Difficulty discriminating between threat and safety cues is a hallmark symptom of many fear-related disorders including anxiety, which are highly prevalent during adolescence. Moreover, females are disproportionately affected by fear and anxiety disorders. Correspondingly, growing evidence suggests that sex differences in fear responding and regulation are readily apparent in adults. Yet, it remains unclear when these differences emerge throughout development and what behavioral factors may drive them. Using adult (postnatal day/PND 69-128) and adolescent (PND 29-34) mice, we set out to study age and sex differences in learning about cues explicitly indicating safety (i.e., safety learning). Our results revealed that female mice of both ages froze more and discriminated less than males of both ages during initial discriminative conditioning. All mice showed evidence of conditioned inhibition during a summation test, though the magnitude of suppression was smaller in females. During an expanded summation test that included novel cues and different combinations of stimulus parameters, females of both ages exhibited higher fear generalization to novel cues. In addition, adolescents of both sexes failed to inhibit fear using a safety cue, suggesting that adolescent learning may be disrupted by complex experimental design. Finally, neural activity (cFos expression) was greater in the prefrontal cortex and ventral hippocampus of adolescents relative to adults, and the retrosplenial cortex and ventral hippocampus of males relative to females. Together, these findings illustrate the potential to take age and sex into account in the identification and treatment of fear and anxiety disorders.

Aberrant reward processing is common in psychiatric disorders that begin during development. However, our understanding of the early reward system is limited, due to few studies assessing reward engagement across development. Moreover, the interpretation of these findings is based primarily on our understanding of the adult reward system. Here, we argue that approaches to early reward processing must be re-framed within the context of developmental transitions. This alternate perspective takes into account unique, age-specific brain network functions that promote adaptive behaviors as environmental demands change from infancy through childhood. We survey the literature on developing reward systems and ask the following critical questions: (1) how are rewarding stimuli defined for infants and children? (2) do adult-defined neural reward circuits also support early reward behavior? and (3) how can early circuit perturbation impact infant and adult circuit function? Altogether, we argue that this developmental niche-centered framework is needed for conceptually and theoretically approaching developmental research questions, including but also extending beyond the scope of reward. Finally, this framework can help us understand how disturbance in developmental processes may ultimately manifest as pathology.

Anxiety and related disorders are a significant public-health burden with rising prevalence in the wake of the COVID-19 pandemic. As demand for effective anxiety treatment increases, so too does the need for strategies to bolster treatment outcomes. Research on the mechanisms of exposure therapy, the frontline behavioral treatment, will be critically important for optimizing clinical outcomes. We outline an initial agenda for future research on the mechanisms of change of exposure therapy, developed in collaboration with a large international team of researchers through the Exposure Therapy Consortium. Key questions and recommendations for future research focus on four priority areas: conceptualization, measurement, study design/analysis, and individual/contextual differences. Rising to the challenge of addressing these questions will require coordinated action and availability of centralized tools that can be used across trials, settings, and research groups.

Systemic inflammation has been implicated in the development and progression of neurodegenerative conditions such as cognitive impairment and dementia. Recent clinical studies indicate an association between sepsis, endothelial dysfunction, and cognitive decline. However, the investigations of the role and therapeutic potential of the cerebral microvasculature in sepsis-induced cognitive dysfunction have been limited by the lack of standardized experimental models for evaluating the alterations in the cerebral microvasculature and cognition induced by the systemic inflammatory response. Herein, we validated a mouse model of endotoxemia that recapitulates key pathophysiology related to sepsis-induced cognitive dysfunction, including the induction of an acute systemic hyperinflammatory response, blood-brain barrier (BBB) leakage, neurovascular inflammation, and memory impairment after recovery from the systemic inflammation. In the acute phase, we identified novel molecular (e.g., upregulation of plasmalemma vesicle-associated protein, PLVAP, a driver of endothelial permeability, and the procoagulant plasminogen activator inhibitor-1, PAI-1) and functional perturbations (i.e., albumin and small-molecule BBB leakage) in the cerebral microvasculature along with neuroinflammation. Remarkably, small-molecule BBB permeability, elevated levels of PAI-1, intra-/perivascular fibrin/fibrinogen deposition, and microglial activation persisted 1 month after recovery from sepsis. We also highlight molecular neuronal alterations of potential clinical relevance following systemic inflammation including changes in neurofilament phosphorylation and decreases in postsynaptic density protein 95 and brain-derived neurotrophic factor, suggesting diffuse axonal injury, synapse degeneration, and impaired neurotrophism. Our study serves as a standardized mouse model to support future mechanistic studies of sepsis-associated cognitive dysfunction and to identify novel endothelial therapeutic targets for this devastating condition.

BACKGROUND:The complex healthcare environment requires nursing students to be prepared to effectively reason in emotionally charged situations. Clinical reasoning is a complex cognitive process that involves many elements, with little attention given to the role of emotions in this process. PURPOSE:The purpose of this pilot study was to explore the EI of senior Bachelor of Science in Nursing (BSN) students and its relationship to clinical reasoning to gain a better understanding of how emotions are used in clinical learning experiences. METHODS:This study utilized a convergent parallel mixed methods design. RESULTS:Quantitative findings indicated a positive relationship between Strategic EI and the clinical reasoning scale of inference (rs = 0.489, p = .044). A positive relationship was also found between the EI branch of Understanding Emotions and overall clinical reasoning (rs = 0.559, p = .024) and the clinical reasoning scale of induction (rs = 0.530, p = .035). The three categories that resulted from the qualitative findings: (1) Sadness for…, (2) Shifting Emotions, and (3) Presence converged with quantitative findings. CONCLUSION:EI is an important construct when it comes to reasoning and providing care during clinical experiences. Fostering the development of EI may be one way nurse educators can better prepare nurses for safe practice.

Dr Goobie is a Section Editor for Pediatric Anesthesia. Data sharing is not applicable to this article as no new data were created or analyzed in this study.

Objectives: Pulmonary hypertension (PH) secondary to obstructive sleep apnea (OSA) is an uncommon but serious perioperative risk factor in children undergoing surgery for adenotonsillar hypertrophy. Routine pre-operative echocardiography is commonly requested if severe OSA is suspected. We investigated the incidence of PH in children with suspected OSA and explored the association between PH and OSA severity.Methods: A prospective study of children aged 1-13 years with suspected OSA admitted for overnight oximetry (OO) and echocardiography at a pediatric referral hospital in Cape Town, South Africa from 2018 to 2019. OSA severity was defined by McGill Oximetry Score (MOS): MOS 1-2 (mild-moderate) and MOS 3-4 (severe). PH was defined as mean pulmonary arterial pressure (mPAP) & GE;20 mmHg estimated on echocardiographic criteria. Children with congenital heart disease, underlying cardio-respiratory or genetic disorders, and severe obesity were excluded. Results: One hundred and seventy children median age 3.8 years (IQR 2.7-6.4) were enrolled and 103 (60%) were female. Twenty-two (14%) had a BMIz >1.0 and 99 (59%) had tonsillar enlargement grade 3/4. One hundred and twenty-two (71%) and 48 (28%) children had mild-moderate and severe OSA, respectively. Echocardiographic assessment for PH was successful in 160 (94%) children of which eight (5%) had PH with mPAP 20.8 mmHg (SD 0.9): six with mild-moderate OSA and two with severe OSA. No significant difference in mPAP and other echocardiographic indices was observed in children with mild-moderate (16.1 mmHg; SD 2.4) and severe OSA (15.7 mmHg; SD 2.1). Similarly, no clinical and OSA severity differences were observed in children with and without PH. Conclusion: PH is uncommon in children with uncomplicated OSA and there is no association of PH with severity of OSA measured by OO. Routine echocardiographic screening for PH in children with clinical symptoms of OSA without co-morbidity is unwarranted.

OBJECTIVES:Large data sets have been published on short- and long-term outcomes following bidirectional Glenn surgery (BDG), or partial cavopulmonary connection, in high-income countries. Data from low-income and middle-income countries are few and often limited to the immediate postoperative period. The primary outcome was any in-hospital postoperative complication, assessed according to predefined criteria, in children who underwent BDG surgery at Red Cross War Memorial Children's Hospital. DESIGN:A retrospective cohort study. SETTING:A tertiary teaching hospital. PARTICIPANTS:The study authors identified 61 children (<18 years of age) who underwent BDG over 8 years. The median age of patients undergoing BDG was 2.5 years (interquartile range, 1.4-5.5 years). INTERVENTIONS:BDG surgery. MEASUREMENTS AND MAIN RESULTS:Thirty-five patients (57.4%) had a postoperative complication, with some patients (17 of 61, 27.9%) having more than 1 complication. The most frequent complications were infective (29.5%). Univariate analysis found that postoperative complications were associated with the use of nitric oxide (p = 0.004) and a longer duration of anesthesia (p = 0.045) and surgery (p = 0.004). Patients with complications spent longer in the pediatric intensive care unit (ICU) (p < 0.001) and in the hospital (p < 0.012). On multivariate analysis, a priori risk factors based on previous studies were not found to be statistically significant. A total of 37.3% of patients completed their single-ventricle palliation, and 30.5% of patients were lost to follow-up. CONCLUSIONS:Important findings were the older age at which the BDG was performed compared to high-income countries, an acceptable mortality rate of 3.3%, infection being the most common complication, the association of a complication with increased ICU and hospital lengths of stay, and the high rate of patients lost to follow-up.

A peak in diagnoses for anxiety disorders occurs during adolescence and earlier onset has been associated with increased symptom severity and comorbidities on a long-term scale. This highlights the necessity of research investigating the mechanisms underlying fear inhibition specifically as it manifests during adolescence, which can be used to inform the translation of novel methods for threat response inhibition to developmental populations.

BACKGROUND:The prevalence of anemia in the South African pediatric surgical population is unknown. Anemia may be associated with increased postoperative complications. We are unaware of studies documenting these findings in patients in low- and middle-income countries (LMICs).AIM:The primary aim of this study was to describe the association between preoperative anemia and 26 defined postoperative complications, in noncardiac pediatric surgical patients. Secondary aims included describing the prevalence of anemia and risk factors for intraoperative blood transfusion.METHOD:This was a secondary analysis of the South African Paediatric Surgical Outcomes Study, a prospective, observational surgical outcomes study. Inclusion criteria were all consecutive patients aged between 6 months and <16 years, presenting to participating centers during the study period who underwent elective and nonelective noncardiac surgery and had a preoperative hemoglobin recorded. Exclusion criteria were patients aged <6 months, undergoing cardiac surgery, or without a preoperative Hb recorded. To determine whether an independent association existed between preoperative anemia and postoperative complications, a hierarchical stepwise logistic regression was conducted.RESULTS:There were 1094 eligible patients. In children in whom a preoperative Hb was recorded 46.2% had preoperative anemia. Preoperative anemia was independently associated with an increased risk of any postoperative complication (odds ratio 2.0, 95% confidence interval: 1.3-3.1, P = .002). Preoperative anemia (odds ratio 3.6, 95% confidence interval: 1.8-7.1, P < .001) was an independent predictor of intraoperative blood transfusion.CONCLUSION:Preoperative anemia had a high prevalence in a LMIC and was associated with increased postoperative complications. The main limitation of our study is the ability to generalize the results to the wider pediatric surgical population, as these findings only relate to children in whom a preoperative Hb was recorded. Prospective studies are required to determine whether correction of preoperative anemia reduces morbidity and mortality in children undergoing noncardiac surgery.

The Pediatric Perioperative Outcomes Group (PPOG) is an international collaborative of clinical investigators and clinicians within the subspecialty of pediatric anesthesiology and perioperative care which aims to use COMET (Core Outcomes Measures in Effectiveness Trials) methodology to develop core outcome sets for infants, children, and young people that are tailored to the priorities of the pediatric surgical population. Focusing on four age-dependent patient subpopulations determined a priori for core outcome set development: (a) neonates and former preterm infants (up to 60 weeks postmenstrual age); (b) infants (>60 weeks postmenstrual age-<1 year); (c) toddlers and school age children (>1-<13 years); and (d) adolescents (>13-<18 years), we conducted a systematic review of outcomes reported in perioperative studies that include participants within age-dependent pediatric subpopulations. Our review of pediatric perioperative controlled trials published from 2008 to 2018 identified 724 articles reporting 3192 outcome measures. The proportion of published trials and the most frequently reported outcomes varied across predetermined age-groups. Outcomes related to patient comfort, particularly pain and analgesic requirement, were the most frequent domain for infants, children, and adolescents. Clinical indicators, particularly cardiorespiratory or medication-related adverse events, were the most common outcomes for neonates and infants <60 weeks and were the second most frequent domain at all other ages. Neonates and infants <60 weeks of age were significantly under-represented in perioperative trials. Patient-centered outcomes, healthcare utilization, and bleeding/transfusion-related outcomes were less often reported. In most studies, outcomes were measured in the immediate perioperative period, with the duration often restricted to the postanesthesia care unit or the first 24 postoperative hours. The outcomes identified with this systematic review will be combined with patient-centered outcomes identified through a subsequent stakeholder engagement study to arrive at a core outcome set for each age-specific group.

Evidence from both humans and animals has indicated that adolescents are sensitive to threat, and that fear is easily generalized and retained during this developmental stage. Moreover, although the emergence of anxiety disorders is highly prevalent in developing populations, conventional behavioral treatments are ineffective for a notable percentage of adolescents. Many treatments rely on enhancing safety learning, making it critical to understand the development of this form of learning.

BACKGROUND:Paediatric penetrating cardiac injury is extremely rare, precluding published management guidelines, therefore warranting a case-by-case approach with learning points gleaned from each case. CASE SUMMARY:A 7-year-old boy presented to a rural hospital with a stab wound to the chest by a Withaak (Vachellia tortilis) thorn. The patient was haemodynamically stable on presentation, but a 2 cm subcutaneous, pulsatile mass was present at the cardiac apex. Echocardiography revealed a foreign body penetrating from the apex into the heart, with evidence for a fistula between a cardiac chamber and the pulsatile mass. Angiography confirmed the existence of the fistula between the right ventricle (RV) and the pulsatile mass. A controlled extraction under general anaesthaesia via median sternotomy was performed in-theatre, with blood products and cardiac bypass on standby. The patient recovered without complications and was discharged after 4 days. DISCUSSION:Our case illustrates the limitations of echocardiography in identifying the precise anatomical definition of penetrating cardiac injuries. Angiography is therefore indicated in such cases. The injury to the RV and the haemostatic effects of the in situ thorn were favourable prognostic factors. We believe that the mortality risk reduction of extraction under full control warrants the minor morbidity of a median sternotomy.

Children's development is largely dependent on caregiving; when caregiving is disrupted, children are at increased risk for numerous poor outcomes, in particular psychopathology. Therefore, determining how caregivers regulate children's affective neurobiology is essential for understanding psychopathology etiology and prevention. Much of the research on affective functioning uses fear learning to map maturation trajectories, with both rodent and human studies contributing knowledge. Nonetheless, as no standard framework exists through which to interpret developmental effects across species, research often remains siloed, thus contributing to the current therapeutic impasse. Here, we propose a developmental ecology framework that attempts to understand fear in the ecological context of the child: their relationship with their parent. By referring to developmental goals that are shared across species (to attach to, then, ultimately, separate from the parent), this framework provides a common grounding from which fear systems and their dysfunction can be understood, thus advancing research on psychopathologies and their treatment.

Summary Aim This study aimed to quantify the incidence of anesthesia‐related and perioperative mortality at a large tertiary pediatric hospital in South Africa. Methods This study included all children aged <18 years who died prior to discharge from hospital and within 30 days of their last anesthetic at the Red Cross War Memorial Children's Hospital between January 1, 2015 to December 31, 2015. A panel of three senior anesthetists reviewed each death to reach a consensus as to whether: (i) anesthesia caused the death; (ii) anesthesia may have contributed to or influenced the timing of death; or (iii) anesthesia was entirely unrelated to the death. Results There were 47 deaths within 30 days of anesthesia prior to discharge from hospital during this 12‐month period. The in‐hospital mortality within 24 h of administration of anesthesia was 16.5 per 10 000 cases (95% confidence intervals [CI]=7.8‐25.1) and within 30 days of administration of anesthesia was 55.3 per 10 000 cases (95% CI=39.5‐71.2). Age under 1 year (OR 4.5; 95% CI=2.5‐8.0, P =.012) and cardiac surgery and interventional cardiology procedures (OR 2.5; 95% CI=1.2‐5.2, P <.01) were both independent predictors of increased risk of perioperative mortality. Conclusion The overall 24‐h and 30‐day anesthesia‐related and in‐hospital perioperative mortality rates in our study are comparable with other similar studies from tertiary pediatric centers.

Book Review| October 01 2016 Prospection and the Integrative Capacities of the Prefrontal Cortex: A Contemporary Synthesis The Prefrontal Cortex (5th Edition). By Joaquín Fuster. Cambridge, MA: Academic Press, 2015. 460 pp. Hardcover, $125. Heidi Meyer Heidi Meyer Department of Psychological and Brain Sciences, 6207 Moore Hall, Dartmouth College, Hanover, NH 03755, E-mail: Heidi.C.Meyer.GR@dartmouth.edu Search for other works by this author on: This Site Google The American Journal of Psychology (2016) 129 (3): 333–337. https://doi.org/10.5406/amerjpsyc.129.3.0333 Cite Icon Cite Share Icon Share Facebook Twitter LinkedIn MailTo Permissions Search Site Citation Heidi Meyer; Prospection and the Integrative Capacities of the Prefrontal Cortex: A Contemporary Synthesis. The American Journal of Psychology 1 January 2016; 129 (3): 333–337. doi: https://doi.org/10.5406/amerjpsyc.129.3.0333 Download citation file: Zotero Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All Scholarly Publishing CollectiveUniversity of Illinois PressThe American Journal of Psychology Search Advanced Search The text of this article is only available as a PDF. Copyright 2016 by the Board of Trustees of the University of Illinois2016 Article PDF first page preview Close Modal You do not currently have access to this content.