Children's Research Research Articles

Childhood: The Paradoxes of Autonomy

The article problematizes the possibility of developing agency in childhood. It is shown that the usually non-differentiable constructs "agency" and "autonomy" psychologically represent fundamentally different actions. The basis for their distinction is the nature of the individual's interaction with the social structure. Autonomy is an integration into an existing structure, the acquisition of skills for independent functioning in it. Agency, on the other hand, involves the transformation of the structure and "crossing the border of semantic fields," according to Yu.M. Lotman. There have been several important "turns" in childhood research over the past decades. Initially, childhood was considered as a preparation for adulthood, which was implemented in fundamentally hierarchical forms of education. Since about the 1970s, children have been talked about as potential actors in the social world. And since the beginning of the XXI century, the discussion of independence (autonomy) has been gaining momentum, as part of which they distinguish the ability to act independently of others and act in accordance with their goals and beliefs. The authors distinguish agency as overcoming the boundaries characterizing the structure, and autonomy as actions within the initially defined boundaries. They consider productive action (event) to be the mechanism of agency as a situation—changing action, and as a way of "learning" agency - a trial, including a game. Examples of statements by teenagers and young people that can be qualified as specific to agency, independence and volitional action are given.

Hydroxyurea dose optimisation for children with sickle cell anaemia in sub-Saharan Africa (REACH): extended follow-up of a multicentre, open-label, phase 1/2 trial

Realizing Effectiveness Across Continents with Hydroxyurea (REACH) is an open-label non-randomised trial of hydroxyurea (hydroxycarbamide) in children with sickle cell anaemia in sub-Saharan Africa. The short-term results of REACH on safety, feasibility, and effectiveness of hydroxyurea were published previously. In this paper we report results from extended hydroxyurea treatment in the REACH cohort up to 8 years. In this open-label, non-randomised, phase 1/2 trial, participants were recruited from four clinical sites in Kilifi, Kenya; Mbale, Uganda; Luanda, Angola; and Kinshasa, Democratic Republic of Congo. Eligible children were 1-10 years old with documented haemoglobin SS or haemoglobin Sβ zero thalassaemia, weighing at least 10 kg. Participants received fixed-dose hydroxyurea of 17.5 (±2.5) mg/kg per day for 6 months (fixed-dose phase), followed by 6 months of dose escalation (2·5-5·0 mg/kg increments every 8 weeks) as tolerated, up to 20-35 mg/kg per day (maximum tolerated dose; MTD), defined as mild myelosuppression. After the MTD was reached, hydroxyurea dosing was optimised for each participant on the basis of changes in bodyweight and laboratory values over time (MTD with optimisation phase). After completion of the first 12 months, children with an acceptable toxicity profile and favourable responses were given the opportunity to continue hydroxyurea until the age of 18 years. The safety and feasibility results after 3 years has been reported previously. Here, haematological responses, clinical events, and toxicity rates were compared across the dosing phases (fixed-dose hydroxyurea vs MTD with optimisation phase) as protocol-specified outcomes. REACH is registered on ClinicalTrials.gov (NCT01966731) and is ongoing. We enrolled 635 children between July 4, 2014, and Nov 11, 2016. 606 children were given hydroxyurea and 522 (86%; 266 [51%] boys and 256 [49%] girls) received treatment for a median of 93 months (IQR 84-97) with 4340 patient-years of treatment. The current (Oct 5, 2023) mean dose is 28·2 (SD 5·2) mg/kg per day with an increased mean haemoglobin concentration (7·3 [SD 1·1] g/dL at baseline to 8·5 [1·5] g/dL) and mean fetal haemoglobin level (10·9% [SD 6·8] to 23·3% [9·5]) and decreased absolute neutrophil count (6·8 [3·0] × 109 cells per L to 3·6 [2·2] × 109 cells per L). Incidence rate ratios (IRR) comparing MTD with fixed-dose hydroxyurea indicate decreased vaso-occlusive episodes (0·60; 95% CI 0·52-0·70; p<0·0001), acute chest syndrome events (0·21; 0·13-0·33; p<0·0001), recurrent stroke events (0·27; 0·07-1·06; p=0·061), malaria infections (0·58; 0·46-0·72; p<0·0001), non-malarial infections (0·52; 0·46-0·58; p<0·0001), serious adverse events (0·42; 0·27-0·67; p<0·0001), and death (0·70; 0·25-1·97; p=0·50). Dose-limiting toxicity rates were similar between the fixed-dose (24·1 per 100 patient-years) and MTD phases (23·2 per 100 patient-years; 0·97; 0·70-1·35; p=0·86). Grade 3 and 4 adverse events were infrequent (18·5 per 100 patient-years) and included malaria infection, non-malarial infections, vaso-occlusive pain, and acute chest syndrome. Serious adverse events were uncommon (3·6 per 100 patient-years) and included malaria infections, parvovirus-associated anaemia, sepsis, and stroke, with no treatment-related deaths. Hydroxyurea dose escalation to MTD with dose optimisation significantly improved clinical responses and treatment outcomes, without increasing toxicities in children with sickle cell anaemia in sub-Saharan Africa. US National Heart, Lung, and Blood Institute and Cincinnati Children's Research Foundation.

Response of bilateral Wilms tumor to chemotherapy suggests histologic subtype and guides treatment.

Patients with bilateral Wilms tumor initially receive neoadjuvant chemotherapy to shrink the tumors and increase the likelihood of successful nephron-sparing surgery. Biopsy of poorly responding tumors is often done to better understand therapy resistance. The purpose of this retrospective, single-institution study was to determine whether initial chemotherapy response is associated with tumor histology, potentially obviating the need for biopsy or change in chemotherapy. Patients with synchronous bilateral Wilms tumors who underwent surgery at St Jude Children's Research Hospital from January 2000 to March 2022 were considered for this study. A mixed-effects logistic regression model was used to evaluate the likelihood of the tumor being stromal predominant, as predicted by tumor response to neoadjuvant chemotherapy. A total of 68 patients were eligible for this study. Tumors that increased in size had an odds ratio of 19.5 (95% confidence interval [CI] = 2.46 to 155.03) for being stromal predominant vs any other histologic subtype. Age at diagnosis was youngest in patients with stromal-predominant tumors, with a mean age of 18.8 (14.1) months compared with all other histologic subtypes (χ2 = 7.05, P = .07). The predictive value of a tumor growing combined with patient aged younger than 18 months for confirming stromal-predominant histology was 85.7% (95% CI = 57.18% to 93.5%). Tumors that increased in size during neoadjuvant chemotherapy were most frequently stromal-predominant bilateral Wilms tumor, especially in younger patients. Therefore, nephron-sparing surgery, rather than biopsy, or extension or intensification of neoadjuvant chemotherapy, should be considered for bilateral Wilms tumors that increase in volume during neoadjuvant chemotherapy, particularly in patients aged younger than 18 months.

Awareness, access, and communication: provider perspectives on early intervention services for children with sickle cell disease.

This study aimed to identify determinants influencing the utilization of early intervention services among young children with sickle cell disease (SCD) based on perspectives from medical and early intervention providers. Early intervention and medical providers from the catchment area surrounding St. Jude Children's Research Hospital and Washington University were recruited (20 total providers). Interviews were completed over the phone and audio recorded. All interviews were transcribed verbatim, coded, and analyzed using inductive thematic analysis. Three overarching themes were identified from both groups: Awareness (e.g., lack of awareness about the EI system and SCD), Access (e.g., difficulties accessing services), and Communication (e.g., limited communication between medical and early intervention providers, and between providers and families). Although these three themes were shared by medical and early intervention providers, the differing perspectives of each produced subthemes unique to the two professional fields. Early intervention services can limit the neurodevelopmental deficits experienced by young children with SCD; however, most children with SCD do not receive these services. The perspectives of early intervention and medical providers highlight several potential solutions to increase early intervention utilization among young children with SCD.

Research on the Problems and Improvement Strategies of Rural Early Childhood Teachers' Health Education Competence

The health concept of the new era calls for the return and renewal of the identity of rural early childhood teachers, as health educators, what makes them competent in their professional roles? The health education ability of rural early childhood teachers has become an important factor affecting the physical and mental health of rural young children. This study points out that the development of rural early childhood teachers' health education ability is not balanced, rural early childhood teachers' health education curriculum resources development ability is weak, and it points to the lack of rural early childhood teachers' family health education guidance ability. Therefore, based on the analysis of the problem, we start by updating the concept of health education for rural early childhood teachers, establishing the evaluation system of rural early childhood teachers' health education ability, integrating the rural early childhood health education resources, and carrying out rural early childhood health education garden-based teaching and research. Therefore, based on the analysis of the problem, we put forward the strategies to improve the health education ability of rural kindergarten teachers from four aspects: updating the health education concept of rural kindergarten teachers, establishing the evaluation system of rural kindergarten teachers' health education ability, integrating rural kindergarten health education resources, conducting rural kindergarten health education garden-based teaching and research and reflection.

Abstract P464: Performance of an Automated Sleep Scoring Approach for Actigraphy Data in Children and Adolescents

Background: Actigraphy has advanced the measurement of sleep for cardiometabolic research in childhood. However, actigraphy methods lack standardization, limiting rigor and reproducibility. GGIR, an open-source R package, facilitates raw accelerometer data processing to generate sleep data in a standardized manner. This tool has been validated and applied to adult data, but less is known about the suitability of this tool for generating sleep estimates among children. We aimed to (1) determine the validity of multiple sleep scoring settings available within GGIR in children, and (2) evaluate how this tool automatically generates sleep data in community-based pediatric studies. Method: The validation study included 30 children (14 female, 8-16y) referred for in-lab overnight polysomnography at Children’s Hospital of Philadelphia. Participants wore a GENEActiv during polysomnography that captured data at 50 Hz, which were aligned into 30-second epochs against the sleep stages from polysomnography scored by a sleep medicine physician. Balanced accuracy was the primary validation metric, which is the average of sensitivity and specificity. For community-based testing, three pediatric cohorts were used: Study 1 (Philadelphia; 12-16y; GENEActiv, N=251), Study 2 (Mexico City, 9-18y; ActiGraph GT3X-BT; N=543), and Study 3 (Houston; 5-8y; ActiGraph GT3X+, N=226). We processed raw accelerometry data with the Cole-Kripke (CK), Sadeh (S), and Van Hees (VH) algorithm settings. Result: For in-lab validation, 271.5 hours of polysomnography data were collected with 80% of the epochs scored as sleep; sleep duration averaged 7.3 hours (SD = 1.3). In rank order, average balanced accuracies were 0.81 (SD = 0.08) for GGIR-CK, 0.77 (SD = 0.09) for GGIR-VH, and 0.68 (SD = 0.11) for GGIR-S. The GGIR-S algorithm had the poorest detection of night awakenings (specificity: 0.38 [SD = 0.21]). For community-based data, without manually altering the data, the average sleep duration was highest when using the Sadeh algorithm in each study (8.3 [SD = 1.6], 8.0 [SD = 1.9], and 5.2 [SD = 4.4] hours for studies 1-3) and lower when using the GGIR-CK algorithm (7.1 [SD = 1.4], 6.9 [SD = 1.7], 4.3 [SD = 3.7] hours for studies 1-3). Approximately 2% of the data were affected by obvious errors (e.g., negative wake after sleep onset), with almost all such errors detected with the Sadeh algorithm. Conclusion: In a controlled setting, GGIR-CK had the optimal balanced accuracy performance for estimating sleep duration in children. In keeping with the lab-based finding of poorer detection of night awakenings, sleep duration was highest in the community samples when using GGIR-S. When applied to community-based data the automated GGIR approach generated sleep data that included errors, necessitating additional data cleaning. Incorporating standardized data cleaning steps within GGIR would improve rigor and reproducibility.

Abstract MP30: Sugar-Sweetened Beverages, Fruit Juices, and Whole Fruits Throughout Childhood and Adolescence and Glycemic Outcomes in Late Adolescence in Project Viva

Objective: To investigate sex-specific associations of sugar-sweetened beverages (SSBs), 100% fruit juices, and whole fruit intake throughout childhood and adolescence with insulin resistance and glycemic outcomes in late adolescence. Methods: We used data from Project Viva, an ongoing pre-birth cohort from eastern Massachusetts. We evaluated intake of SSBs, 100% fruit juices, and whole fruit at early childhood (median age: 3.1 yrs), mid-childhood (7.6 yrs) and early teen research visits (12.9 yrs) using food frequency questionnaires. We measured fasting blood glucose, insulin and glycated hemoglobin (HbA1c) levels in late adolescence (17.4 yrs). We estimated insulin resistance with the homeostasis model assessment for insulin resistance (HOMA-IR). We computed sex-specific linear regression models to estimate associations of average consumption of SSBs, fruit juice and whole fruit across the 3 childhood-early teen visits with late adolescence HOMA-IR, fasting glucose and HbA1c adjusting for demographics, socioeconomic status, mother BMI, child BMI z-score, and parental history of type 2 diabetes in early childhood (model 1), and additionally for lifestyle habits and diet quality in early childhood (model 2). Results: A total of 240 girls and 215 boys met eligibility criteria and had an outcome measure in late adolescence. Greater SSB intake throughout childhood and adolescence was associated with higher HOMA-IR, fasting glucose, and HbA1c in boys only (Figure). Also in boys, greater fruit juice intake was associated with higher HbA1c in late adolescence. Effect estimates in girls were of small magnitude and centered to the null, except for fruit juice and HbA1c with associations in the same direction as boys (Figure). We did not observe any association with respect to whole fruits for either sex. Conclusion: Findings suggest that SSBs and fruit juice consumption throughout childhood and adolescence are associated with less favorable glycemic traits in boys, suggesting greater risk of developing diabetes.

Impact of treatment adherence and inhalation technique on asthma outcomes of pediatric patients: a longitudinal study.

Introduction: We aimed to evaluate the longitudinal relationships, both at between- and within-person levels, that adherence to inhaled corticosteroid-based maintenance treatment and inhalation technique present with symptom control, exacerbations, and health-related quality of life (HRQoL) in children and adolescents with asthma. Methods: Participants (6-14years old) from the ARCA (Asthma Research in Children and Adolescents) cohort-a prospective, multicenter, observational study (NCT04480242)-were followed for a period from 6months to 5years via computer-assisted telephone interviews and a smartphone application. The Medication Intake Survey-Asthma (MIS-A) was administered to assess the implementation stage of adherence, and the Inhalation Technique Questionnaire (InTeQ) was used to assess the five key steps when using an inhaler. Symptom control was measured with the Asthma Control Questionnaire (ACQ), and HRQL was measured with the EQ-5D and the Patient-Reported Outcomes Measurement Information System-Pediatric Asthma Impact Scale (PROMIS-PAIS). Multilevel longitudinal mixed models were constructed separately with symptom control, exacerbation occurrence, EQ-5D, and PROMIS-PAIS as the dependent variables. Results: Of the 360 participants enrolled, 303 (1,203 interviews) were included in the symptom control and exacerbation analyses, 265 (732) in the EQ-5D, and 215 (617) in the PROMIS-PAIS. Around 60% of participants were male subjects, and most of them underwent maintenance treatment with inhaled corticosteroids plus long-acting β-agonists in a fixed dose (73.3%). Within-person variability was 83.6% for asthma control, 98.6% for exacerbations, 36.4% for EQ-5D, and 49.1% for PROMIS-PAIS. At the within-person level, patients with higher adherence had better symptom control (p = 0.002) and HRQoL over time (p = 0.016). Patients with a better inhalation technique reported worse HRQoL simultaneously (p = 0.012), but they showed better HRQoL in future assessments (p = 0.012). The frequency of reliever use was associated with symptom control (p < 0.001), exacerbation occurrence (p < 0.001), and HRQoL (p = 0.042); and boys were more likely to present better symptom control and HRQoL than girls. Conclusion: Our results confirm longitudinal associations at the within-person level of the two indicators of quality use of inhalers: for adherence to maintenance treatment with symptom control and HRQoL, and for the inhalation technique with HRQoL. Although treatment adherence was shown to be excellent, a third of the participants reported a suboptimal inhalation technique, highlighting the need for actions for improving asthma management of the pediatric population.

Comprehensive analysis of MYB/MYBL1-altered pediatric-type diffuse low-grade glioma.

Pediatric-type diffuse low-grade gliomas (pLGG) harboring recurrent genetic alterations involving MYB or MYBL1 are closely related tumors. Detailed treatment and outcome data of large cohorts are still limited. This study aimed to comprehensively evaluate pLGG with these alterations to define optimal therapeutic strategies. We retrospectively reviewed details of pLGG with MYB or MYBL1 alterations from patients treated or referred for pathologic review at St. Jude Children's Research Hospital. Tumor specimens were centrally reviewed, and clinical data were collated. Thirty-three patients (18 male; median age, 5 years) were identified. Two tumors had MYBL1 alterations; 31 had MYB alterations, MYB::QKI fusion being the most common (n = 10, 30%). Most tumors were in the cerebral hemispheres (n = 22, 67%). Two patients (6%) had metastasis at diagnosis. The median follow-up was 6.1 years. The 5-year event-free survival (EFS) rate was 81.3% ± 8.3%; the 5-year overall survival (OS) rate was 96.4% ± 4.1%. Patients receiving a near-total or gross-total resection had a 5-year EFS of 100%; those receiving a biopsy or subtotal resection had a 5-year EFS rate of 56.6% ± 15.2% (P < .01). No difference in EFS was observed based on location, histology, or molecular alterations. However, the tumors that progressed or metastasized may have distinct methylation profiles with evidence of activation of the MAPK and PI3K/AKT/mTOR pathways. pLGG with MYB/MYBL1 alterations have good outcomes. Our findings suggest that surgical resectability is a crucial determinant of EFS. Further characterization is required to identify optimal treatment strategies for progressive tumors.

Current Status of Pharmacokinetic Research in Children: A Systematic Review of Clinical Trial Records.

Many medications have different pharmacokinetics in children than in adults. Knowledge about the safety and efficacy of medications in children requires research into the pharmacokinetic profiles of children's medicines. By analysing registered clinical trial records, this study determined how frequently pharmacokinetic data is gathered in paediatric drug trials. We searched for the pharmacokinetic data from clinical trial records for preterm infants and children up to the age of 16 from January 2011 to April 2022. The records of trials involving one or more drugs in preterm infants and children up to the age of 16 were examined for evidence that pharmacokinetic data would be collected. In a total of 1483 records of interventional clinical trials, 136 (9.17%) pharmacokinetic data involved adults. Of those 136 records, 60 (44.1%) records were pharmacokinetics trials involving one or more medicines in children up to the age of 16. 20 (33.3 %) in America, followed by 19 (31.6 %) in Europe. Most trials researched medicines in the field of infection or parasitic diseases 20 (33.3%). 27 (48.2%) and 26 (46.4%) trials investigated medicines that were indicated as essential medicine. The pharmacokinetic characteristics of children's drugs need to be better understood. The current state of pharmacokinetic research appears to address the knowledge gap in this area adequately. Despite slow progress, paediatric clinical trials have experienced a renaissance as the significance of paediatric trials has gained international attention. The outcome of paediatric trials will have an impact on children's health in the future. In recent years, the need for greater availability and access to safe child-size pharmaceuticals has received a lot of attention.

Preventing and Treating Pain and Anxiety during Needle-Based Procedures in Children with Cancer in Low- and Middle-Income Countries.

Introduction: Children with cancer experience significant pain and anxiety during needle-based procedures. Undertreated pain in children has long-lasting consequences and reduces the efficacy of subsequent analgesic efforts. A validated quality improvement (QI) intervention, known as the "Children's Comfort Promise", includes (1) topical anesthetics, (2) sucrose or breastfeeding for infants, (3) comfort positioning, and (4) distraction techniques, and has been shown to be highly effective in decreasing procedural pain and anxiety in children. However, there is limited data about the adoption, adaptation, and implementation of these interventions in low- and middle-income countries (LMICs). Methods: A QI pilot project utilizing the Model for Improvement of the "Global Comfort Promise" was implemented in four global pediatric cancer hospitals (Lima, Peru; Barretos, Brazil; Pietermaritzburg, South Africa; and Manila, Philippines). Between August 2021 and January 2023, the pilot sites identified a specific aim, co-designed the measurement strategy with St. Jude Children's Research Hospital, and adopted, adapted, and implemented the project at their individual sites. Results: A total of 2,185 different procedures were recorded in the first year of implementation. Most patients were less than 10 years old (60.5%) and solid tumors (37.9%) were the most common diagnosis. Overall, healthcare professionals (98.3%) were satisfied with the procedures. Parents and patients reported that only 33.7% of patients experienced pain during the procedure. All (100%) parents and patients felt the healthcare teams adequately addressed their child's pain. Median self-reported adherence to ≥2 interventions was 98.0%. Challenges to the implementation of the QI initiative included lack of training, turnover of the medical staff, maintaining staff enthusiasm, and access to topical anesthetics. Each site had unique change ideas to implement the initiative. Conclusions: This multi-site, multi-country QI initiative was feasible and was successfully adopted, adapted, and implemented in the LMIC context to improve procedural pain in children (Global Comfort Promise). Additionally, this intervention resulted in high satisfaction of both healthcare professionals and patients/families. Further work is needed to overcome the challenges of topical anesthetic access and education of the workforce. Additional plans include modifying the Global Comfort Promise to include high-quality communication and expanding to additional sites with further refinement of the implementation strategy.

Reflections on the Past Decade in Evidence-Based Practice Within the Children's Oncology Group.

Background: The Children's Oncology Group (COG) is the only National Cancer Institute-supported clinical trials organization focused exclusively on childhood and adolescent cancer research. The COG Nursing Discipline Committee has embedded the tenets of evidence-based practice (EBP) into clinical trials nursing in order to standardize the nursing care delivered to children enrolled on these trials. The COG nursing EBP initiative is aimed at developing evidence-based clinical resources and tools to provide guidance to clinicians regarding topics relevant to the provision of cancer treatment for patients enrolled on COG clinical trials from diagnosis through survivorship. A rigorous, evidence-based process designed to guide development of the evidence-based clinical tools and resources within the COG nursing discipline was developed and was implemented with the first nurse expert team beginning in 2012. Method: The standardized process included (a) selecting EBP projects and nursing expert teams (NETs), (b) providing leadership, mentoring, and championship for NETs; (c) approving clinical content developed through the NETs; and (d) providing guidance and oversight over planned dissemination of the COG EBP projects. Results: The COG Nursing EBP Subcommittee has developed 15 publications to date that include 90 authors. Eleven of these authors contributed to multiple publications. Discussion: On this 10th anniversary of the development of the EBP within the COG nursing discipline, we recognize its contributions to the professional growth of many of the discipline's members and to advances in nursing care for children enrolled in pediatric cancer clinical trials.

Towards attentive, playful arts-based methodology with children

This paper shares methodological insights from our research which sought to centre children in the production of knowledge during the 2020 global pandemic to consider how this can inform research with children beyond the crisis. Drawing on our longitudinal participatory arts-based research with 30 children aged 9–12 during 2020–22, the paper illustrates our response to the shifting research landscape which included navigating social restrictions to develop child-centred ways of working with socially distanced arts-based methods and technologies. The paper sets out key principles focused on foregrounding children’s ways of knowing and attentive seeing which underpinned our reframing of the research encounter from one in which adults are intent on extracting children’s ready-made thoughts to a space in which knowledge generation is recognised as a process of co-construction and engagement with children. Central to this process is our commitment to feminist care ethics and the application of principles from early childhood research and pedagogy which prioritise attentiveness to younger children’s rhythms and pace. Our aim, in setting out an approach which makes a space for playfulness with older children, is to elaborate the potential of slower, attentive methods and to offer a methodological framework to address to wider questions about what arts-based methods do.

Ommaya reservoir use in pediatric ALL and NHL: a review at St. Jude Children's Research Hospital.

The intraventricular route of chemotherapy administration, via an Ommaya Reservoir (OmR) improves drug distribution in the central nervous system (CNS) compared to the more commonly used intrathecal administration. We retrospectively reviewed our experience with intraventricular chemotherapy, focused on methotrexate, in patients with Acute Lymphoblastic Leukemia (ALL) and Non-Hodgkin Lymphoma (NHL). Twenty-four patients (aged 7 days - 22.2 years) with 26 OmR placements were identified for a total of 25,009 OmR days between 1990 and 2019. Methotrexate cerebrospinal fluid (CSF) concentrations (n = 124) were analyzed from 59 courses of OmR therapy in 15 patients. Twenty-one courses involved methotrexate dosing on day 0 only, whereas 38 courses involved booster dosing on days 1, 2, or both. We simulated the time CSF methotrexate concentrations remained > 1 µM for 3 days given various dosing regimens. CSF methotrexate exposure was higher in those who concurrently received systemic methotrexate than via OmR alone (p < 10- 7). Our simulations showed that current intraventricular methotrexate boosting strategy for patients ≥ 3 years of age maintained CSF methotrexate concentrations ≥ 1 µM for 72h 40% of the time. Alternatively, other boosting strategies were predicted to achieve CSF methotrexate concentrations ≥ 1 µM for 72h between 46 and 72% of the time. OmR were able to be safely placed and administer intraventricular methotrexate with and without boost doses in patients from 7 days to 22 years old. Boosting strategies are predicted to increase CSF methotrexate concentrations ≥ 1 µM for 72h.

Excluded and Erased: The Conspicuous Absence of Native Children in Research on School Discipline Disparities

ABSTRACT Despite extensive scholarly and policy attention to the phenomenon of racially disparate school discipline, its negative effect on academic achievement, and its relationship to later criminal system involvement and incarceration, little has been written about the experiences of Native youth. This article seeks to bring attention to Native youth in the scholarly conversation about school discipline disparities. It summarizes extant research and data showing that Native youth disproportionately experience exclusionary discipline. It identifies barriers that may contribute to the lack of in-depth research on Native youth. Finally, it describes theoretical insights gleaned from the small subset of school discipline research focused on Native youth that can enrich future work.

COVID-19 in Pediatric Patients With Acute Lymphoblastic Leukemia or Lymphoma

COVID-19 in pediatric patients with acute lymphoblastic leukemia or lymphoma (ALL/LLy) has not been described in detail and may affect chemotherapy administration and long-term outcomes. To describe the clinical presentation of COVID-19 and chemotherapy modifications in pediatric patients with ALL/LLy. This is a retrospective case series of patients at St Jude Children's Research Hospital and its affiliate sites with newly diagnosed ALL/LLy who were treated on the Total XVII protocol (NCT03117751) between March 30, 2020, and June 20, 2022. Participants included patients aged 1 to 18 years who were receiving protocol chemotherapy. Acute symptoms and chemotherapy modifications were evaluated for 60 days after the COVID-19 diagnosis, and viral clearance, adverse events, and second SARS-CoV-2 infections were followed up during the 27-month study period. SARS-CoV-2; all patients were screened at least weekly and at symptom onset and/or after known exposure to SARS-CoV-2. Description of the spectrum of COVID-19 illness and chemotherapy modifications. Of 308 pediatric patients, 110 (36%) developed COVID-19 at a median age of 8.2 (IQR, 5.3-14.5) years. Sixty-eight patients (62%) were male. Most patients were in the continuation/maintenance phase of chemotherapy (101 [92%]). Severe disease was rare (7 [6%]) but was associated with older age, higher white blood cell counts at ALL/LLy diagnosis, lower absolute lymphocyte counts at COVID-19 diagnosis, abnormal chest imaging findings, and SARS-CoV-2 reinfection. Rare but serious thrombotic events included pulmonary embolism and cerebral venous sinus thrombosis (n = 1 for each). No multisystem inflammatory syndrome in children or death was seen. SARS-CoV-2 reinfection occurred in 11 patients (10%) and was associated with older age and with receiving standard or high-risk vs low-risk ALL/LLy therapy. Chemotherapy interruptions occurred in 96 patients (87%) and were longer for patients with severe disease, SARS-CoV-2 reinfection, and/or a COVID-19 diagnosis during the pre-Omicron variant period vs the post-Omicron period (after December 27, 2021). In this case series of COVID-19 in pediatric patients with ALL/LLy, severe COVID-19 was rare, but chemotherapy administration was affected in most patients. Long-term studies are needed to establish the outcomes of COVID-19 in this population.

“I want to see them thrive!”: exploring health service research priorities for young Aboriginal children growing up in Alice Springs – a qualitative study

To better understand the specific influences of early life on the long-term health and well-being of local Aboriginal children in Alice Springs, high-quality local longitudinal data is required. The Central Australian Aboriginal Congress and the Murdoch Children's Research Institute are exploring the feasibility of establishing a cohort study to fill this gap. A nested qualitative study was conducted to identify priority issues that can be translated into research questions answerable through the proposed cohort study. Semi-structured interviews and focus group discussions (FGDs) were conducted with a range of key community stakeholders, parents and caregivers of young Aboriginal children from Alice Springs in the Northern Territory between 2020 and 2021. Two Aboriginal and two non-Aboriginal researchers conducted 27 interviews and 3 FGDs with 42 participants. Three broad themes were constructed through reflexive thematic analysis representing the areas of focus community stakeholders and parents want future research to prioritise: (1) social determinants of health (2) building positive connections, and (3) making sure kids grow up strong and healthy. Priority setting for future research should be driven by Aboriginal and Torres Strait Islander peoples in order to be of practical benefit to their community. This qualitative study found that housing, transport and positive connections through nurturing and engaged parents were some of the most important issues raised. Participants also wanted future research to focus on issues specific to children such as nutrition, hearing loss, language development and capacity to learn. These findings will guide future work led by local Aboriginal researchers to co-design the proposed cohort study.

О рисках нарушений развития в раннем возрасте и их профилактике

&lt;p style="text-align: justify;"&gt;The article shows the foreign experience of the approach to creating conditions for the development of an early age child, including children with disabilities. The factors of early childhood development, as well as the risks for development and their prevention are considered. Using the example of successful practices, it is discussed what educational conditions are to be created for the development of toddlers, especially for social and emotional development in groups of young children, including integration formats to promote the child's own research activity, free play and movement, interaction with other children and adults. Special attention is paid to the prevention of the risks of developmental disorders, the peculiarities of working with children with disabilities, the role of the teacher and his/her interaction with the child in the group &amp;mdash; the style of communication, the use of speech, the peculiarities of assistance and support to the child's own activity and the development of his/her selfdependence. The principal trends of the modern approach to creating conditions in the group for the development of young children in foreign practice are highlighted: the importance of the quality of interaction, scaffolding, the creation of a subject-based developing environment, the synthesis of achievements of various psychological and pedagogical theories, the attitude to dialogue and cooperation with parents, the possibility of inclusion. In terms of creating conditions for children with disabilities and early intervention, individual classes are more often used, less frequently group classes, the format of integrative groups with typically developing children is promising, while active interaction and cooperation with parents is important. The principal trends of the modern approach to creating conditions in the group for the development of young children in foreign practice are highlighted: the importance of the quality of interaction, scaffolding, the creation of a subject-based developing environment, the synthesis of achievements of various psychological and pedagogical theories, the attitude to dialogue and cooperation with parents, the possibility of inclusion. In terms of creating conditions for children with disabilities and early intervention, individual classes are more often used, less often group classes, the format of integrative groups with normotypically developing children is promising, while active interaction and cooperation with parents is important.&lt;/p&gt;

Effects of Mindfulness-Based Practices on Children’s Self-Regulation: A Review on Early Childhood Research

Effects of Mindfulness-Based Practices on Children’s Self-Regulation: A Review on Early Childhood Research

A conceptual model of an effective early childhood physical literacy pedagogue

Physical inactivity has become increasingly prevalent among young children in early childhood education and care settings. One promising way to intervene and promote physical activity in these settings is to develop children’s physical literacy. Where most children spend their weekday in early childhood settings in the care of early childhood educators, the educators are viewed as ‘change agents’ and become responsible for developing children’s physical literacy. Thus, early childhood educators must possess adequate skills, knowledge, and practices to promote such development. However, research has yet to conceptualize a theory which identifies the significant capabilities and competencies that make early childhood educators, what we propose, an Effective Early Childhood Physical Literacy Pedagogue. Therefore, this paper draws on early childhood research regarding physical literacy, physical activity, and active play, to present a conceptual model theorizing an Effective Early Childhood Physical Literacy Pedagogue. Within this model, we propose educators’ professional identity and implementation of play-based pedagogy are essential characteristics of an Effective Early Childhood Physical Literacy Pedagogue. Furthermore, educators’ physical literacy capabilities (psychomotor, affective, social, and cognitive) are recognized as the vehicle that drives the aforementioned characteristics to be the Effective Early Childhood Physical Literacy Pedagogue. This conceptual model provides implications for future research to appropriately assess and target physical literacy interventions towards early childhood educators.