Effect of Inter-Hospital Transfer on Mortality in Patients Admitted through the Emergency Department.

Background: Despite advancements in emergency medical systems, inter-hospital transfer (IHT) remains a critical component. Several studies have analyzed the impact of IHT on patient outcomes. Some studies have reported positive effects, indicating that transfers can improve patient prognosis. However, other studies have suggested that transfers may worsen outcomes. We investigated whether IHT is associated with in-hospital mortality. Methods: This retrospective observational study utilized data on patient outcomes from the National Emergency Department Information System (NEDIS) from 2016 to 2018, focusing on patients admitted to hospitals after visiting the emergency department (ED). The primary outcome was the in-hospital mortality rate. Results: This study included 2,955,476 adult patients admitted to emergency medical centers, with 832,598 (28.2%) undergoing IHT. The in-hospital mortality rate was significantly higher in the transfer group (6.9%) than in the non-transfer group (4.8%). Multiple logistic regression analysis revealed that IHT was an independent predictor of in-hospital mortality (adjusted odds ratio [aOR] 1.114, 95% confidence interval [CI] 1.101-1.128) after adjusting for variables. Sub-analysis indicated that higher severity scores, shorter symptom onset-to-arrival duration, and diagnoses of infectious or respiratory diseases were significantly associated with increased in-hospital mortality among transferred patients. Conclusions: This study identifies IHT as a significant factor associated with increased in-hospital mortality. Additionally, it suggested the need for policies to mitigate the risks associated with IHT, particularly in critically ill patients, those with the acute phase response, and those with infectious, genitourinary, and respiratory diseases.

Being sensitive in their own way: parental ethnotheories of caregiver sensitivity and child emotion regulation across five countries.

Caregiver sensitivity builds a basis for children's sense of security and effective emotion regulation during their development. Applying a cross-cultural lens, caregiver sensitivity can be divided into two subtypes, reactive and proactive, and its prevalence and meaning may differ across cultures. Guided by the theoretical frameworks of developmental niche and parental ethnotheories, the current study examines culture-specific meanings of caregiver sensitivity across five countries: India, Nepal, Korea, the United States of America (USA), and Germany. We examine the prevalence of maternal reactive and proactive sensitivity, children's emotional lability and regulation, and how mothers' sensitivity types are related to children's emotional characteristics. Participants included 472 mothers from the five countries with children aged between 6 and 7 years. Mothers reported their sensitivity preference in multiple vignettes and completed an emotion regulation checklist to report their children's emotional lability and regulation. A set of analyses of covariance (ANCOVAs) found cultural differences in mothers' preference for proactive and reactive sensitivity. Mothers in India and Nepal reported the highest preference for proactive sensitivity followed by Korea and the USA, while German mothers reported the lowest preference for proactive sensitivity. Consequent regression analyses revealed varying associations between proactive sensitivity and child emotional characteristics in all five countries either directly or as moderated by child sex. These results evidence that parental ethnotheories are part of the developmental niche embedded in a larger cultural context. Findings on the differential links between the types of sensitivity and child emotion regulation provide cultural models of parental emotion socialization and children's emotional functioning.

Don't touch: Developmental trajectories of toddlers' behavioral regulation related to older siblings' behaviors and parental discipline.

Behavioral regulation is one of the key developmental skills children acquire during early childhood. Previous research has focused primarily on the role of parents as socializing agents in this process, yet it is likely that older siblings also are influential given the numerous daily interactions between siblings. This exploratory longitudinal study investigated developmental heterogeneity in behavioral regulation during toddlerhood and the early preschool years (18 to 36 months) and relations with older siblings' control and behavioral regulation while taking into account parental discipline. Toddlers were visited at home at 18, 24, and 36 months and observed during a gift-delay task with their older sibling in 93 families. Behavioral regulation of both siblings and gentle and harsh control of the older sibling were coded during the sibling gift-delay task, which was validated using parent-reports of toddlers' internalized conduct. Analyses revealed five distinct developmental trajectories among toddlers' behavioral regulation, revealing different patterns of developmental multifinality and equifinality. Older siblings' harsh control and parental discipline differed across toddler trajectory groups. Older siblings' behaviors covaried with the toddlers' behavioral regulation suggesting that older siblings may be acting as models for younger siblings, as well as disciplining and teaching toddlers to resist temptation.

Taming anger and trusting others: Roles of skin conductance, anger regulation, and trust in children's aggression.

Proactive and reactive aggression subtypes are distinguishable as early as the preschool years. However, their early physiological and social-emotional correlates have not been examined simultaneously. We tested whether children's skin conductance level, anger regulation, and trust in others were differentially related to their proactive and reactive aggression. Four-year-olds and their primary caregivers were recruited from a large Canadian city (N = 150). Controlling for reactive aggression, higher trust was associated with lower proactive aggression, but only for children with low anger regulation or skin conductance level. Controlling for proactive aggression, lower anger regulation was related to higher reactive aggression, and higher trust was related to higher reactive aggression for children with high skin conductance level. Findings highlight the unique and collective relations of physiology, emotion regulation, and trust to different forms of aggression in early childhood. Statement of contribution What is already known on this subject Proactive and reactive aggression subtypes are distinguishable as early as the preschool years. Unique physiological and social-emotional correlates of each subtype have been studied in middle and late childhood. Trust is a critical milestone for positive social interactions in early childhood and has been linked to aggression. What the present study adds Physiological and social-emotional correlates are uniquely linked to subtypes of aggression already at age 4. Trust is differentially linked to aggression subtypes as a function of anger regulation and skin conductance level.

Anger and Sadness Regulation in Refugee Children: The Roles of Pre- and Post-migratory Factors.

Pre- and post-migratory factors have been implicated in refugee children's mental health. However, findings regarding their unique and joint roles are inconsistent or nonexistent. We examined the main and interactive relations of pre-migratory life stressors and post-migratory daily hassles and routines to emotion regulation-a key marker of mental health-in 5- to 13-year-old Syrian refugee children (N = 103) resettling in Canada. Mothers and children completed questionnaires assessing pre-migratory life stressors and post-migratory daily hassles. Mothers also reported their children's adherence to family routines and emotion regulation abilities (i.e., anger and sadness regulation) via questionnaire. Overall, children who more frequently engaged in family routines showed better anger regulation. Pre- and post-migratory factors also interacted, such that greater post-migratory daily hassles were associated with worse sadness regulation for children with lower levels of pre-migratory life stressors, but were unassociated with the sadness regulation of children who experienced higher levels of pre-migratory life stressors. Results suggest that pre- and post-migratory factors play unique and joint roles in refugee children's emotion regulation during resettlement.

Effect of rapid influenza diagnostic tests on patient management in an emergency department.

OBJECTIVE: We evaluated the effect of rapid influenza diagnostic tests (RIDTs) on patient management in an emergency department for 3 years after 2009, and also identified factors associated with the choice of treatment for patients with influenza-like illnesses. METHODS: The study period consisted of three influenza epidemic seasons. Patients older than 15 years who underwent RIDTs in the emergency department and were then discharged without admission were included. RESULTS: A total of 453 patients were enrolled, 114 of whom had positive RIDT results. Antiviral medication was prescribed to 103 patients (90.4%) who had positive RIDT results, while 1 patient (0.3%) who tested negative was treated with antivirals (P<0.001). Conservative care was administered to 11 RIDT-positive patients (9.6%) and 244 RIDT-negative patients (72.0%) (P<0.001). Symptom onset in less than 48 hours, being older than 65 years, and the presence of comorbidities were not associated with the administration of antiviral therapy. CONCLUSION: RIDT results had a critical effect on physician decision-making regarding antiviral treatment for patients with influenza-like illnesses in the emergency department. However, symptom onset in less than 48 hours, old age, and comorbidities, which are all indications for antiviral therapy, were not found to influence the administration of antiviral treatment.

Children's Early Awareness of Comprehension as Evident in Their Spontaneous Corrections of Speech Errors.

A crucial human cognitive goal is to understand and to be understood. But understanding often takes active management. Two studies investigated early developmental processes of understanding management by focusing on young children's comprehension monitoring. We ask: When and how do young children actively monitor their comprehension of social-communicative interchanges and so seek to clarify and correct their own potential miscomprehension? Study 1 examined the parent-child conversations of 13 children studied longitudinally in everyday situations from the time the children were approximately 2 years through 3 years. Study 2 used a seminaturalistic situation in the laboratory to address these questions with more precision and control with 36 children aged 2-3 years.

Positive Parenting Moderates the Association between Temperament and Self-Regulation in Low-Income Toddlers.

Self-regulation develops rapidly during the toddler years and underlies many important developmental outcomes, including social-emotional competence and academic achievement. It is important to understand factors that contribute to early self-regulation skills among children at risk for adjustment difficulties in these domains, such as children growing up in poverty. The current study examined mother-reported child temperament (negative affect, effortful control) and observed maternal parenting (during a mother-child free play) as contributing factors to toddlers' observed self-regulation during delay of gratification tasks at 27 months (snack delay) and 33 months (gift delay). Participants were 198 toddlers (M age = 27 months; 53% boys; 48% non-Hispanic white) and their mothers from low-income families. Mothers' negative parenting characterized by negative affect, hostility, and negative control was associated with poorer self-regulation contemporaneously. Toddlers' lower negative affect and higher effortful control predicted better self-regulation at 33 months, but positive parenting characterized by positive affect and sensitivity moderated these associations at both time points. Specifically, we found a buffering effect of high positive parenting among toddlers with a temperamental risk and a deleterious effect of low positive parenting despite toddlers' temperamental strength. Results highlight the importance of positive parenting for fostering the development of self-regulation among toddlers growing up with poverty-related and child-level risks.

Theory-of-Mind Development and Early Sibling Relationships after the Birth of a Sibling: Parental Discipline Matters.

This study investigated relations among children's Theory-of-Mind (ToM) development, early sibling interactions, and parental discipline strategies during the transition to siblinghood. Using a sample of firstborn children and their parents (N = 208), we assessed children's ToM before the birth of a sibling and 12 months after the birth, and sibling interactions (i.e., positive engagement and antagonism) and parental discipline strategies (i.e., child-centred and parent-centred discipline) at 4 and 8 months in the first year of siblinghood. Structural equation modelling analyses revealed that children's ToM before the birth of the sibling predicted children's positive engagement with the infant sibling, whereas children's antagonistic behaviours towards the infant sibling negatively predicted children's ToM at 12 months, but only when mothers used low levels of child-centred discipline. These findings emphasize the role of parents in the development of young children's social- cognitive understanding in the context of sibling interactions even as early as the first year after the sibling's birth.

Helping yourself helps others: Linking children's emotion regulation to prosocial behavior through sympathy and trust.

Although emotionally well-regulated children are more likely to behave prosocially, the psychological processes that connect their emotion regulation abilities and prosocial behavior are less clear. We tested if other-oriented sympathy and trust mediated the links between emotion regulation capacities (i.e., resting respiratory sinus arrhythmia [RSA], negative emotional intensity, and sadness regulation) and prosocial behavior in an ethnically diverse sample of 4- and 8-year-olds (N = 131; 49% girls). Resting RSA was calculated from children's electrocardiogram data in response to a nondescript video. Sympathy was child and caregiver reported, whereas negative emotional intensity, sadness regulation, trust, and prosocial behavior were caregiver reported. Regardless of age, higher resting RSA was linked to higher sympathy, which was associated with higher prosocial behavior. The positive link between sadness regulation and prosocial behavior was mediated by higher sympathy and trust. Children's other-oriented psychological processes may play important roles in translating certain emotion regulation capacities into prosocial behavior. (PsycINFO Database Record

"Only you can play with me!" Children's inclusive decision making, reasoning, and emotions based on peers' gender and behavior problems.

This study examined the development of children's decisions, reasoning, and emotions in contexts of peer inclusion/exclusion. We asked an ethnically diverse sample of 117 children aged 4years (n=59; 60% girls) and 8years (n=58; 49% girls) to choose between including hypothetical peers of the same or opposite gender and with or without attention deficit/hyperactivity problems and aggressive behavior. Children also provided justifications for, and emotions associated with, their inclusion decisions. Both 4- and 8-year-olds predominantly chose to include the in-group peer (i.e., the same-gender peer and peers without behavior problems), thereby demonstrating a normative in-group inclusive bias. Nevertheless, children included the out-group peer more in the gender context than in the behavior problem contexts. The majority of children reported group functioning-related, group identity-related, and stereotype-related reasoning after their in-group inclusion decisions, and they associated happy feelings with such decisions. Although most children attributed sadness to the excluded out-group peer, they attributed more anger to the excluded out-group peer in the aggression context compared with other contexts. We discuss the implications of our findings for current theorizing about children's social-cognitive and emotional development in contexts of peer inclusion and exclusion.

Child cortisol moderates the association between family routines and emotion regulation in low-income children.

Biological and social influences both shape emotion regulation. In 380 low-income children, we tested whether biological stress profile (cortisol) moderated the association among positive and negative home environment factors (routines; chaos) and emotion regulation (negative lability; positive regulation). Children (M age = 50.6, SD = 6.4 months) provided saliva samples to assess diurnal cortisol parameters across 3 days. Parents reported on home environment and child emotion regulation. Structural equation modeling was used to test whether cortisol parameters moderated associations between home environment and child emotion regulation. Results showed that home chaos was negatively associated with emotion regulation outcomes; cortisol did not moderate the association. Child cortisol level moderated the routines-emotion regulation association such that lack of routine was most strongly associated with poor emotion regulation among children with lower cortisol output. Findings suggest that underlying child stress biology may shape response to environmental influences.

Learning curve and period of experience required for the competent diagnosis of acute appendicitis using abdominal computed tomography: a prospective observational study.

OBJECTIVE: To assess the learning curve of novice residents in diagnosing acute appendicitis using abdominal computed tomography (CT) scans. METHODS: This prospective observational study was conducted within a 4-month period from March 1 to June 30, 2015. After CT scans for right lower quadrant pain or similar acute abdomen were evaluated, postgraduate year 1 (PGY-1) residents completed an interpretation checklist. The primary outcome was evaluation of the learning curve for competent CT scan interpretation under suspicion of acute appendicitis. Secondary outcomes were cumulative numbers of accurate abdominal CT interpretations regardless of initial clinical impression and training period. RESULTS: PGY-1 residents recorded a total of 230 interpretation checklists. There were 53, 51, 46, 44, and 36 checklists recorded by individual residents and 92, 92, 91, 91, and 61 respective training days in the emergency department, excluding rotation periods in other departments. After 16 to 20 interpretations of abdominal CT scans performed under suspicion of acute appendicitis, the residents could diagnose acute appendicitis with more than 95% accuracy. Overall, the sensitivity and specificity for diagnosing acute appendicitis were 97% (95% confidence interval, 94 to 100) and 83% (95% confidence interval, 80 to 87), respectively. After 61 to 80 abdominal CT interpretations regardless of suspicion of acute appendicitis and after 41 to 50 days in training, PGY-1 emergency department residents could diagnose acute appendicitis with more than 95% accuracy. CONCLUSION: PGY-1 residents require 16 to 20 checklist interpretations to acquire acceptable abdominal CT interpretation. After performing 61 to 80 CT scans regardless of suspicion of acute appendicitis, they could diagnose acute appendicitis with acceptable accuracy.

Aggression, Sibling Antagonism, and Theory of Mind During the First Year of Siblinghood: A Developmental Cascade Model.

A developmental cascade model was tested to examine longitudinal associations among firstborn children's aggression, theory of mind (ToM), and antagonism toward their younger sibling during the 1st year of siblinghood. Aggression and ToM were assessed before the birth of a sibling and 4 and 12 months after the birth, and antagonism was examined at 4 and 12 months in a sample of 208 firstborn children (initial Mage  = 30 months, 56% girls) from primarily European American, middle-class families. Firstborns' aggression consistently predicted high sibling antagonism both directly and through poorer ToM. Results highlight the importance of examining longitudinal influences across behavioral, social-cognitive, and relational factors that are closely intertwined even from the early years of life.

Early Callous-Unemotional Behavior, Theory-of-Mind, and a Fearful/Inhibited Temperament Predict Externalizing Problems in Middle and Late Childhood.

Childhood externalizing problems are more likely to be severe and persistent when combined with high levels of callous-unemotional (CU) behavior. A handful of recent studies have shown that CU behavior can also be reliably measured in the early preschool years, which may help to identify young children who are less likely to desist from early externalizing behaviors. The current study extends previous literature by examining the role of CU behavior in very early childhood in the prediction of externalizing problems in both middle and late childhood, and tests whether other relevant child characteristics, including Theory-of-Mind (ToM) and fearful/inhibited temperament moderate these pathways. Multi-method data, including parent reports of child CU behavior and fearful/inhibited temperament, observations of ToM, and teacher-reported externalizing problems were drawn from a prospective, longitudinal study of children assessed at ages 3, 6, and 10 (N = 241; 48 % female). Results demonstrated that high levels of CU behavior predicted externalizing problems at ages 6 and 10 over and above the effect of earlier externalizing problems at age 3, but that these main effects were qualified by two interactions. High CU behavior was related to higher levels of externalizing problems specifically for children with low ToM and a low fearful/inhibited temperament. The results show that a multitude of child characteristics likely interact across development to increase or buffer risk for child externalizing problems. These findings can inform the development of targeted early prevention and intervention for children with high CU behavior.

Coparenting and children's temperament predict firstborns' cooperation in the care of an infant sibling.

This study examined how coparenting and firstborn children's temperament predicted children's cooperative behavior in response to maternal requests for assistance in the care of a 1-month-old infant sibling. Children's cooperative responding was observed during a diaper change session for 216 firstborns (ages 13 to 70 months; M = 32). Parents also completed questionnaires assessing coparenting and children's temperament. Results suggested that coparenting quality moderated the association between children's temperament (i.e., soothability) and children's cooperation as revealed in a Temperament × Cooperative Coparenting × Undermining Coparenting interaction. Specifically, low soothability predicted low levels of children's cooperation in families with high undermining and low cooperative coparenting, over and above the effects of child age, gender, and mothers' education. Findings further our understanding of how temperamental characteristics and coparenting quality conjointly predict individual differences in firstborn children's positive adjustment across the transition to siblinghood.

Inhibition of phospholipase D2 induces autophagy in colorectal cancer cells.

Autophagy is a conserved lysosomal self-digestion process used for the breakdown of long-lived proteins and damaged organelles, and it is associated with a number of pathological processes, including cancer. Phospholipase D (PLD) isozymes are dysregulated in various cancers. Recently, we reported that PLD1 is a new regulator of autophagy and is a potential target for cancer therapy. Here, we investigated whether PLD2 is involved in the regulation of autophagy. A PLD2-specific inhibitor and siRNA directed against PLD2 were used to treat HT29 and HCT116 colorectal cancer cells, and both inhibition and genetic knockdown of PLD2 in these cells significantly induced autophagy, as demonstrated by the visualization of light chain 3 (LC3) puncta and autophagic vacuoles as well as by determining the LC3-II protein level. Furthermore, PLD2 inhibition promoted autophagic flux via the canonical Atg5-, Atg7- and AMPK-Ulk1-mediated pathways. Taken together, these results suggest that PLD2 might have a role in autophagy and that its inhibition might provide a new therapeutic basis for targeting autophagy.