Sleep-Wake Disturbances in Adolescents with Spina Bifida: Prevalence and Associations with Bio-Neuropsychosocial Functioning

Sleep is a critical component of healthy development during adolescence, and when disrupted, has been linked to difficulties with physical status, psychological health, family functioning, neuropsychological symptoms, and academic performance. The overarching goal of this project was to examine sleep-wake disturbances in association with bio-neuropsychosocial functioning in a vulnerable pediatric population of adolescents with spina bifida (SB). Specifically, this study aimed to 1) examine sleep-wake patterns in adolescents with SB using a multimodal sleep assessment, 2) identify daily temporal associations between sleep and pain as well as sleep and mood, and 3) identify the relationship between sleep-wake disturbances and bio-neuropsychosocial functioning in adolescents with SB. Sleep-wake patterns in adolescents ages 12 to 18 with SB (N = 37) were compared to a matched comparison group of typically developing (TD) peers (N = 37). A subjective and objective sleep assessment was conducted; ambulatory actigraphy recordings was completed over 10 days, and adolescents completed several sleep questionnaires (e.g., sleep quality, pre-sleep arousal) and a daily diary. In addition, adolescents and parents completed questionnaires to assess physical (pain, BMI), psychological (internalizing symptoms, health-related quality of life), family (conflict, cohesion), neuropsychological (attention, executive function), and academic functioning (school competence, grades). Study findings revealed that adolescents with SB experienced higher rates of sleep-wake disturbances compared to their typically developing peers. Results of actigraphy and questionnaire report data found that adolescents were particularly at-risk for reduced sleep quantity (i.e., lower total sleep time) and poor sleep quality (i.e., difficulties with bedtime settling and staying asleep). Adolescents with SB also experienced higher levels of daytime fatigue compared to their peers. Sleep-wake disturbances were associated with every domain of adolescent functioning within the bio-neuropsychosocial model. In particular, there were consistent data to support the connection between nighttime sleep disturbances and psychological maladjustment (i.e., internalizing, quality of life). To a lesser extent, nighttime sleep disturbances were linked to worse physical health (pain, BMI) and family functioning (family conflict). Furthermore, daytime sleepiness and/or fatigue, but not nighttime sleep disturbances, predicted worse neuropsychological and academic functioning, including inattention/hyperactivity, executive dysfunction, and lower school grades. Ongoing evaluation and treatment of sleep disturbances will be critical to optimize health and functioning in this vulnerable pediatric population

Confronting and Countering Bias and Oppression through Early Childhood Policy and Practice: An Introduction. [Special issue]

Across the globe, there has been sustained anti-bias and anti-oppressive scholarship and policywork addressing social inclusion in early childhood and teacher education, grounded in the work of Louise Derman-Sparks and the ABC Task Force, 1989 (Kumishiro, 2000; Murray & Urban, 2012; Swadener, Aquino-Sterling, Nagasawa, & Bartlett, 2009). In this special issue, contributors address a range of social inclusion focused policies and practices across continents, including the challenges and opportunities of implementing anti-bias education. This kind of research takes a principled stance as it works to ameliorate, and eventually eliminate, exclusionary practices impacting young children and their families. The primary goal of this special issue is to rethink the importance, conceptualizations, and enactments of scholarship on anti-bias and socially inclusive approaches in early childhood education contexts

The Freedom to Marry for Same-Sex Couples: The Opening Appellate Brief of Plaintiffs Stan Baker Et Al. In \u3cem\u3eBaker Et Al. V. State of Vermont\u3c/em\u3e

As the first state to prohibit slavery by constitution, and one of the few states which, from its inception, extended the vote to male citizens who did not own land, the State of Vermont has long been at the forefront of this nation\u27s march toward full equality for all of its citizens. In July 1997, three same-sex couples challenged Vermont to act as a leader yet again, this time in affording full civil rights to the State\u27s gay and lesbian citizens. Stan Baker and Peter Harrigan, Nina Beck and Stacy Jolles, and Holly Puterbaugh and Lois Farnham were denied marriage licenses by their respective town clerks in the summer of 1997. They sued the State of Vermont and the towns, arguing that the marriage statutes allowed them to marry, and that if the law did purport to limit marriage to different sex unions it would be unconstitutional. The trial court dismissed their claims in December 1997, and the couples appealed to the Vermont Supreme Court. The court heard oral arguments on the case on November 18, 1998

The Freedom to Marry for Same-Sex Couples: The Opening Appellate Brief of Plaintiffs Stan Baker Et Al. In \u3cem\u3eBaker Et Al. V. State of Vermont\u3c/em\u3e

As the first state to prohibit slavery by constitution, and one of the few states which, from its inception, extended the vote to male citizens who did not own land, the State of Vermont has long been at the forefront of this nation\u27s march toward full equality for all of its citizens. In July 1997, three same-sex couples challenged Vermont to act as a leader yet again, this time in affording full civil rights to the State\u27s gay and lesbian citizens. Stan Baker and Peter Harrigan, Nina Beck and Stacy Jolles, and Holly Puterbaugh and Lois Farnham were denied marriage licenses by their respective town clerks in the summer of 1997. They sued the State of Vermont and the towns, arguing that the marriage statutes allowed them to marry, and that if the law did purport to limit marriage to different sex unions it would be unconstitutional. The trial court dismissed their claims in December 1997, and the couples appealed to the Vermont Supreme Court. The court heard oral arguments on the case on November 18, 1998

The Freedom to Marry for Same-Sex Couples: The Opening Appellate Brief of Plaintiffs Stan Baker Et Al. In \u3cem\u3eBaker Et Al. V. State of Vermont\u3c/em\u3e

As the first state to prohibit slavery by constitution, and one of the few states which, from its inception, extended the vote to male citizens who did not own land, the State of Vermont has long been at the forefront of this nation\u27s march toward full equality for all of its citizens. In July 1997, three same-sex couples challenged Vermont to act as a leader yet again, this time in affording full civil rights to the State\u27s gay and lesbian citizens. Stan Baker and Peter Harrigan, Nina Beck and Stacy Jolles, and Holly Puterbaugh and Lois Farnham were denied marriage licenses by their respective town clerks in the summer of 1997. They sued the State of Vermont and the towns, arguing that the marriage statutes allowed them to marry, and that if the law did purport to limit marriage to different sex unions it would be unconstitutional. The trial court dismissed their claims in December 1997, and the couples appealed to the Vermont Supreme Court. The court heard oral arguments on the case on November 18, 1998

Social-Environmental Predictors of Health-Related Quality of Life in Youth with Spina Bifida

Health-related quality of life (HRQOL) is a multidimensional construct including an individual\u27s physical and mental health and psychosocial well-being (De Civita et al., 2005), and the measurement of HRQOL has been recognized as a key marker of health outcomes in pediatric populations (Eiser & Jenney, 2007). Due to medical and technological advances, an increasing number of individuals with chronic illnesses are living longer. As such, research that investigates improvements in HRQOL in youth with chronic illnesses has become essential. Indeed, the number of studies examining HRQOL in pediatric populations has increased markedly; spina bifida (SB) is one among several chronic illnesses that has received increased attention with regard to HRQOL assessment in the past decade (see Sawin & Bellin, 2010 for a review). The experience of a chronic illness may have deleterious consequences on several aspects of a youth\u27s life. In particular, SB is a relatively common congenital birth defect associated with a multitude of physical and cognitive impairments (e.g., orthopedic abnormalities, urinary and bowel difficulties; Fletcher & Brei, 2010) as well as individual and contextual social-environmental difficulties (e.g., poor social competence, a stressful family environment; Alriksson-schmidt, Wallander, & Biasini, 2007). Due to the range of physical, cognitive, and social impairments associated with this condition, youth with SB may be at an increased risk of reduced HRQOL. Research on HRQOL for children and adolescents with SB has begun to identify demographic, illness-related, and social-environmental factors that are associated with HRQOL. Elucidating factors that influence HRQOL is an important step in informing the development of interventions to improve HRQOL in youth with SB. Thus far, extant research investigating HRQOL in youth with SB has tended to focus on non-modifiable demographic and illness-specific correlates, such as age, gender, and degree of mobility impairment. Studies examining modifiable social-environmental factors on youth\u27s HRQOL may be particularly important in informing future interventions for youth with SB. In addition, despite the importance of this work, current research has several methodological weaknesses, including the utilization of mixed samples, small sample sizes, single informants, and cross-sectional designs. The current study seeks to address these weaknesses and bridge critical gaps in the literature by testing a longitudinal, multi-method and multi-informant model of individual and contextual social-environmental predictors of HRQOL in youth with SB across two independent studies (see Figure 1). The following sections provide a general overview of historical and current conceptualizations, measurement issues related to quality of life as a construct, and an extensive review of studies that have investigated demographic, illness-specific, and social-environmental correlates of HRQOL in youth with SB. Methodological weaknesses and gaps in current literature are identified and a detailed description of the current study is provided

Global stakeholder perspectives of home birth: a systematic scoping review

Home birth is experienced by people very differently worldwide. These experiences likely differ by the type of stakeholder involved (women, their support persons, birth attendants, policy-makers), the experience itself (low-risk birth, transfer to hospital, previous deliveries), and by the health system within which home birth occurs (e.g., high-resource versus low- and middle-resource countries). Research evidence of stakeholders’ perspectives of home birth could usefully inform personal and policy decisions about choosing and providing home birth, but the current literature is fragmented and its breadth is not fully understood. We conducted a systematic scoping review to understand how the research literature on stakeholders’ perspectives of home birth is characterized in terms of populations, settings and identified issues, and what potential gaps exist in the research evidence. A range of electronic, web-based and key informant sources of evidence were searched. Located references were assessed, data extracted, and descriptively analyzed using robust methods. Our analysis included 460 full reports. Findings from 210 reports of studies in high-resource countries suggested that research with fathers and same-sex partners, midwives, and vulnerable populations and perspectives of freebirth and transfer to hospital could be synthesized. Gaps in primary research exist with respect to family members, policy makers, and those living in rural and remote locations. A further 250 reports of studies in low- and middle-resource countries suggested evidence for syntheses related to fathers and other family members, policy makers, and other health care providers and examination of issues related to emergency transfer to hospital, rural and remote home birth, and those who birth out of hospital, often at home, despite receiving antenatal care intended to increase healthcare-seeking behavior. Gaps in primary research suggest an examination is needed of perspectives in countries with higher maternal mortality and among first-time mothers and young mothers. Our scoping review identified a considerable body of research evidence on stakeholder perspectives of home birth. These could inform the complex factors influencing personal decisions and health system planning around home birth in both high- and low- and middle-resource countries. Future primary research is warranted on specific stakeholders worldwide and with vulnerable populations in areas of high maternal mortality

IL-10-conditioned dendritic cells, decommissioned for recruitment of adaptive immunity, elicit innate inflammatory gene products in response to danger signals

Dendritic cells (DCs) are the professional APCs of the immune system, enabling T cells to perceive and respond appropriately to potentially dangerous microbes, while also being able to maintain T cell tolerance toward self. In part, such tolerance can be determined by IL-10 released from certain types of regulatory T cells. IL-10 has previously been shown to render DCs unable to activate T cells and it has been assumed that this process represents a general block in maturation. Using serial analysis of gene expression, we show that IL-10 pretreatment of murine bone marrow-derived DCs alone causes significant changes in gene expression. Furthermore, these cells retain the ability to respond to Toll-like receptor agonists, but in a manner skewed toward the selective induction of mediators known to enhance local inflammation and innate immunity, among which we highlight a novel CXCR2 ligand, DC inflammatory protein-1. These data suggest that, while the presence of a protolerogenic and purportedly anti-inflammatory agent such as IL-10 precludes DCs from acquiring their potential as initiators of adaptive immunity, their ability to act as initiators of innate immunity in response to Toll-like receptor signaling is enhanced

Henry J. Kaiser Family Foundation; National Alliance of State and Territorial AIDS Directors - National ADAP Monitoring Project Annual Report

Based on a survey of AIDS Drug Assistance Programs (ADAPs), which provide prescription drugs to low-income, uninsured, and underinsured HIV/AIDS patients, provides an overview of ADAPs' operations, developments, challenges, and policy and program changes