The promise and pitfalls of a strength-based approach to child poverty and neurocognitive development: Implications for policy.

There has been significant progress in understanding the effects of childhood poverty on neurocognitive development. This progress has captured the attention of policymakers and promoted progressive policy reform. However, the prevailing emphasis on the harms associated with childhood poverty may have inadvertently perpetuated a deficit-based narrative, focused on the presumed shortcomings of children and families in poverty. This focus can have unintended consequences for policy (e.g., overlooking strengths) as well as public discourse (e.g., focusing on individual rather than systemic factors). Here, we join scientists across disciplines in arguing for a more well-rounded, "strength-based" approach, which incorporates the positive and/or adaptive developmental responses to experiences of social disadvantage. Specifically, we first show the value of this approach in understanding normative brain development across diverse human environments. We then highlight its application to educational and social policy, explore pitfalls and ethical considerations, and offer practical solutions to conducting strength-based research responsibly. Our paper re-ignites old and recent calls for a strength-based paradigm shift, with a focus on its application to developmental cognitive neuroscience. We also offer a unique perspective from a new generation of early-career researchers engaged in this work, several of whom themselves have grown up in conditions of poverty. Ultimately, we argue that a balanced strength-based scientific approach will be essential to building more effective policies.

iCatcher+: Robust and Automated Annotation of Infants' and Young Children's Gaze Behavior From Videos Collected in Laboratory, Field, and Online Studies.

Technological advances in psychological research have enabled large-scale studies of human behavior and streamlined pipelines for automatic processing of data. However, studies of infants and children have not fully reaped these benefits because the behaviors of interest, such as gaze duration and direction, still have to be extracted from video through a laborious process of manual annotation, even when these data are collected online. Recent advances in computer vision raise the possibility of automated annotation of these video data. In this article, we built on a system for automatic gaze annotation in young children, iCatcher, by engineering improvements and then training and testing the system (referred to hereafter as iCatcher+) on three data sets with substantial video and participant variability (214 videos collected in U.S. lab and field sites, 143 videos collected in Senegal field sites, and 265 videos collected via webcams in homes; participant age range = 4 months-3.5 years). When trained on each of these data sets, iCatcher+ performed with near human-level accuracy on held-out videos on distinguishing "LEFT" versus "RIGHT" and "ON" versus "OFF" looking behavior across all data sets. This high performance was achieved at the level of individual frames, experimental trials, and study videos; held across participant demographics (e.g., age, race/ethnicity), participant behavior (e.g., movement, head position), and video characteristics (e.g., luminance); and generalized to a fourth, entirely held-out online data set. We close by discussing next steps required to fully automate the life cycle of online infant and child behavioral studies, representing a key step toward enabling robust and high-throughput developmental research.

Vaccine Effectiveness of Primary Series and Booster Doses against Omicron Variant COVID-19-Associated Hospitalization in the United States

Objectives: To compare the effectiveness of a primary COVID-19 vaccine series plus a booster dose with a primary series alone for the prevention of Omicron variant COVID-19 hospitalization. Design: Multicenter observational case-control study using the test-negative design to evaluate vaccine effectiveness (VE). Setting: Twenty-one hospitals in the United States (US). Participants: 3,181 adults hospitalized with an acute respiratory illness between December 26, 2021 and April 30, 2022, a period of SARS-CoV-2 Omicron variant (BA.1, BA.2) predominance. Participants included 1,572 (49%) case-patients with laboratory confirmed COVID-19 and 1,609 (51%) control patients who tested negative for SARS-CoV-2. Median age was 64 years, 48% were female, and 21% were immunocompromised; 798 (25%) were vaccinated with a primary series plus booster, 1,326 (42%) were vaccinated with a primary series alone, and 1,057 (33%) were unvaccinated. Main Outcome Measures: VE against COVID-19 hospitalization was calculated for a primary series plus a booster and a primary series alone by comparing the odds of being vaccinated with each of these regimens versus being unvaccinated among cases versus controls. VE analyses were stratified by immune status (immunocompetent; immunocompromised) because the recommended vaccine schedules are different for these groups. The primary analysis evaluated all COVID-19 vaccine types combined and secondary analyses evaluated specific vaccine products. Results: Among immunocompetent patients, VE against Omicron COVID-19 hospitalization for a primary series plus one booster of any vaccine product dose was 77% (95% CI: 71-82%), and for a primary series alone was 44% (95% CI: 31-54%) (p<0.001). VE was higher for a boosted regimen than a primary series alone for both mRNA vaccines used in the US (BNT162b2: primary series plus booster VE 80% (95% CI: 73-85%), primary series alone VE 46% (95% CI: 30-58%) [p<0.001]; mRNA-1273: primary series plus booster VE 77% (95% CI: 67-83%), primary series alone VE 47% (95% CI: 30-60%) [p<0.001]). Among immunocompromised patients, VE for a primary series of any vaccine product against Omicron COVID-19 hospitalization was 60% (95% CI: 41-73%). Insufficient sample size has accumulated to calculate effectiveness of boosted regimens for immunocompromised patients. Conclusions: Among immunocompetent people, a booster dose of COVID-19 vaccine provided additional benefit beyond a primary vaccine series alone for preventing COVID-19 hospitalization due to the Omicron variant.

Clinical Severity and mRNA Vaccine Effectiveness for Omicron, Delta, and Alpha SARS-CoV-2 Variants in the United States: A Prospective Observational Study

ObjectivesTo characterize the clinical severity of COVID-19 caused by Omicron, Delta, and Alpha SARS-CoV-2 variants among hospitalized adults and to compare the effectiveness of mRNA COVID-19 vaccines to prevent hospitalizations caused by each variant. DesignA case-control study of 11,690 hospitalized adults. SettingTwenty-one hospitals across the United States. ParticipantsThis study included 5728 cases hospitalized with COVID-19 and 5962 controls hospitalized without COVID-19. Cases were classified into SARS-CoV-2 variant groups based on viral whole genome sequencing, and if sequencing did not reveal a lineage, by the predominant circulating variant at the time of hospital admission: Alpha (March 11 to July 3, 2021), Delta (July 4 to December 25, 2021), and Omicron (December 26, 2021 to January 14, 2022). Main Outcome MeasuresVaccine effectiveness was calculated using a test-negative design for COVID-19 mRNA vaccines to prevent COVID-19 hospitalizations by each variant (Alpha, Delta, Omicron). Among hospitalized patients with COVID-19, disease severity on the WHO Clinical Progression Ordinal Scale was compared among variants using proportional odds regression. ResultsVaccine effectiveness of the mRNA vaccines to prevent COVID-19-associated hospitalizations included: 85% (95% CI: 82 to 88%) for 2 vaccine doses against Alpha; 85% (95% CI: 83 to 87%) for 2 doses against Delta; 94% (95% CI: 92 to 95%) for 3 doses against Delta; 65% (95% CI: 51 to 75%) for 2 doses against Omicron; and 86% (95% CI: 77 to 91%) for 3 doses against Omicron. Among hospitalized unvaccinated COVID-19 patients, severity on the WHO Clinical Progression Scale was higher for Delta than Alpha (adjusted proportional odds ratio [aPOR] 1.28, 95% CI: 1.11 to 1.46), and lower for Omicron than Delta (aPOR 0.61, 95% CI: 0.49 to 0.77). Compared to unvaccinated cases, severity was lower for vaccinated cases for each variant, including Alpha (aPOR 0.33, 95% CI: 0.23 to 0.49), Delta (aPOR 0.44, 95% CI: 0.37 to 0.51), and Omicron (aPOR 0.61, 95% CI: 0.44 to 0.85). ConclusionsmRNA vaccines were highly effective in preventing COVID-19-associated hospitalizations from Alpha, Delta, and Omicron variants, but three vaccine doses were required to achieve protection against Omicron similar to the protection that two doses provided against Delta and Alpha. Among adults hospitalized with COVID-19, Omicron caused less severe disease than Delta, but still resulted in substantial morbidity and mortality. Vaccinated patients hospitalized with COVID-19 had significantly lower disease severity than unvaccinated patients for all the variants.

Predicting COVID19 Critical Care Beds - The London North-West University Healthcare Trust Experience

Our trust has an urgent need to make short-term (3-4 days in advance) informed operational decisions which take into account best-practice treatment regimens and known clinical features of COVID19 inpatients. We believe that any model which is relied upon for operational decision making should have clinically identifiable parameters. Our models parameters take into account the conversion rates from acute wards into wards equipped with Non-Invasive Ventilation (NIV) and Mechanical Ventilation (MV), the typical time that these conversions take place and, the historical non-COVID usage of NIV and MV beds. We have observed that this clinical performance is mathematically identical to a series of linear delays on the time varying inpatient level. High frequency inpatient data, sampled [~]4 hourly, has allowed our hospital trust to predict total critical care usage up to 4 days in advance without making any assumptions on upcoming inpatients. It is based entirely upon current bed occupancy levels and measured clinical pathways. Through back-testing over the recent 4 months, the bounds of this model include 93.8% of all 4 day inpatient sequences. The average next-day error is 0.8 (95% CI: 0.44, 1.15) and so the system tends to over-predict the next day critical care inpatients by approximately 1 bed. Potential extensions to the basic model include adjustments for seasonality, case mix, probabilistic marginalisation and known discharges.

Rhabdoid tumor of the kidney in the National Wilms' Tumor Study: age at diagnosis as a prognostic factor.

PURPOSE: The objective of this study is to determine prognostic factors in rhabdoid tumor of the kidney (RTK), including both demographic and treatment variables. PATIENTS AND METHODS: A total of 142 patients studied on National Wilms' Tumor Studies 1, 2, 3, 4, and 5 were analyzed. Patients were enrolled between the years 1969 and 2002. Variables examined included sex, age of diagnosis, tumor stage, presence of CNS lesions, as well as treatment variables, including the use of doxorubicin and/or radiotherapy (RT). RESULTS: No survival differences were observed between males and females, between those treated with or without doxorubicin, or with or without RT. Patients with tumors of lower stage had an overall survival rate of 41.8%, whereas, tumors of higher stage were associated with a 15.9% survival (P < .001). A highly significant difference in survival was noted when patients were stratified according to age of diagnosis. Survival at 4 years in infants under 6 months of age at diagnosis was 8.8%, whereas, survival in patients 2 years of age or older was 41.1% (P < .0001). Stratification into intermediate age brackets demonstrated a strong correlation of increasing survival with increasing age at diagnosis. All patients with a CNS lesion, except one, died. CONCLUSION: Age at diagnosis is a highly significant prognostic factor for survival of children with RTK. Infants have a dismal prognosis, whereas, older children have a more favorable outcome. Higher tumor stage and presence of a CNS lesion were both factors predictive of a poor survival rate.