OBJECTIVE:To examine the effects of opening a school-based health center on primary and preventive care utilization among students in a rural setting. STUDY DESIGN:This quasi-experimental study used patient-level electronic health records data from a healthcare network serving a rural region of New York. The sample included patients aged 5-18 residing in 1 school district that opened a school-based health center and those who resided in similar districts without a center, spanning 2.5 years before and 2.5 years after the new center opened. The number of primary care visits and occurrence of any well-child, immunization, and convenient care visits were studied. Difference-in-differences event study models were used to estimate post-intervention changes in utilization trends adjusting for age, sex, treatment district, and half-year fixed effects. RESULTS:Multivariable estimates demonstrated increases in primary care visits and increased odds of receiving an immunization among patients in the treatment group vs those in comparison groups, after the school-based health center opened. CONCLUSIONS:These data provide robust associations consistent with causal evidence that school-based health centers increase utilization of primary care and expand access to a usual source of care in rural settings, highlighting the value of expanding school-based care in these communities.
We evaluated whether gestational age is associated with outpatient respiratory outcomes among infants born at extreme limits of viability. Among infants born extremely preterm who presented to a BPD clinic after hospital discharge, those born at gestational ages of 22 to 23 6/7 weeks did not experience worse respiratory outcomes during the first 3 years of life compared with those born at gestational ages of 24 to 25 6/7 weeks.
Objective To test the hypothesis that specific saliva-based biomarkers are associated with pediatric concussion subtypes. Study design A cross-sectional, multicenter study was conducted from August 2021 to January 2024, of pediatric patients aged 11-20 years within 10 days of a diagnosed concussion and uninjured, healthy controls. Concussion subtypes, including anxiety/mood, cognitive, migraine, ocular, and vestibular, were blindly adjudicated using previously published common data elements criteria. Participants completed a multidomain, concussion assessment and provided a passive drool saliva sample within 10 days of injury. Digital immunohistochemistry assays measured a panel of 82 stress-response biomarkers in pooled saliva samples representing individual subtypes. Fold change (FC) thresholds (>2-fold) with coefficients of variability (CV) identified elevated biomarkers in pediatric concussion subtypes. Results 156 participants (mean age=15.3±2.1; 46% female) with concussion and 15 controls were enrolled. Analyses of assays identified 21 biomarkers with ≥2-fold elevation compared with controls in at least 1 concussion subtype. Six of these biomarkers were subtype-specific, including: oxytocin (OXT) for anxiety/mood (FC=3.3; CV=13%); hypoxia-induced factor alpha 1 (HIF1A), neurofilament light (NfL), and c-Fos immediate early transcription factor (c-Fos) for cognitive (FCs=7.9, 3.0, 2.9; CVs=18%, 22%, 18%); and natriuretic peptide B (BNP) and toll-like receptor 2 (TLR2) for headache/migraine (FCs=2.0, 2.2; CVs=9%, 14%). Neuropathy target esterase (NTE) was elevated across subtypes (FCs: 4.0-16.7; CVs: 5-25%). Conclusions Results identified an association between saliva-based biomarkers and pediatric concussion subtypes, specifically the anxiety/mood, cognitive, and headache/migraine subtypes. These findings provide preliminary support for using a saliva-based biomarker approach to complement existing multidomain clinical assessments; however, external validation and additional research are needed before clinical implementation.
Rapid and reliable identification of multivariate geochemical anomalies is critical for delineating prospective mineralized zones and reducing uncertainty in mineral exploration targeting. Extended isolation forest (EIF) is a powerful unsupervised ensemble learning algorithm that efficiently isolates anomalies from high-dimensional geochemical datasets using randomly oriented hyperplane partitions. Previous studies have demonstrated the effectiveness of EIF in multivariate geochemical anomaly detection and mineral potential modeling. However, its performance can be significantly affected by stochastic variability arising from random partitioning and random subsampling during isolation tree construction, which may result in unstable anomaly patterns and inconsistent exploration targets in complex geological environments. To mitigate this limitation, we developed a robust unsupervised framework for the identification of multivariate geochemical anomalies associated with gold mineralization in the Southwestern Yilgarn Craton, Australia. The proposed framework integrates robust factor analysis (RFA), a Jaccard-based stability index and EIF to enhance the reliability and reproducibility of anomaly detection. RFA was first applied to compositional soil geochemical data to identify the most significant pathfinder elements associated with gold mineralization, which were subsequently used as input variables for the EIF model. The model was then optimized using a Jaccard-based stability criterion to ensure consistent anomaly detection across repeated independent runs. Model performance was assessed using area under the receiver operating characteristic curve (AUC). The obtained AUC value of 0.82 indicates strong predictive capacity, confirming that the generated anomaly map effectively delineates mineralization-related geochemical patterns and provides a reliable proxy for mineral prospectivity mapping. Overall, the proposed framework offers a robust and reproducible unsupervised approach for multivariate geochemical anomaly detection with strong applicability in both greenfield and brownfield mineral exploration settings.
OBJECTIVE:To assess the prevalence of posterior cerebral artery (PCA) stenosis, its risk factors, and disease progression in children with moyamoya arteriopathy. STUDY DESIGN:We retrospectively reviewed all patients <21 years old with moyamoya who underwent surgical revascularization at a single institution between December 2015-2022. Patients were assessed for the presence of PCA stenosis and timing of onset or progression. Clinical and radiographic features were compared between children with and without PCA involvement. RESULTS:Among159 children with moyamoya, 36 (23%) had PCA stenosis, of whom 18 (50%) presented with PCA stenosis at time of moyamoya diagnosis. Among children who developed PCA stenosis during ongoing monitoring (n=18), the median time to onset of PCA involvement was 43 weeks. No significant differences in age at moyamoya diagnosis, sex, or race were identified between groups. Children with PCA stenosis were significantly more likely to have bilateral disease requiring revascularization (p=0.02). Children with moyamoya and cardiac anomalies had 4-fold higher odds of PCA stenosis (p=0.006). CONCLUSIONS:PCA stenosis occurs in approximately one-quarter of children with moyamoya, with half presenting at diagnosis. The association of PCA stenosis and cardiac anomalies in children with moyamoya may warrant genetic evaluations in affected children.
OBJECTIVE:To describe changes in fractional anisotropy (FA) of the corpus callosum and neurodevelopmental outcomes in infants born preterm at or less than 32 weeks' gestational age (GA) with bronchopulmonary dysplasia (BPD). STUDY DESIGN:In this prospective regional cohort study, 392 infants born preterm underwent diffusion MRI (dMRI) at term corrected age (CA) and were invited for standardized motor, cognitive, and language developmental testing (Bayley-III) at 2 years CA. We used an automated tractography software to segment the corpus callosum (CC) into its 7 subsegments and calculate fractional anisotropy (FA), a measure of dMRI brain microstructure. We performed multivariable linear regression analyses to examine associations between BPD severity and FA values, and between BPD and Bayley-III scores, adjusting for confounders. Mediation analysis assessed whether FA values mediated the relationship between BPD and Bayley scores. RESULTS:Of 392 infants, 227 (57.9%) had no BPD, 91 (23.2%) grade 1, 56 (14.3%) grade 2 and 18 (4.6%) grade 3. Of the same 392 infants, 245 had usable dMRI scans and 341 (87%) returned for Bayley-III testing. In multivariable analyses, higher BPD grades were associated with lower FA in the posterior midbody and isthmus of the CC (both Q≤0.005). Infants with higher grades of BPD also had lower Bayley-III cognitive (P=0.016), language (P=0.019), and motor (P<0.001) scores. Corpus callosum microstructure partially mediated the association between BPD severity and cognitive outcome (posterior midbody, 12.7% of the total effect; P = 0.026), although mediated effects were modest and most did not reach statistical significance. The direct effect of BPD persisted throughout. CONCLUSIONS:In our regional preterm cohort, greater BPD severity was linked to poorer neurodevelopment, and this relationship was partially mediated by aberrant CC development, although the mediation was modest.
OBJECTIVE:To examine the relationship between dosage of the clinic component and child weight status in the Greenlight Plus Trial, a clinic plus digital intervention aimed to reduce early childhood obesity. STUDY DESIGN:Longitudinal data were used from parent-child dyads (N=900) in the Greenlight Plus Trial. Clinic intervention dosage was assessed after each well child visit (WCV), as the sum of parent-reported receipt of: (1) a Greenlight booklet; (2) discussion of booklet content; and/or (3) goal setting. Multivariable models assessed the relationship between dosage and child weight-for-length (WFL). RESULTS:Across all WCVs (n=7200), parents reported not receiving any clinic intervention component at 20% of visits, receiving booklet only (dosage score=1) at 39.2% of visits, booklet receipt and discussion (dosage score=2) at 11.7% of visits, and booklet receipt, page discussion, and goal setting (dosage score=3) at 26.9% of visits. No association was detected between cumulative dosage and child WFL trajectory (p=0.31). However, we observed a statistically significant difference in the relationship of dosage to WFL in the 2 treatment arms (p=0.021). Within the clinic-only arm, there was a significant association between dosage and child WFL (p=0.005) in the first 6 months. CONCLUSIONS:Exposure to the full conceptual model of behavioral change was limited. Among those who received only the clinic intervention, dosage modestly and transiently improved infant weight. Enhancing primary care behavioral interventions with digital components, such as text messages, between visits may optimize their impact on child health outcomes including healthy growth.
OBJECTIVE:To determine whether acute emotional symptoms were elevated and associated with subsequent emotional functioning after concussion in children and adolescents. STUDY DESIGN:This prospective, longitudinal observational study consecutively recruited children (ages 8-17 years) with concussion or mild orthopedic injury (OI) who presented acutely (≤48 hours) to 5 pediatric emergency departments. Acute emotional symptoms were rated using the Acute Concussion Evaluation. Pre- and post-injury emotional functioning were measured using 3 standardized and validated parent and child report questionnaires at 1 week (post-acutely), 3 months, and 6 months post-injury. Poisson regression and linear mixed-effects modeling were used to compare groups in acute emotional symptoms and the association between acute emotional symptoms and later emotional functioning. RESULTS:Of 3,051 children approached, 967 enrolled in the study, and 793 (82%; 509 concussion/284 OI; 57.6% male; age 12.4±2.40 years) had acute and follow-up emotional symptom data. Greater acute emotional symptoms were more likely following concussion vs OI for males (IRR=1.37) and especially females (IRR=2.12). Emotional functioning was worse following concussion relative to OI (parent and child d=-0.31 and -0.33), across time, age, and sex. More acute emotional symptoms (4 vs 0) predicted worse emotional functioning after concussion vs OI 1-week post-injury (post-acutely) in younger children (d=-1.05), 3 months post-injury in females (d=-1.10), and across sex (d=0.67). In post hoc follow-up analyses, odds of clinically elevated emotional dysfunction were higher after concussion vs OI 1-week post-injury for younger children (OR=95.05, 95% CI 1.53, 5,900) and 3 months post-injury for older children (OR=468.43, 95% CI 1.41, 155,000). CONCLUSIONS:More acute emotional symptoms following concussion predict worse emotional functioning up to 6 months post-injury. Acute emotional symptom screening may identify at-risk children.
We conducted a retrospective analysis of data collected prospectively from a cohort of 114 neonates with hypoxic-ischemic encephalopathy. Magnetic resonance imaging (MRI) obtained during therapeutic hypothermia (TH) showed 95% concordance with MRI obtained at a median postnatal age of 11 days in regard to injury pattern and severity. These results support MRIs during TH as a reliable tool to assess brain injury, facilitating timely clinical decisions, parental counseling and trial enrollment.
Teaching and Tomorrow is an educational program integrated into our society's annual meeting for pediatrics residents who are considering a career in pediatric gastroenterology (GI). Surveys of 494 participants from 2015 to 2023 assessed likelihood of choosing GI, priorities for future careers, and benefits of participating.
Water conservancy and hydropower projects enhance regional climate resilience and watershed water security yet inevitably trigger large-scale involuntary reservoir resettlement. As representative involuntarily displaced populations, reservoir resettlees' social identity directly impacts local social stability and regional sustainable socioeconomic development. Based on a ten-year longitudinal qualitative investigation including in-depth interviews and participant observation in Village Y of Wuxikou Reservoir, Jiangxi Province, this paper divides the entire resettlement process into three stages: relocation, stabilization and development. From the dual perspectives of host community identity and out-groups identity, this study explores the dynamic evolutionary rules of resettlees' social identity. The results indicate that resettlees sequentially develop alienated identity, superficial adaptive identity and segregated identity across different phases. On this basis, the core concept of differential identity is proposed, which features a dual structure of vertical temporal differentiation and horizontal spatial differentiation. This paper expands the applicable scope and explanatory power of the “differential mode of association” and social identity theory in involuntary resettlement contexts. Grounding on the differential identity framework, this paper puts forward targeted integrated governance solutions to break intergroup segregation, facilitate cross-group integration and build resilient resettlement communities consistent with Sustainable Development Goals (SDGs) 11 and 13.
The discrimination of ore deposit types is primarily based on geological, geochemical, and isotopic characteristics. Conventionally, these types are identified using specific element diagrams. However, traditional geochemical methods often fail to determine scheelite deposit types of the complex Xuefengshan Sb-Au-W metallogenic belt in China, where mineralization resulted from the superposition of multiphase geological events. Machine learning (ML) methods, have been increasingly applied to identify deposit genesis by establishing relationships between deposit characteristics and genetic types using extensive datasets. However, inaccurate data labels, the limitations of single models, and poor model interpretability lead to decreased accuracy. This study proposes a ML framework based on interpretable ensemble learning. We collects geochemical element data from typical orogenic and magmatic-hydrothermal scheelite deposits globally. Deep clustering is used to filter data and overcome the subjectivity of original data labels. An ensemble learning model is used to construct a classifier to improve the model's robustness and generalization ability. An interpretable model is introduced to analyze the contribution of individual feature elements, revealing the metallogenic genesis. This method demonstrates high accuracy on the test set. According to this method, the scheelite deposit type of the Xuefengshan metallogenic belt is primarily magmatic-hydrothermal in origin, with orogenic superposition. This helps resolve a long-standing controversy in the region and establishes a repeatable and interpretable new paradigm for ML-based discrimination of ore deposit genetic types.
Though volcanogenic massive sulfide (VMS) deposits are major global sources of indium (In), the physicochemical mechanisms and key factors controlling its significant enrichment remain poorly understood. To address the issue, this study investigates the Tiemurt VMS Pb-Zn-Cu deposit, utilizing detailed petrography, in-situ LA-ICP-MS analysis, and thermodynamic modeling to reveal the In enrichment mechanisms in VMS deposits. Petrographic observations identified two distinct generations of sphalerite corresponding to different mineralization stages. The early-stage sphalerite (Sp1) is euhedral-subhedral, associated with pyrite, and displays darker colors (red to brown), whereas the late-stage sphalerite (Sp2) is anhedral, intimately intergrown with chalcopyrite, and shows lighter colors (mainly yellow). The trace element results demonstrate that Sp1 has a significantly higher In content (average 317 ppm) than Sp2 (average 220 ppm). Additionally, In concentrations positively correlate with Fe contents. Because Fe is the primary chromophore that darkens sphalerite, this strong coupled enrichment mechanism allows macroscopic sphalerite color (red > brown > yellow) to serve as a reliable indicator for In concentration. Crystallization temperatures calculated using the GGIMFis thermometer range from 344 to 382 °C for Sp1 and 312 to 355 °C for Sp2, indicating a cooling trend during fluid evolution. Thermodynamic modeling data showed that in the early-stage hydrothermal fluids (≥360 °C), Zn2+ preferentially complexes with Cl−, leaving InCl2+ or In3+ as unstable species, and In efficiently precipitates into Sp1 under the environment of log fO2 = −32 to −26 and pH = 6–8. As the fluids cool at ~340 °C, weakened Zn2+ competition allows In3+ to form stable InCl3, and In precipitates into Sp2 under the conditions of log fO2 = −42 to −32 and pH = 5.5–11. We therefore conclude that the key factor controlling the difference in In content between Sp1 and Sp2 is the precipitation mechanism rather than migration capacity. This may be different from the In enrichment mechanism associated with magmatic hydrothermal systems, where In is mainly present as InCl3 complexes with strong migration capacity. These new findings enable us to understand how the physicochemical conditions of fluids control the enrichment of In in VMS deposits, and also highlight that the color of sphalerite can be used to target potential In resources in PbZn deposits.
OBJECTIVE(S):Infection Triggered Encephalopathy Syndrome (ITES) is a rare but potentially severe complication of infections in children. ITES is a syndrome of acute encephalopathy that occurs in the context of a febrile illness and hypothesised to result from a cytokine mediated infection-triggered cytotoxicity in the central nervous system (CNS) without parenchymal inflammatory cell infiltration. ITES is considered distinct from infectious and immune-mediated encephalitis. We aimed to describe the demographics, associated pathogens, clinical spectrum and outcomes of ITES in Australian children from May 2013 until June 2024. STUDY DESIGN:We extracted and analysed data from the prospective, multicentre Australian Childhood Encephalitis (ACE) study. Cases of ITES aged ≤14 years were reviewed and categorised by a multidisciplinary expert panel. We estimated the incidence for specific sub-types of ITES. RESULTS:Of 1160 cases of Australian children with suspected encephalitis, 220 met criteria for ITES. In 83% (n=183) an associated pathogen was detected of which influenza (50%; n=109), enterovirus (8%; n=18), SARS-CoV-2 (COVID-19) (7%; n=15), and adenovirus (6%; n=13) were most common. The median age of affected children was 4.3 years (IQR 2-8.1). Of sub-types of ITES, the most frequent was Acute Necrotising Encephalopathy (ANE) (n=28, 13%), followed by Acute Encephalopathy with biphasic Seizures and late reduced Diffusion (AESD) (n=20, 9%), then Mild Encephalopathy with Reversible Splenial lesion (MERS) (n=21, 10%), although most children did not have a specific sub-type (n=135, 61%). For ITES sub-types, incidence was highest for ANE (0.82 per 1,000,000), and lowest for Febrile Infection Related Epilepsy Syndrome (FIRES, 0.23 per 1,000,000). Most children with ITES (60%; n=132) recovered fully. Poorer outcomes were seen in children diagnosed with ITES sub-types including ANE, AESD, and Acute Fulminant Cerebral Edema (AFCE). CONCLUSION(S):ITES is an uncommon complication of common infections in Australian children. Influenza was the most frequently associated pathogen, with ANE the most frequent specific ITES sub-type. Outcomes are variable, but concerningly poor for some ITES sub-types including ANE.
