Rising complexity in pediatric patients is reshaping hospital care

University of Rochester Medical Center

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A new national analysis shows that over the past two decades, inpatient care for children with complex chronic conditions (CCCs) has become far more intensive—and is now overwhelmingly concentrated in urban teaching children’s hospitals. The authors argue that these shifts necessitate changes in pediatric training, staffing, and Medicaid policy.

Analyzing U.S. hospital discharge data from 2000 to 2022, the study found that children with at least one CCC now account for more than two-fifths of pediatric bed days and nearly three-fifths of hospital charges. Examples include children with cerebral palsy, congenital heart defects, and genetic disorders, and although these children represent a small share of the overall pediatric population, their hospital stays are longer, more complex, and increasingly involve multiple co-occurring conditions and reliance on medical technologies such as feeding and breathing tubes. Children with multiple CCCs drove most of the growth, and discharges for those with three or more CCCs increased more than threefold over the study period.

“Over the last 20 years, the inpatient pediatric caseload has shifted, the children we see in the hospital are far more complex, and almost all children with complex conditions seek care in specialty children’s hospitals,” said Nathaniel Bayer, MD, associate professor at the University of Rochester’s Golisano Children’s Hospital and lead author of the study which appears in JAMA Network Open. “That concentration of very sick children has real implications for where care happens, who delivers it, and how it is paid for.”

From a small group to a large share of inpatient resources

The study grew out of a national collaboration among pediatric health services researchers from the University of Rochester, Boston Children’s Hospital, Johns Hopkins University, the University of Vermont, Children’s Mercy Hospital in Kansas City, the University of Toronto, and the Children’s Hospital Association. Jay Berry, MD, MPH, with Boston Children’s Hospital and Harvard University, is the senior author of the study. The new research builds on a similar analysis conducted 15 years ago.

Using the Kids’ Inpatient Database series and national weighting, the research team estimated trends in discharge rates, bed days, and hospital charges for children with and without CCCs. Between 2000 and 2022:

• The rate of hospital discharges for children with at least one CCC rose by more than 24 percent, while the discharge rate for children without CCCs fell by more than 9 percent.
• Children with CCCs increased their share of total pediatric bed days and, despite consisting of 22 percent of all discharges, represent 40 percent of bed days and almost 60 percent of hospital charges.
• The number of children with two CCC diagnoses increased by 60 percent, and the number with three or more increased by 340 percent.

“What jumped out was the rise in hospital resource use by children with multiple, interacting chronic conditions. These are kids who require highly coordinated, intensive inpatient care,” said Bayer.

Implications for children’s hospitals

The study’s findings raise operational and policy concerns. The authors note that most of these complex hospitalizations are covered by Medicaid, and current reimbursement levels frequently do not reflect the true costs of the care provided. “Children’s hospitals are providing the majority of this care, but payment rates aren’t keeping up. That mismatch contributes to closures of pediatric units in community and rural hospitals and centralizes care in academic centers with unsustainable financial models,” said Bayer.

The study also highlighted implications for the workforce and training. “Residency and fellowship programs need to adapt so future pediatricians and subspecialists are prepared to care for these medically complex children. The inpatient experience is changing—residents may care for sicker, more complex patients—and training must address that reality.”

Systemic and federal responses are required

The paper calls for a multi-pronged response: hospitals should evaluate team structures and staffing models to ensure safe, coordinated inpatient care; training programs should update curricula and clinical experiences; and policymakers should consider Medicaid policy changes that acknowledge the distinct needs and costs of medically complex children.

“We need pediatric-specific Medicaid policies and payment structures that recognize these children aren’t the same as the average adult Medicaid population,” said Bayer. “If we want to sustain high-quality pediatric inpatient care, reimbursement and workforce investments have to follow from the public and private payers.”

The study contributes to a growing body of evidence documenting the evolution of pediatric inpatient care. The research team hopes their findings will inform hospital planning, training reforms, and policy discussions at the state and federal levels.

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Journal

JAMA Network Open

DOI

10.1001/jamanetworkopen.2025.44686 

Article Title

Trends in Hospital Resource Use for Children With Complex Conditions

Article Publication Date

2-Dec-2025

 

Georgia State brain researchers draw cellular blueprint for how we think, feel

The breakthrough study connects brain biology to behavior, offering new hope for understanding mental health

Georgia State University

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image: 

Spatial maps of intrinsic connectivity networks (ICNs) identified using the NeuroMark framework developed at the TReNDS Center. Each map represents a distinct functional component of the brain involved in thought, perception and emotion.

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Credit: Courtesy: Georgia State University

ATLANTA — A new study from experts with Georgia State University has achieved a long-standing goal in neuroscience: showing how the brain’s smallest components build the systems that shape thought, emotion and behavior.

The research, published in the journal Nature Communications, could transform how scientists understand cognition and aging, as well as mental health disorders like depression and schizophrenia.

By combining brain scans with genetic data and molecular imaging, the researchers have uncovered a detailed biological map linking different levels of the brain and revealing the long-sought bridge between micro- and macro-level brain organization.

Vince Calhoun is a Distinguished University Professor with Georgia State and a Georgia Research Alliance Eminent Scholar with faculty appointments at Georgia Tech and Emory University. He leads the collaborative tri-institutional Center for Translational Research in Neuroimaging and Data Science, or TReNDS Center, and is a senior author on the study.

“We found that the brain’s large-scale networks are built on a hidden biological blueprint. By aligning data from cells, molecules and imaging, we showed that the same architecture seen in fMRI is rooted in cellular and molecular organization,” Calhoun said. “Each dataset alone gives part of the story. Together, they reveal how chemical and cellular gradients actually help wire the brain’s networks.”

Calhoun said understanding this connection could help experts better understand mental health conditions and brain disorders. It could also offer new insights, like why some people stay sharp later in life and others don’t.

The research team combined brain scans that show how regions communicate over time. By capturing shifting patterns of activity called dynamic connectivity — with detailed maps of brain cells, chemical messengers like serotonin and dopamine, and energy-producing structures such as mitochondria — they were able to build a comprehensive picture of the brain’s inner workings.

Using a statistical technique called mediation analysis, the researchers showed that these networks don’t just correlate with biology and behavior — they actively bridge the two, helping explain how molecular features influence cognition.

Guozheng Feng, the study’s lead author and a postdoctoral research associate at the TReNDS Center, said the research reveals how certain brain networks act as middlemen, linking the microscopic biology of the brain (like specific cell types) to complex behaviors and mental processes.

“This study is bringing us closer to answering one of the most fundamental questions in neuroscience: how microscopic cellular and molecular foundations shape the brain’s networks which, in turn, give rise to complex thought, emotion and behavior,” Feng said.

“Many mental and neurodegenerative disorders involve both molecular imbalance and network disruption,” Calhoun added. “This work shows these are linked. Understanding the biological foundation of networks could help us pinpoint which systems are most vulnerable in schizophrenia, depression or Alzheimer’s — and why.”

Jiayu Chen is a research assistant professor with the TReNDS Center who was part of the research team. Her work, using advanced brain scans, focuses on studying how genes influence the way the brain looks and works.

“This work helps answer a big question in neuroscience: How do cellular and molecular organizations underlie the architecture of functional brain networks, which influence the way we think, feel and behave?” Chen said. “We are now one step closer to those answers.”

Calhoun said the collaborative TReNDS Center is uniquely equipped for these kinds of discoveries. He hopes to ultimately create a “map” that links each person’s biology with how their brain networks function.

This could help doctors customize treatments specifically to their patients based on how their particular biology influences their brain’s networks.

The TReNDS Center, a partnership among Georgia State, Georgia Tech and Emory University, develops advanced tools to turn brain imaging data into meaningful biomarkers. Its goal is to improve understanding and treatment of brain health and disease.

To learn more about the TReNDS Center, visit trendscenter.org.

For more information about Georgia State research, visit research.gsu.edu.

This research was supported by funding from the National Science Foundation (NSF) under Grant #2112455 and the National Institutes of Health (NIH) through Grants #R01MH123610 and #R01MH136665.

Brain maps of cellular, neurotransmitter and mitochondrial distributions, representing the microscopic biological foundations of large-scale brain networks.

Credit

Courtesy: Georgia State University

Journal

Nature Communications

Method of Research

Imaging analysis

Subject of Research

Not applicable

Article Title

Cellular and molecular associations with intrinsic brain organization

 

Are primary students prepared to write in a digital world?

A nation-wide study on computer-based writing instruction in Australian classrooms has shined a spotlight on how little time and attention primary schools are giving to teaching students how to write using a computer.

Edith Cowan University

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2 December 2025

Lead author Dr Anabela Malpique from the School of Education at ECU said the research surveyed 340 primary education teachers (Years 1–6) from across Australia about the computer-based writing instruction provided in their classrooms.

Instructional time

“While results showed that teachers found it was important to teach computer-based writing skills, most respondents reported allocating less than one hour per week on computer-based writing practice in their classrooms,” Dr Malpique explained.

Instead, teachers spent significantly more time teaching paper-based writing, with teaching keyboarding receiving the least instructional time – approximately nine minutes per week.

“The findings show that more than 96 per cent of teachers believed that students’ keyboarding skills contributed to their performance when completing national online exams – like NAPLAN and other assessments.”

Teaching in preparation for a digital world

With most primary teachers having little time set aside to teach keyboarding and word processing skills, few reported having knowledge of teaching strategies for students to learn how to plan and revise computer-generated texts. Instead, teachers tend to focus more on spelling.

“In the digital age, skillful computer-based writing is essential for school aged children since it empowers them to communicate, acquire knowledge, critically engage with information, and produce text-based original thoughts,” Dr Malpique said.

Research suggests students should be taught typing and word processing skills as soon as they are introduced to computers.

“It is difficult to correct children as they get older if they are not adequately taught the foundations of computer-based writing, including keyboarding skills such as key locations and hand and finger positions,” Dr Malpique explained.

“Instead, we should be empowering children in the early primary school years to better understand how computers work, and to write proficiently using a computer, particularly as we enter the age of artificial intelligence.”

Perceived importance vs practice, access and ability

The majority of teachers surveyed (more than 98 per cent) agreed it was important to teach keyboarding and word-processing skills for writing, and that students should be able to type as fast as they can write by hand when completing Year 5.

Many teachers (40 per cent) also shared that keyboarding instruction should be administered by specialised lab teachers, librarians or media specialists in Years 1 – 3. Around 30 per cent said the responsibility should sit with the classroom teacher.

“Findings from our research suggest that students may have limited typing and computer-based word processing skills due to lack of access to a computer, laptop or portable device with an external keyboard, both within their school environment and in the home,” Dr Malpique said.

“It is very difficult to develop computer navigation and typing skills and write longer texts with only an iPad.”

Only 17.4 per cent of teachers stated that their students had access to a computer device with an external keyboard at school and 69.4 per cent reported that students had access to a digital device within the classroom with only an on-screen keyboard – like an iPad or tablet.

The challenge for teachers is the task of ensuring children in their classroom have the opportunity to learn how to effectively write using a computer, as well as by hand.

Teacher preparation and confidence

Findings from this national study suggest that, although teachers understand the importance and are motivated to teach computer-based writing in a digital world, they don’t feel as prepared as they could be.

“Most respondents described not having received formal training to teach computer-based writing and that they felt little confidence to teach students how to create texts using digital devices,” Dr Malpique said.

“Teachers reported feeling they lacked the preparation and confidence to teach computer-based writing skills, which explains their instructional practices and the minimal time dedicated to teaching children how to type and write texts using a computer.”

Supporting teaching and learning of digital skills

Dr Malpique highlighted the importance of providing more resourcing of technology in schools to bridge the equity divide, considering future careers will require students to have adequate digital skills.

“We also need to support the teaching and learning of digital writing in primary schools through increased ongoing professional learning for teachers and by integrating foundational computer-based writing skills into regular classroom activities.”

Teaching computer-based writing: primary teachers’ preparation, self-efficacy, and instructional practices is included in the Writing for All: Handwriting and keyboarding skills in the Early Years project funded by The Ian Potter Foundation.

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Media contact:

Hayley Butler, (08) 6304 5575, h.butler@ecu.edu.au

or
ECU Corporate Relations, (08) 6304 2222, pr@ecu.edu.au

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Journal

The Australian Educational Researcher

DOI

10.1007/s13384-025-00910-9 

Method of Research

Survey

Subject of Research

People

Article Title

Teaching computer-based writing: primary teachers’ preparation, self-efficacy, and instructional practices

 

New archaeological study challenges the paleo diet, revealing humans have always eaten processed plant foods

University of Toronto

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Humans evolved over hundreds of thousands of years to be the ultimate flexible eaters – chasing carbohydrates and fats from plant and animal sources alike. A new study in the Journal of Archaeological Research by researchers at the Australian National University and the University of Toronto Mississauga reveals early humans were far from the Palaeolithic meat-eaters sometimes portrayed, but rather relied heavily on a wide range of plant and animal foods. 

“We often discuss plant use as if it only became important with the advent of agriculture,” said Dr. Anna Florin, co-author of The Broad Spectrum Species: Plant Use and Processing as Deep Time Adaptations. “However, new archaeological discoveries from around the world are telling us our ancestors were grinding wild seeds, pounding and cooking starchy tubers, and detoxifying bitter nuts many thousands of years before this.”  

The research highlights that humans are a “broad-spectrum species,” and our ability to use diverse plant resources has shaped our evolutionary trajectory.  

 “This ability to process plant foods allowed us to unlock key calories and nutrients, and to move into, and thrive in, a range of environments globally,” added Dr. Monica Ramsey, the other co-author of this study, emphasizing the importance of “processed plant foods” to early human diets. 

“Our species evolved as plant-loving, tool-using foodies who could turn almost anything into dinner,” said Ramsey. 

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Journal

Journal of Archaeological Research

DOI

10.1007/s10814-025-09214-z 

Method of Research

Commentary/editorial

Subject of Research

People

Article Title

The Broad Spectrum Species: Plant Use and Processing as Deep Time Adaptations