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1
Heaton, Jacqueline. "Notes on the Proposed Amendment of Section 21 of the Children's Act 38 of 2005." Potchefstroom Electronic Law Journal 22 (September 3, 2019): 1–21. http://dx.doi.org/10.17159/1727-3781/2019/v22i0a5974.
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In terms of section 21 of the Children's Act 38 of 2005, an unmarried father acquires full parental responsibilities and rights in respect of his child if he lives with the child's mother in a permanent life-partnership when the child is born. He also acquires full parental responsibilities and rights if, regardless of whether or not he has ever lived with the child's mother, he consents or successfully applies to be identified as the child's father or pays damages in terms of customary law, and contributes or attempts in good faith to contribute to the child's upbringing and maintenance for a reasonable period. Several provisions of section 21 are unclear and/or unsatisfactory. The draft Children's Amendment Bill, 2018 seeks to address problematic aspects of the section. Unfortunately, the proposed amendments to section 21 leave one disappointed. Although some of the amendments are welcome, the draft Bill fails to address several of the uncertainties flowing from the current wording of section 21 and even creates additional uncertainties. The wording of many of the amendments has not been properly thought through, and the draft Bill fails to address the key question of whether the requirements in section 21(1)(b) operate conjunctively or independently.
2
Büchner-Eveleigh, Mariana, and Annelize Nienaber. "Gesondheidsorg vir Kinders: Voldoen Suid-Afrikaanse Wetgewing Aan die Land se Verpligtinge Ingevolge die Konvensie Oor die Regte van die Kind en die Grondwet?" Potchefstroom Electronic Law Journal/Potchefstroomse Elektroniese Regsblad 15, no. 1 (May 22, 2017): 102. http://dx.doi.org/10.17159/1727-3781/2012/v15i1a2459.
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Included in the Convention on the Rights of the Child, 1989 (UN Children's Convention) is the right of children to the highest attainable standard of health. In terms of article 4 of the UN Children's Convention, in implementing the UN Children's Convention state parties must "undertake all appropriate legislative, administrative, and other measures for the implementation of the rights recognised in the present Convention". South Africa showed its commitment to protecting and promoting children's health when it ratified the UN Children's Convention and subsequently adopted the Constitution of the Republic of South Africa, 1996, which includes provisions guaranteeing the health rights of children. South Africa also showed commitment to giving legislative effect to the protection and promotion of children's health by promulgating the National Health Act 61 of 2003, the Children's Act 38 of 2005 and the Mental Health Care Act 17 of 2002. The article evaluates existing policy and legislation affecting child health in order to assess how well South African legislation addresses the issue of children's healthcare rights and whether or not it complies with its international law and constitutional obligations in this regard. The article concludes that although much legislation exists, none provides comprehensively for children's healthcare rights, and there are many gaps in existing legislation. Most importantly, there is no reference to the core minimum requirements for the state in providing for the health of children, particularly in the way of healthcare services and nutrition. Further, there is a complete lack of legislation which protects the health needs of children with disabilities. In order to ensure that the health rights of children are protected and promoted, we propose more comprehensive legislative protection.
3
Kruger, Hanneretha. "The Protection of Children's Right to Self-Determination in South African Law with Specific Reference to Medical Treatment and Operations." Potchefstroom Electronic Law Journal 21 (October 15, 2018): 1–34. http://dx.doi.org/10.17159/1727-3781/2018/v21i0a4609.
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The Children's Act 38 of 2005 provides that children over the age of 12 years can consent to their own medical treatment or that of their children, provided they are of sufficient maturity and have the mental capacity to understand the benefits, risks, social and other implications of the treatment (section 129(2)). The predecessor of the Children's Act set the age at which children could consent to medical treatment at 14 years, and no maturity assessment was required (Child Care Act 74 of 1983 section 39(4)). Children over the age of 12 years can consent to the performance of surgical operations on themselves or their children, provided that they have the level of maturity described above and they are duly assisted by their parents or guardians (Children's Act section 129(3)). Before the Children's Act came into operation, the Child Care Act allowed children over the age of 18 to consent to their own operations (section 39(4)). Neither a maturity assessment nor parental assistance was required. (Note that when the Child Care Act was in operation the majority age was still 21 years.) In this article the question is considered if the relaxation of the limitations on children's capacity to consent to medical treatment and surgical operations in the Children's Act recognises the right of children to make independent decisions without the assistance of their parents or guardians or other substitute decision-makers. Firstly the article investigates the theoretical foundations of the protection of children's rights, particularly their autonomy rights. Secondly the meaning of the concept "competence" in medical decision-making and the related concept of "informed consent" are discussed. Thirdly some developmental and neuroscientific research on children's decision-making capacities and how they influence children's competence to give consent valid in law are highlighted. Fourthly possible legal foundations for the protection of children's right to self-determination in medical decision-making are sought in the Constitution and international and regional human rights treaties. Finally the relevant provisions of the Children's Act are examined in order to ascertain whether children's right to self-determination is sufficiently protected in South African law
4
Couzens, Ed. "A very long engagement: The Children's Act 38 of 2005 and the 1993 Hague Convention on the Protection of Children and Cooperation in Respect of Intercountry Adoption." Potchefstroom Electronic Law Journal/Potchefstroomse Elektroniese Regsblad 12, no. 1 (June 26, 2017): 53. http://dx.doi.org/10.17159/1727-3781/2009/v12i1a2720.
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This article analyses the intercountry adoptions provisions contained in Chapter 16 of the Children’s Act 38 of 2005, against the standards of the Hague Convention on the Protection of Children and Cooperation in Respect of Intercountry Adoptions, 1993. After a brief overview of the two leading South African cases on intercountry adoption, which stress the importance of having this institution statutorily regulated, the author proceeds to analyse the most significant clauses pertaining to intercountry adoptions contained in the Act, in order to identify the strengths and weaknesses in this new statutory framework. The author concludes that the Children’s Act is a dramatic improvement on the current regime of intercountry adoptions and that it has the potential to make this institution work in the best interests of children.
5
Pillay, Basil J., and Jerome A. Singh. "‘Mental capacity’, ‘sufficient maturity’, and ‘capable of understanding’ in relation to children: how should health professionals interpret these terms?" South African Journal of Psychology 48, no. 4 (December 21, 2017): 538–52. http://dx.doi.org/10.1177/0081246317747148.
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South Africa’s Children’s Act 38 of 2005 requires health professionals to determine whether a child possesses ‘sufficient maturity’ and ‘mental capacity’ to make decisions about themselves in relation to surgery, treatment, and HIV testing. Similarly, the National Health Act 61 of 2003 requires a child to be ‘capable of understanding’ to provide informed consent in research. However, neither the Children’s Act nor the National Health Act defines these terms. Moreover, there is no common definition of ‘sufficient maturity’ among healthcare professionals in South Africa. Appreciating how foreign law interprets ‘mental capacity’ and how different healthcare professionals evaluate ‘maturity’ could prove illuminative in respect to how these terms could be interpreted by health professionals in South Africa, and elsewhere.
6
Kruger, Hester B., and Hennie Oosthuizen. "South Africa – Safe Haven for Human Traffickers? Employing the Arsenal of Existing Law to Combat Human Trafficking." Potchefstroom Electronic Law Journal/Potchefstroomse Elektroniese Regsblad 15, no. 1 (May 22, 2017): 282. http://dx.doi.org/10.17159/1727-3781/2012/v15i1a2466.
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Having ratified the Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children, South Africa is obliged to adopt legislative measures that criminalise human trafficking and comply with other standards laid down in this international instrument. However, by mid-2011, South Africa had not enacted the required comprehensive counter-trafficking legislation. The question that now arises is if the absence of such anti-trafficking legislation poses an insurmountable obstacle to the prosecution of traffickers for trafficking-related activities. In asking this question the article examines the utilisation of existing crimes in order to prosecute and punish criminal activities committed during the human trafficking process. Firstly, a selection of existing common law and statutory crimes that may often be applicable to trafficking-related activities is mapped out. Secondly, transitional trafficking provisions in the Children's Act 38 of 2005 and the Criminal Law (Sexual Offences and Related Matters) Amendment Act 32 of 2007 are discussed. Finally, since the Prevention and Combating of Trafficking in Persons Bill B7 of 2010 will in all probability be enacted in the near future, the use of other criminal law provisions in human trafficking prosecutions, even after the passing of this bill into law, is reflected upon.
7
Spijker, Arda, and Madelene De Jong. "Family Conferencing: Responsibility at Grassroots Level – A Comparative Analysis between the Netherlands and South Africa." Potchefstroom Electronic Law Journal 24 (April 22, 2021): 1–32. http://dx.doi.org/10.17159/1727-3781/2021/v24i0a9325.
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As family group conferencing is gaining world-wide recognition as an alternative dispute resolution process, this article aims to outline the origin and relevance of this process, which promotes solution-finding to family problems by the family themselves and/or the social network and usually results in a plan or agreement that will be implemented collaboratively by the people involved. Although it was originally used in child protection matters, the process is now used for a wide range of problems pertaining to families and individual family members, including divorce matters, the illness or death of a family member, the care of the elderly, family financial problems, bullying, addiction cases, domestic violence and child justice matters. The process is also suitable for application in problems concerning any group, neighbourhood or school. Next, the application of family group conferencing in both the Netherlands and South Africa is first examined and then briefly compared. It appears that family group conferencing through Eigen Kracht in the Netherlands is an established practice which consists of a relatively simple and quick process and yields positive results for families/communities experiencing problems. Recently the Dutch Youth Act of 2015 (Jeugdwet) made legislative provision inter alia for a family group plan to be drafted by parents, in conjunction with next-of-kin or others who are part of the social environment of a youth/juvenile person. On the other hand, although extensive legislative provision is made for family group conferencing by the Children's Act 38 of 2005 in children's court proceedings and by the Child Justice Act 75 of 2008 in the child justice system in South Africa, the process has not yet reached its potential in terms of the implementation of the concept. Lastly, some recommendations are made which mainly aim to contribute to the implementation of the concept in South Africa, in that the model will eventually be fully developed and utilised for the benefit of individuals, children, their families and/or social network.
8
Basson, Yvette. "Selected Developments in South African Labour Legislation related to Persons with Disabilities." Potchefstroom Electronic Law Journal/Potchefstroomse Elektroniese Regsblad 20 (May 25, 2017): 1. http://dx.doi.org/10.17159/1727-3781/2017/v20i0a1216.
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In South Africa marginalised groups have historically been afforded legislative protection in order to ensure that the rights of these groups are respected, protected, promoted and fulfilled. Examples of two such groups are older persons, whose rights are provided for in terms of the Older Persons Act 13 of 2006 and children, whose rights are provided for in terms of the Children's Act 38 of 2005. Persons with disabilities have, however, not yet been the subject of dedicated legislation outlining the content of the rights to which they are entitled. As a result of this lack of dedicated legislation, the rights of persons with disabilities are dealt with in a piecemeal fashion, often in disparate pieces of legislation.In addition to this focus on the rights of persons with disabilities, South African labour law has recently undergone extensive amendments. These amendments have led to the rights of persons with disabilities in the workplace being affected substantially. Since these amendments are as yet untested, little scrutiny of these provisions and the effect they may have on persons with disabilities has been undertaken. This article will thus discuss selected amendments of the labour legislation, and interrogate the practical effect these amendments may have on the rights of such persons. Of particular importance for the purposes of this article is the updating of an existing institution known as Sheltered Employment Factories, as well as the introduction of harsher penalties for employers who remain non-compliant with certain provisions of the Employment Equity Act 55 of 1998.
9
Baase, Mathabo. "The Ratification of Inadequate Surrogate Motherhood Agreements and the Best Interest of the Child." Potchefstroom Electronic Law Journal 22 (May 21, 2019): 1–26. http://dx.doi.org/10.17159/1727-3781/2019/v22i0a6083.
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South Africa has developed domestic legislation governing all surrogacy matters within the country. These provisions are contained in Chapter 19 of the Children's Act 38 of 2005.
In Ex parte MS; In re: Confirmation of Surrogate Motherhood Agreement 2014 2 All SA 312 (GNP), the commissioning parents did not adhere to the requirement provided by Chapter 19. The parties to the (initially informal) surrogacy agreement authorised the artificial fertilisation of the surrogate mother prior to the confirmation of the surrogate motherhood agreement by the court. In considering the best interest of the resultant child, the High Court decided to ratify the inadequate surrogate motherhood agreement.
This discussion aims to establish whether the court's judgement in Ex parte MS; In re: Confirmation of Surrogate Motherhood Agreement 2014 2 All SA 312 (GNP) was in accordance with the provisions of current legislation and case law. It furthermore aims to answer two primary questions: firstly, whether adjudicators should make use of the best interest of the child when ratifying inadequate surrogate motherhood agreements; and secondly, in what manner the court should go about implementing the best interest of the child when validating inadequate surrogate motherhood agreements.
It is submitted that courts should refrain from applying the best interest of the child as a constitutional right in inadequate surrogacy matters where the child is yet to be born alive, in accordance with the Digesta Texts. Parties to the invalid agreement should rather be instructed to make use of a section 22 parental responsibilities and rights agreement, a section 28 termination agreement, or adoption as provided for by chapter 15 of the Children's Act.
10
Olusegun Olaitan Oluwaseyi and Olatawura Oladimeji. "Surrogacy Agreements and the Rights of Children in Nigeria and South Africa." Obiter 42, no. 1 (May 2, 2021): 20–38. http://dx.doi.org/10.17159/obiter.v42i1.11054.
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Surrogacy agreements help to provide children for persons who cannot achieve conception or carry a child to term themselves. This practice has improved several lives over the years but can also be exploitative for some parties involved, if not adequately regulated.Using the doctrinal research method, this study discusses the rights of children in surrogacy agreements and examines the regulation of the practice in Nigeria and South Africa. This study found that a comprehensive framework regulating surrogacy agreements is lacking in Nigeria, while the practice is regulated in South Africa under Chapter 19 of the Children’s Act 38 of 2005 (Children’s Act). The lack of a legal framework in Nigeria implies that the rights of children born through surrogacy agreements may be violated. Two Bills are however awaiting passage into law in Nigeria.This study thus recommends the enactment of these Bills into one comprehensive law so as to regulate surrogacy agreements effectively in Nigeria and safeguard the well-being of children. Legislation regulating surrogacy agreements in Nigeria should include provisions similar to those found in the Children’s Act of South Africa. Policies that promote the best interests of the child should be adhered to and their rights to know their biological heritage, identity and nationality, and to prevention from harm, should be protected and promoted.
11
Delport, Rina, and Gloudien Spies. "ADOLESCENTS’ RIGHT TO PARTICIPATE DURING STATUTORY INTERVENTION." Southern African Journal of Social Work and Social Development 26, no. 1 (February 17, 2017): 24–41. http://dx.doi.org/10.25159/2415-5829/2177.
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Social work practice remains concerned about the widespread human rights abuses and the exclusion of children’s voices during statutory intervention. As stipulated by The United Nations Convention on the Rights of the Child (1994), confirmed by The African Charter on the Rights and Welfare of the Child (1999) and the Children’s Act (Section 10, 38 of 2005), it is of paramount importance that the child, which includes the adolescent, must experience freedom of expression as well as the right to be heard during statutory proceedings. However, it is argued that despite the national and international focus on the importance of child participation, the question remains if children do understand and receive the opportunity to participate in practise. This article reflects on adolescents’ understanding and experiences of their right to participate during statutory intervention.
12
Lutchman, Salona. "Notes: Children, autonomy and statements: The need for a bright-line rule." South African Law Journal 138, no. 3 (2021): 500–508. http://dx.doi.org/10.47348/salj/v138/i3a2.
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Currently, a child cannot provide a statement without parental or guardian consent. This limits the child’s right to participate fully in matters which affect the child. Indeed, it also impacts the fact-finding process of an investigation. In terms of international conventions and the Children’s Act 38 of 2005, child participation is a cornerstone of children’s rights. This note proposes that South African law recognise adolescent autonomy — specifically, an adolescent’s competence to provide a statement in matters affecting the child. An adolescent’s stage of growth (physical and mental) makes the child capable of understanding the consequences of such conduct, and the child’s developing agency and cognitive abilities mean that the child may wish to do so. The note proposes that the law recognise the autonomy of a child who is twelve years or older to provide an unassisted statement in legal fora.
13
Ferreira, S., and CJ Pretorius. "Interpretation of a Trust Deed – Harvey v Crawford 2019 (2) SA 153 (SCA)." Obiter 41, no. 2 (October 1, 2020): 447–60. http://dx.doi.org/10.17159/obiter.v41i2.9165.
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Recently, in Harvey v Crawford (2019 (2) SA 153 (SCA)) (Harvey), the Supreme Court of Appeal had to consider whether the adopted grandchildren of a trust donor were beneficiaries in terms of a notarially executed deed of trust. Presently, an adopted child is for all purposes regarded as the child of the adoptive parent, and an adoptive parent is for all purposes regarded as the parent of the adopted child (s 242(3) of the Children’s Act 38 of 2005) (the Children’s Act)). This was also the case in 1953, when the deed of trust in Harvey was executed and when the Children’s Act 31 of 1937 (the 1937 Act) regulated adoption. However, contrary to current legislation, the 1937 Act included a proviso with regard to property that was included in an instrument prior to the date of the adoption order: the instrument was required to display a clear intention that such property would indeed devolve upon an adopted child.Upon interpretation of the deed in question, the court ruled that the adopted children were not entitled to benefit from the capital in the trust. In this regard, the majority opted for a rather restrictive approach, seemingly out of step with recent developments in the interpretation of contracts. The minority decision, on the other hand, came to the opposite conclusion, displaying a more balanced approach to the issue of interpretation. This decision raises some noteworthy issues regarding the interpretation of inter vivos trust deeds with specific reference to adoption. It is submitted that the court erred in its findings; the aim of this case discussion is to analyse the judgment.
14
Louw, Anne. "The Constitutionality of a Biological Father's Recognition as a Parent." Potchefstroom Electronic Law Journal/Potchefstroomse Elektroniese Regsblad 13, no. 3 (June 19, 2017): 155. http://dx.doi.org/10.17159/1727-3781/2010/v13i3a2688.
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Despite the increased recognition afforded to biological fathers as legal parents, the Children's Act[1] still does not treat fathers on the same basis as mothers as far as the automatic allocation of parental responsibilities and rights is concerned. This article investigates the constitutionality of the differential treatment of fathers in this respect, given South Africa's international obligations, especially in terms of the United Nations Convention on the Rights of the Child, to ensure that both parents have common responsibilities for the upbringing of their child. After a brief consideration of the constitutionality of the mother's position as parent, the constitutionality of the father's position is investigated, firstly, with reference to Section 9 of the Constitution and the question of whether the differentiation between mothers and fathers as far as the allocation of parental responsibilities and rights is concerned, amounts to unfair discrimination. The inquiry also considers whether the differentiation between committed fathers (that is, those who have shown the necessary commitment in terms of Sections 20 and 21 of the Children's Act to acquire parental responsibilities and rights) and uncommitted fathers may amount to discrimination on an unspecified ground. Since the limitation of the father's rights to equality may be justifiable, the outcomes of both inquiries are shown to be inconclusive. Finally, the legal position of the father is considered in relation to the child's constitutional rights – the rights to parental care and the right of the child to the paramountcy of its interests embodied in Section 28 of the Constitution. While there appears to be some justification for the limitation of the child's right to committed paternal care, it is submitted that an equalisation of the legal position of mothers and fathers as far as the automatic acquisition of parental responsibilities and rights is concerned, is not only justified but imperative if the constitutional rights of children are to be advanced and protected.[1] 38 of 2005.
15
Boniface, Amanda. "African-Style Mediation and Western-Style Divorce and Family Mediation: Reflections for the South African Context." Potchefstroom Electronic Law Journal/Potchefstroomse Elektroniese Regsblad 15, no. 5 (June 1, 2017): 377. http://dx.doi.org/10.17159/1727-3781/2012/v15i5a2529.
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Both Western-styled mediation and African-styled mediation are practised in South Africa. Each of these models is applied in specific social contexts. In this article a brief explanation of what is meant by the term divorce and family mediation is provided. Thereafter the principles and processes of both Western-styled divorce and family mediation and African-styled group mediation are explored. Attention is given to the roles of mediators in both of these models as well as the ubuntu-styled values found in African group mediation. In Africa, there is a tradition of family neighbourhood negotiation facilitated by elders and an attitude of togetherness in the spirit of humanhood. Both of these show a commitment to the community concerned and a comprehensive view of life. In Africa conflicts are viewed as non-isolated events and are viewed in their social contexts. Not only are consequences for the disputing parties taken into account but also consequences for others in their families. These methods can be found in present-day methods, which are either used independently of imported Western structures or used alternatively to such structures. In this article the concept of mediation circles, as currently found in Western-styled mediation are also covered. Additionally, the provisions of the Children’s Act 38 of 2005 referring to mediation as well as the provisions of the Child Justice Act 75 of 2008 and family group conferencing in the realm of restorative justice in South Africa are critiqued. It is suggested that divorce and family mediation can learn from the principles of restorative justice applied during family group conferencing as well as from African-styled group mediation.
16
Mokwena, Kebogile Mokwena. "Neglecting Maternal Depression Compromises Child Health and Development Outcomes, and Violates Children’s Rights in South Africa." Children 8, no. 7 (July 19, 2021): 609. http://dx.doi.org/10.3390/children8070609.
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The intention of the South African Children’s Act 38 of 2005 is to provide guarantees for the protection and promotion of optimum health and social outcomes for all children. These guarantees are the provision of basic nutrition, basic health care and social services, optimal family or parental care, as well as protection from maltreatment, neglect and abuse services. However, despite these guarantees, child and maternal mortality remain high in South Africa. The literature identifies maternal depression as a common factor that contributes to negative health and social outcomes for both mothers and their children. Despite the availability of easy-to-use tools, routine screening for maternal depression is not carried out in public health services, which is the source of services for the majority of women in South Africa. The results are that the mothers miss out on being diagnosed and treated for maternal depression, which results in negative child outcomes, such as malnutrition, as well as impacts on mental, social and physical health, and even death. The long-term impacts of untreated maternal depression include compromised child cognitive development, language acquisition and deviant behaviors and economic disadvantage in later life. The author concludes that the neglect of screening for, and treatment of maternal depression therefore violates the constitutional rights of the affected children, and goes against the spirit of the Constitution. The author recommends that maternal and child health services integrate routine screening for maternal depression, which will not only satisfy the Constitutional mandate, but also improve the health and developmental outcomes of the children and reduce child mortality.
17
Glynis van der Walt. "A Consideration of Sections 249, 250 and 259 of the Proposed Third Amendment Bill to the Children’s Act in Light of the Best Interests Principle." Obiter 41, no. 4 (March 24, 2021): 934–47. http://dx.doi.org/10.17159/obiter.v41i4.10496.
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With the promulgation of the Constitution in 1996, national legislative recognition was given to the principle that a child’s best interests are of paramount importance in every matter concerning the child (s 28(2) of the Constitution of the Republic of South Africa, 1996). Section 28(1)(b) expressly provides for the right of a child to family care, parental care or appropriate alternative care. Based on economic and other factors, developing countries like South Africa experience difficulties in meeting the constitutional right of a child to have his or her best interests met and the placement of an orphaned or abandoned child (OAC) in appropriate alternative care is no exception. In light hereof, the current note considers whether the proposed amendments to the Children’s Act (CA, Act 38 of 2005 as amended) introduced by the Third Amendment Bill (GG 42005 of 2019-02-25), with particular reference to sections 249, 250 and 259 comply with this constitutional right. These three sections are of particular relevance to placing a child in permanent care in the form of both national and intercountry adoption. In particular, section 249 makes provision that no consideration may be given in respect to adoption, section 250 limits the persons who are allowed to provide adoption services and section 259 makes provision for the accreditation for the provision of intercountry adoption services. All three sections are relevant to the adoption process of an OAC. Alternative care options available and the basis for determining which placement decided upon is deemed to be the most appropriate for the child concerned, are considered in light of the proposed amendments. A consideration of the current status of the child welfare system in South Africa as well as the statistics of the many children in need of alternative care, serves to provide a background in determining whether the proposed amendments meet and further the vulnerable OAC’s best interests.
18
Sonnekus, JC. "Huweliksluiting én aanneming van kinders kragtens kulturele gebruike in stryd met die reg behoort kragteloos te wees – sed, ex Africa semper aliquid novi." Tydskrif vir die Suid-Afrikaanse Reg 2021, no. 2 (2021): 211–39. http://dx.doi.org/10.47348/tsar/2021/i2a1.
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Section 211(3) of the Constitution of the Republic of South Africa, 1996 provides that no recognition of customary norms may be upheld if such norms are in conflict with either the constitution or any other law that deals specifically with customary law: “The courts must apply customary law when that law is applicable, subject to the Constitution and any legislation that specifically deals with customary law.” The current Recognition of Customary Marriages Act 120 of 1998 deals explicitly with the recognition of customary marriages which are concluded in accordance with customary law (s 1). Customary law is defined as the “customs and usages traditionally observed among the indigenous African peoples of South Africa and which form part of the culture of those peoples”. It follows from a further reading of section 1 that a customary marriage is reserved for those indigenous African peoples who observe such customs and usages. It is provided in section 10(4) that “[d]espite subsection (1), no spouse of a marriage entered into under the Marriage Act, 1961, is, during the subsistence of such marriage, competent to enter into any other marriage”. This must be read with the definitions contained in section 1: “‘customary law’ means the customs and usages traditionally observed among the indigenous African peoples of South Africa and which form part of the culture of those peoples; ‘customary marriage’ means a marriage concluded in accordance with customary law”. Without the requisite legal competency, no legal subject can enter into any relationship to which the law may attach any consequences. Nobody can enter into a customary marriage if any of the presumed future spouses is already in a civil marriage according to the Marriage Act 25 of 1961, not even if the two parties are married to each other. According to the custom of various indigenous nations, if a man enters into a valid customary marriage with a woman who had never been married before but who is the mother of children born out of wedlock (spurii), the metaphor applies that he “who takes the cow also acquires the calf”. He will as part and parcel of the lobola ceremony be seen as the adopting stepfather of his wife’s children, with all the accompanying consequences. He will automatically be responsible for the future maintenance of those children as his adoptive children and they will acquire all rights and privileges that are bestowed on a child, including the right to inheritance and the right to his family name. As a consequence of this new relationship, all legal ties with the biological father of the adopted child are severed and the biological father will no longer be responsible for the maintenance of his offspring. In January 2019 an erstwhile law professor from UNISA who still retained his German citizenship, was gravely ill and cared for on life-support at a hospital in the Pretoria district. While in hospital, he tied the marriage knot with Miss Vilakazi, a Zulu woman with whom he had been in a relationship for the past five years. Miss Vilakazi was a spinster, but she had a Zulu daughter who was born out of wedlock more than eight years previously out of a relationship with an erstwhile Zulu lover. This child had been in the care of her maternal grandmother in Natal and, according to Zulu customary norms, was considered part of the house of her maternal grandfather, Vilakazi. She consequently carried the name Vilakazi as her registered surname on her official birth certificate. The marriage, which was conducted on 29 January 2019 in the hospital in Pretoria, was concluded with adherence to all the requirements of Act 25 of 1961. The civil marriage was duly registered as such. The late professor passed away in the hospital barely three weeks later on 19 February 2019. Less than 24 hours before the demise of the professor a purported customary marriage was concluded, apparently on behalf of the professor with the recently married Mrs Schulze by proxy by a friend of his in the Newcastle district in Natal after having paid R60 000 as ilobolo. The ceremony was concluded with the ceremonial slaughtering of the prescribed goat. However, during this ceremony the groom was not present but on life support in a Pretoria hospital and not necessarily compos mentis – the court was told that he was represented by a friend. Zulu customary law, however, does not recognise a marriage concluded by proxy with a substitude bridegroom as was known in Roman-Dutch law as “a wedding with the glove”. Neither the Marriage Act nor the Recognition of Customary Marriages Act, however, recognises a second marriage after the conclusion of a civil marriage by any of the purported newly weds – even if both “spouses” had been present in person. The mother of the late Professor Schulze, after his demise in South Africa, amended her last will in Germany and appointed her lifelong partner as sole beneficiary of her significant estate. She passed away in Germany in October 2019. In November 2019 the recently married Mrs Schulze, on behalf of her minor daughter, successfully approached the high court in Pietermaritzburg, where Zaca AJ issued an order compelling the South African department of home affairs to issue the daughter with a new birth certificate that reflects the late Professor Schulze as her father. Notwithstanding the unease of the officials at home affairs with this court order, the minister of home affairs, Mr Motsoaledi, personally intervened in August 2020 and the new birth certificate was issued as requested. Relying on this newly issued birth certificate, the applicant claims an amount of not less than R8 million in Germany from the estate of the late mother of Professor Schulze. For this purpose, the applicant relies on a principle in German law, the Pflichtteilsanspruch, according to which any descendant of the deceased has a right to a prescribed portion, a so-called legitimate portion of the estate, if not mentioned or sufficiently bestowed in the last will. This raises a number of seriously flawed legal arguments that are analysed in this article. It is submitted that the perceived lobola marriage ceremony conducted on behalf of the late professor on 18 February 2019 in Newcastle, less than 24 hours before his demise, is void because of the explicit constitutional provision and the relevant section 10(4) of the Recognition of Customary Marriages Act 120 of 1998, which excludes any competency to enter into a customary marriage if any of the parties involved is already married. At the date of the perceived lobola ceremony, Mrs Schulze had already been civilly married to Professor Schulze for more than three weeks and thus both spouses lacked the necessary competency to enter into a valid customary marriage. Whether a valid customary marriage could have been concluded at all with a man who did not live according to the customs and usages of the Zulu, is also highly questionable. Because the perceived lobola marriage is a nullity, no legal consequences can flow from this nullity and the so-called customary adoption of the daughter (“the calf with the cow”) is a nullity too. At no stage was any of the requirements for a valid adoption as governed by the Children’s Act 38 of 2005 adhered to. The minister of home affairs should have immediately given notice of appeal after the unconvincing judgment of Zaca AJ was handed down in January 2020. As the responsible minister, he should guard the upholding of the constitution and the applicable legal provisions unambiguously contained in the relevant section 10(4) of Act 120 of 1998. It is a pity that the so-called adherence to the principles of the “rule of law” is not even paid lip service in this case. Bennett, as a renowned expert on customary law, correctly pointed out that the legal orders are not unconnected. It may never be assumed that the people concerned are unaware of how to manipulate the resources offered them by legal pluralism (A Sourcebook of African Customary Law for Southern Africa (1991) 50).
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Gao, Ying, Martti Melin, Karoliina Mäkäräinen, Timo Rantalainen, Arto J. Pesola, Arto Laukkanen, Arja Sääkslahti, and Taija Finni. "Children’s physical activity and sedentary time compared using assessments of accelerometry counts and muscle activity level." PeerJ 6 (August 21, 2018): e5437. http://dx.doi.org/10.7717/peerj.5437.
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Background This research compared accelerometry (ACC)-derived and muscle electromyography (EMG)-based estimates of physical activity (PA) and sedentary time in typical PA tasks and during the daily lives of children. Methods Data was included from two exploratory studies. In Study I, 6–7-year-old children (n = 11, 64% girls) were assessed for eight PA tasks (walking, stair negotiation, climbing, crawling, swinging, balancing, trampoline jumping and a game of tag). In Study II, 7–9-year-old children (n = 14, 38% girls) were assessed for six PA tasks (walking, sitting, static squat, single leg hops, jump for height and standing long jump), and daily PA during one day with and one day without structured exercise. Quadriceps and hamstring muscle activity and inactivity using EMG shorts and acceleration by waist-mounted accelerometer were simultaneously measured and classified as sedentary, light, moderate and vigorous activity. Data from ACC was further analyzed using five different published cut-off points and varying time windows (1−60 s) for comparison with EMG. Results In the PA tasks ACC counts and EMG amplitude showed marked differences in swinging, trampoline jumping, crawling, static squat, single leg hops, standing long jump and jump for height, the difference being over 170% when signals were normalized to that during walking. Furthermore, in walking, swinging, trampoline jumping, stair negotiation and crawling ACC classified over 60% of the time as vigorous-intensity activity, while EMG indicated primarily light- and moderate-intensity activities. During both days with and without exercise, ACC resulted in greater proportion of light activity (p < 0.01) and smaller proportion of moderate activity compared to EMG (p < 0.05). The choice of cut-off points and epoch length in ACC analysis influenced the classification of PA level and sedentary time. In the analysis of daily activities the cut-off points by Evenson et al. (2008) with epochs of 7.5 s and 15 s yielded the smallest difference (less than 10% of recording time at each intensity) against EMG-derived PA levels. Discussion This research provides novel insight on muscle activity and thereby on neuromuscular loading of major locomotor muscles during normal daily activities of children. While EMG and ACC provided similar estimates of sedentary time in 13 typical PA tasks, duration of light, moderate and vigorous PA varied considerably between the methods especially during walking, stair negotiation, crawling, swinging and trampoline jumping. Evenson et al.’s (2008) cut-off points with ≤15 s epoch provided similar classification of PA than EMG during daily life. Compared to impacts recorded using ACC, EMG can provide understanding on children’s neuromuscular loading during motor tasks that is useful when studying effects of PA interventions on, and development of, motor competence and coordination.
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Sferruzzi-Perri, Amanda N., Julie A. Owens, Kirsty G. Pringle, Jeffrey S. Robinson, and Claire T. Roberts. "Maternal Insulin-Like Growth Factors-I and -II Act via Different Pathways to Promote Fetal Growth." Endocrinology 147, no. 7 (July 1, 2006): 3344–55. http://dx.doi.org/10.1210/en.2005-1328.
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The placenta transports substrates and wastes between the maternal and fetal circulations. In mice, placental IGF-II is essential for normal placental development and function but, in other mammalian species, maternal circulating IGF-II is substantial and may contribute. Maternal circulating IGFs increase in early pregnancy, and early treatment of guinea pigs with either IGF-I or IGF-II increases placental and fetal weights by mid-gestation. We now show that these effects persist to enhance placental development and fetal growth and survival near term. Pregnant guinea pigs were infused with IGF-I, IGF-II (both 1 mg/kg·d), or vehicle sc from d 20–38 of pregnancy and killed on d 62 (term = 69 d). IGF-II, but not IGF-I, increased the mid-sagittal area and volume of placenta devoted to exchange by approximately 30%, the total volume of trophoblast and maternal blood spaces within the placental exchange region (+29% and +46%, respectively), and the total surface area of placenta for exchange by 39%. Both IGFs reduced resorptions, and IGF-II increased the number of viable fetuses by 26%. Both IGFs increased fetal weight by 11–17% and fetal circulating amino acid concentrations. IGF-I, but not IGF-II, reduced maternal adipose depot weights by approximately 30%. In conclusion, increased maternal IGF-II abundance in early pregnancy promotes fetal growth and viability near term by increasing placental structural and functional capacity, whereas IGF-I appears to divert nutrients from the mother to the conceptus. This suggests major and complementary roles in placental and fetal growth for increased circulating IGFs in early to mid-pregnancy.
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Dietiker, Leslie, Lorraine M. Males, Julie M. Amador, and Darrell Earnest. "Research Commentary: Curricular Noticing: A Framework to Describe Teachers' Interactions With Curriculum Materials." Journal for Research in Mathematics Education 49, no. 5 (November 2018): 521–32. http://dx.doi.org/10.5951/jresematheduc.49.5.0521.
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Building on the work of Professional Noticing of Children's Mathematical Thinking, we introduce the Curricular Noticing Framework to describe how teachers recognize opportunities within curriculum materials, understand their affordances and limitations, and use strategies to act on them. This framework builds on Remillard's (2005) notion of participation with curriculum materials, connects with and broadens existing research on the relationship between teachers and written curriculum, and highlights new areas for research. We argue that once mathematics educators better understand the strategic curricular practices that support ambitious teaching, which we refer to as professional curricular noticing, such knowledge could lead to recommendations for how to support the curricular work of teachers and novice teachers in particular.
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Ripley, Sian, Sarah Jones, and Alastair Macdonald. "Capacity assessments on medical in-patients referred to social workers for care home placement." Psychiatric Bulletin 32, no. 2 (February 2008): 56–59. http://dx.doi.org/10.1192/pb.bp.106.013219.
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Aims and MethodsTo investigate the feasibility of a clinical algorithm to assess capacity and examine the relationship between its results and the assessments of capacity by others involved in the decision of a patient to permanently enter a care home from a medical ward.ResultsA total of 23 patients out of 38 (60.5%, 95% CI 44–77) had some mention of capacity in any type of record (medical, social work or nursing). At formal assessment 47% of older patients lacked capacity.Clinical ImplicationsThe absence of any recorded assessment in at least a third of patients is worrying, given the importance of the decision to the patients' lives and their financial status. It is to be hoped that the implementation of the Mental Capacity Act (2005) will rectify this situation.
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Cave, Emma. "GoodbyeGillick? Identifying and resolving problems with the concept of child competence." Legal Studies 34, no. 1 (March 2014): 103–22. http://dx.doi.org/10.1111/lest.12009.
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The landmark decision ofGillick v West Norfolk Area Health Authoritywas a victory for advocates of adolescent autonomy. It established a test by which the court could measure children's competence with a view to them authorising medical treatment. However, application of the test by clinicians reveals a number of ambiguities which are compounded by subsequent interpretation ofGillickin the law courts. What must be understood by minors in order for them to be deemed competent? At what point in the consent process should competence be assessed? Does competence confer on minors the authority to refuse as well as to accept medical treatment? These are questions which vex clinicians, minors and their families. A growing number of commentators favour application of parts of the Mental Capacity Act 2005 to minors. In this paper, the limitations of this approach are exposed and more radical reform is proposed.
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Ball, Chad G., Marc P. Dupre, Vincent Falck, Susan Hui, Andrew W. Kirkpatrick, and Zu-Hua Gao. "Sessile Serrated Polyp Mimicry in Patients With Solitary Rectal Ulcer Syndrome: Is There Evidence of Preneoplastic Change?" Archives of Pathology & Laboratory Medicine 129, no. 8 (August 1, 2005): 1037–40. http://dx.doi.org/10.5858/2005-129-1037-sspmip.
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Abstract Context.—Solitary rectal ulcer syndrome (SRUS) is associated with erythema and ulceration of the rectal wall. Serrated lesions of the colon are divided into conventional hyperplastic polyps and a new set of lesions that are variably called sessile serrated polyps (SSPs) and sessile serrated adenomas. The SSPs are epithelial proliferative lesions that appear to act as a unique pathway to colorectal carcinogenesis. No association between SRUS and SSPs has been previously reported. Objective.—To assess a possible association between SRUS and morphologic features that mimic SSPs. Design.—Twenty-six patients with SRUS, who presented to our institution between January 1, 1999, and November 14, 2004, were retrospectively reviewed for SSP-type morphologic features by 3 pathologists. Ki-67 and hMLH1 immunohistochemical stains were used. Control tissues included 10 conventional left-sided hyperplastic polyps, 10 right-sided large SSPs, 7 adenocarcinomas with known loss of hMLH1 gene expression, and 4 normal human tonsil tissues. Results.—Ten (38%) of 26 SRUS specimens demonstrated histologic features consistent with SSPs. These features included exaggerated serration within the lower crypt compartments, crypt branching, hypermucinous appearance of epithelium, and horizontal extension of crypt bases along the muscularis mucosa. All 10 cases of SRUS had positive basal Ki-67 staining in 10% to 20% of cells. Two (20%) of the 10 cases demonstrated focal superficial loss of hMLH1 mismatch repair gene expression within areas of serrated morphologic features. One hyperplastic polyp superimposed on SRUS showed a reduced number of surface epithelial cells that express hMLH1 protein. Conclusions.—Up to 38% of patients with SRUS have histologic changes that mimic SSPs. More importantly, 20% of these serrated lesions were found to have focal loss of hMLH1 gene expression, indicating a potential of preneoplastic change. This phenomenon may reflect an increased propensity for neoplastic progression in response to repeated trauma and repair process in certain cases of SRUS.
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Barbaric, Draga, Todd A. Alonzo, Robert B. Gerbing, Soheil Meshinchi, Nyla A. Heerema, Dorothy R. Barnard, Beverly J. Lange, William G. Woods, Robert J. Arceci, and Franklin O. Smith. "Minimally differentiated acute myeloid leukemia (FAB AML-M0) is associated with an adverse outcome in children: a report from the Children's Oncology Group, studies CCG-2891 and CCG-2961." Blood 109, no. 6 (December 7, 2006): 2314–21. http://dx.doi.org/10.1182/blood-2005-11-025536.
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Abstract To assess the impact of minimally differentiated acute myeloid leukemia (AML-M0) morphology in children, we analyzed 2 sequential Children's Cancer Group AML clinical trials. We compared presenting characteristics and outcomes of 82 CCG-2891 and CCG-2961 patients with de novo, non–Down syndrome (DS) AML-M0 with those of 1620 patients with non-M0 AML, and of 10 CCG-2891 patients with DS-associated AML-M0 with those of 179 with DS-associated non-M0 AML. Morphology and cytogenetics were centrally reviewed. The non-DS AML-M0 children had a lower white blood cell (WBC) count (P = .001) than their non-M0 counterparts and a higher incidence of chromosome 5 deletions (P = .002), nonconstitutional trisomy 21 (P = .027), and hypodiploidy (P = .002). Outcome analyses considering all children with non-DS AML demonstrated no significant differences between M0 and non-M0 patients. Analyses restricted to intensive-timing CCG-2891 and CCG-2961 demonstrated comparable complete response (CR) rates (79% and 78%) between non-DS M0 and non-M0 patients. Overall survival (OS) from diagnosis (38% ± 14% versus 51% ± 3%; P = .160) was not significantly different between the 2 groups. OS from end of induction (45% ± 17% versus 63% ± 3%; P = .038), event-free survival (EFS; 23% ± 11% versus 41% ± 3%; P = .018), and disease-free survival (DFS; 31% ± 14% versus 52% ± 3%; P = .009) were inferior in the M0 group. There was no significant outcome difference between DS-associated AML-M0 and non-M0 children. This study suggests that intensively treated non–DS-associated AML-M0 children have an inferior outcome compared with children with non-M0 AML.
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Mackenzie, Robin, and John Watts. "Is childhood a disability? Using Mental Capacity Tribunals and the Deprivation of Liberty Safeguards to shield children's capacity to consent to and refuse medical treatment." Tizard Learning Disability Review 19, no. 2 (April 1, 2014): 96–106. http://dx.doi.org/10.1108/tldr-01-2014-0001.
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Purpose – The purpose of this paper is to demonstrate that the common and statutory law governing children's capacity or competence to consent to and to refuse medical treatment is unsatisfactory and to suggest solutions. Design/methodology/approach – Critical legal analysis of the law on assessing minors’ decision-making capacity in relation to legal recognition of their consent to and refusal of medical treatment. Findings – Without legal mechanisms which protect both children and their rights, all children and young people are effectively disabled from exercising age and capacity-related autonomy and participation in decisions affecting their lives. Yet in English law, inconsistencies between legal and clinical measures of decision-making capacity, situations where compulsory medical or mental health treatment is lawful, and tensions between rights and duties associated with human rights, autonomy, best interests and protections for the vulnerable create difficulties for clinicians, lawyers and patients. Research limitations/implications – As the paper acknowledges in its recommendations, the views of stakeholders are needed to enrich and inform legal reforms in this area. Originality/value – The paper makes suggestions to amend the law and clinical practice which are original and far reaching. The paper suggests that in order to observe children's rights while protecting them appropriately, the Mental Capacity Act 2005 and Deprivations of Liberty Safeguards should be applied to minors. The paper recommends the establishment of Mental Capacity Tribunals, similar in nature and purpose to Mental Health Tribunals, to provide legal safeguards and mechanisms to foster the supported decision-making envisaged in recent United Nations Conventions.
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Booth, Christopher M., Gavin Li, James Joseph Biagi, Monika K. Krzyzanowska, William J. Mackillop, and Sulaiman Nanji. "Surgical resection and peri-operative chemotherapy for colorectal cancer (CRC) liver metastases in routine clinical practice: A population-based outcomes study." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): 3632. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.3632.
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3632 Background: Resection of liver metastases combined with peri-operative chemotherapy is an important treatment option for patients with advanced CRC. Most of the literature describes outcomes achieved in highly selected patients treated at a few high volume institutions. Here we report the results of a population-based study of the management and outcome of all patients who underwent resection of CRC liver metastases in Ontario, Canada. Methods: All cases of CRC in Ontario who underwent surgical resection of liver metastases in 1994-2009 were identified using the population-based Ontario Cancer Registry (OCR). The OCR captures diagnostic and demographic information on ~98% of all incident cancer cases in Ontario. We linked electronic records of treatment to the OCR to identify surgery, neoadjuvant (NACT) and adjuvant chemotherapy (ACT). We describe time trends in treatment and survival using 3 study periods: 1994-1999, 2000-2004, 2005-2009. Results: During 1994-2009, 2717 patients underwent resection of CRC liver metastases in Ontario; mean age was 65 years and 61% were male. From 1994-2009 there was a 103% increase in the number of patients undergoing resection of liver metastases (117/year to 237/year) while incident cases of CRC during this time increased by 31% (5285/year to 6956/year). Use of NACT increased over the study period: 94-99, 11% (78/700); 00-04, 15% (124/830); 05-09, 36%; (424/1187), (p<0.001). Use of ACT also increased: 94-99, 38% (263/700); 00-04, 40% (335/830); 05-09, 45% (532/1187), (p=0.006). In 2005-2009 there was substantial variation across geographic regions in use of NACT (range 19% to 46%, p=0.029) and ACT (range 31% to 56%, p=0.015). Five year overall survival during the 3 study periods was 36% (95%CI 32-39%), 40% (95%CI 36-43%), and 47% (95%CI 43-51%) (p<0.001). Conclusions: Resection of CRC liver metastases in routine practice in the general population of Ontario is associated with survival outcomes that are comparable to those reported in case series from leading comprehensive cancer centres. Survival improved over the study period despite a greater proportion of patients with CRC undergoing liver resection.
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Shaikh, Ulfat, and Christina Slee. "Triple Duty: Integrating Graduate Medical Education With Maintenance of Board Certification to Improve Clinician Communication at Hospital Discharge." Journal of Graduate Medical Education 7, no. 3 (September 1, 2015): 462–65. http://dx.doi.org/10.4300/jgme-d-14-00760.1.
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ABSTRACT Background Complete and accurate discharge summaries can improve communication and continuity of care between inpatient and ambulatory settings as well as reduce adverse events. However, discharge summaries commonly lack key information. Objective To determine if a quality improvement intervention that actively engages residents and attending physicians would improve the timeliness and quality of hospital discharge summaries at our academic children's hospital, and would help trainees and clinicians complete educational requirements. Methods Electronic health record queries were used to assess time to completion of discharge summaries. A total of 120 discharge summaries from 36 eligible residents were reviewed by 9 attending pediatricians using an objective discharge summary scoring instrument. Improvement was facilitated through monthly learning sessions and Plan-Do-Study-Act cycles. Results The proportion of summaries completed within 24 hours of discharge increased from 38% to 73%; mean discharge summary scores improved from 54% to 99%; and percentage of summaries that included all 13 elements in the scoring instrument increased from 0% to 80%. All elements most likely to be deficient at baseline showed a higher likelihood of being included in summaries following the intervention. The rate of summaries that were scored as containing appropriate detail and being an appropriate length also increased from 0% to 80%. The 9 attending pediatricians received maintenance of certification credits for their participation. Conclusions A multifaceted quality improvement intervention, which included stakeholder involvement, clinician education, standardization of documentation, policy changes, and provision of board certification credits, improved the quality and timeliness of discharge summaries at our academic children's hospital.
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Kochanska, Grazyna, Sanghag Kim, and Lea J. Boldt. "(Positive) power to the child: The role of children's willing stance toward parents in developmental cascades from toddler age to early preadolescence." Development and Psychopathology 27, no. 4pt1 (October 6, 2015): 987–1005. http://dx.doi.org/10.1017/s0954579415000644.
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AbstractIn a change from the once-dominant view of children as passive in the parent-led process of socialization, children are now seen as active agents who can considerably influence that process. However, these newer perspectives typically focus on the child's antagonistic influence, due either to a difficult temperament or aversive, resistant, negative behaviors that elicit adversarial responses from the parent and lead to future coercive cascades in the relationship. Children's capacity to act as receptive, willing, even enthusiastic, active socialization agents is largely overlooked. Informed by attachment theory and other relational perspectives, we depict children as able to adopt an active willing stance and to exert robust positive influence in the mutually cooperative socialization enterprise. A longitudinal study of 100 community families (mothers, fathers, and children) demonstrates that willing stance (a) is a latent construct, observable in diverse parent–child contexts, parallel at 38, 52, and 67 months and longitudinally stable; (b) originates within an early secure parent–child relationship at 25 months; and (c) promotes a positive future cascade toward adaptive outcomes at age 10. The outcomes include the parent's observed and child-reported positive, responsive behavior, as well as child-reported internal obligation to obey the parent and parent-reported low level of child behavior problems. The construct of willing stance has implications for basic research in typical socialization and in developmental psychopathology as well as for prevention and intervention.
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Yoshii, Yumi, Masanori Matsumoto, Kurumatani Norio, Ayami Isonishi, Masahito Uemura, Yuji Hori, Masaki Hayakawa, Hideo Yagi, Charles L. Bennett, and Yoshihiro Fujimura. "Introduction of a Quick Assay for ADAMTS13 Activity Improved a Survival of Acquired TTP Patients Who Received Platelet Transfusions." Blood 124, no. 21 (December 6, 2014): 4209. http://dx.doi.org/10.1182/blood.v124.21.4209.4209.
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Abstract Introduction: Daily plasma exchange (PE) has become a definitive first-line treatment for acquired thrombotic thrombocytopenic purpura (TTP). However, it remains to be controversial whether platelet transfusion is harmful or not for patients with acquired TTP during initial treatment. Some articles showed that platelet transfusion was considered as hazardous because platelet transfusion might generate widespread fresh platelet aggregates in circulation, but others reported that the mortality rate was not different between patients with and without platelet transfusion. Herein, we conducted a retrospective analysis of a large cohort of patients with acquired idiopathic TTP (ai-TTP) in Japan evaluating whether platelet transfusion was associated with unfavorable outcomes. Patients and Methods: Our laboratory has been functioning as a nationwide referral center for thrombotic microangiopathies (TMAs) in Japan. We collected a large dataset of medical information on 1211 patients with TMA from March 2000 to December 2013. Among them, 263 were ai-TTP patients with severe deficiency (<10% of normal controls) of ADAMTS13 activity (ADAMTS13:AC), with positive anti-ADAMTS13 inhibitors. These ai-TTP patients were retrospectively analyzed in detail using reported medical records that contained detailed clinical data and outcome information. ADAMTS13:AC was determined by classic von Willebrand factor multimer (VWF) assay. These results were available within 4 to 7 days in the initial period (March 2000 to March 2005, n=91). Subsequently, with use of a chromogenic ADAMTS13-act-ELISA, reporting occurred within 2 days of obtaining a plasma sample (April 2005 to December 2013, n=172). All plasma samples collected before March 2005 were re-examined by act-ELISA. Results: In 263 ai-TTP patients, 48 patients received platelet transfusions during the initial treatment and 215 did not. Factors associated with increased mortality included age greater than 60 years and presentation with central nervous system (CNS) dysfunction (p<0.05 for each), but not use of platelet transfusions [22.9% (11/48) versus 17.7% (38/215), respectively]. Next, we analyzed the mortality rate in 2 groups categorized by method of ADAMTS13 activity assay. In the initial period using classic VWF assay, mortality of patients with platelet transfusion tended to be higher versus those without platelet transfusions (p=0.051, Log-rank test) as shown in Figure left (Kaplan-Meier survival curve). In contrast, in the latter period using the more rapid act-ELISA, no differences in mortality of patients with versus without platelet transfusions was noted (p=0.52, Figure right). To evaluate whether platelet transfusion is a significant hazard for patients with ai-TTP, Cox-proportional-hazards regression analysis was performed using 5 variables (age, sex, rituximab use, presence of CNS dysfunction, and platelet transfusion). Older age and use of platelet transfusion were independently associated with mortality in the initial period, and age and presence of CNS dysfunction were identified as unfavorable factors in the latter period (Table). Conclusions: Our results clearly indicated that platelet transfusion was harmful in ai-TTP patients with severe deficiency of ADAMTS13:AC before 2005 (when a quick ADAMTS13:AC assay was unavailable). After 2005 (when a quick ADAMTS13:AC assay available), the survival rate of ai-TTP patients with platelet transfusions became almost indistinguishable from those without. This result may indicate that persistent PE after platelet transfusion together with confirmation of severe ADAMTS13:AC reduces risk for aggravated platelet thrombi formation in microvasculatures of patients. However, use of platelet transfusion before PE may lead to serious thrombotic complications in heart and brain, a complication that should be avoided. Figure 1 Figure 1. Disclosures Matsumoto: Alfresa Pharma Corporation: Patents & Royalties. Fujimura:Alfresa Pharma Corporation: Patents & Royalties.
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Sembiring, Muhlis Fahdiar. "ANALISIS NORMATIF UNDANG-UNDANG NOMOR 14 TAHUN 2005 SEBAGAI IMPLEMENTASI PERLINDUNGAN TENAGA PENDIDIK (Studi Kasus Penganiayaan Guru SMAN 1 Torjun Sampang Jawa Timur)." Serunai : Jurnal Ilmiah Ilmu Pendidikan 3, no. 2 (November 16, 2018): 74–85. http://dx.doi.org/10.37755/sjip.v3i2.36.
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Educators are an important role in the formation of human resources as a nation's strength in fortifying themselves in cognitive, affective, and psychomotor concepts. The success of a nation does not escape the role of educators in the equitable development of knowledge and technology. Competitiveness is so high as the development of globalization requires human resources to always be able to develop both in terms of hard skills and soft skills. Based on this, educators are expected to have competence in the application of the learning and teaching process. Legal events that occur in this study are not only the responsibility of educational institutions, but the factors of the family are very influential on the pattern of child development, because the family is the first place and place where children spend more time in the family environment. The way students are applied by parents is also very influential on children's attitudes. Parenting that tends to spoil also shapes the attitude of children who are accustomed to what they want to be fulfilled and with such a pattern of life the child does not learn to control emotions and not learn to manage themselves Law enforcement is a process that is essentially the implementation of directors which involves making decisions that are not strictly regulated by the rule of law but have elements of personal judgment. Conceptually, the core and meaning of law enforcement lies in harmonizing the relationships of values described in solid rules and attitude to act as a series of final stages of value translation, to create, give birth and maintain the peace of life.
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Ginnyatulina, Rufiya I. "International practices of quality management in healthcare (a review)." Science and Innovations in Medicine 4, no. 4 (December 15, 2019): 38–43. http://dx.doi.org/10.35693/2500-1388-2019-4-4-38-43.
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An analysis of international publications revealed a growing interest in all aspects of quality in medical care, especially in the definition of the concept of quality in healthcare. In the world community, the following approaches to quality management are widely used: the Total Quality Control (TQC); Total Quality Management (TQM), which includes Quality Assurance and Quality Improvement; Continuous Quality Improvement (CQI); Lean management, including Hoshin Kanri's policy and PDCA's Deming - Shuhart Cycle (Plan-Do-Check-Act). Practical implementation of the principles of General Quality Management (TQM) and Continuous Quality Improvement (CQI) is based on the models of business improvement in quality management: the EFQM (European Foundation for Quality Management) model, the MBQA (Malcolm Baldrige Quality Award) model and the Chronic Care Model. In management ofmedical organizations, the International standards for services perfection are more often used, which use the experience of quality assurance, as well as the international systems and standards: JCI, ISO 9001, IWA1, ISO 15189, ISO 14000, OHSAS 18001. The ISO interstate standards represent the international consensus of world practice in quality management. Nowadays, medical organizations use the following standards: SRPS ISO 9001: 2015, SRPS EN 15224: 2017, SRPS EN ISO 15189: 2014, SRPS EN ISO 13485: 2017, IWA 1: 2005. In the period of globalization of the world economy and healthcare, the best international practices should form the basis for improving domestic health care in medical care quality management.
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Rosebush, Christina E., Brian Zaidman, Katherine E. Schofield, Darin J. Erickson, Breca Tschida, Marizen Ramirez, and Patricia M. McGovern. "Evaluation of the Minnesota Safe Patient Handling Act: trends in workers’ compensation indemnity claims in nursing home workers before and after enactment of the law." Occupational and Environmental Medicine 78, no. 1 (September 7, 2020): 22–28. http://dx.doi.org/10.1136/oemed-2020-106575.
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ObjectivesThe 2007 Minnesota Safe Patient Handling Act aims to protect healthcare workers from injuries caused by lifting and transferring patients. The effectiveness of the law in nursing homes is unknown. This policy evaluation measured changes in patient handling injuries before and after the law was enacted. Additionally, it assessed whether effects of the law were modified by facility levels of staffing and retention.MethodsWorkers’ compensation indemnity claims for years 2005–2016 were matched to annual direct care productive hours and facility characteristics (eg, profit status, hospital affiliation and region) for all Medicaid-certified nursing homes in Minnesota. Trends in patient handling claims were analysed using negative binomial regression with generalised estimating equations. The primary predictors were time period, staff hours per resident day and staff retention.ResultsThe patient handling indemnity claim rate declined by 25% in years 4–6 and 38% in years 7–9 following enactment of the law. Claims for all other injuries and illnesses declined by 20% in years 7–9 only. Associations between time period and patient handling claims did not vary by levels of staffing or retention. However, independent of time, facilities with annual retention ≥75% (vs <65%) had a 17% lower patient handling claim rate.ConclusionsResults suggest the law reduced patient handling claims in nursing homes. However, claim rates were elevated in facilities with low worker retention and those that were non-profit, not hospital-affiliated or in a non-metro area. Facilities with these characteristics may benefit from targeted state grants and consultation efforts.
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Bekelis, Kimon, Symeon Missios, Todd A. MacKenzie, Nicos Labropoulos, and David W. Roberts. "A predictive model of hospitalization cost after cerebral aneurysm clipping." Journal of NeuroInterventional Surgery 8, no. 3 (January 12, 2015): 316–22. http://dx.doi.org/10.1136/neurintsurg-2014-011575.
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BackgroundCost containment is the cornerstone of the Affordable Care Act. Although studies have compared the cost of cerebral aneurysm clipping (CAC) and coiling, they have not focused on identification of drivers of cost after CAC, or prediction of its magnitude. The objective of the present study was to develop and validate a predictive model of hospitalization cost after CAC.MethodsWe performed a retrospective study involving CAC patients who were registered in the Nationwide Inpatient Sample (NIS) database from 2005 to 2010. The two cohorts of ruptured and unruptured aneurysms underwent 1:1 randomization to create derivation and validation subsamples. Regression techniques were used for the creation of a parsimonious predictive model.ResultsOf the 7798 patients undergoing CAC, 4505 (58%) presented with unruptured and 3293 (42%) with ruptured aneurysms. Median hospitalization cost was US$24 398 (IQR $17 079 to $38 249) and $73 694 (IQR $46 270 to $115 128) for the two cohorts, respectively. Common drivers of cost identified in the multivariate analyses included the following: length of stay, number of admission diagnoses and procedures, hospital size and region, and patient income. The models were validated in independent cohorts and demonstrated final R2 values very similar to the initial models. The predicted and observed values in the validation cohort demonstrated good correlation.ConclusionsThis national study identified significant drivers of hospitalization cost after CAC. The presented model can be utilized as an adjunct in the cost containment debate and the creation of data driven policies.
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Schlitt, John J., Linda J. Juszczak, and Nancy Haby Eichner. "Current Status of State Policies That Support School-Based Health Centers." Public Health Reports 123, no. 6 (November 2008): 731–38. http://dx.doi.org/10.1177/003335490812300609.
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Objectives. This study explored the current status of the role of state school-based health center (SBHC) initiatives, their evolution over the last two decades, and their expected impact on SBHCs' long-term sustainability. Methods. A national survey of states was conducted to determine ( 1) the amount and source of funding dedicated by the state directly for SBHCs, ( 2) criteria for funding distribution, ( 3) designation of staff/office to administer the program, ( 4) provision of technical assistance by the state program office, ( 5) types of performance data collected by the program office, ( 6) state perspective on future outlook for long-term sustainability, and ( 7) Medicaid and the State Children's Health Insurance Program (SCHIP) policies for reimbursement to SBHCs. Results. Nineteen states reported allocating a total of $55.7 million to 612 SBHCs in school year 2004–2005. The two most common sources of state-directed funding for SBHCs were state general revenue ($27 million) and Title V of the Social Security Act ($7 million). All but one of the 19 states have a program office dedicated to administering and overseeing the grants, and all mandate data reporting by their SBHCs. Sixteen states have established operating standards for SBHCs. Eleven states define SBHCs as a unique provider type for Medicaid; only six do so for SCHIP. Conclusions. In 20 years, the number of state SBHC initiatives has increased from five to 19. Over time, these initiatives have played a significant role in the expansion of SBHCs by earmarking state and federal public health funding for SBHCS, setting program standards, collecting evaluation data to demonstrate impact, and advocating for long-term sustainable resources.
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Pratiwi, Hardiyanti, Ikta Yarliani, Murniyanti Ismail, Rizki Noor Haida, and Noer Asmayanti. "Assessing the Toxic Levels in Parenting Behavior and Coping Strategies Implemented During the COVID-19 Pandemic." JPUD - Jurnal Pendidikan Usia Dini 14, no. 2 (November 30, 2020): 231–46. http://dx.doi.org/10.21009/jpud.142.03.
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The COVID-19 pandemics have caused a lot of stressors for parents. Apart from doing daily activities, parents also have to take care of their children and accompany them to study. The number of stressors can lead to toxic behavior in parenting. This study aims to measure the level of toxicity in parenting behavior and coping strategies adopted by parents. This study uses quantitative descriptive methods to measure toxic levels in parenting behavior during the COVID-19 pandemic. A total of 568 parents from Banjarmasin and Yogyakarta participated in this study. The survey results show that several factors can trigger parenting stress during the COVID-19 pandemic, namely worsening economic conditions, delinquent children, excessive anxiety, accumulated daily hassles, growing family demands, and disputes with spouses. However, some of these stressors do not lead to toxic parenting. The results showed that 97.79% of respondents from Banjarmasin and 95.29% from Yogyakarta showed a low toxic level. The remaining 2.21% of respondents in Banjarmasin and 4.71% of respondents in Yogyakarta indicated a moderate toxic level. Coping strategies are crucial for neutralizing stress. There are several strategies applied, namely trying to consider a problem is God's test, and there is a positive side to every problem; trying to address the source of stress and solving it; Withdrawing and finding individual time; looking for social support from the family and others; crying and releasing it by doing favorite things and capitulate and get back the problem. This Research is expected to be a reference for parents in choosing coping strategies to manage the stress they feel in parenting during the pandemic.
Keywords: Toxic parenting; stress trigger, coping strategy; COVID-19
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Lu, Zhiqiang, Zaina Parvez Qureshi, Brian Chen, Sudha Xirasagar, Paul Ray, Gowtham Rao, Isaac Lopez, et al. "Why Is Cancer Care So Expensive: Potential Implications of Fraud and Abuse." Blood 120, no. 21 (November 16, 2012): 4275. http://dx.doi.org/10.1182/blood.v120.21.4275.4275.
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Abstract Abstract 4275 Introduction: Annually, $82 billion to $272 billion is reportedly lost to federal health care fraud. Between 1996 and 2005, 379 federal health care fraud cases initiated by qui tam relators (“whistle blowers”) concluded, resulting in $9.3 billion in recoveries. Of these, pharmaceutical companies accounted for 13 cases (False Claims Act (FCA) cases, the primary statute invoked in health care fraud and abuse), but $3.9 billion of recoveries (4% of the cases and 39% of the financial recoveries). We report concluded FCA cases involving pharmaceutical manufacturers between 2006 and 2011. Oncology accounts for the largest per cent of total pharmaceutical expenditures. Over 90% of all new cancer pharmaceuticals cost > $20,000 for 12-weeks of treatment. Methods: Websites for the Department of Justice (DOJ), Taxpayers Against Fraud, Health and Human Services Inspector General's Office, Health Care Fraud and Abuse Control Project, and Lexis/Nexis were queried for pharmaceutical FCA cases (2006 to 2011). Results: Between 2006 and 2011, the DOJ closed 54 cases with pharmaceutical FCA violations, 38 with and 16 without qui tam relators, accounting for recoveries of $11.3 billion (mean $296 million) and $2.6 billion (mean, $165 million), respectively. Illegal marketing is the most common fraud allegations invoked against pharmaceutical manufacturers (19 cases). Pharmaceutical manufacturers accounted for 31% of total FCA cases, and 71.5% of total FCA recoveries (Table 1). Conclusion: Since the DOJ's shift of focus to pharmaceutical corporations in 2001, the trend has intensified, with virtually every large pharmaceutical corporation settling at least one FCA case. Pharmaceutical cases now account for 31% of the federal fraud cases and 71% of the financial recoveries. Fraud and abuse may be an important component of the high costs of cancer care in the United States. Moreover, unless fundamental changes occur, the pharmaceutical industry will continue to be the main FCA investigative target as this sector has the deepest pockets and is the health care sector most resistant to deterrence. Disclosures: No relevant conflicts of interest to declare.
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., Rahmadi, Toto Sudargo, and Agus Wijanarka. "Perilaku sadar gizi dan ketahanan pangan keluarga serta hubungannya dengan status gizi balita di Kabupaten Tanah Laut, Kalimantan Selatan." Jurnal Gizi dan Dietetik Indonesia (Indonesian Journal of Nutrition and Dietetics) 1, no. 1 (March 9, 2016): 31. http://dx.doi.org/10.21927/ijnd.2013.1(1).31-38.
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Background: Act No. 25/2000 about National Development Program and Vision Healthy Indonesia 2010 specifi ed that 80% of Indonesian families become nutrition aware families. The result of survey on nutrition aware families in indicated that in 2006 as much as 52.7% and in 2007 as much as 27.2% of families were not yet nutrition aware. The result of nutritional status monitoring of underfi ves (Z-score) showed undernourishment increased from 5.1% in 2004 to 10.1% in 2005.<br /><br />Objective: To analyze association between nutrition aware behavior and food security of the family and nutrition status of underfi ves at District of Tanah Laut, Province of Kalimantan Selatan.<br /><br />Method: The study was observational with cross sectional design. The dependentvariable was nutritional status of underfi ves (z-score for weight/length); the independent variables were nutrition aware behavior and food security of the family; and the confounding variables were characteristics of the family (parents’ education, number of the family members, knowledge of mothers about nutrition and family income). Subject consisted of underfi ves of 6–24 months with as many as 198 underfi ves. Data analysis used chi square and double logistic regression (multiple logistic regression) and qualitative analysis with indepth interview for families that were not yet nutrition aware.<br /><br />Result: There were 145 families (73.2%) that were nutrition aware and 53 (26.8%) that were not yet nutrition aware; based on energy consumption 51.1% of families had enough food and 48.9% were undernourished; based on protein consumption 52.5% of families had enough food and 47.5% were undernourished; and children with good nutrition status were 72.6% for boys and 72.8% or girls. There was signifi cant association between nutrition aware behavior and nutrition status of underfi ves (p=0.010). The result of logistic regression test showed that there was signifi cant association between the number of family members and food security of the family (p<0.05) with OR=5.516 (95%CI=2.584–11.775). There was signifi cant association between knowledge of mothers about nutrition and food security of the family (p<0.05) with OR=0.486 (95%CI=0.25–0.914).<br /><br />Conclusion: There was no association between nutrition aware behavior and food security of the family based on level of energy and protein consumption. There was signifi cant association (p<0.05) between number of family members and food security of the family based on level of energy and protein consumption. There was signifi cant association between knowledge of mothers about nutrition and food security of the family based on energy consumption. There was no association between parents’ education and family income based on level of energy and protein consumption. There was signifi cant association between nutrition aware behavior of the family and nutrition status of underfi ves; however there was no association between food security of the family and nutrition status of underfi ves.<br /><br />KEYWORDS: nutrition aware, family characteristics, food security, nutritional status of underfi ves<br /><br />ABSTRAK<br /><br />Latar Belakang: Undang-undang nomor 25 tahun 2000 tentang Program Pembangunan Nasional dan Visi Indonesia Sehat 2010 menetapkan 80% keluarga menjadi keluarga sadar gizi (kadarzi). Hasil data survei kadarzi pada tahun 2006 dan 2007 didapatkan keluarga yang belum kadarzi 52,7% dan 27,2%. Hasil pemantauan status gizi balita (z-ScoreBB/U) didapatkan status gizi kurang menunjukkan adanya peningkatan, yaitu tahun 2004 sebesar (5,1%), tahun 2005 (9,8%)dan tahun 2006 (10,1%) <br /><br />Tujuan: Untuk menganalisis hubungan antara perilaku sadar gizi dan ketahanan pangan keluarga dengan status gizi balita di Kabupaten Tanah Laut Provinsi Kalimantan Selatan.<br /><br />Metode: Jenis penelitian observasional dengan rancangan cross sectional. Variabel terikat: status gizi balita (z-score BB/TB) dan variabel bebas: perilaku sadar gizi, ketahanan pangan keluarga serta variabel pengganggu: pendidikan orang tua, jumlah anggota keluarga, pengetahuan gizi ibu dan pendapatan keluarga. Subjek penelitian balita usia 6-24 bulan, jumlah 198 balita. Analisis yang digunakan adalah uji chi-square dan regresi logistik berganda (multiple logistic regression) dan didukung analisis kualitatitf dengan indepth interview bagi keluarga belum kadarzi.<br /><br />Hasil: Keluarga sudah kadarzi 145 (73,2%) dan belum kadarzi 53 (26,8%). Indikator kadarzi tentang dukungan keluarga memberikan ASI eksklusif 0-6 bulan paling banyak tidak dilaksanakan. Alasannya adalah setelah melahirkan ASI tidak keluar, susu ibu bengkak dan mengeluarkan darah, hamil lagi, dan alasan pekerjaan. Semua keluarga menggunakan garam beryodium dalam memasak makanan. Keluarga tahan pangan dan tidak tahan pangan berdasarkan tingkat konsumsi energi masing-masing sebesar 47,5% dan 52,5%, keluarga yang tahan pangan dan tidak tahan pangan berdasarkan tingkat konsumsi protein masing-masing sebesar 52,5% dan 47,5% dan status gizi balita hasil z-score BB/TB didapatkan balita gizi baik 72,7% dan gizi kurang 27,3%. Perilaku sadar gizi berhubungan signifi kan dengan ketahanan pangan keluarga berdasarkan tingkat konsumsi energi (p<0,05). Perilaku sadar gizi dan ketahanan pangan keluargaberdasarkan tingkat konsumsi energi dan protein tidak berhubungan signifi kan dengan status gizi balita (p>0,05).<br /><br />Kesimpulan: Perilaku sadar gizi, jumlah anggota keluarga, pengetahuan gizi ibu dan pendapatan per kapita berhubungan signifikan dengan ketahanan pangan keluarga berdasarkan tingkat konsumsi energi, sedangan pengetahuan gizi ibu dan pendapatan per kapita berhubungan signifi kan dengan ketahanan pangan keluarga berdasarkan tingkat konsumsi protein. Perilaku sadar gizi keluarga dan ketahanan pangan keluarga berdasarkan tingkat konsumsi energi dan protein tidak berhubungan dengan status gizi balita (z-score BB/TB).<br /><br />KATA KUNCI: keluarga sadar gizi, karakteritik keluarga, ketahanan pangan, status gizi balita
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Nanni, O., P. Serra, C. Tison, M. De Castro, R. Ridolfi, F. Falcini, D. Amadori, V. Erroi, and E. Meggiolaro. "Survey of the sociodemographic and motivational profile of volunteers in oncology." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 16011. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.16011.
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16011 Background: The volunteer sector developed rapidly in Italy throughout the 1980s, especially in the areas of cancer and palliative care. Istituto Oncologico Romagnolo (IOR), a non profit organization based in Forlì, actively supports the public health sector in the fight against cancer by funding scientific research, organizing voluntary work, promoting education campaigns, and setting up prevention and screening programs. The aim of the present work is to trace a sociodemographic and motivational profile of IOR volunteers. Methods: In May 2005, all IOR volunteers were invited to complete an anonymous questionnaire composed of 12 structured questions designed to collect sociodemographic data, information on type of voluntary work done and the reasoning behind such a choice. Results: Of IOR’s 1043 volunteers, 471 completed the questionnaire, of whom 70% were female and about one-third over 65 years of age. The majority of professions were represented, even though about two-thirds of men and half of the female volunteers were retired. About 40% of the group had been doing voluntary work for more than 10 years. Although fund-raising proved to be the most frequent activity (80%), there is a growing number of volunteers, especially those of a younger age group, involved in home- and hospital-based care. Various reasons were given for becoming a IOR volunteer: ethical considerations (35 % males and 28% females), personal experiences (24% and 38%, respectively), high regard held for IOR and its work (31 and 26%, respectively), and involvement directly through other volunteers (29 and 36%, respectively). Conclusions: The major involvement in fund-raising and perseverance over time of volunteers indicate a favorable social perception of medical research. It also emerged that the decision to start voluntary work was often closely linked to a previous personal experience of loss or disease, especially in female volunteers, who tend to react more constructively and develop a more active and concrete solidarity than men. We can therefore conclude that volunteers in the area of cancer act out of a sense of responsibility and awareness rather than out of pity or a desire for self-gratification. No significant financial relationships to disclose.
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Kutny, Matthew A., Todd A. Alonzo, Robert B. Gerbing, Yi-Cheng Wang, Cecilia Fu, Soheil Meshinchi, Alan S. Gamis, James H. Feusner, and John Gregory. "Results of a Phase III Trial Including Arsenic Trioxide Consolidation for Pediatric Patients with Acute Promyelocytic Leukemia (APL): A Report from the Children's Oncology Group Study AAML0631." Blood 126, no. 23 (December 3, 2015): 219. http://dx.doi.org/10.1182/blood.v126.23.219.219.
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Abstract Results from cooperative group trials demonstrating the effectiveness of arsenic trioxide in the treatment of newly diagnosed APL have thus far been restricted to trials consisting of primarily adult patients. The Children's Oncology Group trial AAML0631 incorporated two cycles of arsenic trioxide (ATO) during consolidation with approximately 40% reduction in anthracycline dosing compared to the Italian AIDA0493 trial which has the largest cohort and best phase III results published for pediatric APL (Testi et al Blood 2005). Eligibility criteria included age ≥ 2 to < 22 years, de novo APL confirmed by PML-RARA PCR and no prior therapy. Diagnostic white blood cell count (WBC) determined risk group as standard risk (SR) for WBC < 10,000 and high risk (HR) for WBC ≥ 10,000. ATRA was given at the pediatric dose of 12.5 mg/m2/dose PO BID on days 1-30 of induction and days 1-14 of each consolidation course and each maintenance cycle. Other therapy was as follows: Induction- idarubicin 12 mg/m2/dose for 3 doses; Consolidation 1- 2 cycles of ATO 0.15 mg/kg/day IV 5 days each week for 5 weeks; Consolidation 2- cytarabine 1,000 mg/m2/dose IV q12 hours days 1-3, mitoxantrone 10 mg/m2/dose IV days 3, 4; Consolidation 3- idarubicin 5 mg/m2/dose IV days 1, 3, 5; Consolidation 4 (HR APL only)- cytarabine 1,000 mg/m2/dose IV q12 hours days 1-3, idarubicin 10 mg/m2/dose IV day 4; Maintenance (12 weeks/cycle for 9 cycles)- 6-mercaptopurine 50 mg/m2/day PO, methotrexate 25 mg/m2 PO once weekly. Intrathecal cytarabine was given once during each consolidation 2-4 and cycle 1 of maintenance. Between 3/2009 and 11/2012, 108 patients enrolled and 101 (66 SR and 35 HR) were evaluable for outcome (4 PML-RARA PCR negative, 3 local consent issues). Hematologic CR after induction (without central review) was 81%. The molecular (RQ-PCR) remission rate for those tested at end of Consolidation was 100%. For all patients, overall survival (OS) was 94% and event free survival (EFS) was 92% at 2 years. Comparing SR to HR, the OS was 98% vs. 86% (p=0.004) and EFS was 97% vs. 83% (p=0.014) (Figure 1). The predetermined statistical plan was to compare the EFS results to AIDA0493 which had 2 year EFS of 91% for SR and 79% for HR APL. Relapse risk on AAML0631 from end consolidation I (following ATO treatment) was 2% at 2 years and did not differ significantly between patients with SR vs. HR APL. Events on this trial included 3 relapses, 1 second malignant neoplasm (squamous cell carcinoma in situ) and 7 deaths (6 HR APL, 1 SR APL) including one death post-relapse. Four deaths during induction (all HR APL) included multiple etiologies, but coagulopathy was a factor in each. There were 2 post-induction on-therapy deaths: SR APL patient with accidental (non-chemotherapy) drug overdose during Consolidation 3 and HR APL patient with gram negative sepsis during Consolidation 2. Three relapses included: combined molecular bone marrow (detected by PCR) and CNS relapse in a SR APL patient during maintenance cycle 7 (24 months post diagnosis), combined hematologic bone marrow and CNS relapse in a HR APL patient during maintenance cycle 6 (23 months post diagnosis), and molecular bone marrow relapse in a HR APL patient after therapy completion (38 months post diagnosis) who later died of stem cell transplant complications. Both patients with molecular relapse had low level PML-RARA transcript detection (under 0.001 NCN) during maintenance beginning 1 and 16 months prior to relapse. No other patients had similar "borderline" results. While 28 patients had a diagnostic LP performed in pre-therapy evaluation, 7 patients met the protocol definition of CNS disease (CNS2 N=4, or CNS3 N=3). The 2 patients with relapse involving the CNS did not have CNS disease at diagnosis. Historically, AIDA0493 represents the largest (N=107) and best published outcomes for a major pediatric phase III trial in APL. The current trial of 101 pediatric patients achieved higher EFS rates in both SR and HR APL through incorporation of ATO while significantly reducing anthracycline doses. The reported CR rate was lower than historical comparisons, but this was likely due to difficulty in assessing differentiating and recovering bone marrow cells after APL induction. The excellent molecular remission rate at end of consolidation and the low relapse rate confirm the effectiveness of this therapy. These results strongly support use of ATO in pediatric patients with newly diagnosed APL. Disclosures Off Label Use: Arsenic Trioxide in pediatric patients with newly diagnosed APL. Gemtuzumab Ozogamicin in Pediatric AML..
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Prutchi-Sagiv, Sara, Nataliya Golishevski, Odelia Katz, Howard S. Oster, Elizabeth Naparstek, Michael Hoffman, Drorit Neumann, and Moshe Mittelman. "T-Cell Abnormalities in Patients with Myelodysplastic Syndromes: Improved Immunological Functions in Patients Treated with Recombinant Erythropoietin." Blood 108, no. 11 (November 16, 2006): 2675. http://dx.doi.org/10.1182/blood.v108.11.2675.2675.
Full textAbstract:
Abstract Erythropoietin (Epo) is being used to treat anemias. We have observed prolonged survival in patients with multiple myeloma (MM) on recombinant Epo (rHuEpo) (Mittelman, EJH 2004). Studies on mice suggested an Epo anti-MM immune effect (Mittelman, PNAS 2001; Katz, Acta Haem 2005), and we have also found improved immunity in rHuEpo-treated MM patients. Here we tested the effect of Epo on immune function in myelodysplastic syndrome (MDS). We tested 27 MDS patients (15 controls). We show immune defects in early (IPSS low/int1) MDS, that are more pronounced in progressive disease. Consistent with previous reports, and extending our analysis to other immunologic functions, we show that MDS patients have decreased lymphocyte counts, manifested mainly in reduced CD4+ T-cell percentage and reduced mononuclear cell (MNC) proliferation induced by phytohemagglutinin (PHA). In MDS, the basal function of both CD4+ and CD8+ T cells expressing the early activation marker CD69 was higher than in controls, but following PHA stimulation, the increment of these CD69+ cells was attenuated. MDS patients also had a decreased percentage of the CD4+ cells expressing the IL-2 receptor, CD25. Finally, in MDS the proportion of CD8+ T-cells expressing the co-stimulatory molecule CD28 was reduced. To test whether rHuEpo treatment had any effect on these parameters, we compared these functions in 14 MDS patients (early disease) on rHuEpo with 8 early MDS patients who were not on rHuEpo. The rHuEpo-treated group included 12 patients responding to rHuEpo (increased Hb; Epo-responders) and 3 patients who continued to require transfusions (Epo-non-responders). The results show a significant increase in PHA-mediated activation of both CD4+ and CD8+ T cells, and a tendency towards normalized CD4+ percentage. The non-responders also showed a tendency towards normalized T-cell percentage and number, but they did not show any augmented activation, or proliferation potential (Table, mean ± SE). Our findings: add to the other reports, regarding the immune dysfunction in MDS; show that MDS patients on rHuEpo for anemia, also benefit from improved immune function. Taken together, our study suggests a potential role for rHuEpo as an immunomodulatory agent in MDS treatment. Parameter Healthy Controls Non-Treated MDS Patients rHuEpo-treated MDS Patients Early MDS Late MDS Responders Non-Responders a. p<0.05 early MDS compared to healthy controls. b. P<0.05 advanced MDS compared to healthy controls. c. p<0.05 rHuEpo-treated early MDS compared to non-treated early MDS. Number of patients N = 15 N = 8 N = 4 N = 12 N = 3 CD4+ T cell (%) 47.3±1.9 36.4±5.4a 31.9±6b 42.9±4 44.7±8.7 CD8+ (%) 22.2±1.6 21.6±3.1 14.4±3.9b 23.4±3.7 21.7±2.8 CD4:CD8 2.4±0.3 2.2±0.7 3.0±1.3 1.9±0.2 2±0.2 PHA act-CD4+ (%) 57.1±3.9 33.6±5.4a 39.5±9.1 58.6±8.8c 36.7±14 PHA act-CD8+ (%) 60±4.5 40.3±8.7a 53.4±8.5 65.5±8.2c 23.7±2.8 Proliferation (%) 232.5±10 189±23 100±0 185±23 164.9±0 CD8+CD28+ (%) 73.2±5.4 34±8.1a 31±0.7b 41±7.8 34±0 CD4+CTLA-4+ (%) 3.5±0.3 6.3±0.9 24±0.6 11.6±1.2 NA CD8+CTLA-4+ (%) 2.4±0.7 2.8±0.5a 12±0b 4.8±1.9 NA CD4+CD25+ (%) 72.7±0 55.1±5a 41±6.9b 61±8.5 38±0
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Sutrisno, Firdaus Zar'in, and Siti Salehcah. "Local Content Curriculum Model for Early Childhood Scientific Learning." JPUD - Jurnal Pendidikan Usia Dini 15, no. 1 (April 30, 2021): 81–100. http://dx.doi.org/10.21009/jpud.151.05.
Full textAbstract:
Curriculum material is generally considered the subject matter of information, talents, dispositions, understandings, and principles that make up research programs in the field. At a more complex level, the curricula need to contain historical and socio-political strengths, traditions, cultural views, and goals with wide differences in sovereignty, adaptation, and local understanding that encompass a diversity of cultures, laws, metaphysics, and political discourse This study aims to develop a curriculum with local content as a new approach in early childhood science learning. The Local Content Curriculum (LCC) is compiled and developed to preserve the uniqueness of local culture, natural environment, and community crafts for early childhood teachers so that they can introduce local content to early childhood. Research and model development combines the design of the Dick-Carey and Dabbagh models with qualitative and quantitative descriptive analysis. The results showed that local content curriculum products can be supplemented into early childhood curricula in institutions according to local conditions. Curricula with local content can be used as a reinforcement for the introduction of science in early childhood. The research implication demands the concern of all stakeholders to see that the introduction of local content is very important to be given from an early age, so that children know, get used to, like, maintain, and love local wealth from an early age.
Keywords: Early Childhood, Scientific Learning, Local Content Curriculum Model
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Gupta, Punkaj, Rachel McDonald, Sunali Goyal, Jeffrey M. Gossett, Michiaki Imamura, Amit Agarwal, Warwick Butt, and Adnan T. Bhutta. "Extubation failure in infants with shunt-dependent pulmonary blood flow and univentricular physiology." Cardiology in the Young 24, no. 1 (January 18, 2013): 64–72. http://dx.doi.org/10.1017/s1047951112002181.
Full textAbstract:
AbstractObjectiveThe objective of the study was to identify incidence, aetiology, and outcomes of extubation failure in infants with shunt-dependent pulmonary blood flow at a single tertiary care, academic children's hospital. The second objective of this study was to determine the haemodynamic effects of transition of positive pressure ventilation to spontaneous breathing in infants with extubation failure.Patients and methodsExtubation failure for our study was defined as the need for positive pressure ventilation within 96 hours after extubation. We collected demographics, pre-operative, intra-operative, post-operative, and peri-extubation data in a retrospective, observational format in patients who underwent a modified Blalock–Taussig shunt between January, 2005 and March, 2011. Infants undergoing Norwood operation or Damus–Kaye–Stansel with modified Blalock–Taussig shunt were excluded from the study. The cardiorespiratory variables collected before extubation and immediately after extubation included heart rate, respiratory rate, mean arterial blood pressure, central venous pressures, near infrared spectroscopy, oxygen saturations, and lactate levels. Clinical outcomes evaluated included the success or failure of extubation, cardiovascular intensive care unit length of stay, hospital length of stay, and mortality. Descriptive and univariate statistics were utilised to compare groups with extubation failure and extubation success.ResultsOf the 55 eligible patients during the study period, extubation failure occurred in 27% (15/55) of the patients. Of the 15 patients with extubation failure, 10 patients needed reintubation and five patients received continuous positive pressure ventilation without getting reintubated. There were three patients who had extubation failure in the first 2 hours after extubation, nine patients in the 2–24-hour period, and three patients in the 24–96-hour period. In all, eight patients were extubated in the second attempt after the first extubation failure, with a median duration of mechanical ventilation of 2 days (1 day, 6 days). The median age of patients at extubation was 19 days (12 days, 22 days) and median weight of patients was 3.6 kg (3.02 kg, 4.26 kg). In all, 38% (21/55) of the patients were intubated before surgery. The most common risk factors for failed extubation were lung disease in 46% (7/15), cardiac dysfunction in 26% (4/15), diaphragmatic paralysis in 13% (2/15), airway oedema in 6% (1/15), and vocal cord paralysis in 6% (1/15). The median duration of mechanical ventilation was 4 days (1 day, 10.5 days), median cardiovascular intensive care unit length of stay was 11 days (6.5 days, 23.5 days), and the median hospital length of stay was 30 days (14 days, 48 days). The overall mortality at the time of hospital discharge was 7%.ConclusionsExtubation failure in infants with shunt-dependent pulmonary blood flow and univentricular physiology is high and aetiology is diverse. Cardiopulmonary effects of removal of positive pressure ventilation are more pronounced in children with extubation failure and include escalation in the need for oxygen requirement and increase in mean arterial blood pressure. The majority of extubation failures in this select patient population occurs in the first 24 hours. Extubation failure in these patients is not associated with increased hospital length of stay or mortality.
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Cahen, Viviane C., Yimei Li, Evanette Burrows, Caitlin W. Elgarten, Amanda M. DiNofia, Jennifer J. Wilkes, Lena E. Winestone, et al. "A Novel Approach to Identifying Septic Shock (SS) in Children with Acute Lymphoblastic Leukemia (ALL) Using Pediatric Health Information System (PHIS) Data: Methods Validation and Incidence Estimation in a National Cohort." Blood 132, Supplement 1 (November 29, 2018): 3597. http://dx.doi.org/10.1182/blood-2018-99-114235.
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Abstract Infectious complications are major contributors to morbidity and mortality in children with leukemia; however, clinical trial reporting is incomplete (Miller 2016 J Clin Oncol). Using administrative data to identify SS events could improve estimates of incidence and clinical impact. However, accurate SS determination is challenging, and the 2005 International Pediatric Sepsis Consensus Conference (IPSCC) definition is often modified for individual studies. ICD-9 codes, assigned at discharge, do not permit precise timing estimates. We hypothesized PHIS resource utilization (RU) codes could identify vasopressor exposures as proxies for IPSCC-defined SS events. We present the operating characteristics of our methods and use the approach to estimate SS incidence for a national cohort. We previously identified and validated a longitudinal cohort of children aged 0-21 with newly diagnosed ALL using PHIS billing and diagnosis codes (Fisher 2014 Med Care), expanded through 12/31/2013. PHIS RU data were used to identify distinct vasopressor exposure patterns hypothesized to represent true SS (Figure 1). Epinephrine alone with asparaginase within ± 3 days was considered anaphylaxis rather than SS. We captured vasopressor patterns occurring ≥7 days from first chemotherapy until the first of: 30 days prior to relapse, 10 days prior to stem cell transplantation, or 3 years from diagnosis. We reviewed charts of all patients with ALL diagnosed from 2004 to 2013 at the Children's Hospital of Philadelphia (CHOP) to establish the SS gold-standard. We assumed true SS events would be associated with blood cultures. Each blood culture triggered a chart review and was classified by IPSCC sepsis criteria. A PHIS RU-defined vasopressor exposure had to be within ±14 days of the chart-defined SS to be considered a true positive. We predicted a patient may meet criteria for a PHIS vasopressor exposure if vasopressors were ordered to the bedside for impending SS but ultimately not administered. For CHOP patients with available electronic medication administration record (MAR) data (1/1/2011-12/31/2013), we assessed whether using vasopressor orders marked as "given" or "given or held at bedside" resulted in different operating characteristics relative to gold standard IPSCC SS events. We calculated sensitivity and positive predictive value (PPV) of PHIS RU exposure patterns for IPSCC SS, then used them to estimate SS incidence for the entire PHIS cohort and for certain risk group subsets. We identified 360 patients common to both PHIS and CHOP chart review cohorts. Chart review revealed 38 events meeting IPSCC SS criteria. PHIS RU data identified vasopressor exposure patterns in 35 of these 38 SS events within ±14 days (sensitivity 92%). PHIS RU data identified an additional 43 vasopressor patterns that did not correlate with a chart review IPSCC SS event (PPV: 35/78, 45%). When considering chart-defined sepsis event of any severity (ie, not restricted to SS), the PPV for PHIS-defined vasopressor events increased to 88%. MAR data were available for 149 patients to delineate whether ordered vasopressors were given or held. Among these 149 patients, 10 SS events met IPSCC criteria by chart review. Restricting RU-identified vasopressor exposure events to patients who actually received vasopressors resulted in sensitivity of 70% and PPV 77%; including orders where vasopressors were given or held, the sensitivity increased to 100% and PPV decreased to 55%. Using PHIS RU vasopressor patterns, we estimated an incidence of 12.6% (95% CI 12.0 - 13.3 %) of patients ever experiencing SS in the PHIS ALL cohort. Infants, children aged ≥10 years, with public insurance, or receiving daunorubicin all had significantly higher SS rates than the cohort baseline (Table 1). PHIS RU-defined vasopressor exposure patterns have a high sensitivity for IPSCC-defined SS but a low PPV. The PPV may be the result of including patients with vasopressors ordered but not given; however, IPSCC-defined SS excludes children with fluid-responsive shock. The low PPV suggests this RU-defined approach results in "overcapture" of SS, but the gold standard definition may be too restrictive. Vasopressor exposure patterns from RU data may identify patients with SS or impending SS that can augment incomplete clinical trial data collection. PHIS RU SS incidence estimates for a national pediatric ALL cohort exceed 12%, with even higher rates in high-risk subgroups. Disclosures Fisher: Merck: Research Funding; Pfizer: Research Funding.
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Blanco-Alemany, Esther, and Donna Johnston. "Neutropenia In Infants with Hemolytic Disease of the Newborn." Blood 116, no. 21 (November 19, 2010): 3794. http://dx.doi.org/10.1182/blood.v116.21.3794.3794.
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Abstract Abstract 3794 Introduction: Hemolytic disease of the newborn (HDN) results from maternal IgG antibodies that cross the placenta into the fetal circulation during gestation and cause red blood cell (RBC) destruction. Anemia, hyperbilirubinemia and, in severe cases, hydrops fetalis are well-recognized complications. However, much less is known about the prevalence and outcome of neutropenia as a feature of HDN. This study examined the prevalence and outcome of neutropenia in infants with HDN who were followed in the Pediatric Hematology Clinic at the Children's Hospital of Eastern Ontario (CHEO) during the last 5 years, and also investigates possible risk factors for the development of neutropenia in this setting. Methods: A retrospective chart review was perfomed on all infants with HDN followed in the Pediatric Hematology Clinic at CHEO from April 2005 to May 2010. Neutropenia was defined as a neutrophil count low for patient's age according to laboratory normal values (<1.5×109/L for patients <14 days, <1.0×109/L for patients ≥14 days). Statistical analysis was done using SPSS version 18.0 and a Chi-squared test was used to determine significance. The study was approved by the Research Ethics Board at CHEO. Results: Seventy-four infants with a diagnosis of HDN were identified during the study time period, of which 69 were evaluable. The male to female ratio was 1:1 and the median gestational age at birth was 38 weeks. Rh antibodies were the most prevalent (48%), followed by ABO incompatibility (42%). No cases of hydrops fetalis were recorded. Fifty-three percent of the infants studied developed some degree of neutropenia, with a median neutrophil count at nadir of 0.56 ×109/L. The mean age at the nadir of the neutropenia was 56 days (range 5–181 days) and the neutropenia lasted a mean of 37 days following the nadir (range 3–153 days). No infectious complications were recorded during the period of neutropenia except for one patient born at 32 weeks of gestational age who had necrotizing enterocolitis and bowel perforation at the onset of the neutropenia. In most instances the neutropenia resolved spontaneously within days, but interestingly, 6 infants subsequently developed chronic neutropenia. Statistical analysis revealed that males with HDN were at a significantly higher risk of developing neutropenia (p=0.022) compared to females, but no statistically significant associations between neutropenia and severity of HDN, antibody specificity, treatment with IVIG or transfusions were found. Not surprisingly, 77% of infants with HDN developed thrombocytosis with a maximum platelet count of 1200 ×109/L, and this was not significantly associated with the development of neutropenia. Conclusion: This is the largest study to date to determine the prevalence of neutropenia in the context of hemolytic disease of the newborn. Our results demonstrate that neutropenia is a common feature of HDN, regardless of the severity of disease, the treatment received or the antibody specificity. Although its clinical course seems to be benign, careful follow-up of these infants should be undertaken. Given the retrospective nature of the study, possible contributing factors such as maternal conditions of pre-eclampsia, drug exposure or ethnicity were not available. Larger prospective studies should be conducted to learn more about the pathophysiology of this phenomenon and its natural course. Disclosures: No relevant conflicts of interest to declare.
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De la Serna, Javier, Jaime Sanz, Arancha Bermudez, Carlos Vallejo, David Serrano, Dolores Caballero, Rafael De La Camara, et al. "Myeloablative Conditioning with Intravenous Busulfan In One Daily Dose and Fludarabine (BUF) for HLA-Identical Sibling Allogeneic HSCT In Myeloid Malignancies." Blood 118, no. 21 (November 18, 2011): 3010. http://dx.doi.org/10.1182/blood.v118.21.3010.3010.
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Abstract Abstract 3010FN2 Background: There is a need to improve the conditioning regimens for allogeneic HSCT, both reducing the regimen related toxicity and improving the anti-leukemic effect. The myeloablative (MA) regimen consisting in intravenous (iv) busulfan (BU) with fludarabine (F) might be a better option than the conventional BU-CY (Cyclophosphamide) combination, since BU and F act synergistically against leukemia cell lines and previous studies with iv BU-F conditioning have reported an improved safety profile over BU-CY. Objective: We aimed to evaluate the efficacy and safety of the MA BU-F regimen, delivering iv BU in a one-daily dose after F infusion, since previous pharmacologic and clinical data supported its safety compared with the standard four-daily doses in the HLA identical sibling allogeneic HSCT setting. Patients: One hundred thirty seven consecutive adult patients with myeloid malignancies from nine Spanish institutions were recruited from 2005 to 2011. They had a median age of 47 years (range 19–74) and 60% were males. Diagnosis were AML: 80 (58.4%), AML secondary to MDS: 24 (17.5%), MDS: 23 (16.8%) and MPD: 10 (7.3%). At HSCT, the disease stage was 1st CR or untreated in 85 (62%) and more advanced stage in 52 (38%) cases. Patients having Karnofsky < 90% and Sorror CI >1 accounted for 11.7% and 38.3%. The conditioning regimen consisted in F, 40 mg/m2 daily for 4 days (total dose 160 mg/m2) followed by BU, one-daily IV 3.2 mg/kg infusion (total dose 12.8 mg/kg). GVHD prophylaxis consisted in cyclosporine and methotrexate. HSC infusion and post-transplant supportive measures and follow-up were made according each institution policies. Results: Donor graft source was peripheral blood (PB) in 93 (67.9%) and bone marrow (BM) in 44 (32.1%) cases. Median CD34+ cells infused were 4.5 millions/kg (range 0.6–17.8). All but one patient engrafted, with a median of 15 days (range 8–49) to >0.5 ×10E9 PMN/L and 13 days (range 7–149) to >20 ×10E9 platelets/L. The most frequent toxicity was mucositis, which was grade >1, in 68.8% cases. Three patients had hepatic SOS grade >1, and all of them resolved. Median hospitalization time was 30 days (range 17–114). Acute GVHD grade 2–4 incidence was 25% with a median of 32 days (range 12–87) to GVHD onset. The day-100 mortality was 4.8%. The chronic GVHD incidence in 114 patients at risk is 61.4%, with 37.7% of cases in extended form. At the time of this analysis, the median follow-up is 12 months (range 1–74). Crude survival data showed 106 (77.4%) patients remaining alive and 106 (77.4%) relapse free. Overall, 31 patients have died, 19 relapse-related (13.9%) and 12 (8.8%) due to transplant related mortality. Actuarial survival at 12 months is 79.4% and disease free survival is 71.3% in the whole series. Kaplan-Meier analysis showed that advanced age, comorbidities or advanced disease status at HSCT did not predict an inferior outcome. In conclusion, in the HLA identical sibling allogeneic HSCT setting, the BU-F regimen provides an adequate control of myeloid malignancies, with low regimen related toxicity and both reduced day-100 and non-relapse related mortality. Disclosures: Lahuerta: Janssen: Honoraria; Celgene: Honoraria.
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Sominina, A. A., D. M. Danilenko, K. A. Stolyarov, L. S. Karpova, M. I. Bakaev, T. P. Levanyuk, E. I. Burtseva, and D. A. Lioznov. "Interference of SARS-CoV-2 with other Respiratory Viral Infections agents during Pandemic." Epidemiology and Vaccinal Prevention 20, no. 4 (September 4, 2021): 28–39. http://dx.doi.org/10.31631/2073-3046-2021-20-4-28-39.
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Background. Integrative epidemiological and etiological analysis of peculiarities of the development of the COVID-19 pandemic in different countries of the world is of significant scientific and practical interest in order to improve the preparedness of medical and social services during the upcoming pandemics. The purpose of the research. To determine the features of the epidemic process caused by a new coronavirus infection COVID-19, in all the diversity of its interaction with influenza viruses and other ARVI agents in the Russian Federation.Materials and methods. The studies were performed in the system of routine influenza surveillance by the Federal Center for Influenza and ARI at the Smorodintsev Research Institute of Influenza and the Center for Ecology and Epidemiology of Influenza at the National Center for Epidemiology and Microbiology named after N.F. Gamaleya, in cooperation with Regional Collaborating Base Laboratories in accordance with the Order of the Federal Service for Consumer Rights Protection Surveillance and Human Well-being No. 373 of March 31, 2005. Information on morbidity and hospitalization was provided by the erritorial Departments of Rospotrebnadzor. Information on the results of PCR detection of influenza and ARVI viruses, including SARS-CoV-2, was received from the «enters for Hygiene and Epidemiology" and was entered on-line into the electronic database of the Smorodintsev Research Institute of Influenza of the Ministry of Health of Russia. «AmpliSens reagent kits produced by the Central Research Institute of Epidemiology were used for PCR detection and subtyping of influenza A and B viruses, to identify ARVI agents, for PCR diagnosis of COVID-19 the kits certified in the Russian Federation of various producers were used.Results. It has been established that the annual epidemics of influenza, as well as the development of the second wave of the COVID- 19 pandemic in the season 2020–2021 was preceded pronounced increase of incidence rate (55.0 - 67.9 per 10,000), associated with rhinoviruses activity, starting from the week 38 to week 43. 2020, which reached on the peak 23–29.0% of patients examined. The increase of COVID-19 activity in the fall of 2020 began from week 41 with the peak (26.6–31.3%) of detection in the period from the week 47.2020 to week 4. 2021. The duration and severity of COVID-19 diseases, requiring hospitalization, distinguished the SARS-CoV-2 pandemic from influenza epidemics/pandemics. Significant changes in the nature of the epidemic process were found in the analysis of the age structure of morbidity and hospitalization – their distinct decrease in children's age groups against the background of pronounced growth among patients of the age group 15–64 yrs and, especially, in elderly people ≥ 65 yrs. The incidence growth curves coincided in time with an increase in SARS-CoV-2 activity against the background of a decrease in the detection frequency of other ARVI pathogens, including influenza and RSV viruses, as a result of pronounced interference between pathogens. Interestingly, as the frequency of SARS-CoV-2 detection decreased to 15–19%, the activity of rhinoviruses, seasonal coronaviruses and metapneumoviruses began to increase again from 0.7–3.0% to 5.6–6.6%, which indicated the existence of a quantitative relationship between the interference indicators of SARS-CoV-2 with other ARI agents. It was most clearly manifested in relation to influenza and RSV viruses, which detection in general for the season dropped to 0.04% and 0.3% respectively.Conclusions. The phenomenon of interference of SARS-CoV-2 with other viral respiratory agents was established, based on the facts of a sharp suppression of the circulation of influenza viruses, respiratory syncytial virus and other ARVI pathogens during the period of active spread of the pandemic coronavirus. A distinctive feature of the SARS-CoV-2 pandemic, in comparison with influenza epidemics, was its long duration and the severity of the diseases caused by that virus. During the period of the pandemic, a clear decrease in the incidence and hospitalization among children was revealed, with their pronounced growth in adults and, especially, in older people ≥ 65 years old.
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Yalcin, Arzu, Marlon Kovarbasic, Mahmoud Abdelkarim, Gregor Klaus, Julius Wehrle, Verena I. Gaidzik, Heike L. Pahl, et al. "The Oligodendrocyte Lineage Transcription Factor 2 (OLIG2) Is Epigenetically Regulated in AML and Suppresses Leukemia Cell Growth." Blood 124, no. 21 (December 6, 2014): 3540. http://dx.doi.org/10.1182/blood.v124.21.3540.3540.
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Abstract Introduction: DNA methylation differences between normal and cancer tissue that result in differential expression of genes are a hallmark of acute myeloid leukemia (AML). DNA methylation mediated silencing of specific genes, especially transcription factors, can provide a growth advantage for malignant cells. Global DNA methylation analyses have not only led to a better understanding of AML subgroups and the impact of epigenetic aberrations in leukemogenesis, but also to the identification of new epigenetically regulated genes. We and others have recently identified the oligodendrocyte lineage transcription factor 2 (OLIG2) as differentially methylated in AML cell lines compared with normal bone marrow cells. Aim of the study: With the hypothesis that OLIG2, which is not expressed in normal hematopoiesis, may play a role in cancerogenesis as shown for acute lymphoblastic leukemia (Lin et al., Cancer Res. 2005) and malignant glioma (Mehta et al., Cancer Cell 2011), we sought to further dissect the impact of OLIG2 in AML, implementing functional studies and primary samples. Results: First, in a cohort of 93 AML patients, we could confirm previous results by Kröger et al. (Blood 2008) that OLIG2 is differentially methylated: using pyrosequencing, 37 patients (39.8%) showed methylation levels > 25% (range (r): 26-79%) in the 5 CpG containing amplicon of the OLIG2 promoter region, independent of cytogenetic subgroup. In a small subset of 13 patients where expression-data was available, an inverse correlation between OLIG2 DNA methylation and mRNA expression was significant (r2=0.55, p<0.005). This observation was further supported by a highly significant inverse DNA methylation/mRNA expression correlation in 10 leukemia cell lines (r2=0.74, p< 0.002). Moreover, we could demonstrate that this inverse correlation held also true for OLIG2 protein levels in cell lines with strong expression in THP-1 and NB-4, moderate expression in HL-60 and HEL and no expression in U937, KG-1A, PL-21, Kasumi-1, K-562 and Jurkat. Interestingly, while CD 34+ cells from two healthy donors and 10 out of 12 AML patients where protein was available, showed no protein expression, OLIG2 was expressed in 2 patients, both bearing the translocation t(15;17). This corresponds well to OLIG2 expression of cell line NB-4, which also harbours t(15;17). Treatment of non-expressing cell lines PL-21 and U937 with 200 nM 5-aza-2'-deoxycytidine led to robust re-expression of OLIG2, both on mRNA and protein level, strongly implicating DNA methylation as a silencing mechanism in a subset of AML. To investigate the relationship between OLIG2 expression and AML cell growth we used a siRNA transient knock-down in OLIG2 expressing cell lines THP-1 and NB-4. While OLIG2 protein expression measured via densitometry could be strongly reduced to 38% and 45% from pre-treatment levels in THP-1 and NB-4 cells, respectively, no change on cell viability or cell growth was detected. However, stable over-expression of OLIG2 using the lentiviral-vector pLeGO-iG in Kasumi-1 cells, led to a significant growth-inhibition of 32.2% (r: 27.0-37.3%) after 5 days and a 47.7% (r: 30.7-64.6%) increase of apoptotic cells (Annexin-V-staining) as compared to control-vector transfected cells. This negative effect on cell proliferation supports our presumption that OLIG2 could act as a growth-regulator in a subgroup of AML. This could be caused by a direct interaction between OLIG2 and a cell cycle regulator or a transcription factor complex. Conclusion: We show that OLIG2 (I) is in part epigenetically regulated via DNA methylation in AML, resulting in an inverse correlation between DNA methylation and expression; (II) can be re-expressed upon demethylating treatment in cell lines, therefore making it an attractive biomarker to study in AML patients treated with demethylating agents; (III) shows antiproliferative activity in leukemia cell lines and thus should be further studied as a potential tumor suppressor in AML. Disclosures Lübbert: Cephalon / TEVA: Travel support Other.
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Okamoto, Yasuhiro, Yoshihisa Nagatoshi, Akinobu Matsuzaki, Aiko Suminoe, Hideki Nakayama, Noriko Hotta, Shuuichi Ohzono, et al. "Combined Analysis of Treatments for Pediatric T-ALL in KYCCSG Protocols, ALL-96 and ALL-02." Blood 114, no. 22 (November 20, 2009): 4102. http://dx.doi.org/10.1182/blood.v114.22.4102.4102.
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Abstract Abstract 4102 Background Previously we reported the result of Kyushu-Yamaguchi Children's Cancer Study Group (KYCCSG) protocol, ALL-96, for pediatric acute lymphoblastic leukemia (ALL) (ASH meeting in 2005). The 7-year event-free survival (EFS) and overall survival (OS) rates were 72% (95% CI; 68 - 76 %) and 85 % (95% CI; 80 - 90 %), respectively. Following protocol, ALL-02, was aimed to assess the usefulness of polymerase chain reaction (PCR)-based minimal residual disease (MRD) in the same context as ALL-96 protocol. Purpose In this combined analysis, we analyzed the outcome and risk factors for relapse/survival in children with T-ALL who were treated with the ALL-96/ALL-02 protocols. Study Design and Treatment A total of 42 patients (22 of 218 in ALL-96 and 20 of 165 in ALL-02, 26 males and 16 females) with median age of 8 years (range 1 - 14) were treated. Patients were classified into 2 groups, standard risk (SR) and high risk (HR). HR patients had one of the followings: high white blood cell (WBC) counts more than 50,000/μl, T-cell immunophenotype, central nervous system (CNS) disease at diagnosis, organomegaly (hepatomegaly or splenomegaly more than 5 cm below costal margin), M2/3 marrow at day 15 of induction therapy. Both protocols consisted of induction, early intensification, consolidation, late intensification and maintenance therapy. Predonisolone (PSL), weekly vincristine (VCR), 4 doses of daunorubicin (DNR), 8 doses of L-asparaginase (L-asp) and 2 or 4 doses of intrathecal (IT) methotrexate (MTX) depending on the CNS status, were given during induction. In early intensification, DNR, cytarabine (CA), etoposide and 6-mercaptopurine (6-MP) were given. Consolidation consisted of intermediate dose of MTX, combination of cyclophosphamide(CPM), CA and 6-MP, and high dose CA. Late intensification similar to induction included 2 weeks of dexamethasone (DEX), weekly VCR, 2 doses of pirarubicin, single dose of CPM, 5 doses of L-asp and IT-MTX followed by combination of CA, 6-MP, IT-MTX along with 18 Gy cranial irradiation in 12 fractions. In ALL-96 protocol, patients were randomized to receive maintenance therapy of either combination of 6-MP/MTX and DEX/ VCR pulse (A-arm) or LSA2L2-type therapy (B-arm). In ALL-02 protocol, A-arm was chosen as a maintenance therapy based on result of ALL-96. No patient underwent hematopoietic stem cell transplantation (SCT) in 1st complete remission (CR). Results Median follow-up periods were 96 and 38 months in ALL-96 and ALL-02, respectively. Two patients were off-protocol before achieving CR because of toxicity and chromosome abnormality with t(4;11). Induction rate in 40 patients was 95%. All 14 events were relapses and TRM rate was 0%. Last event occurred at 40 months. The sites of relapse were isolated BM in 9, isolated testis in 2, isolated CNS in 1 and combined sites in 2. Nine died from disease progression and 2 died from toxicity after SCT in 2nd CR. The 4-year EFS and OS rates in all patients were 55 % (95 % CI; 39 – 71 %) and 71 % (95 % CI; 56 -86 %), respectively. EFS of ALL-96 and ALL-02 were 50 %[95 % CI; 29 -71 %]) and 65 % [95 % CI; 45 - 85 %]), respectively. OS of ALL-96 and ALL-02 were 59 % [95 % CI; 39 – 80 %]) and 90 % [95 % CI; 77 - 103 %]), respectively (p = 0.063). EFS of patients treated in A and B arm were 60 % [95 % CI; 41 -71 %]) and 55 % [95 % CI; 25 - 84 %]), respectively. None of age, sex, organomagaly, WBC, chromosomal abnormalities, CNS status, protocol, and maintenance arm was identified as a risk factor for relapse or survival. Two of 10 (ALL-96) and 3 of 4 (ALL-02) relapsed patients have survived with allogeneic SCT. Conclusion Although T-ALL patients received an intensified treatment including cranial radiation, the outcome was unsatisfactory. One possible explanation for better OS in ALL-02 protocol is that the majority of relapsed patients in ALL-02 were salvaged by SCT in 2nd CR. Disclosures: No relevant conflicts of interest to declare.
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Regling, Katherine, Katherine Cashen, Manisha Gadgeel, Yue Xi, Andrew Herppich, Michael Tarasev, Patrick C. Hines, and Meera B. Chitlur. "Evaluation of Coagulation and Inflammatory Markers in Pediatric Patients on Extracorporeal Membrane Oxygenation (ECMO)." Blood 136, Supplement 1 (November 5, 2020): 14. http://dx.doi.org/10.1182/blood-2020-140900.
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Background: Bleeding and thrombosis remain the primary complications related to the use of extracorporeal membrane oxygenation (ECMO). To date, no single test or parameter has been identified to accurately predict the risk of these hemostatic complications. Thrombin generation may be the key marker for both thrombosis and bleeding, and may be influenced by inflammation. The aims of this study were to evaluate if novel laboratory tests including thrombin generation assay, neutrophil extracellular traps (NETs), microparticles (MPs), and red blood cell (RBC) membrane fragility/adhesion could better predict patients at risk for bleeding and/or thrombosis compared to routine laboratory tests. We hypothesized that ECMO related thrombosis is associated with increased thrombin generation and ECMO related bleeding is associated with decreased thrombin generation. Methods: An IRB approved prospective pilot study of patients requiring ECMO was conducted at Children's Hospital of Michigan. Patients were enrolled within 24 hours of ECMO cannulation after informed consent. Patients aged 0-17 years placed on venoarterial (VA) or venovenous (VV) ECMO were included. Patient demographics, baseline laboratory, clinical data, and novel assays were collected. Presented is the preliminary data of the first 16 patients enrolled. SPSS was used for data analysis. Results: Of the 16 patients, there were 9 males and 7 females with the majority being cannulated for primary respiratory etiologies. Median age was 8.5 months with 6 patients being neonates (38%). Twelve patients (75%) survived the ECMO run, and 11 patients (69%) survived to hospital discharge. Laboratory data was grouped based on "no event" (N=94), "bleeding event" (N=13) and "clotting event" (N=21) days. There were no differences in the number of RBC, fresh frozen plasma, or cryoprecipitate transfusions between events. Platelet transfusions were used at higher volumes in bleeding events, p=0.011. Platelet counts did not differ between groups, whereas fibrinogen levels were significantly lower on days of bleeding events, p≤0.001 (Figure 1A). There were no differences seen in the activated partial thromboplastin time (aPTT) or activated clotting time (ACT) which are routinely used for monitoring anticoagulation. However, the prothrombin time (PT) was significantly prolonged in bleeding events with a median of 16 seconds (p=0.001), which may be related to the lower fibrinogen levels (Figure 1B). Thrombin generation was assessed using the maximum rate of thrombin generation (MRTG) value from the thromboelastograph (TEG) generated velocity curve (Figure 1D). Bleeding events had a significantly lower median MRTG of 7.93 mm/min compared to 12.36 mm/min in the no event group and 12.14 mm/min in the clotting event group (p=0.004). The thrombin generation assay results are in process. NETs were analyzed using an ELISA to detect citrullinated histone-3 (CitH3) levels (ng/mL). There were no significant differences seen in our population, however there is a trend toward increased levels in thrombotic events (Figure 1E). Both absolute MPs and platelet MPs were significantly increased in clotting events compared to bleeding events, p=0.003 and p≤0.001 respectively (Figure 1C). In our population, there was no evidence that hemolysis played a role in thrombosis as assessed by flow based RBC mechanical fragility testing. Of note, flow based RBC adhesion showed a non-significant trend toward increased adhesion to P-selectin. This finding requires further investigation because P-selectin is a primary site for adhesion on endothelial cells and plays a crucial role in coagulation (Figure 1F). Conclusions: Bleeding events on ECMO are associated with increased mortality. Our findings suggest that lower fibrinogen levels, prolonged PT and decreased thrombin generation (as assessed by the TEG) are associated with an increased risk for major bleeding. Increased levels of NETs, MPs and RBC adhesion have a trend towards increased thrombotic events. Thus, although preliminary, our results suggest that novel laboratory tests were effective in identifying bleeding events, and the trends seen in thrombotic events may allow for the use of new medications to reduce clotting in ECMO. The results illustrate the challenges in monitoring ECMO anticoagulation and additional study of novel tests are needed to identify and avoid clinical complications. Disclosures Tarasev: Functional Fluidics:Current Employment, Current equity holder in private company.Hines:Functional Fluidics:Current equity holder in private company.Chitlur:Biovertiv:Honoraria;Pfizer:Honoraria;Novo Nordisk:Consultancy, Honoraria;Takeda:Honoraria;Agios Pharmaceuticals:Research Funding.