Plain language summary

Thrombolysis for acute ischemic stroke
Database of Systematic Reviews 2014, Issue 7. Art. No.: CD000213

Most strokes are due to blockage of an artery in the brain by a blood clot. Prompt treatment with thrombolytic drugs can restore blood flow before major brain damage has occurred and improve recovery after stroke in some people. Thrombolytic drugs, however, can also cause serious bleeding in the brain, which can be fatal.
One drug, recombinant tissue plasminogen activator (rt-PA), is licensed for use in selected patients within 4.5 hours of stroke in Europe and within three hours in the USA. There is an upper age limit of 80 years in some countries, and a limitation to mainly non-severe stroke in others. Forty per cent more data are available since this review was last updated in 2009.

Authors’ conclusions
Thrombolytic therapy given up to six hours after stroke reduces the proportion of dead or dependent people. Those treated within the first three hours derive substantially more benefit than with later treatment. This overall benefit was apparent despite an increase in symptomatic intracranial hemorrhage, deaths at seven to 10 days, and deaths at final follow-up (except for trials testing rt-PA, which had no effect on death at final follow-up).
Further trials are needed to identify the latest time window, whether people with mild stroke benefit from thrombolysis, to find ways of reducing symptomatic intracranial hemorrhage and deaths, and to identify the environment in which thrombolysis may best be given in routine practice.

Plain language summary: …


an instance of technical jargon:
Unary splits (11:59)

Sleep disturbances caused by shift work (Cochrane, 2014)

Pharmacological interventions for sleepiness and sleep disturbances caused by shift work
Cochrane Database of Systematic Reviews 2014, Issue 8. Art. No.: CD009776

Shift work results in sleep-wake disturbances, which cause sleepiness during night shifts and reduce sleep length and quality in daytime sleep after the night shift. In its serious form it is also called shift work sleep disorder. Various pharmacological products are used to ameliorate symptoms of sleepiness or poor sleep length and quality.

Main results
Hypnotic medication, zopiclone, did not result in significantly longer daytime sleep length compared to placebo in one low quality trial and we could not use the data from the study on lormetazepam.

There is low quality evidence that melatonin improves sleep length after a night shift but not other sleep quality parameters.
Both modafinil and armodafinil increase alertness and reduce sleepiness to some extent in employees who suffer from shift work sleep disorder but they are associated with adverse events.
Caffeine plus naps reduces sleepiness during the night shift, but the quality of evidence is low.
Based on one low quality trial, hypnotics did not improve sleep length and quality after a night shift.

We need more and better quality trials on the beneficial and adverse effects and costs of all pharmacological agents that induce sleep or promote alertness in shift workers both with and without a diagnosis of shift work sleep disorder.
We also need systematic reviews of their adverse effects.

Lifestyle interventions in obese children (Cochrane, 2014)

Lifestyle intervention for improving school achievement in overweight or obese children and adolescents.
Cochrane Database Syst Rev. 2014 Mar 14;3:CD009728.
Martin A1, Saunders DH, Shenkin SD, Sproule J.

The prevalence of overweight and obesity in childhood and adolescence is high.
Excessive body fat at a young age is likely to persist into adulthood and is associated with physical and psychosocial co-morbidities, as well as lower cognitive, school and later life achievement.
Lifestyle changes, including reduced caloric intake, decreased sedentary behaviour and increased physical activity, are recommended for prevention and treatment of child and adolescent obesity.
Evidence suggests that lifestyle interventions can benefit cognitive function and school achievement in children of normal weight.
Similar beneficial effects may be seen in overweight or obese children and adolescents.

To assess whether lifestyle interventions (in the areas of diet, physical activity, sedentary behaviour and behavioural therapy) improve school achievement, cognitive function and future success in overweight or obese children and adolescents compared with standard care, waiting list control, no treatment or attention control.

Despite the large number of childhood obesity treatment trials, evidence regarding their impact on school achievement and cognitive abilities is lacking.
Existing studies have a range of methodological issues affecting the quality of evidence.
Multicomponent interventions targeting physical activity and healthy diet could benefit general school achievement, whereas a physical activity intervention delivered for childhood weight management could benefit mathematics achievement, executive function and working memory.
Although the effects are small, a very large number of children and adolescents could benefit from these interventions. Therefore health policy makers may wish to consider these potential additional benefits when promoting physical activity and healthy eating in schools.
Future obesity treatment trials are needed to examine overweight or obese children and adolescents and to report academic and cognitive as well as physical outcomes.

A lifestyle intervention in preschool children (Ballabeina)

Influence of a lifestyle intervention in preschool children on physiological and psychological parameters (Ballabeina): study design of a cluster randomized controlled trial.
BMC Public Health. 2009 Mar 31;9:94.
Niederer I1, Kriemler S, Zahner L, Bürgi F, Ebenegger V, Hartmann T, Meyer U, Schindler C, Nydegger A, Marques-Vidal P, Puder JJ.

Childhood obesity and physical inactivity are increasing dramatically worldwide.
Children of low socioeconomic status and/or children of migrant background are especially at risk.
In general, the overall effectiveness of school-based programs on health-related outcomes has been disappointing.
A special gap exists for younger children and in high risk groups.

This paper describes the rationale, design, curriculum, and evaluation of a multicenter preschool randomized intervention study conducted in areas with a high migrant population in two out of 26 Swiss cantons. Twenty preschool classes in the German (canton St. Gallen) and another 20 in the French (canton Vaud) part of Switzerland were separately selected and randomized to an intervention and a control arm by the use of opaque envelopes.
The multidisciplinary lifestyle intervention aimed to increase physical activity and sleep duration, to reinforce healthy nutrition and eating behavior, and to reduce media use.
According to the ecological model, it included children, their parents and the teachers.
The regular teachers performed the majority of the intervention and were supported by a local health promoter. The intervention included physical activity lessons, adaptation of the built infrastructure; promotion of regional extracurricular physical activity; playful lessons about nutrition, media use and sleep, funny homework cards and information materials for teachers and parents. It lasted one school year. Baseline and post-intervention evaluations were performed in both arms. Primary outcome measures included BMI and aerobic fitness (20 m shuttle run test).
Secondary outcomes included total (skinfolds, bioelectrical impedance) and central (waist circumference) body fat, motor abilities (obstacle course, static and dynamic balance), physical activity and sleep duration (accelerometry and questionnaires), nutritional behavior and food intake, media use, quality of life and signs of hyperactivity (questionnaires), attention and spatial working memory ability (two validated tests). Researchers were blinded to group allocation.

The purpose of this paper is to outline the design of a school-based multicenter cluster randomized, controlled trial aiming to reduce body mass index and to increase aerobic fitness in preschool children in culturally different parts of Switzerland with a high migrant population.

The CON group continued to follow their usual school curriculum which included one 45 min physical education lesson taught by the classroom teachers and one 45 min rhythmic lesson (given by a rhythmic specialist)

… PA lessons were given four times a week including 40 min lessons and 5 min cool down.

…Results of the intervention will be available in 2010.

Urie Bronfenbrenner

iLearn II (2012)

iLearn II
An Analysis of the Education Category of Apple’s App Store
Carly Shuler
January 2012
The Joan Ganz Cooney Center at Sesame Workshop

Create standards for products marketed as educational
Previous analyses of children’s digital media have identified a lack of standards around marketing products as educational, making it difficult for parent or educators to discern if products live up to their claims (Shuler, 2007). This has been a long-­‐standing issue in the educational toy and game industry, and perhaps one that can be tackled early in the evolution of the app market.

Protect Children from Digital Age Commercialism
The Children’s Television Act was put in place to protect children from inappropriate commercialism. This act needs to be updated for a digital age with an emphasis on the app market. In the long term, apps will be better for children, parents and businesses alike if there are policies that protect without hindering creative development and innovation.

Set a research agenda Academia needs to address the rapidly growing app market by setting a research agenda regarding digital age learning. Developers and researchers should work together toward the design of effective, high-­‐quality products.

The consumer marketplace for apps consists not only of Apple’s App Store, but the burgeoning Android Market and key players like Microsoft, Samsung, RIM and others must be considered. Furthermore, apps are just one slice of the rich digital media world that today’s children are growing up in. Where do the LeapPad, Innotab, and VINCI Jit in? eReaders? How about the DS? Clearly, this is a complex market -­‐ all the more reason this analysis is necessary.

In July of 2011, The Joan Ganz Cooney Center compiled a sample of 200 apps that included the 100 top-­‐selling paid apps for both the iPad and iPhone in the Education category of the iTunes App Store.
{How on earth did they select the other 100? Currently there are 150 listed.}

This is a market analysis, not empirical research about the educational effectiveness of apps in the sample or apps in general. App category in iTunes is designated by the app developer.

with over 500,000 apps on Apple’s App Store and another 300,000 on the Android Market

Moms With Apps, a collaborative group of developers seeking to promote quality apps for kids and families.

Developers: Respect the Sanctity of Childhood and Play
7. Do not disguise costs or manipulate children’s emotions to entice spending
{bibliography on monetization strategies on blog}

Literacy apps are surprisingly sparse
There are surprisingly few apps in the literacy category.
From this analysis, it is impossible to discern whether there are apps available in these subjects that are not being purchased, there is a dearth of such apps available, or whether these apps may be in a different section of the iTunes Store (such as in the eBooks). However, it seems reasonable to suggest that this may be an underserved market and represent an opportunity for developers.

Over 12 years ago, pediatric immunologist Dr. Avraham Kadar, M.D. was spending a significant amount of time explaining how the body works to his young patients and their families, and found that animation could be helpful in understanding difficult concepts. That finding led to the creation of BrainPOP

the devices (and iTunes) are primarily consumer-­‐ and not institutional-­‐focused

Assessing quality and learning value is difficult in the educational app market
There are currently no Jirm and independently verified standards of educational value in the app market, and there is a dearth of empirical evidence about the effectiveness of apps for learning. To help assess overall quality of the sample of best-­‐selling apps in the Education category of the iTunes App Store, third party sources including Children’s Technology Review (CTR), Common Sense Media (CSM) and a consumer rating on iTunes were consulted.

More than half of the apps were not rated by either expert source Only 27 apps (14%) out of the entire sample were rated by Children’s Technology Review, which currently has the most rigorous review instrument.
Common Sense Media has rated more apps (43%).

NAEYC & Fred Rogers Center Quality Statement

The CTIA Mobile Application Rating System with ESRB

Create standards for products marketed as educational

By Jennifer Kotler

Childhood Disability: changing trends

What’s Behind The Stark Rise In Children’s Disabilities
August 19, 2014

A recent study finds that the rate of children diagnosed with a disability is rising — particularly among kids who come from a more affluent background. Dr. Amy Houtrow was one of the lead authors on the study, and she speaks with Audie Cornish.

Six million – that’s how many children are considered disabled in the U.S. today, a nearly 16 percent increase from a decade ago. And what accounts for that rise is explained in a new study out this week in the journal Pediatrics. The research shows that while physical disabilities are down, neurodevelopmental or mental health conditions are up, especially among children from more affluent families.

undetected bias. In what way and what’s your basis for that assessment?

HOUTROW: There’s quite a bit of literature that supports the idea that the way physicians and health care providers approach families differs in terms of what the family brings to the table and the encounter. So a family from a more affluent background is able to articulate their concerns and their needs in a different way. That might raise the suspicion of the doctor to look for the condition, to make a diagnosis and recommend treatment. On the flipside, a family who is less affluent might not bring to the attention of the provider in the same way, nor may the provider ask the questions that would lead them down the path of making a diagnosis of a developmental problem or mental health problem.

original paper:
Changing Trends of Childhood Disability, 2001–2011
Pediatrics. 2014 Aug 18. pii: peds.2014-0594.
Amy J. Houtrow, MD, PhD, MPH, et al.
CONCLUSIONS: Over the past decade, parent-reported childhood disability steadily increased. As childhood disability due to physical conditions declined, there was a large increase in disabilities due to neurodevelopmental or mental health problems. For the first time since the NHIS began tracking childhood disability in 1957, the rise in reported prevalence is disproportionately occurring among socially advantaged families. This unexpected finding highlights the need to better understand the social, medical, and environmental factors influencing parent reports of childhood disability.

Key Words: disability
activity limitations

Dimitri Christakis: Media and Children (2011)

Dimitri Christakis – Media and Children
TEDxRainier. Dec 27, 2011

Dimitri Christakis is a pediatrician, parent, and researcher whose influential findings are helping identify optimal media exposure for children.

Baby Einstein: Baby MacDonald
there were 17 scene changes; about one every three seconds …
and of course, it’s nothing like being on a real farm, right?
Adults watching this find it confabulating because your mind is trying to make a coherent narrative out of this. And there is no coherent narrative, it jumps all over the place!

Innatention_in_later_lifeThe Overstimulation Hypothesis:
Prolonged exposure to rapid image change during critical period of brain development ->
Precondition mind to expect high levels of stimulation ->
Innatention in later life.

13:12 Novel Object Recognition

13:49 Overstimulated mice either don’t remember which object is novel or don’t care. But one way or another, they were not learning, not acting like normal mice.

14:15 Building Blocks Study
Parents got “blocktivities”

promoting interactive play promoted language development

If we change the beginning of the story, we change the whole story.

an illustrative example: League of Legends

When It Comes to Kids, Is All Screen Time Equal?
Dimitri Christakis, MD
September 11, 2015
The way our brain is stimulated matters, especially when we’re young. Our brains are being shaped by that stimulation.
typical passive media
“I did it”: how important it is to their cognitive and social development

The Road (2009)

The Road (2009)

Original film score by: Nick Cave & Warren Ellis

He walked back into the woods and knelt beside his father. He was wrapped in a blanket as the man had promised and the boy didn’t uncover him but he sat beside him and he was crying and he couldn’t stop. He cried for a long time. I’ll talk to you every day, he whispered. And I wont forget. No matter what. Then he rose and turned and walked back out to the road.

You do the best you can

Adapting to the Possibilities of Life
by Donald Rosenstein, MD
April 27, 2008

I believe in adaptation — that is, the same stimulus does not invariably elicit the same response over time.

The first time I saw my son flap his arms, I nearly threw up.
My son Koby was 2 at the time, and he and my wife and I were at an evening luau in Hawaii. Dancers emerged from the dark twirling torches to loud, rhythmic drumbeats. I thought it was exciting and so did Koby. He began to flap his arms — slowly, at first, and then with an intensity that mirrored the movement of the dancers.
In an instant, I was overwhelmed. I knew just enough about arm-flapping to know that it was characteristic of autism. I was confused, panicked and strangely preoccupied with the fear that I would never play tennis with my son as I had with my father.

I believe that “reframing a problem” can help to overcome it. But adaptation is not the same as becoming tolerant of or inured to something. Adaptation allows for creative possibilities.

before he adapted to his son’s illness, he wouldn’t always know how to respond when his very sick patients would tell him, I just don’t know what to do. Now his answer is, you do the best you can.