It’s possible that I shall make an ass of myself. But in that case one can always get out of it with a little dialectic. I have, of course, so worded my proposition as to be right either way (K.Marx, Letter to F.Engels on the Indian Mutiny)
Saturday, September 28, 2024
ANOTHER AQUARIST FAVORITE
Stowers scientists uncover a critical component that helps killifish regenerate their fins
The findings are a step toward closing the gap on how we could one day deploy regenerative medicine in humans
Stowers Institute for Medical Research
video:
Stowers scientists discuss findings of killifish limb regeneration research, shedding light on the evolutionary aspects of regeneration and the potential for developing novel therapeutic strategies in regenerative medicine for humans.
KANSAS CITY, MO—September 26, 2024—Spontaneous injuries like the loss of a limb or damage to the spinal cord are impossible for humans to repair. Yet, some animals have an extraordinary capacity to regenerate after injury, a response that requires a precise sequence of cellular events. Now, new research from the Stowers Institute for Medical Research has unveiled a critical timing factor—specifically how long cells actively respond to injury—involved in regulating regeneration.
A recent study published in iScience on September 20, 2024, sought to understand exactly how an organism knows how much tissue has been lost post-injury. Led by former Predoctoral Researcher Augusto Ortega Granillo, Ph.D., in the lab of Stowers President and Chief Scientific Officer Alejandro Sánchez Alvarado, Ph.D., the team investigated how African killifish properly regrow their tail fin following damage. By analyzing tissue dynamics during regrowth, they found that in addition to known factors, including how many cells are participating and where they are located, the length of time cells spend engaged in the repair process is also key.
“One of the greatest unsolved mysteries of regeneration is how an organism knows what has been lost after injury,” said Sánchez Alvarado. “Essentially, the study points to a new variable in the equation of regeneration. If we can modulate the rate and the length of time that a tissue can launch a regenerative response, this could help us devise therapies that may activate and perhaps prolong the regenerative response of tissues that normally would not do so.”
Shortly after a killifish tail injury, the remaining tissue needs to know how much damage has occurred. Then, this tissue must enlist the right number of repair cells to the site of injury for the right amount of time. Damage sensing, repair cell recruitment, and timing somehow must work together to regrow the tail.
“If an animal that can regenerate extremities, like a tail, loses just a tiny portion, how does it know not to regenerate a whole new tail but just the missing piece?” said Sánchez Alvarado. To address this question, the team probed different locations of injury in the killifish tail fin.
They found that skin cells both near an injury and in distant, uninjured regions launch a genetic program that primes the whole animal to prepare for a repair response. Then, skin cells at the site of injury sustain this response and temporarily change their state to modify the surrounding material called the extracellular matrix. Ortega Granillo likens this matrix to a sponge that absorbs secreted signals from the injured tissue that then guides repair cells to get to work. If the signals are not received or not interpreted correctly, the regeneration process may not restore the tail’s original shape and size.
“We very clearly defined when and where—at 24 hours post-injury and in the extracellular matrix—the transient cell state is acting in the fin tissue,” said Ortega Granillo. “Knowing when and where to look allowed us to make genetic disruptions and gain a better understanding of the function of these cell states during regeneration.”
To investigate whether these distinct cellular states communicate information to the extracellular matrix—the supportive structure surrounding cells—during the repair process, the researchers employed the CRISPR-Cas9 gene editing technique. They specifically targeted a gene known to modify the extracellular matrix, as they had observed its activation at the onset of the regeneration response. By disrupting the function of this gene, the team aimed to determine its role in relaying information from cells to the matrix during regeneration.
“These modified animals no longer know how much tissue was lost,” said Ortega Granillo. “They still regenerated, but the speed of tissue growth was deficient. This is telling us that by changing the extracellular space, skin cells inform the tissue how much was lost and how fast it should grow.”
Indeed, the speed and amount of tissue regenerated in these genetically modified killifish increased regardless of whether the tail injury was mild or severe. This finding opens the possibility that cell states that modify the matrix increase regenerative regrowth. If the cell states could be adjusted, it may be a way to stimulate a more robust regeneration response.
From an evolutionary perspective, understanding why certain organisms excel at regeneration while others, such as humans, have limited regenerative abilities is a driving force in the field of regenerative biology. By identifying general principles in organisms with high regenerative capacity, researchers aim to potentially apply these insights to enhance regeneration in humans. This comparative approach not only sheds light on the evolutionary aspects of regeneration but also holds promise for developing novel therapeutic strategies in regenerative medicine.
“Our goal is to understand how to shape and grow tissues,” said Ortega Granillo. “For people who sustain injuries or organ failure, regenerative therapies could restore function that was compromised during illness or following injury.”
Additional authors include Daniel Zamora, Robert Schnittker, Allison Scott, Alessia Spluga, Jonathon Russell, Carolyn Brewster, Eric Ross, Daniel Acheampong, Ning Zhang, Ph.D., Kevin Ferro, Ph.D., Jason Morrison, Boris Rubinstein, Ph.D., Anoja Perera, and Wei Wang, Ph.D.
This work was funded by institutional support from the Stowers Institute for Medical Research and the Howard Hughes Medical Institute.
About the Stowers Institute for Medical Research
Founded in 1994 through the generosity of Jim Stowers, founder of American Century Investments, and his wife, Virginia, the Stowers Institute for Medical Research is a non-profit, biomedical research organization with a focus on foundational research. Its mission is to expand our understanding of the secrets of life and improve life’s quality through innovative approaches to the causes, treatment, and prevention of diseases.
The Institute consists of 21 independent research programs. Of the approximately 500 members, over 370 are scientific staff that include principal investigators, technology center directors, postdoctoral scientists, graduate students, and technical support staff. Learn more about the Institute at www.stowers.org and about its graduate program at www.stowers.org/gradschool.
The African Killifish
Shortly after a killifish tail injury, the remaining tissue needs to know how much damage has occurred. Then, this tissue must enlist the right number of repair cells to the site of injury for the right amount of time. Damage sensing, repair cell recruitment, and timing somehow must work together to regrow the tail.
Credit
Stowers Institute for Medical Research
Journal
iScience
Method of Research
Experimental study
Subject of Research
Animals
Article Title
Positional information modulates transient regeneration-activated cell states during vertebrate appendage regeneration
Article Publication Date
20-Sep-2024
Naloxone successful in over half of uses in reversing signs of opioid overdose in the prehospital setting
Study of naloxone use documented by emergency responders found most involved teenagers, more often boys
ORLANDO, Fla.—The opioid epidemic is a leading cause of morbidity and mortality in the United States, and it is increasingly impacting children and teenagers. Naloxone can reverse the effects of opioid overdose and is being used in hospitals and by emergency responders outside the hospital to save the lives of young people poisoned by opioids.
Research titled, “Naloxone Administration to Pediatric Patients During Emergency Medical Service Events,” finds that among pediatric emergency medical service responses where naloxone was administered, the first dose was successful in improving clinical status in 54.1% of cases. Approximately one-third (32.7%) of pediatric patients received two or more naloxone doses, according to an abstract presented during the American Academy of Pediatrics 2024 National Conference & Exhibition at the Orange County Convention Center from Sept. 27-Oct. 1.
“Emergency medical services clinicians rarely reported that naloxone worsened clinical status, and naloxone improved a patient's clinical condition in over half of emergency responses in our study,” said lead study author Christopher Gaw, MD, MPH, MBE, FAAP, emergency medicine physician at Nationwide Children’s Hospital. “This finding underscores how naloxone can be a safe and effective antidote when used for suspected opioid poisonings in children and adolescents.”
Researchers examined data from the National Emergency Medicine Service Information System (NEMSIS) on emergency medical service activations for pediatric patients ages 17 and younger in 2022, and found naloxone was administered to teenagers and children at least 6,215 times that year. The study also found that one in five adolescents 13-17 years old were documented as receiving naloxone prior to emergency medical service arrival (20.7%), meaning that somebody on the scene administered naloxone. Naloxone administrations occurred most often in the home or residential setting (61.4%). The research also found that most overdoses occur in adolescents, ages 13-17 (79.4%), followed by children ages 1-5 (10.2%), and boys were also slightly more likely to receive naloxone (55.3%).
The calls for assistance suggest there may be initial confusion in the early emergency medical service response period before a diagnosis is made. In the study, the initial emergency call was for an overdose, poisoning, or ingestion in about a third of the calls for adolescents 13-17 (31.5%) and just 12.8% of calls for infants.
“Our study highlights how EMS clinicians are reporting naloxone use after responding to different types of emergency dispatch calls, such as poisonings, unconsciousness, and problems breathing,” Dr. Gaw said. “These signs and symptoms could represent a possible opioid poisoning, which may explain why naloxone was administered in those situations.”
Dr. Gaw is scheduled to present his research, which is below, from 4:15-5 p.m. Saturday, Sept. 28, at the Section of Emergency Medicine program during the national conference.
In addition, Dr. Gaw will be among highlighted abstract authors who will give brief presentations and be available for interviews during a press conference from noon-1:30 pm Saturday in the National Conference Press Room, W208 AB. During the meeting, you may reach AAP media relations staff at 407-685-5401.
Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.
# # #
The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/
ABSTRACT
Program Name: 2024 AAP National Conference-Abstracts
Submission Type: Section on Emergency Medicine
Abstract Title: Naloxone Administration to Pediatric Patients During Emergency Medical Service Events
Christopher Gaw
Columbus, OH, United States
The opioid epidemic is a leading cause of morbidity and mortality in the United States. In recent years, opioids have been implicated in rising injury and fatality rates among children. Early recognition and reversal of opioid poisoning can be lifesaving, and emergency medical services (EMS) clinicians are often the first healthcare providers to respond to an overdose event. Few studies have characterized the pre-hospital response to pediatric opioid poisonings. The objective of this study is to describe the patient and EMS response characteristics for children and adolescents receiving naloxone in the prehospital setting.
We acquired data from the National Emergency Medicine Service Information System (NEMSIS) on EMS activations for pediatric patients 1 day to 17 years old in 2022. Among these activations, we identified children who received ≥ 1 dose of naloxone. We analyzed patient demographics and EMS response characteristics using descriptive statistics and characterized the incidence rate of pediatric EMS activations where naloxone was administered.
In 2022, 6,215 EMS activations met our inclusion criteria. Activations more commonly involved males (55.3%) and were dispatched to a home or residential setting (61.4%) (Table 1). Most responses involved adolescents 13-17 years old (79.4%), followed by children 1-5 years (10.2%) and infants < 1 year (6.0%). The incidence of naloxone administration per 10,000 activations was highest in the 13–17-year age group (57.5), followed by the < 1 year (17.9) and 1–5-year (11.1) age groups. One in five adolescents 13-17 years old were documented as receiving naloxone prior to EMS arrival (20.7%, 974/4,702) compared to fewer than one in ten infants < 1 year (8.2%, 28/341). Most EMS activations involving naloxone administration involved an advanced life support unit (91.0%) (Table 2). An initial dispatch complaint of an overdose, poisoning, or ingestion was more common among responses to adolescents 13-17 years old (31.5%, 1,555/4,937) compared to infants < 1 year (12.8%, 48/375). Approximately one third (32.7%) of pediatric patients received 2 or more naloxone doses. The first dose of naloxone led to a clinical improvement in a greater proportion of 1-5 years old (64.7%, 388/600) compared to infants < 1 year (51.3%, 184/359) and adolescents 13-17 years (54.0%, 2,474/4,580). Naloxone administration was followed by a worsening in clinical status in 11 individuals in our study population (0.2%).
Infants and young children administered naloxone received different EMS care compared to adolescents. EMS dispatches to infants receiving naloxone were uncommonly identified as poisonings or ingestions, and few infants received naloxone prior to EMS arrival. Notably, naloxone administration was rarely documented to worsen clinical status in pediatric patients. These findings highlight opportunities to improve community and prehospital provider identification and management of suspected pediatric opioid poisonings.
Table 1. Characteristics of pediatric patients receiving naloxone from emergency medical services, NEMSIS 2022
Table 2. Emergency medical service response characteristics of pediatric patients receiving naloxone by age, NEMSIS 202
Opioid poisoning in children increasing alongside adult misuse
Fentanyl found to be the most common drug causing the increase, according to new research
American Academy of Pediatrics
Orlando, Fla.—The impacts of the ongoing opioid crisis are trickling down to young children, according to research presented during the American Academy of Pediatrics 2024 National Conference & Exhibition at the Orange County Convention Center from Sept. 27-Oct. 1.
One abstract, “Characteristics of Children with Opioid Poisoning Consulted by a Child Protection Service,” examined the demographic and medical records of 69 children who were assessed by Suspected Child Abuse and Neglect teams in the Philadelphia, PA area.
The study found that over a 10-year period from June 2012 to Dec. 2023, there was an increase in cases of children overdosing on opioids, with a four-fold increase from 2019 to 2023. Most of the children were under the age of 2, with the youngest being 19-days old.
Dr. Maria Quidgley-Martin, Pediatric Emergency Medicine Attending and Clinical Assistant Professor of Emergency Medicine at the University of Florida and lead author on the study, found that fentanyl was the drug most often found in these overdose cases.
“As parents and other adults increasingly misuse opioids, it’s becoming more and more possible for those drugs to end up in children’s hands,” Quidgley-Martin explained. “Children are most often coming across these drugs in familiar settings such as their home or the home of a relative.”
Non-Hispanic Black children were the most susceptible as the group experienced an 11-fold increase from 2019 to 2023, a sharp increase even when compared to the four-fold general increase over that same timeframe.
Typical symptoms of opioid poisoning in children include changes in behavior, unresponsiveness, difficulty breathing and seizures. According to Dr. Quidgley-Martin, most also weren’t given naloxone, a powerful nasal drug used to counteract the effects of opioid overdose.
“Children are the overlooked tragic victims of the United States’ opioid epidemic and fentanyl is now the greatest danger,” Dr. Quidgley-Martin said. “We need our first responders to always consider administering naloxone to unconscious pediatric patients in case they have unknowingly been exposed.”
Over half of the patient’s families had previous contact with Child Protective Services with 65% reporting a family history of opioid abuse. These numbers highlight the ongoing crisis opioids are perpetuating on families across the country.
Of the 69 patients studied, four died. They were all younger than 2 -years-old and all tested positive for fentanyl.
“As a pediatric emergency medicine doctor, I have seen children injured and killed by fentanyl way too often,” Dr. Quidgley-Martin said. “We need to speak about this more and work together to protect our children.”
Study author Dr. Maria Quidgley-Martin, is scheduled to present her research, which is below, at the Council on Child Abuse and Neglect at 1:20 p.m. on Sunday, Sept. 29 in the Regency Ballroom R at the Hyatt Regency Orlando. To request an interview with the authors, contact Joey McCool Ryan at MCCOOL@chop.edu.
Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.
# # #
The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/
ABSTRACT
Program Name: 2024 AAP National Conference-Abstracts
Submission Type: Council on Child Abuse and Neglect
Abstract Title: Characteristics of Children with Opioid Poisoning Consulted by a Child Protection Service
Maria Quidgley Martin
Philadelphia, PA, United States
The opioid epidemic in the United States significantly affects children, with rising opioid exposures, notably fentanyl, leading to fatal poisonings among young children. Increased adult opioid misuse also correlates with heightened child abuse and neglect, requiring intervention from the child welfare system. However, to date, there is no literature that describes the demographic, clinical, and social characteristics, as well as acute medical outcomes of children with opioid poisoning evaluated for child maltreatment. This study aims to address this gap by detailing these features among children consulted by the child protection team at our institution.
This retrospective cohort study conducted at a quaternary urban children's hospital analyzed children who received a Suspected Child Abuse and Neglect (SCAN) team consultation for opioid exposure between June 2012 and December 2023. Demographic, clinical, and social de-identified data were collected from medical records from an existing patient registry and entered into a REDCap database. Descriptive statistics were used to characterize the population, and comparisons were made based on age and fentanyl exposure.
There were 69 consults for opioid ingestions, with a four-fold increase observed from 2019 to 2023. Most patients were under two years old (72%), with a notable proportion being non-Hispanic Black children (11-fold increase from 2019 to 2023). Fentanyl was the most common opioid. The majority (87%) of cases occurred in the patient's home or a relative's residence. The most common chief complaints were altered mental status, abnormal breathing, and seizures. Eleven patients presented in cardiac arrest (9 under age 2), and 71% had respiratory arrest or depression on presentation. Emergency medical services initially cared for 59% of patients, and 61% were transferred from 23 area hospitals. Naloxone was administered to 71% of patients, with higher odds in children under age 2 (OR 3.2, (1.04-9.8, p=0.04)). Fifty-eight percent were admitted to the ICU, with higher odds for those under age 2 (OR 3.33 (1.1 to 10, p=0.03)). Four children died, all under 2 due to fentanyl poisoning. Fifty-two percent of patients' families had prior child protective services (CPS) involvement, with higher odds in children under age 2 (OR 4.57 (1.42 to 14.7), p=0.01)). A family history of opioid abuse was reported in 65% of cases. Nearly half of patients were discharged to an out-of-home placement.
The increase in SCAN consults for opioid ingestions, primarily fentanyl-related, highlights the urgent need to address opioid exposure among children. Young children and non-Hispanic Black patients are disproportionately affected. Most ingestions occur in familiar settings, and pre-hospital care is often provided by emergency medical services, with many children transferred from general emergency departments. Results from this study can guide education, advocacy, and policy efforts to address the impact of the opioid crisis on children.
Race and Ethnicity Trends Over Time
There was an eleven-fold increase in the number of Non-Hispanic, Black patients consulted by the SCAN team between 2019 and 2023 compared to previous years.
Urine Drug Screen Results Over Time
There were 45 patients (65% of all) who tested positive for fentanyl, mostly all after 2019.
Journal
PEDIATRICS
Telehealth program expansion to reduce alcohol use on college campuses
$3.2 million grant puts gold standard treatment online
University of Houston
image:
University of Houston Professor of Psychology Clayton Neighbors is adapting the gold standard treatment for college drinking into a telehealth format accessible on Zoom.
The gold standard treatment motivating college students to reduce alcohol use to decrease the negative consequences of drinking is called the BASICS program, or Brief Alcohol Screening and Intervention for College Students. The prevention program targets students who drink alcohol heavily and have experienced or are at risk for alcohol-related problems.
To reach a greater number of students, University of Houston Professor of Psychology Clayton Neighbors is adapting the treatment into a telehealth format accessible on Zoom. He is supported in his work by a $3.2 million grant from the National Institute on Alcohol Abuse and Alcoholism.
According to the NIAAA, alcohol use is a significant public health problem among college students.
The consequences of alcohol use in college include:
Death - About 1,519 college students ages 18 to 24 die from alcohol-related unintentional injuries each year
Assault - About 696,000 students ages 18 to 24 are assaulted by another student who has been drinking each year
Sexual assault - Research indicates that 1 in 5 college women experience sexual assault during their time in college
Academic performance - Heavy drinking can disrupt students' educational goals, reduce engagement and decrease academic performance
Drop out - Alcohol is a factor in students dropping out of college
“We expect to show that the program administered in a telehealth format by Zoom will work as well as in an in-person format and will be more cost-effective,” said Neighbors. “The significance of this research lies in the potential to maximize access to the highest standard of care by establishing support for easier access without sacrificing any central features of the traditional BASICS intervention.”
The BASICS screening and intervention is delivered in an empathetic, nonconfrontational, and nonjudgmental manner and is aimed at revealing the discrepancy between the student's risky drinking behavior and his or her goals and values. The intervention is delivered by trained personnel proficient in motivational interviewing.
While it is the best treatment available, researchers report that the in-person delivery format of BASICS has presented barriers to wider implementation due to the time, effort and costs of traveling to and from sessions, the need for private meeting space, and the firmly fixed scheduling of intervention sessions.
Three hundred mandated and 300 volunteer students who report hazardous drinking will be recruited from the University of Houston and the University of Missouri and randomly assigned to a condition (in person BASICS, Tele-BASICS, or treatment as usual). Follow-up assessments will occur 1, 3, 6 and 12-months
The project includes investigators from the University of Houston, the University of Southern California and the University of Missouri. At UH, Neighbors is partnering with Reuben Parrish, director of UH Wellness, to work with students who are found to be in violation of campus alcohol policies. They will also work with volunteer students who have experienced unwanted alcohol-related consequences.
Not only does Neighbors expect the telehealth service to be successful, but he also says it may be more successful among women, heavier drinkers, students without co-occurring substance use, and those with greater motivation.
“Generally, women are more conscientious and will be more attentive in an online format than men. Heavier drinkers will be more invested in the information and will pay more attention in an online format than lighter drinkers. Students without co-occurring substance use will have less difficulty paying attention in an online format. Those with greater motivation will also be more attentive in an online format,” said Neighbors.
DICKENSIAN AMERIKA
Children in foster care with disabilities face significant challenges
Research on children in foster care with disabilities found profound impacts, including lower likelihood of permanent placement and higher risk of death
American Academy of Pediatrics
ORLANDO, Fla.— Children with disabilities in foster care are extremely vulnerable, facing risks of maltreatment and removal from their homes and greater need for healthcare services. New research suggests that children with specific disabilities in foster care are less likely to find a permanent home and have a higher risk of mortality while in care compared to those without disabilities.
This research, “The Effect of Initial Disability on Permanency Outcomes of Children in Foster Care,” presented during the American Academy of Pediatrics 2024 National Conference & Exhibition at the Orange County Convention Center from Sept. 27-Oct. 1, found that children in foster care with specific disabilities were far less likely to achieve a positive outcome like adoption, guardianship, or reunion with family. Furthermore, children in foster care with intellectual disability, physical disability, and emotional disturbance had a significantly higher risk of death compared to those without disabilities.
“In undertaking this study, we expected to find differential outcomes for children with disabilities,” said senior author JillD McLeigh, PhD. “We were, however, surprised by the degree to which risk levels for failing to achieve permanency were higher for children with disabilities – across several disability types – and for dying while in care for physical disability, emotional disturbance and other medical conditions.”
Researchers analyzed national data from the federal Adoption and Foster Care Reporting System from fiscal year 2005 to 2019 for about 3.24 million children, ages 16 and younger, with disabilities in foster care. Results showed surprising challenges for these children. Children with intellectual disability, visual/hearing impairment, or emotional disturbance were less likely to achieve a positive outcome, such as reunification with family, adoption or permanent custody with another individual, and were more likely to leave foster care by running away, through emancipation or by being transferred to other agencies.
“Given that children in foster care have higher rates of disability, it is very important that the child welfare and healthcare systems work to address the needs of this highly vulnerable population and to provide support to their caregivers,” said presenting author Gunjan Singh, MD, FAAP.
Study author Dr. Singh is scheduled to present the research, which is below, from 2:25- 2:35 p.m. Sunday, Sept. 29, 2024, at the Council on Foster Care, Adoption, and Kinship Care program at the Orange County Convention Center.
Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.
# # #
The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/
ABSTRACT
Program Name: 2024 AAP National Conference-Abstracts
Submission Type: Council on Foster Care, Adoption, and Kinship Care
Abstract Title: The Effect of Initial Disability on Permanency Outcomes of Children in Foster Care
Children with disabilities in foster care (FC) are an exceptionally vulnerable group. In addition to significant physical, mental, and/or developmental health challenges, they also face risk factors related to maltreatment and removal from their homes and greater need for healthcare services. The few studies that have explored disability and FC status have shown that having a disability is a barrier to permanency and associated with other poor outcomes. These studies, however, have been limited by single-state or small samples, exclusive focus on older youth, and/or cross-sectional data.
To address this gap, this study merged data from the federal Adoption and Foster Care Reporting System (AFCARS) from fiscal year (FY) 2005 to 2019 to provide longitudinal data on children with disabilities, and by disability type, in foster care and comparison data for children without disabilities in FC. The state ID and record number were used to find 3.24 million unique participants aged 0 to 16 when they first entered FC and link records among different FY data. The participants who first entered FC were selected based on their first removal date and excluded if seen in previous FY data (Table 1). They were divided into disability groups pre-defined by the AFCARS Code Book. Participants' longitudinal outcomes were collected from the time when they first entered FC to FY 2021. Any participants, if they stayed in FC, had at least 2-year follow-up time since they first entered FC. The study estimated the relative risk of different discharge types from FC for participants with various disabilities, using participants without disability as the reference (Figure 1).
Findings show that children in FC with disabilities are associated with greater risk for negative outcomes and that risk profiles vary by disability type. Participants with disabilities, except those with other medical conditions, were less likely to get permanence discharge (RR< 1, p< 0.0001). Participants with intellectual disability, visual/hearing impairment, or emotional disturbance were more likely to get a non-permanence discharge (RR=1.79, 1.72, 3.01 respectively, p< 0.0001). Participants with physical disability had a surprisingly high risk of death in the follow-up period (RR=9.07, p< 0.0001) as compared to participants without disability. Participants with intellectual disability or other medical conditions also had a significantly high risk of death (RR=3.12, 3.31, respectively, p< 0.0001).
This study showed that children in FC with different disabilities had different risk characteristics for non-permanence discharge or death. Given that children in FC have higher rates of disability than children not in care, specialized effort is needed from the child welfare and healthcare systems to recognize and address the health-related needs of this population and to support their caregivers.
Table 1: Data Management
Figure 1: Discharge Type at the End of Follow-up by Participant Disability Type on Entry into Foster Care
Asthma rates lower in children who received only breast milk at birth hospital
Research from a large Cincinnati medical system will be presented during the American Academy of Pediatrics 2024 National Conference & Exhibition
American Academy of Pediatrics
ORLANDO, Fla.—Infants who were exclusively fed breast milk during their hospitalization at birth were 22% less likely to develop asthma in early childhood, according to research presented during the American Academy of Pediatrics 2024 National Conference & Exhibition in Orlando.
The abstract, “Association Between Hospital Feeding Patterns and Childhood Asthma,” found lower rates of asthma in the infants born at the Cincinnati Children’s Hospital Medical Center who were exclusively fed breast milk even after adjusting for maternal race, insurance, infant sex, and length of hospital stay. Researchers will present their findings during the conference at the Orange County Convention Center from Sept. 27-Oct. 1.
“Although the birth hospitalization lasts only a few days, it sets a critical foundation for establishing breastfeeding, which can influence health outcomes like childhood asthma,” said Laura Placke Ward MD, IBCLC, FAAP, a study author and co-director for the Center for Breastfeeding Medicine at Cincinnati Children’s Hospital Medical Center.
“Our study underscores the importance of hospital practices in supporting exclusive breastfeeding, as these early experiences may impact long-term health,” she said.
While longer duration and exclusive breastfeeding are known to reduce asthma risk, the effect of breastfeeding during the birth hospitalization is less understood, the authors note.
Of the 9,649 children included in the study, 81% received some breast milk and 31% exclusively received breast milk during the birth hospitalization. Five percent had a diagnosis of asthma. Infants who received only breast milk had a lower rate of asthma diagnosis compared to those who did not receive any breast milk or did not receive breast milk exclusively after adjusting for sex, race, and insurance status. Additionally, infants whose first feeding was breast milk also had a lower rate of asthma compared to those whose first feeding was not breast milk.
“This finding highlights the need for greater emphasis on supporting and promoting exclusive breastfeeding during the early days of life,” Dr. Ward said. “By focusing on these crucial first days, we may impact children's health and potentially reduce the risk of chronic conditions like asthma.”
Dr. Ward is scheduled to present the research, which is below, from 1:05-1:15 PM on Sunday, Sept. 29, 2024, in the Hyatt Regency Ballroom C.
In addition, Dr. Ward and Jennifer McAllister, MD, IBCLC, FAAP, will be among highlighted abstract authors will give brief presentations and be available for interviews during a press conference at noon-1:30 PM on Saturday, September 28, 2024, in the National Conference Press Room, W208 AB. During the meeting, you may reach AAP media relations staff at 407-685-5401.
Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.
# # #
The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/
ABSTRACT
Program Name: 2024 AAP National Conference-Abstracts
Submission Type: Section on Breastfeeding
Abstract Title: Association Between Hospital Feeding Patterns and Childhood Asthma
Laura Ward
Cincinnati, OH, United States
Breast milk is the optimal nutrition for newborns, and breastfed infants have a decreased risk of developing many childhood illnesses, including asthma. Studies have shown that longer periods of exclusive breastfeeding confer greater protection against asthma, but few studies have evaluated the impact of birth hospital feeding patterns on childhood asthma. Our objective was to examine the relationship between breastfeeding patterns during birth hospitalization and the diagnosis of childhood asthma.
We utilized the Maternal Infant Data Hub (MIDH), a regional perinatal data repository of maternal and infant dyads born within a large academic hospital system and linked to childhood data within the regional children’s hospital. Children born between 2017-2019 were included. Demographic information was collected, including sex, race, and insurance status. Feeding data including feeding type, frequency, and timing were collected from the birth hospitalization data, and asthma diagnoses were collected from the children's hospital records. We used descriptive statistics to examine demographic characteristics and multiple regression models to examine feeding type and asthma. Odds ratios were calculated from the bivariate and multivariable analyses.
There were 9649 children included in our study. Of those, 81% received any breast milk and 31% exclusively received breast milk during the birth hospitalization. Five percent had a diagnosis of asthma. Infants who received only breast milk had a lower rate of asthma diagnosis compared to those who did not receive any breast milk or did not receive breast milk exclusively after adjusting for sex, race, and insurance status. Additionally, infants whose first feeding was breastmilk also had a lower rate of asthma compared to those whose first feeding was not breast milk.
Development of asthma is multifactorial. Our study demonstrated that feeding patterns including first feed and exclusivity of breast milk feeding during the birth hospitalization are associated with decreased rates of childhood asthma. Although external factors may impact those who develop asthma, this work highlights the importance of early breastfeeding in mitigating the risk. Further work is needed to examine additional variables including prenatal, postnatal, and environmental factors and the influence of asthma outcomes.
Table 1.
Demographic and descriptive data and bivariate analysis comparing those with and without an asthma diagnosis. Discharge feeding defined as feeding type for twenty-four hours prior to birth hospital discharge.
Figure 1.
Forest plot demonstrating the odds ratios and confidence intervals (CI) for the diagnosis of asthma by hospital feeding patterns in A) bivariate analysis and B) multivariable analysis controlling for sex, race, insurance type
A recent doctoral thesis shows that learning is also something that needs to be learned and taught
Estonian Research Council
In his thesis, entitled "Teachers' and students' knowledge of learning strategies and how to teach them in the classroom", Granström investigated the methods used in Estonian schools to make learning more effective and the extent of their use. "Teachers were found to employ a variety of learning strategies and to value deeper learning strategies more than superficial ones, but their knowledge of them is sometimes incomplete,” he summarises the findings of his study. “There is also a lack of knowledge of how to teach and link learning strategies to learning.”
At the same time, his research shows that students value strategies that support shallow rather than deep learning, which can be difficult to understand, as immediate results are harder to perceive and teachers tend not to explain the advantages of one method or another. "In order for students to move towards the use of more sophisticated learning strategies that support deep learning, teachers should consciously support the development of students' knowledge of learning strategies and encourage their independent use,” Granström finds.
The more rapidly the world around us changes, the more topical this issue becomes, because knowing how to plan learning more effectively and to learn independently is important not only in school, but also later in life. "In a society where flexibility of knowledge is of great importance, and adaptation and the independent acquisition of knowledge is a lifelong process, poor knowledge of learning can become an obstacle to adapting to change," the researcher notes.
"If a teacher can adequately explain and demonstrate to their students the advantages of different learning strategies and how to use them independently, as well as guiding the students to use them, this will have a positive impact on students' motivation to learn."
In order to ensure that teachers are able to use learning strategies when planning lessons, and to explain them to pupils, Granström recommends that teacher training and school development programmes place more emphasis on introducing them: teachers need to be taught how to use learning strategies starting with students in Grade 1.
Mikk Granstöm defended his PhD thesis "Teachers' and students' knowledge of learning strategies and their teaching in the classroom" on 17 September. The thesis was supervised by Professors Eve Kikas and Eve Eisenschmidt of Tallinn University and opposed by Associate Professor Pirko Tõugu of the University of Tartu and Professor Markku Hannula of the University of Helsinki.
Ph.D. thesis: Media offers multiple niches to researchers
"Researchers who are driven by a more strategic goal are usually able to be more visible in the media and to guide coverage in the direction that suits them,” explains Arko Olesk, whose doctoral thesis is titled "The mediatization of researchers: process, indicators, impact”.
"One can see similarities between media communication of scientists and the processes taking place in evolution,” Olesk adds. “A researcher has to adapt in order to successfully get their message across in the media. If they are primarily interested in explaining their subject in a comprehensible way, they need different skills and techniques than if their aim is to guide a public debate. Just as species adapt to their ecological niche, scientists adapt to the media niche they wish to inhabit."
"In my work, I outline five dimensions for assessing such adaptations," explains Olesk. These include an understanding of media logic and the ability to use it to your advantage. "For a researcher who wants to present their work, it's enough to adapt to journalists' expectations to respond quickly and to explain topics simply and interestingly. However, researchers with a more strategic aim need to be able to bring issues to the press themselves, by contacting journalists and offering ideas in a way that is attractive for them.”
The work builds on, among other things, the experience of the research group that launched Estonia's first satellite, ESTCube-1. "Studying their interactions with the media allowed us to see how researchers learn the written and unwritten rules of the media, and to understand how different objectives shape patterns in media communication," notes Olesk.
The scientific literature on media relations of scientists has pointed out that if researchers become overly concerned with media visibility, the scientific quality of their work can suffer. "No similar effects were apparent from this study,” says Olesk. “But while there is a lot of talk about the need for researchers to do more public outreach, we need to be aware of the threats this can pose to the quality of media coverage of science.”
The paper also identifies the weakening of the position of the press as a potential threat. "As scientists get better and better at 'selling' their ideas, and journalists don't have the time or desire to dig deeper, it's easy for scientists to get the media coverage they want," Olesk describes. "As long as a scientist's motives are noble, nothing bad may happen, but it is easy to overblow scientific results or spread questionable claims by exploiting journalists' trust in scientists. Societies will therefore continue to need critical science journalism."
"We can see that the media communication patterns of researchers can also be judged by the beneficial or detrimental impact they have on science in general, researchers themselves, the public or journalists,” says Olesk. “There are patterns that lead to problems, but there are also patterns where everyone benefits. It is precisely the skills needed to maintain and create such patterns that we need to pay more attention to when training researchers and journalists."
The defence of Arko Oleski's doctoral thesis took place on 18 September. Thesis supervisors were Barbi Pilvre and Anastassia Zabrodskaya, and the opponents Ragne Kõuts-Klemm from the University of Tartu and Mike Schäfer from the University of Zurich. The full text of the paper is available here: https://www.etera.ee/zoom/202230/view
Subject of Research
People
The survival rate for avalanche burials has increased by ten percent since 1994
An analysis of 40 years of avalanche data highlights the importance of rescues undertaken by companions
Eurac Research
Modern avalanche transceivers, shovels and probes are now standard in ski touring. Along with a rise in the uptake of avalanche courses and increasingly efficient rescue teams, quicker detection and rescue of buried victims has also improved. The result: increased survival rates in avalanche burials over the past four decades. “Up until 1990, 43.5 percent of buried victims survived; now, it’s 53.5 percent,” explains Simon Rauch, the study’s lead author and an emergency physician at Eurac Research. “We analyzed data from 1981 to 2020 and compared it with a 1994 Nature study that covered a ten-year period.”
The new analysis also shows that the survival probability for long-term burials (over 130 minutes) has increased from 2.6 percent to 7.3 percent. The average rescue time has dropped from 45 minutes to 25 minutes. Rescue time decreased from 15 to 10 minutes in cases when a companion was present, while organized rescue times fell from 153 to 90 minutes. However, the phase where survival probability exceeds 90 percent has shortened from 18 to just 10 minutes.
“In 1994, we divided the survival curve into different phases and discovered that the first phase, when survival rate is very high, lasted up to 18 minutes. This became a global reference point in mountain rescue, but it now needs to be modified,” says Hermann Brugger of Eurac Research, author of the original 1994 study and co-author of the current one.
There are only hypotheses for the drastic reduction in this time window. “It could be that due to climate change and other factors, snow density has increased. The denser the snow, the less air it contains, making it harder to breathe under the snow.” Rauch suggests. However, this theory has yet to be confirmed by data. “Time is the critical factor, and ten minutes is not long. Therefore, it’s essential to understand that the survival chances in an avalanche burial are three times higher when excursion companions are able to dig out the victims, rather than when organized rescue teams are involved.” Rauch emphasizes.
The study also highlights preventive measures such as avalanche warning services, training for ski tourers, and advancements in location and rescue techniques, along with improved emergency medical care, have significantly reduced the mortality rate for avalanche victims in recent decades.
WSL, the Swiss Institute for Snow and Avalanche Research provided the data for the study, with biostatistician Markus Falk contributing a statistical analysis using a complex model.
The results of the study by Eurac Research and WSL: the Swiss Institute for Snow and Avalanche Research were published in the renowned JAMA Network Open
