De‐Escalating Medical Evaluation for Kidney Transplantation: A Potential Avenue to Improve Access to Kidney Transplantation

ABSTRACT There is broad agreement among the US public, medical community, and policy community on a top priority to expand kidney transplantation to more patients while promoting quality and equity. How to achieve these goals within existing health systems is the key question. Essential to successful kidney transplantation is a proper pretransplant medical evaluation. However, an increasing body of evidence suggests that this process can be burdensome to patients and caregivers, resource‐intensive for transplant programs and the healthcare system, and potentially perpetuate inequity in transplant access—all factors running counter to the objectives of improving transplant access. A strategy of systematically reducing the number or intensity of testing procedures—or de‐escalation—that is supported by available medical evidence and clinical consensus holds promise as a potential avenue to improve transplant access. In this perspective, we outline the rationale for de‐escalation of portions of the pretransplant medical evaluation for kidney transplantation, apply an implementation science framework to systematically examine the barriers and facilitators for de‐escalation, and finally lay out a blueprint for how de‐escalation may be achieved in an efficacious, safe, and sustainable manner.

Grading Melanocytic Dysplasia: Updated Histopathologic Criteria

ABSTRACT Dr. Martin C. Mihm, Jr.'s innovative work on the dysplastic nevus achieved a milestone in his chapter in the World Health Organisation Classification of Skin Tumours (WHO‐C). WHO‐C presents a dichotomous classification (high‐grade versus low‐grade dysplastic nevi) and a quantitative metric to assess melanocytic nuclear enlargement. The Duke classification is a related approach that provides mostly quantitative histopathologic criteria for dysplastic nevi and gives due weight to architectural features as well as cytology. This paper proposes and illustrates updated criteria for scoring and grading melanocytic dysplasia, incorporating some of the definitions and categories of WHO‐C, while refining the quantitative and architectural elements of the Duke grading system to facilitate more detailed and precise assessment of dysplastic nevi.

Climate Change Will Resize and Reshape Plant–Hummingbird Networks in the Atlantic Forest

ABSTRACT Aim To assess how climate change could reshape plant–hummingbird interaction networks in the Atlantic Forest by predicting shifts in species co‐occurrence and evaluating changes in network structure. Location Atlantic Forest, South America. Methods We used ecological niche modelling to predict changes in the co‐occurrence of plants and hummingbirds under climate change scenarios. Modelled networks were analysed to compare network metrics, such as network size, number of links, niche overlap and robustness, between present and future conditions. We also simulated species extinctions to assess network resilience. Results Future local networks showed lower species richness, reduced size, fewer links and shared partners, increased niche overlap and decreased robustness. While network robustness improved under simulated plant and secondary hummingbird extinctions, future networks exhibited reduced resilience to species loss. Plants had higher niche overlap than hummingbirds, making them more vulnerable to secondary extinctions driven by hummingbird losses. Main Conclusions Climate change is expected to drive shifts in species co‐occurrence, leading to novel assemblages and structural changes in plant–hummingbird interaction networks. These alterations will likely decrease network robustness and resilience, highlighting potential cascading effects on ecosystem function. Our findings contribute to understanding the impacts of climate change on mutualistic networks and ecosystem stability in the Atlantic Forest and beyond.

Early Emergence of Spontaneous Trait Content in Children's Unconstrained Impressions of Faces

ABSTRACT We investigated children's spontaneous impressions of faces; a question critical for understanding the developmental trajectory of facial stereotypes. Adults and children aged 4 to 10 from the UK (children: n = 59, adults: n = 61) and the US (children: n = 189, adults: n = 180) described what they thought when viewing each of the four child's faces. Natural language processing was used to classify free‐response descriptors into categories related to traits, emotions, social groups, and appearance. This approach captured over 90% of children's and adults’ impressions. The vocabulary and the prevalence of descriptors related to each of the four categories were comparable across two samples that differed in participant and face diversity. Across childhood, trait descriptors increased, with 14 impressions emerging as the top trait words used across both samples. Notably, children as young as four spontaneously formed trait impressions, suggesting an early emergence of facial stereotyping. Summary Children and adults spontaneously mention personality traits when viewing unfamiliar child faces. Children as young as four mentioned personality traits, and the frequency of trait references increased across childhood. The results converged across two samples that differed in terms of participant and face diversity and the use of real versus AI‐generated faces. These findings demonstrate the relevance of trait impressions in early childhood and underscore the importance of increasing diversity in face perception research.

The contribution of biopsychosocial factors to daily participation: Why do we still relegate psychosocial processes to a secondary role?

This commentary is on the original article by Zaguri‐Vittenberg et al. To view this paper visit   https://doi.org/10.1111/dmcn.16302

Incidence of developmental disorders and special educational needs and disabilities in children in the UK

Abstract Aim To investigate the incidence of developmental disorders (including cerebral palsy, attention‐deficit/hyperactivity disorder, and autism spectrum disorder) and special educational needs provision and to explore associations with gestational age and ethnicity. Method Cumulative incidence of developmental disorders and special educational needs provision up to age 12 years/end of school year 7 respectively was explored using multivariable logistic regression in the Born in Bradford cohort, UK. Incidence rates of individual developmental disorders were calculated. Results There were 13 172 children included in the analysis cohort. Birth before full term was associated with increased odds of developmental disorder compared with birth at full term: adjusted odds ratio (aOR) for those born before 34 weeks 2.22 (95% confidence interval [CI] 1.58–3.12); 34 to 36 weeks aOR 1.43 (95% CI 1.12–1.81); 37 to 38 weeks aOR 1.18 (95% CI 1.03–1.34). Effect sizes were larger among Pakistani heritage children: aOR for those born before 34 weeks 2.59 (95% CI 1.55–4.33); 34 to 36 weeks aOR 1.57 (95% CI 1.08–2.27); 37 to 38 weeks aOR 1.29 (95% CI 1.06–1.56). Unadjusted incidence rates of developmental disorders varied with ethnicity; compared with Pakistani heritage children, White British children had higher rates (per 1000 person‐years) of attention‐deficit/hyperactivity disorder (1.8, 95% CI 1.5–2.1 vs. 0.3, 95% CI 0.2–0.4), and lower incidences of learning disabilities (0.7, 95% CI 0.5–1.0 vs. 1.6, 95% CI 1.4–1.9). Interpretation Irrespective of ethnicity, children born before full term are at increased risk of developmental disorders and/or special educational needs.

Simplifying the language in the proposed description of cerebral palsy: Less is more

This letter to the editor is on the Proposed updated description of cerebral palsy by Dan et al. To view this paper visit   https://doi.org/10.1111/dmcn.16274 .

The distinction between the definition and description of cerebral palsy

This letter to the editor is on the Proposed updated description of cerebral palsy by Dan et al. To view this paper visit   https://doi.org/10.1111/dmcn.16274 .

Parity of esteem in neurodivergence

Physical activity (20 min) is a powerful adjunct to insulin for correcting hyperglycaemia in Type 1 diabetes: A paradigm shift