A crystallography educational outreach activity was developed and implemented in the US kindergarten level (K) (5-6 years old), which included writing and illustrating a new children's book about crystallography titled, X-ray Crystallography Adventures! Cat & Elephant's Sugar Crystal Mystery. The outreach activity included four rotating centers that encompassed hands-on crystallization experiments, observing crystals under microscopes, learning about the crystallography process through coloring, and connecting crystallography to life through reading. Detailed descriptions of the centers and overall activity should enable the ready adoption of this model by others for encouraging young children to engage with and learn about crystallography. >.
Introduction The prognosis of myeloid leukaemia associated with Down syndrome (ML-DS) is excellent with reduced-intensity chemotherapy; however, that of refractory or relapsed ML-DS remains dismal. These contrasting outcomes highlight the importance of risk-stratified therapy, based on reliable prognostic factors, to prevent treatment-related mortality and relapse. In addition, novel therapeutic strategies capable of overcoming the poor prognosis of high-risk patients are eagerly anticipated. Based on the results of molecular analyses, in vitro functional assays and anecdotal case reports, azacitidine (AZA), a hypomethylating agent, is a promising candidate for novel therapeutic strategies for high-risk ML-DS. Methods and analysis In this multicentre, single-arm phase II clinical trial, the Japan Children's Cancer Group AML-D24, we will stratify patients with newly diagnosed ML-DS according to age at diagnosis, GATA1 mutation status and treatment response. Patients <24 months of age at the diagnosis with a GATA1 mutation who achieve morphological complete remission and are negative for flow cytometric measurable residual disease at the end of induction will be classified as the low-risk (LR) group and receive less intensive chemotherapy. The other participants, stratified into the non-LR group, will be treated with AZA-combined chemotherapy. The objective of this trial is to evaluate the efficacy and safety of AZA-combined chemotherapy in children with non-LR ML-DS. The primary endpoint is the 3-year event-free survival in the non-LR group. The planned enrolment is 145 patients, including 47 non-LR patients. The study period consists of a 7-year accrual period (including an enrolment suspension period for interim analysis) followed by a 3-year follow-up period for a total duration of 10 years. Ethics and dissemination This study was approved by the National Hospital Organization Review Board for Clinical Trials (Nagoya, Japan) on 12 May 2025 and was registered in the Japan Registry of Clinical Trials (https://jrct.mhlw.go.jp/latest-detail/jRCTs041250031). Written informed consent will be obtained from all patients and/or their guardians. The results of this study will be disseminated through publication in peer-reviewed journals and presentation at national and international scientific conferences. Trial registration number jRCTs041250031.
Background Children exposed to parental violence (CEPV) may experience a range of adverse outcomes compared to non-exposed peers yet may demonstrate resilience shaped by both internal and external protective factors. Objective To longitudinally explore the profiles of protective factors in children across the continuum of resilience (i.e., low, moderate, high, and exceptional). Participants and setting Parent-reported data were collected on behalf of 211 CEPV (Mage = 10.11, SD = 2.21) residing across Canada. Methods Grounded in Resiliency Theory, this longitudinal study used online surveys administered at three timepoints to assess children's resilience and protective factors. Results Decision tree modelling at baseline found that children with exceptional resilience were more likely to have better health (χ2 = 56.23, p < 0.001), with whole-family support further bolstering resilience (χ2 = 20.66, p < 0.001; χ2 = 21.76, p < 0.001). At T2, exceptional resilience was associated with perceiving child welfare services as supportive (χ2 = 76.55, p < 0.001), with additional benefits from economic support (χ2 = 35.08, p < 0.001). At T3, high resilience was linked to perceived supportiveness of therapy services (χ2 = 122.91, p < 0.001), further strengthened by caregiver perceptions of women's shelter support (χ2 = 25.55, p < 0.001). Conclusions These findings suggest that supporting CEPV resilience requires attention to individual assets, safety and stability needs, and access to supportive services addressing violence exposure. This underscores the necessity of trauma- and violence-informed, integrated approaches that extend beyond individual- and family-level factors.
Background Pediatric pelvic floor dysfunction is a common cause of lower urinary tract symptoms and bowel dysfunction in children, requiring accurate and reliable educational resources for patients and caregivers. With the increasing use of online health information, both YouTube (Google LLC, Mountain View, CA, USA) and artificial intelligence (AI) chatbots have become frequently used sources of medical guidance. This study aimed to evaluate and compare the educational quality, reliability, and safety of YouTube videos and AI-generated responses related to pediatric pelvic floor dysfunction. Materials and methods In this cross-sectional infodemiology study, YouTube was searched using five predefined pediatric pelvic floor-related search terms, and the first 50 videos for each term were screened. After duplicate removal and eligibility assessment, 25 videos were included for analysis. Three publicly available AI chatbots (ChatGPT (OpenAI, San Francisco, CA, USA), Gemini (Google LLC, Mountain View, CA, USA), and Copilot (Microsoft Corporation, Redmond, WA, USA)) were evaluated using a standardized set of 20 pediatric pelvic floor-related questions. Educational quality was independently assessed using the DISCERN instrument, the Global Quality Scale (GQS), and the Pediatric Pelvic Floor Education and Reliability Score (PPFERS), a pediatric-specific assessment tool developed for this study. Results The 25 included YouTube videos accumulated 447,398 total views. Physiotherapists or pediatric physical therapists were the most common content creators (44.0%), followed by healthcare institutions (28.0%). The mean DISCERN, GQS, and PPFERS scores for YouTube videos were 66.24 ± 8.64, 4.28 ± 0.74, and 16.88 ± 1.96, respectively. Among AI chatbots, Gemini achieved the highest educational quality scores (76.00 ± 1.92, 4.95 ± 0.22, and 19.35 ± 0.59), followed by ChatGPT (74.20 ± 2.40, 4.85 ± 0.37, and 18.60 ± 0.82) and Copilot (67.85 ± 2.03, 4.35 ± 0.49, and 17.10 ± 0.72). Overall, AI-generated responses demonstrated higher mean educational quality scores than the YouTube video cohort. Conclusions Both YouTube videos and AI-generated responses provided generally useful educational information regarding pediatric pelvic floor dysfunction. However, AI chatbots, particularly Gemini and ChatGPT, demonstrated greater educational consistency and closer alignment with contemporary pediatric urotherapy principles. AI-assisted educational tools may serve as valuable adjuncts to patient and caregiver education but should complement, rather than replace, professional medical evaluation and individualized clinical guidance.
Background Data on antipsychotic use for the Swedish paediatric population is limited. Objective We assessed the incidence, likely indication and extent of off-label antipsychotic use among children and adolescents in Sweden. Methods In this nationwide register-based study, individuals younger than 18 years with at least one antipsychotic dispensing between 1 January 2008 and 31 December 2021 were identified. Yearly age-standardised and sex-standardised incidence per 1000 persons was estimated and temporal trends were assessed using Poisson log-linear regression. We also assessed the likely indication and the proportion of on-label and off-label use. Findings Among 4 108 171 individuals who were children or adolescents at some point during the study period, 24 742 initiated antipsychotic treatment at least once, contributing 25 576 incident dispensings during the study period. Incidence increased from 0.48 to 1.28 per 1000 persons (risk ratio, RR per year 1.08, 95% CI 1.05 to 1.11; cumulative increase 180%), with a more pronounced rise in females (0.43 to 1.51 per 1000; RR 1.11, 95% CI 1.10 to 1.12; 284%) than males (0.53 to 1.06 per 1000; RR 1.06, 95% CI 1.05 to 1.07; 113%), driven by adolescents aged 12-17 years. The largest drug-specific increases were observed for quetiapine (0.04 to 0.33 per 1000; RR per year 1.18, 95% CI 1.17 to 1.19; cumulative increase 804%) and aripiprazole (0.03 to 0.36 per 1000; RR per year 1.16, 95% CI 1.14 to 1.18; cumulative increase 608%). A likely indication was identified in 64.3% (n=16 455) of incident dispensings, most commonly autism spectrum disorder (15.4%), attention-deficit hyperactivity disorder (10.9%) and anxiety disorders (9.6%). Among those with an identifiable indication, 81% were dispensed off label, mainly due to non-approved indications (64.8%) and most frequently among adolescent females. Conclusions In the paediatric population in Sweden, incidence of antipsychotic use increased between 2008 and 2021, especially among adolescent females and most incident dispensing with an identifiable indication were off label, underscoring the need to evaluate the long-term effectiveness and safety of antipsychotics in children and adolescents. Clinical implications These patterns highlight the need to evaluate the long-term effectiveness and safety of antipsychotics in children and adolescents.
Background Children with life-limiting or life-threatening conditions who are eligible for paediatric palliative care often have complex care needs. However, they prefer to live as normally as possible, which necessitates coordinated and multidisciplinary support that allows them to be at home rather than in a hospital. Advancements in technology have the potential to support home-based care, yet little is known about children's own communication needs, their views on home-based care and the possibilities of technology to support communication. Previous research has primarily focused on the views of parents and healthcare professionals. Consequently, this study aimed to explore what children with life-limiting or life-threatening conditions find important in communication with healthcare professionals and others and the role of technology in daily life. Methods This qualitative study employed an exploratory design and used individual semi-structured interviews with children eligible for paediatric palliative care. Seven children aged 8-15 years with life-threatening or life-limiting conditions participated. The data were analysed using reflexive thematic analysis. Results Three themes were developed: (1) understanding technology through daily life rather than in the frame of healthcare, (2) technology has the potential to be a digital bridge to normalcy and social belonging and (3) seeking information and safety through in-person meetings. Conclusion Children with life-limiting or life-threatening conditions place a high value on in-person communication with healthcare professionals, emphasising the need for safety, predictability and clear information, particularly when medical procedures are involved. The findings highlight gaps in children's involvement in decision-making and underscore the importance of including children's perspectives when developing communication strategies and technologies to support home-based paediatric palliative care. These children primarily associated technology with gaming and everyday social interactions. They had little experience with technology in their healthcare follow-up and were unfamiliar with possibilities for use in the context of communication with healthcare professionals.
Introduction Lower respiratory tract infections (LRTIs) remain a major global health problem and a leading cause of childhood morbidity and mortality worldwide. Inappropriate antibiotic use for predominantly viral LRTIs is common and contributes substantially to the public health threat of antimicrobial resistance. Lung ultrasound (LUS) is a radiation-free, bedside imaging tool with high diagnostic accuracy for paediatric pneumonia. We hypothesise that integrating LUS into the care of children hospitalised with LRTIs can improve antibiotic decision-making and safely reduce unnecessary antibiotic prescriptions. Methods and analysis The PLUS-AP trial is an ongoing phase III, single-centre, blinded, parallel-group randomised controlled superiority trial conducted at a tertiary hospital in Beirut, Lebanon. Children aged 3 months to 18 years hospitalised with LRTI are randomly assigned (1:1) to LUS-guided management or to standard care with a sham lung ultrasound. In the intervention group, LUS is performed within 24 hours of admission and repeated around 48 hours later or before discharge, and the findings are shared with the treating team to inform management. The control group receives standard clinical evaluation, including chest X-ray as indicated, plus a non-diagnostic sham lung ultrasound. The primary outcome is antibiotic prescription at hospital discharge. Secondary outcomes are hospital length of stay; intensive care unit admission, chest tube insertion, mortality, hospital readmission, frequency of chest radiography performance and antibiotic use for LRTIs, all assessed within 4 weeks after enrolment. A total of 176 participants (88 per arm) will provide adequate power to detect a clinically important reduction in antibiotic prescribing, and analyses will follow the intention-to-treat principle with one planned interim analysis at 50% recruitment. Ethics and dissemination The study protocol has been approved by the Institutional Review Board at the American University of Beirut (BIO-2024-0304). Written informed consent (and assent, when applicable) will be obtained for all participants. A Data and Safety Monitoring Committee will oversee patient safety and review interim results. Results will be disseminated through peer-reviewed publications, scientific conferences and targeted outreach to clinical and public health stakeholders to facilitate translation of the findings into routine practice. Trial registration number NCT06876766.
Problem Across low- and middle-income countries (LMICs), an estimated 1.7 billion children lack access to safe surgical and perioperative care. In Latin America, pediatric postoperative mortality remains several-fold higher than in high-income countries, driven largely by preventable airway and critical-care complications. Following the death of an infant after an unplanned extubation in El Salvador, system-level gaps in airway safety, sedation, and communication were identified, motivating development of a scalable intervention to strengthen postoperative critical care for intubated children. Setting This work was designed at Hospital Nacional de Niños Benjamín Bloom, in San Salvador and subsequently tested at Fundación Hospital Infantil Napoleón Franco Pareja in Cartagena, Colombia. Both institutions faced high unplanned extubation rates, variable airway-safety practices, and limited structured training. Approach Using Ariadne Labs ARC (Design-Test-Scale) implementation pathway, we created a bilingual, online pediatric airway and critical-care curriculum alongside a telesimulation-based emergency team-training program. Forty-five short, multilingual video modules addressed airway management, sedation, respiratory therapy, nursing priorities, and teamwork. Remote, high-fidelity simulation reinforced crisis resource management and role clarity, with local champions trained to run courses independently. Results In El Salvador, early implementation was associated with reductions in unplanned extubations and PICU mortality. In Colombia, 101 clinicians completed the curriculum and 39 completed telesimulation training, with mortality declining from 22.4% to 9.5% post-intervention. Lessons learned A combined digital curriculum and telesimulation model can strengthen airway safety, communication, and crisis readiness in resource-constrained PICUs. Following successful design and testing, the model is positioned for scale across LMIC pediatric intensive care settings.
Background Children are particularly vulnerable to healthcare-associated harm. Parents play a vital but under-recognised protective role in paediatric patient safety. Parent perceptions of and contributions to safety improvement efforts within hospital settings are well documented, but little is known about parent experiences and perspectives in primary care. Aim To explore diverse parental perspectives on paediatric safety in primary care and identify target areas for improvement. Design and setting This qualitative study in UK primary care was conducted through online (n = 2) and in-person (n = 2) workshops with parents, taking place between 24 June and 8 July 2024. Method Workshops were structured around a descriptive analysis of paediatric patient safety incident reports in general practice. Parents discussed and reflected on their own experiences in relation to the findings. Transcripts and field notes were analysed thematically to identify key themes. Results Parents (n = 33) from varied backgrounds, including under-served communities, participated. Three major themes were identified: responsibility of care, highlighting perceived unclear roles between parents and healthcare teams; navigating the system, where parents described the need to 'fight' for care and the challenges of understanding healthcare processes; and communication and language, emphasising the difficulties of being heard, especially among ethnic minority parents and those lacking the confidence to speak up. Conclusion Parent perspectives on paediatric safety in primary care have highlighted key areas for practices, researchers, and safety improvement teams to target system change and intervention development. Engaging parents as co-designers in these efforts could enhance trust, reduce risk, and improve safety outcomes for paediatric patients.
Purchase T, Quinn-Scoggins HD, McFadzean IJ et al.
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides food assistance and nutrition education for pregnant and postpartum women and children younger than age five in low-income households. State policy changes implemented during the COVID-19 pandemic aimed to increase WIC access. This study used national administrative data from the period January 2017-March 2021 and a quasi-experimental difference-in-differences approach to assess the associations between five state-level policy changes and WIC participation rates overall and among women, children (ages 1-4), and infants (under age 1) (N = 2,550 state-months). Remote WIC benefit issuance increased participation rates: States that allowed remote benefit issuance experienced a 10 percent relative increase in total WIC participation compared with states that did not. No other policy changes were independently associated with participation, which may be related to difficulty disentangling single policy effects during the pandemic. Findings from this study suggest that policy makers should consider removing barriers to safety-net programs to increase participation rates among eligible people.
