Family-centered care is necessary to deliver high-quality health care services. It is especially critical that family members are included in augmentative and alternative communication (AAC) service provision in the inpatient setting. AAC can be overwhelming to families and requires accommodations for it to effectively integrate into daily communicative interactions. Currently, there is minimal guidance for family-centered care by speech-language pathologists (SLPs) working with children with limited functional speech in the inpatient pediatric setting. The purpose of this clinical focus article is to apply principles from family systems theory to the inpatient pediatric setting to guide effective family-centered clinical practice and improve outcomes. This clinical focus article describes a family systems framework to guide the development and use of supports to families during the extended hospitalization of a child with limited speech who may benefit from AAC in the inpatient rehabilitation setting. Two case studies are used to illustrate the application of a family systems approach in the pediatric inpatient setting. Recommendations are provided for the inclusion of primary caregivers in service delivery by SLPs in the inpatient hospital context. Clinical implications and future directions are discussed. The hospitalization of a child who uses AAC can be a stressful experience for the entire family system. By using a family systems framework, SLPs may improve AAC service delivery outcomes by working collaboratively with family members and offering supports for both AAC implementation and general well-being. SLPs may also benefit from this approach to AAC service delivery as families may be more actively engaged in sessions, leading to increased uptake of intervention strategies and AAC.

Time to initiation of therapy in oncological care is an influential factor in disease progression and survival outcomes in many cancer types. We aim to identify factors associated with delayed time to treatment (TTT) in high-grade osteosarcoma and its relationship to disease-specific survival (DSS). The SEER database was queried for biopsy-confirmed cases of high-grade osteosarcoma between 2000 and 2021 using ICD-O-3 histology codes 9180/3-9194/3 and primary site codes C40.0-41.9. χ2, Kaplan-Meier with log-rank testing, and stepwise multivariable logistic regression were completed using SPSS, with significance set to p < 0.05. Kaplan-Meier analysis demonstrated significantly reduced 5- and 10-year DSS in patients with TTT over 1 month (p < 0.001). Multivariable analysis identified advanced age groups and tumors of the cranium (aOR 2.48; 95% CI 1.96-3.13), thorax (aOR 1.72; 95% CI 1.13-2.61), and pelvis (aOR 1.71; 95% CI 1.31-2.23) as factors associated with TTT delays over 1 month. Black race and Hispanic ethnicity were also significantly associated with treatment delays in subset analysis of patients < 40 years (aOR 1.74; 95% CI 1.27-2.39 and aOR 1.31; 95% CI 1.01-1.70). These findings reveal disparities in TTT for osteosarcoma patients based on age, race/ethnicity, and tumor location, highlighting the need for equitable access to early care.

Large-area bone regeneration remains a significant clinical challenge, as current grafts often mineralize only at the defect edges, leaving the core underdeveloped. This study introduces a biphasic, biomimetic scaffold integrating structural support with uniform bioactivity to address this limitation. The scaffold features a highly porous outer tube for mechanical strength and cell infiltration, paired with an electrospun nanofiber core enriched with decellularized extracellular matrix (dECM) to promote cell recruitment and mineralization. Twenty-five dECMs were derived from co-cultures of bone-healing cell types: osteoblasts (OB), chondrocytes (CH), mesenchymal stromal cells (MSCs), fibroblasts (FB), and endothelial cells (EC). Among them, OB + MSC-derived dECM showed the greatest osteogenic potential. This dECM was applied to an optimized nanofiber core (232 ± 87nm from 5 wt% solution), with a protein content of 67.9 ± 8.3µg/mg and DNA < 50ng/mg. The outer tube exhibited 89.6 ± 5.8% porosity and a compressive modulus of 123 ± 6.7MPa. After BSA coating and simulated body fluid immersion, scaffolds showed calcium phosphate deposition (0.28 ± 0.03mmol/L Ca2⁺/scaffold). In a 10mm critical-sized femoral defect in rats, scaffolds containing both CaP and OB + MSC-derived dECM significantly enhanced bone healing. Imaging and histological analyses showed a twofold increase in bone volume, mineral density, and cortical bone formation. The compressive modulus of regenerated bone was threefold higher than untreated controls and autografts. By 12weeks, complete defect bridging and structural recovery were achieved. This biphasic scaffold design presents a promising strategy for large bone defect repair by enabling uniform tissue regeneration, combining osteoinductive cues with structural performance suited for clinical translation.