cognitive skills affect offspring education through their environment: on average across cohorts and designs, indirect genetic effects explain 36-40% of population polygenic score associations. However, indirect genetic effects are lower for achievement in the Dutch cohort, and for the adoption design. We identify potential causes of higher sibling- and trio-based estimates: prenatal indirect genetic effects, population stratification, and assortative mating. Our phenotype-agnostic, genetically sensitive approach has established overall environmental effects of parents' skills, facilitating future mechanistic work.

Biological sensitivity to environmental context fluctuates dynamically within individuals from day to day.

This longitudinal, within-subjects study examined whether adolescents' biological sensitivity to socioeconomic status (SES) for emerging social difficulties varied day to day. Diverse adolescents (N = 315; ages 11-18; 57% female; 25% Asian, 18% Latinx, 11% Black) provided daily diaries and saliva samples for 4 days. We measured biological sensitivity as daily fluctuations in diurnal cortisol slope, and SES as a principal component of family income and maternal education. A robust analysis of 1013 daily assessments revealed that youth from lower SES homes reported greater social difficulties only on days that they exhibited flatter diurnal cortisol slopes, and youth from higher SES homes reported fewer social difficulties on these days. SES was not associated with social difficulties on days that adolescents exhibited steeper, declining diurnal cortisol slopes. Findings support recent theory that risk and resilience are dynamic processes that change within individuals over time. For better and for worse, youth may be more biologically sensitive to their family socioeconomic environments on days that their diurnal cortisol rhythms are flattened.

Epilepsy with myoclonic absences: a case series highlighting clinical heterogeneity and surgical management.

OBJECTIVE: Epilepsy with myoclonic absences is a rare epilepsy syndrome with distinct features and high rates of drug resistance. Identifying this syndrome may help guide treatment decisions. We highlight clinical heterogeneity in this case series and two cases in which corpus callosotomy was performed. METHODS: Medical records were reviewed between 2017 and 2021 to identify demographics, comorbidities, age at onset, EEG findings, diagnostic evaluations, seizure semiologies, seizure frequency, anti-seizure medications, diet therapy and surgical treatments in patients with myoclonic absences. RESULTS: Ten patients were identified including twins with myoclonic absence status epilepticus. Forty percent had an atonic component, 20% presented with myoclonic absence status epilepticus and 60% had incomplete control of seizures at last follow-up visit. Two patients with epilepsy with myoclonic absences with atonia underwent corpus callosotomy; one patient was seizurefree eight months after surgery and the other had greater than 50% seizure reduction over a five-month period. SIGNIFICANCE: Phenotypic heterogeneity was evident based on seizure semiologies, comorbidities, seizure frequency and response to anti-seizure medications and non-medication treatments. Of patients with an atonic component, 75% did not achieve seizure freedom with medication alone. Corpus callosotomy was performed in two of these patients with encouraging seizure response thus far, however, the efficacy of this treatment should be further evaluated in a larger study.

Adolescents take more risks on days they have high diurnal cortisol or emotional distress.

This study investigates how the interplay between adolescents' daily levels of emotional distress and diurnal cortisol relates to their risk-taking behaviors. Specifically, we test competing hypotheses whether emotional distress exacerbates the link between cortisol and risk taking, or whether cortisol only predicts risk taking in the absence of emotional distress. Ethnically diverse adolescents (N = 370; ages 11-18) reported their daily levels of emotional distress and risk-taking behavior for 5 days, and provided 4 saliva samples/day for 4 days. Emotional distress was positively associated with risk taking the same day and on average across days. Moreover, emotional distress and total cortisol output interactively predicted risk taking, such that total cortisol output was positively associated with risk taking on days when adolescents felt low levels of emotional distress, but not on days when adolescents felt high levels of emotional distress. High levels of emotional distress were associated with high levels of risk taking regardless of total cortisol output. There were no direct associations between cortisol and risk taking on daily or average levels. Results suggest that cortisol is associated with risk-taking behavior on days when adolescents are not already feeling emotionally distressed enough to take risks.