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6-10.7) developed anxiety during follow-up. The incidence density of anxiety was 18 new cases per 1000 person-years at risk. The change in alanine aminotransferase was significantly worse for adolescents with NAFLD who developed depression compared to those who did not develop depression (P < 0.01).

Adolescents with NAFLD had a high incidence of clinically diagnosed depression and anxiety. The rates were higher than expected relative to the available data in the general population. Addressing this mental health burden will require efforts at both the patient level and the systems level.

Adolescents with NAFLD had a high incidence of clinically diagnosed depression and anxiety. The rates were higher than expected relative to the available data in the general population. Addressing this mental health burden will require efforts at both the patient level and the systems level.

The aim of the study was to assess the neurological status in infants with biliary atresia (BA) at time of diagnosis, using Prechtl's validated General Movement Assessment.

Infants diagnosed with BA were prospectively included in a nationwide cohort study. From birth to approximately 46 weeks of postmenstrual age (PMA), general movements (GMs) are defined as "writhing movements." At 46 to 49 weeks PMA, "'fidgety movements" emerge. The infant's early motor repertoire was recorded on video before Kasai portoenterostomy. We scored GM optimality scores (min-max 5-42) or motor optimality scores (MOS, min-max 5-28) as appropriate. We defined GM optimality scores <36 and MOS <26 as atypical, and compared the results with 2 reference groups of healthy peers.

We assessed GMs in 35 infants with BA (11/35 boys, gestational age 40 weeks [36-42], birth weight 3370 g [2015-4285]). At time of diagnosis (PMA 47 weeks [42-60]), 16 infants (46%) showed atypical GMs. The proportion of infants with atypical GMs was significantly higher in BA (46%) than in 2 reference groups of healthy infants (vs 10%, P < 0.001; vs 18%, P < 0.001). Total and direct bilirubin levels were 165 μmol/L (87-364) and 134 μmol/L (72-334), respectively, height z score was 0.05 (-2.90, 1.75), weight z score -0.52 ([-2.50, -0.20) and mean upper arm circumference z score -1.80 (-2.50, -0.20). We found no statistically significant relation between atypical GMs and clinical variables.

Almost half of the infants with BA showed atypical GMs at time of diagnosis, suggesting neurological impairment. Close monitoring of these infants is warranted to determine their individual neurodevelopmental trajectories.

Almost half of the infants with BA showed atypical GMs at time of diagnosis, suggesting neurological impairment. Close monitoring of these infants is warranted to determine their individual neurodevelopmental trajectories.Although the rate of breastfeeding initiation in the United States has continued to rise since 1972, African American mothers continue to experience a significant disparity in initiation. The aim of this study was to explore the perceptions of the facilitators and barriers of breastfeeding initiation among African American mothers from the perspective of subject matter experts (SMEs). This study was part of a larger study that also involved focus group methodology with African American women. The purpose of this article is to describe the opinions, knowledge, and perceptions of SMEs who work with African American mothers. DNQX clinical trial A semistructured interview guide was used to interview 7 SMEs at which point no new themes emerged from the data. SMEs highlighted the significance of modifiable factors in breastfeeding initiation decisions and validated many perceptions of African American mothers. SMEs identified many critical issues foundational to community perspective and shaping future success in raising breastfeeding initiation rates. To increase breastfeeding initiation rates among African American mothers, strategies beyond the individual level are necessary. SMEs recognize the importance of addressing fundamental issues related to historical perspectives, normalization, education, and disparities in breastfeeding as critical.

The COVID-19 pandemic is forcing society to re-evaluate how it educates learners of all levels, from medical students to faculty. Travel restrictions and limits on large public gatherings have necessitated the cancelling of numerous regional and national conferences as well as local grand rounds at many academic centers. Podcasting provides a potential solution for providing CME in a safe, socially distant way as an alternative to these more traditional CME sources for health care professionals. Using a popular CME podcast for pediatric hospitalists as an example, this article describes the many advantages that podcasting poses over more traditional CME methods, outlines some of the methodological and technological considerations that go into creating a high-quality podcast, and describes how podcasting can be leveraged during a global pandemic. Finally, we identify areas for further research regarding podcasting, including effective ways to virtually replace the more social and community building aspects ore social and community building aspects of traditional conferences and grand rounds.

The aims of this retrospective study were to assess the value of the quantitative analysis of apparent diffusion coefficient (ADC) and proton magnetic resonance spectroscopy (1H-MRS) metabolites in differentiating grades of pediatric gliomas.

Two hundred and nine pathology-confirmed pediatric gliomas (143 low-grade gliomas [LGGs] and 66 high-grade gliomas [HGGs]) were retrospectively analyzed on preoperative diffusion-weighted magnetic resonance imaging, of which 84 also underwent 1H-MRS. The mean tumor ADC (ADCmean), minimum tumor ADC (ADCmin), tumor/normal brain ADC ratio (ADC ratio), and metabolites (choline/creatine ratio [Cho/Cr], N-acetylaspartate/creatine ratio [NAA/Cr], N-acetylaspartate/choline ratio [NAA/Cho], presence of lactate and lipid peaks) between LGGs and HGGs were analyzed.

There were significant negative correlations between the ADC values and glioma grade. Receiver operating characteristic analysis showed that the cutoff ADCmean value of 1.192 × 10-3 mm2/s for the differentiation between low- and high-grade pediatric gliomas provided a sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of 77.