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Airway problems emerging after congenital cardiac surgery operations may have an impact on mortality and morbidity. Recently, to improve alveolar gas exchange and reduce respiratory effort, high-flow nasal cannula (HFNC) has started to be used in paediatric cases. This study aimed to evaluate the potential effects of high-flow nasal oxygen therapy on postoperative atelectasis development and reintubation rate in paediatric cardiac surgery patients.
Methods:
This study was conducted retrospectively in term newborns and infants younger than six months of age who underwent congenital cardiac surgery operation from 1 November 2022 to 1 November 2023 and were followed in the paediatric cardiac ICU. Patients who were receiving mechanical ventilator support at least 12 hours postoperatively were evaluated for the development of postoperative atelectasis and reintubation in the first 3 days of extubation. The patients were grouped as HFNC and non-HFNC users. Demographic characteristics, surgery type, and ICU clinical follow-up data were obtained from medical records. The results were statistically evaluated.
Results:
A total of 40 patients who did not use HFNC in the early postoperative period and 40 patients with HFNC in the late period during the study period were included in the study. The median age was 1 month (IQR 15 days–2 months) with equal gender distribution. Among patients, 70% of them were in the neonatal age group. Reintubation rates in the first 72 hours in HFNC users and non-HFNC users were 2.5% and 12.5%, respectively (p < 0.05). The median postoperative atelectasis scores at 24, 48, and 72 hours of extubation were 2 versus 2.5 (p > 0.05), 1.5 versus 3.5 (p < 0.05), and 1 versus 3 (p < 0.05) in HFNC users and non-HFNC users, respectively.
Conclusion:
HFNC therapy may have a positive effect on preventing atelectasis and reducing the reintubation rate in the early postoperative period.
Alexithymia (difficulties identifying and describing feelings) predicts increased risks for psychopathology, especially during the transition from childhood to adolescence. However, little is known of the early contributors to alexithymia. The language hypothesis of alexithymia suggests that language deficits play a primary role in predisposing language-impaired groups to developing alexithymia; yet longitudinal data tracking prospective relationship between language function and alexithymia are scarce. Leveraging data from the Surrey Communication and Language in Education cohort (N = 229, mean age at time point 1 = 5.32 years, SD = 0.29, 51.1% female), we investigated the prospective link between childhood language development and alexithymic traits in adolescence. Results indicated that boys with low language function at ages 4–5 years, and those who later met the diagnostic criteria for language disorders at ages 5–6 years, reported elevated alexithymic traits when they reached adolescence. Parent-reported child syntax abilities at ages 5–6 years revealed a dimensional relationship with alexithymic traits, and this was consistent with behavioral assessments on related structural language abilities. Empirically derived language groups and latent language trajectories did not predict alexithymic traits in adolescence. While findings support the language hypothesis of alexithymia, greater specificity of the alexithymia construct in developmental populations is needed to guide clinical interventions.
Early learning and childcare (ELCC) programmes play an important role in shaping children’s eating behaviours and long-term health by establishing a responsive feeding environment that encompasses not only mealtime behaviours but also extends to play activities and language used throughout the day. Despite their potential benefits, many ELCC centres do not consistently implement responsive feeding behaviours, facing challenges with organisational and behavioural changes within these environments. This study aims to identify influences on responsive feeding behaviours among early childhood educators prior to an intervention.
Design:
A qualitative study guided by the Behaviour Change Wheel framework and Capability Opportunity Motivation – Behaviour (COM-B) model. Semi-structured interviews and focus groups were conducted, recorded and transcribed verbatim. Thematic analysis was employed to identify themes, categorising them within the corresponding COM-B domains.
Setting:
Canada.
Participants:
Forty-one ELCC staff in various roles across eight centres from two provinces in eastern Canada.
Results:
Fifteen influences, spanning across all six domains of the COM-B model, were identified, highlighting gaps in educators’ knowledge and skills, varied approaches to food and feeding, and the interactions with children, parents, and co-workers on mealtimes dynamics. Additionally, costs, centre location and other physical resources emerged as enabling opportunities for responsive feeding behaviours.
Conclusions:
These findings offer a comprehensive exploration of the diverse factors influencing responsive feeding behaviours among educators, each varying in its potential for future behaviour change intervention.
Rates of acute mental health presentations in youth were increasing pre-pandemic internationally. Longitudinal studies following COVID-19 attest to ongoing deterioration in youth mental health, recognising adverse unintended consequences following public health restrictions.
Aims
To examine whether the initial post-COVID-19 increase in mental health presentations persisted following the reclassification of COVID-19 to endemic status, accompanied by the removal of most restrictions.
Method
All referrals to paediatric liaison psychiatry (PLP) between January 2018 and December 2022 in a Dublin tertiary children's hospital were included in the study. An interrupted time series analysis with autoregressive integrated moving average models was conducted, examining referrals with respect to different phases of COVID-19 and application of public health restrictions.
Results
Some 1385 referrals to PLP were received over the 5-year study. There was a significant decrease in PLP referrals immediately post-COVID-19, followed by a significant and sustained increase as the pandemic progressed and moved to endemic status. Public health restriction phases had a unique effect on those presenting with suicidal ideation, with a significant increase in the number of referrals. There was no effect of restrictions on other clinical profiles.
Conclusions
Increased referrals for youth with mental health difficulties, reported during the COVID-19 pandemic, persisted into the early endemic stage, after COVID-19 public health restrictions ceased. Specific impacts of restrictions on suicidal ideation referrals require further study. Investment in child and adolescent mental health services remains a priority, and future pandemic response strategies need to examine unintended consequences of any enforced public health measure.
Due to a result by Glasner and Downarowicz [Isomorphic extensions and applications. Topol. Methods Nonlinear Anal.48(1) (2016), 321–338], it is known that a minimal system is mean equicontinuous if and only if it is an isomorphic extension of its maximal equicontinuous factor. The majority of known examples of this type are almost automorphic, that is, the factor map to the maximal equicontinuous factor is almost one-to-one. The only cases of isomorphic extensions which are not almost automorphic are again due to Glasner and Downarowicz, who in the same article provide a construction of such systems in a rather general topological setting. Here, we use the Anosov–Katok method to provide an alternative route to such examples and to show that these may be realized as smooth skew product diffeomorphisms of the two-torus with an irrational rotation on the base. Moreover – and more importantly – a modification of the construction allows to ensure that lifts of these diffeomorphisms to finite covering spaces provide novel examples of finite-to-one topomorphic extensions of irrational rotations. These are still strictly ergodic and share the same dynamical eigenvalues as the original system, but show an additional singular continuous component of the dynamical spectrum.
The science of developmental psychopathology has made outstanding progress over the past 40 years in understanding adaptive and maladaptive developmental processes across the life span. Yet most of this work has been researcher driven with little involvement of community partners in the research process, limiting the potential public health significance of our work. To continue to advance the field we must move beyond the physical and conceptual walls of our research laboratories and into the real world. In this article, we define and describe the importance of community-engaged research, and present our overarching principles for engaging the community including practicing respect, shared power and decision-making, prioritizing the needs of the community, and engaging in consistent and transparent communication. We present several associated recommendations for best practice and highlight examples from our own research that is grounded in a developmental psychopathology perspective to illustrate these practices. Recommendations for the future of the discipline of development and psychopathology, with emphasis on training and continuing education, are described.
Sexual and gender minority (SGM) migrants’ disclosure of their identity or “coming out” has significant stakes. It can facilitate access to resources (institutional disclosure), cultivate intimacy and belonging (social disclosure), or support claims for legal protections (legal disclosure). This article analyzes SGM unaccompanied minors’ disclosures as shaped by the evolution of their legal consciousness in pursuing legal relief and incorporation in the United States. Ethnographic observations and in-depth interviews from 2014–2019 with 11 SGM unaccompanied minors reveal a striking pattern in their disclosure practices. During apprehension and detention, minors engaged in social, institutional, and legal disclosure of their SGM status. However, their interactions with agents from the Departments of Homeland Security and Health and Human Services led them to believe that SGM rights, support, and acceptance were contingent on legal status. Later, upon release from state custody, minors withheld legal disclosure from their deportation proceedings and immigration cases, even against the advisement of their attorneys. They also became more strategic in their social and institutional disclosure across other contexts. Post-legalization, however, minors broadened their disclosure practices and embarked on claims related to their SGM status. This study raises implications for research and policy. By analyzing shifts in legal consciousness over time, how certain experiences become reference points for how immigrants understand the law with respect to their identity and related behaviors are illustrated. It also extends the discussion of the far-reaching implications of SGM punishment and the disadvantages of immigration detention for children and youth.
This editorial discusses a study by Day and colleagues, in which the authors investigated the prevalence of resolution of alcohol and other drug problems in the UK and compared people who resolved their problems with and without treatment.
Previous studies show that maternal mind-mindedness positively impacts children’s social development. In the current studies, we examine the relation between mind-mindedness during parent–child interaction, oxytocin (OT), and postnatal depression in a sample of mothers (N = 62, ages 23–44) and their infant (ages 3–9 months). In Study 1, infant salivary OT was positively correlated with mothers’ appropriate mind-related comments, and negatively correlated (at trend level) with maternal depression scores. Mothers experiencing symptoms of depression used fewer appropriate mind-related comments than controls. Study 2 was a double-blind, placebo-controlled, experimental study, in which the same women who participated in Study 1 were administered nasal OT. This did not significantly influence levels of mind-mindedness. Study 2 warrants a larger trial to investigate the effect of OT on mind-mindedness further. Study 1 is the first to demonstrate an association between maternal mind-mindedness and variation in children’s OT levels. Since both OT and mind-mindedness have been repeatedly implicated in processes of maternal–infant attachment, this association highlights the centrality of mothers’ caregiving representations in facilitating the parent–child relationship and children’s early development.
Robots are with us, but law and legal systems are not ready. This book identifies the issues posed by human-robot interactions in substantive law, procedural law, and law's narratives, and suggests how to address them. When human-robot interaction results in harm, who or what is responsible? Part I addresses substantive law, including the issues raised by attempts to impose criminal liability on different actors. And when robots perceive aspects of an alleged crime, can they be called as a sort of witness? Part II addresses procedural issues raised by human-robot interactions, including evidentiary problems arising out of data generated by robots monitoring humans, and issues of reliability and privacy. Beyond the standard fare of substantive and procedural law, and in view of the conceptual quandaries posed by robots, Part III offers chapters on narrative and rhetoric, suggesting different ways to understand human-robot interactions, and how to develop coherent frameworks to do that. This title is also available as Open Access on Cambridge Core.
Jews and Christians have interacted for two millennia, yet there is no comprehensive, global study of their shared history. This book offers a chronological and thematic approach to that 2,000-year history, based on some 200 primary documents chosen for their centrality to the encounter. A systematic and authoritative work on the relationship between the two religions, it reflects both the often troubled history of that relationship and the massive changes of attitude and approach in more recent centuries. Written by a team leading international scholars in the field, each chapter introduces the context for its historical period, draws out the key themes arising from the relevant documents, and provides a detailed commentary on each document to shed light on its significance in the history of the Jewish–Christian relationship. The volume is aimed at scholars, teachers and students, clerics and lay people, and anyone interested in the history of religion.
The framework of 'Romanization' developed by Haverfield in 1905 - that Romans 'civilized' their imperial subjects, particularly those in the 'barbarian' western provinces - remains hegemonic, notwithstanding multiple attempts at revisionism. It has been reasserted, rejected, or modified, but still frames the debate. Decolonizing Roman Imperialism investigates how the postcolonial challenge to decolonize the production of historical knowledge has motivated Roman scholars to question the paradigm of Romanization: to review its historiography, to seek fresh approaches, and to rewrite it. The book provides an intellectual genealogy of the debate valuable for every student of the Roman Empire and of Roman Britain, and invites them to rethink the legacy of ancient Roman imperialism.
This Element examines two prominent public health crises – the emergence of bovine spongiform encephalopathy (BSE) in British cattle and the COVID-19 pandemic. It contends that a group of arguments called the informal fallacies functioned as cognitive heuristics and facilitated public health reasoning during both crises. These arguments, which include the argument from ignorance, the argument from authority, and circular argument, are particularly well adapted to the type of uncertainty that surrounds the emergence of novel infectious diseases. By bridging gaps in knowledge, these arguments can facilitate reasoning when evidence about these diseases is limited and the need to take action is urgent. The Element charts a public health journey beginning in the 1950s with a disease called kuru, then examines the response to the emergence of BSE in 1986 and extends to the present day with the COVID-19 pandemic. This title is also available as Open Access on Cambridge Core.