Speech-language pathologist involvement in the paediatric intensive care unit.

PURPOSE: To measure the prevalence of speech-language pathologist (SLP) involvement and associated trends for critically ill children in United States (US) paediatric intensive care units (PICU) through secondary analysis of the Prevalence of Acute Rehab for Kids in the PICU (PARK-PICU) study data. METHOD: A secondary analysis of cross-sectional point prevalence study conducted over 1 day in 82 US PICUs. Data collected included SLP presence, patients' age, length of stay, medical interventions, aetiology, admission data, Glasgow Coma Scale scores, staffing involvement, and family presence. RESULT: Among 961 patients, 82 were visited by an SLP on the study day for a prevalence of 8.5%. Most visits were for children <3 years old. The odds of SLP involvement were lower for children who were 7-12 years old (vs. age 0-2; adjusted odds ratio [aOR] 0.28; 95% CI 0.1-0.8), were mechanically ventilated via endotracheal tube (vs. room air; aOR 0.02; 95% CI 0.005-0.11), or had mild or severe disability (mild vs. no disability; aOR 0.34; 95% CI 0.16-0.76 and severe vs. no disability; aOR 0.39; 95% CI 0.17-0.90). Concurrent physical and/or occupational therapy involvement was associated with higher odds of SLP involvement (aOR 3.6; 95% CI 2.1-6.4). CONCLUSION: SLP involvement is infrequent in US PICUs. PICU teams should be educated about the scope of SLP practice, to support communication and oral feeding needs during early recovery from critical illness.

Resting-State Connectivity Changes After Goal-Oriented Attentional Self-Regulation Training in Veterans With Mild Traumatic Brain Injury: Preliminary Findings from a Randomized Controlled Trial.

Mild traumatic brain injury (mTBI) can have lasting consequences on cognitive functioning and well-being. Goal-Oriented Attentional Self-Regulation (GOALS) training has been shown to improve attention and executive functioning, as well as emotional functioning, in veterans with chronic TBI. An ongoing clinical trial (NCT02920788) is further evaluating GOALS training, including underlying neural mechanisms of change. The present study aimed to examine training-induced neuroplasticity by resting-state functional connectivity (rsFC) changes in GOALS versus active control. Veterans with a history of mTBI ≥6 months post-injury (N = 33) were randomly assigned to GOALS (n = 19) or an intensity-matched active control group (Brain Health Education [BHE] training; n = 14). GOALS consists of attention regulation and problem solving applied to individually defined, relevant goals through a combination of group, individual, and home practice sessions. Participants underwent multi-band resting-state functional magnetic resonance imaging at baseline and post-intervention. Exploratory 2 × 2 mixed analyses of variance identified pre-to-post changes in seed-based connectivity for GOALS versus BHE in five significant clusters. GOALS versus BHE demonstrated a significant increase in right lateral pre-frontal cortex connectivity with the right frontal pole and right middle temporal gyrus, as well as increased posterior cingulate connectivity with the pre-central gyrus. Rostral pre-frontal cortex connectivity with the right precuneus and the right frontal pole decreased in GOALS versus BHE. These GOALS-related changes in rsFC point to potential neural mechanisms underlying the intervention. This training-induced neuroplasticity may play a role in improved cognitive and emotional functioning post-GOALS.

Core components of a rehabilitation program in pediatric cardiac disease.

There is increasing effort in both the inpatient and outpatient setting to improve care, function, and quality of life for children with congenital heart disease, and to decrease complications. As the mortality rates of surgical procedures for congenital heart disease decrease, improvement in perioperative morbidity and quality of life have become key metrics of quality of care. Quality of life and function in patients with congenital heart disease can be affected by multiple factors: the underlying heart condition, cardiac surgery, complications, and medical treatment. Some of the functional areas affected are motor abilities, exercise capacity, feeding, speech, cognition, and psychosocial adjustment. Rehabilitation interventions aim to enhance and restore functional ability and quality of life for those with physical impairments or disabilities. Interventions such as exercise training have been extensively evaluated in adults with acquired heart disease, and rehabilitation interventions for pediatric patients with congenital heart disease have similar potential to improve perioperative morbidity and quality of life. However, literature regarding the pediatric population is limited. We have gathered a multidisciplinary team of experts from major institutions to create evidence- and practice-based guidelines for pediatric cardiac rehabilitation programs in both inpatient and outpatient settings. To improve the quality of life of pediatric patients with congenital heart disease, we propose the use of individualized multidisciplinary rehabilitation programs that include: medical management; neuropsychology; nursing care; rehabilitation equipment; physical, occupational, speech, and feeding therapies; and exercise training.

Infection with chikungunya virus confers heterotypic cross-neutralizing antibodies and memory B-cells against other arthritogenic alphaviruses predominantly through the B domain of the E2 glycoprotein.

Infections with Chikungunya virus, a mosquito-borne alphavirus, cause an acute febrile syndrome often followed by chronic arthritis that persists for months to years post-infection. Neutralizing antibodies are the primary immune correlate of protection elicited by infection, and the major goal of vaccinations in development. Using convalescent blood samples collected from both endemic and non-endemic human subjects at multiple timepoints following suspected or confirmed chikungunya infection, we identified antibodies with broad neutralizing properties against other alphaviruses within the Semliki Forest complex. Cross-neutralization generally did not extend to the Venezuelan Equine Encephalitis virus (VEEV) complex, although some subjects had low levels of VEEV-neutralizing antibodies. This suggests that broadly neutralizing antibodies elicited following natural infection are largely complex restricted. In addition to serology, we also performed memory B-cell analysis, finding chikungunya-specific memory B-cells in all subjects in this study as remotely as 24 years post-infection. We functionally assessed the ability of memory B-cell derived antibodies to bind to chikungunya virus, and related Mayaro virus, as well as the highly conserved B domain of the E2 glycoprotein thought to contribute to cross-reactivity between related Old-World alphaviruses. To specifically assess the role of the E2 B domain in cross-neutralization, we depleted Mayaro and Chikungunya virus E2 B domain specific antibodies from convalescent sera, finding E2B depletion significantly decreases Mayaro virus specific cross-neutralizing antibody titers with no significant effect on chikungunya virus neutralization, indicating that the E2 B domain is a key target of cross-neutralizing and potentially cross-protective neutralizing antibodies.

Parenting stress and autistic children's emotional problems relate to family-school partnerships and parent mental health.

Dimensions of family-school partnerships, including parent-teacher relationship quality and family educational involvement, are associated with positive outcomes for youth. Family-school partnerships are important for autistic youth, who may particularly benefit from cross-setting supports. Coordinated family-school partnerships may help maximize child outcomes. This study investigated the extent to which child behavioral and physical health (emotional, behavioral, and medical problems) and parent mental health (parenting stress, parent mental health history, and parent depressive symptoms) were associated with parent-teacher relationship quality and family involvement in a sample of 68 families of school-aged autistic children. Families were recruited through invitation letters disseminated at local early intervention and early childhood programs. Children in the sample were primarily boys, primarily White, and approximately 8 years old. Results suggest that (a) child emotional problems and parenting stress were negatively associated with parent-teacher relationship quality (large effects) and (b) parent history of mental health problems was negatively associated with family involvement (large effect). Intervention recommendations and future research directions are discussed. For example, it would be helpful for future research to include the perspectives of ethnically diverse samples when examining family-school partnerships among families with autistic children. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Dimensions of family-school partnerships for autistic children: Context and congruence.

Family-school partnerships are crucial for promoting positive outcomes and serving as a protective factor for children at-risk for poor school outcomes (Christenson & Sheridan, 2001). This may be particularly important for autistic children, who are at increased developmental risk (Garbacz et al., 2016). However, little research has examined variables related to dimensions of these partnerships for parents and teachers of autistic children. The present study examined family socioeconomic resources in relation to two dimensions of family-school partnerships (relationship quality and family involvement) among parents of autistic children, as well as dyadic perceptions of relationship quality among parents and teachers of autistic children. Data were collected across two time points (Time 1 N = 68 parents, child ages = 5-11; Time 2 parent-teacher dyad N = 22, child ages = 7-13). Results suggest that (a) higher appraisal of financial resources was associated with higher parent-reported family involvement after controlling for child autism spectrum disorder (ASD) characteristics and (b) higher parent-reported relationship quality and family involvement at one time were significantly associated with positive independent (parent and teacher) and congruent ratings of parent-teacher relationship quality 2 years later. Study limitations, future directions, and practical implications are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Ensuring communication access for all during the COVID-19 pandemic and beyond: supporting patients, providers, and caregivers in hospitals.

The COVID-19 pandemic has revealed substantial gaps in communication access for patients across hospital settings. With the rise in positive cases globally, the need for communication enhancement strategies, including augmentative and alternative communication (AAC), has emerged as a critical need. Many resources exist that describe AAC assessment and intervention processes in the acute care setting; however, AAC service provision in the COVID-19 pandemic is fraught with many unanticipated challenges. Patients, providers, and caregivers have encountered significant communication strain both at the bedside and beyond hospital walls, resulting in a communication crisis induced by many COVID-19 related variables. This article describes the sequelae of symptoms a person with COVID-19 may experience, progression of communication needs, and evidence-based solutions to supporting communication access. Barriers related to the COVID-19 pandemic are outlined (e.g., evolving infection control practices, personal protective equipment requirements, visitor policies, and more) along with response recommendations to support communication enhancement efforts for people with and without COVID-19 benefiting from access to AAC.

Algunos fundamentos de la endodoncia regenerativa con células madre en el diente permanente inmaduro no vital / Some basics of the regenerative endodontics with stem cells in the non-vital immature permanent tooth

La endodoncia regenerativa comprende un conjunto de procedimientos biológicos que se efectúan en los dientes permanentes con ápice no formado y necrosis pulpar, cuyo fin es sustituir los tejidos dañados, incluidas la dentina y la estructura radicular, así como las células del complejo pulpodentinario. En este artículo se describen las bases celulares y moleculares de esta terapia, sustentada en una compleja interacción entre las células madre dentales de la papila apical, los factores de crecimiento y los biomateriales con el microambiente donde se va a restablecer. Asimismo, se argumenta cómo las condiciones ambientales en las que se lleva a cabo el proceso terapéutico influyen en la regeneración, con una función esencial en la regulación de la diferenciación de los tejidos.

The regenerative endodontics comprises a group of biological procedures that are made in the permanent teeth with non-formed apex and pulpar necrosis whose end is to substitute the damaged tissues, including the dentine and radicular structure, as well as the cells of the dentin pulp complex. The cellular and molecular basis of this therapy are described in this work, sustained in a complex interaction between the dental stem cells of the apical papilla, the growth factors and biomaterials with the microenvironment where it will be recover. Likewise, it was argued how the environmental conditions in which the therapeutic process is carried out influence in the regeneration, with an essential function in the regulation of the differentiation of tissues.

Preoperative augmentative and alternative communication enhancement in pediatric tracheostomy.

OBJECTIVES/HYPOTHESIS: Describe augmentative communication tools and strategies used by pediatric patients referred to inpatient speech-language pathologists prior to tracheostomy placement. STUDY DESIGN: Retrospective review. METHODS: A review of patients who underwent initial tracheostomy placement from 2013-2016 was conducted at a tertiary pediatric center. Eligible patients were those who were referred to a specialized speech-language pathologist prior to the date of the tracheostomy placement to support communication abilities. Patients were identified by surgical procedural and billing codes. Data collected included patient demographics, speech and language disorders, and interventions performed. Chart review and cross analysis of billing data for types of assessment and intervention procedures were conducted by two speech-language pathologists for consensus agreement. RESULTS: Forty-six patients (aged 1 month-27 years, mean = 12.9 years) were included in the study. Average time between the bedside communication assessment and tracheostomy procedure date was 17 days. Baseline speech-language disorders were identified in 11 patients (24%). Thirty-eight (83%) patients were nonspeaking at the time of consultation. Thirty-two (70%) patients utilized an electronic communication tool, and 36 (78%) utilized low-technology communication strategies during the preoperative period. A total of 32 (70%) patients were documented as using no-technology or speech-enhancement strategies during the acute hospitalization. CONCLUSIONS: Multidisciplinary tracheostomy teams should consider consultation to speech-language pathologists for patients prior to tracheostomy placement to assess for utility of high-technology, low-technology, and no-technology augmentative and alternative communication strategies. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:1817-1822, 2020.

Association of a Multidisciplinary Care Approach With the Quality of Care After Pediatric Tracheostomy.

IMPORTANCE: Incidence of tracheostomy placement in children is increasing, and these children continue to have high incidences of morbidity and mortality. A multidisciplinary tracheostomy program may help improve the quality of care received by these patients. OBJECTIVE: To determine whether implementation of a multidisciplinary tracheostomy program can improve the care of children who received a tracheostomy through reduction in tracheostomy-related adverse events (TRAEs), improved tracheostomy education, and caregiver preparedness. DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study was conducted from January 2015 to June 2018 at a pediatric tertiary referral center in Boston, Massachusetts. The participants included 700 children who had received a tracheostomy, most of whom were aged birth to 18 years, but some patients with congenital disorders were much older. EXPOSURES: Institution of a multidisciplinary tracheostomy team (MDT) whose activities included conducting staff meetings, organizing outpatient clinics, conducting inpatient tracheostomy ward rounds, and conducting inpatient tracheostomy rounds at a local rehabilitation hospital. Quality improvement initiatives included monitoring standardized TRAEs and distributing standardized tracheostomy "go-bags." MAIN OUTCOMES AND MEASURES: Reduction of TRAEs and improved caregiver preparedness through distribution of tracheostomy go-bags were assessed following the establishment of a multidisciplinary tracheostomy program. RESULTS: In total, 700 children who had received a tracheostomy during the study period were actively followed up by the MDT. Of these children, 378 (54.0%) were males and 322 (46.0%) were females; mean (SD) age was 4.1 (6.1) years. More than 60 new pediatric tracheostomies were performed annually at the referral center. Reported TRAEs were reduced by 43.0% from the first to the third year after the implementation of a standardized, closed-loop monitoring system (from a mean [SD] of 6.1 [5.2] TRAEs per 1000 inpatient tracheostomy-days in 2015 to a mean [SD] of 4.0 [2.5] in 2018). The most common TRAE was unplanned decannulation, which occurred 64 times during the study period. On average, 10 patients were seen in each monthly multidisciplinary tracheostomy clinic. Clinic interventions included continuing care (146 [52.5%]), communication enhancement (67 [23.6%]), plans for decannulation (52 [18.6%]), and referrals for comorbidities (13 [4.6%]). Approximately 19 inpatients were seen during biweekly rounds and 8 during monthly rounds at a local rehabilitation hospital. A total of 297 patients received standardized tracheostomy go-bags, and more than 70 positive bag checks were performed in the monthly MDT clinics. A positive bag check refers to the incidence when a family is given a go-bag and also uses it. In contrast, a negative bag check refers to when a family is given a go-bag but neither brings it to the clinic nor acknowledges that they use it. CONCLUSIONS AND RELEVANCE: This study's findings suggest that a multidisciplinary tracheostomy program may be a powerful tool for enhancing patient safety and quality improvement. Ongoing studies will develop measurable pediatric tracheostomy outcome metrics and assess long-term outcomes.

Family involvement and parent-teacher relationships for students with autism spectrum disorders.

Family educational involvement and parent-teacher relationships are important for supporting student outcomes and have unique implications for families of children with autism spectrum disorder (ASD). However, little research has examined child and family characteristics among families of children with ASD as predictors of family involvement and parent-teacher relationships. The present study examined child and family variables that may affect family involvement and parent-teacher relationships for families of children with ASD. Findings suggested (a) parents of children with higher developmental risk reported less family involvement and poorer relationships with their child's teacher and (b) family histories accessing services predicted family involvement and parent-teacher relationships. Limitations of the current study and implications for science and practice are discussed. (PsycINFO Database Record

Combining temperature and force to study folding of an RNA hairpin.

RNA folding in cells typically occurs at mesophilic temperatures. However, in vitro, RNA can be unfolded either by increasing temperature to values that are much higher than physiological, or by mechanically pulling structures apart at ambient temperature. To directly study RNA folding at physiological temperatures and to unify thermodynamics measured by melting and pulling, we developed temperature-controlled optical tweezers (thermal tweezers) that can be used to mechanically unfold single RNA molecules at mesophilic temperatures. Folding of a 20-base-pair tetraloop hairpin was studied under different ionic conditions and at temperatures ranging from 22 °C to 42 °C. At each temperature, single hairpin molecules were held at constant force, and their two-state folding equilibria were monitored. The change in free energy derived from these measurements was used to construct a phase diagram of RNA structure using force and temperature as variables. Furthermore, we derived ΔG(0pN,T), the folding free energy at zero force and temperature T, by subtracting the stretching energy of unfolded RNA from the reversible mechanical work done to unfold the hairpin. ΔG(0pN,T) and its salt dependence agree reasonably well with the predictions by the nearest neighbor model. Under each ionic condition, ΔG(0pN,T) depended linearly on temperature, yielding ΔH(exp) and ΔS(exp) that also matched the predictions. The combination of force and temperature to study RNA folding is a step toward unifying thermodynamics measured by thermal melting and mechanical unfolding, and opens a new path for directly monitoring temperature induced RNA structural changes, as it occurs often in biology.

The essential role of stacking adenines in a two-base-pair RNA kissing complex.

In minimal RNA kissing complexes formed between hairpins with cognate GACG tetraloops, the two tertiary GC pairs are likely stabilized by the stacking of 5'-unpaired adenines at each end of the short helix. To test this hypothesis, we mutated the flanking adenines to various nucleosides and examined their effects on the kissing interaction. Electrospray ionization mass spectrometry was used to detect kissing dimers in a multiequilibria mixture, whereas optical tweezers were applied to monitor the (un)folding trajectories of single RNA molecules. The experimental findings were rationalized by molecular dynamics simulations. Together, the results showed that the stacked adenines are indispensable for the tertiary interaction. By shielding the tertiary base pairs from solvent and reducing their fraying, the stacked adenines made terminal pairs act more like interior base pairs. The purine double-ring of adenine was essential for effective stacking, whereas additional functional groups modulated the stabilizing effects through varying hydrophobic and electrostatic forces. Furthermore, formation of the kissing complex was dominated by base pairing, whereas its dissociation was significantly influenced by the flanking bases. Together, these findings indicate that unpaired flanking nucleotides play essential roles in the formation of otherwise unstable two-base-pair RNA tertiary interactions.

Developmental change in numerical estimation.

Mental representations of numerical magnitude are commonly thought to undergo discontinuous change over development in the form of a "representational shift." This idea stems from an apparent categorical shift from logarithmic to linear patterns of numerical estimation on tasks that involve translating between numerical magnitudes and spatial positions (such as number-line estimation). However, the observed patterns of performance are broadly consistent with a fundamentally different view, based on psychophysical modeling of proportion estimation, that explains the data without appealing to discontinuous change in mental representations of numerical magnitude. The present study assessed these 2 theories' abilities to account for the development of numerical estimation in 5- through 10-year-olds. The proportional account explained estimation patterns better than the logarithmic-to-linear-shift account for all age groups, at both group and individual levels. These findings contribute to our understanding of the nature and development of the mental representation of number and have more general implications for theories of cognitive developmental change.