Encounters for SI and SA at US children's hospitals increased steadily from 2008 to 2015 and accounted for an increasing percentage of all hospital encounters. Increases were noted across all age groups, with consistent seasonal patterns that persisted over the study period. The growing impact of pediatric mental health disorders has important implications for children's hospitals and health care delivery systems.

The life-long addition of new neurons has been documented in many regions of the vertebrate and invertebrate brain, including the hippocampus of mammals (Altman and Das, 1965; Eriksson et al., 1998; Jacobs et al., 2000), song control nuclei of birds (Alvarez-Buylla et al., 1990), and olfactory pathway of rodents (Lois and Alvarez-Buylla, 1994), insects (Cayre et al., 1996) and crustaceans (Harzsch and Dawirs, 1996; Sandeman et al., 1998; Harzsch et al., 1999; Schmidt, 2001). The possibility of persistent neurogenesis in the neocortex of primates is also being widely discussed (Gould et al., 1999; Kornack and Rakic, 2001). In these systems, an effort is underway to understand the regulatory mechanisms that control the timing and rate of neurogenesis. Hormonal cycles (Rasika et al., 1994; Harrison et al., 2001), serotonin (Gould, 1999; Brezun and Daszuta, 2000; Beltz et al., 2001), physical activity (Van Praag et al., 1999) and living conditions (Kemperman and Gage, 1999; Sandeman and Sandeman, 2000) influence the rate of neuronal proliferation and survival in a variety of organisms, suggesting that mechanisms controlling life-long neurogenesis are conserved across a range of vertebrate and invertebrate species. The present article extends these findings by demonstrating circadian control of neurogenesis. Data show a diurnal rhythm of neurogenesis among the olfactory projection neurons in the crustacean brain, with peak proliferation during the hours surrounding dusk, the most active period for lobsters. These data raise the possibility that light-controlled rhythms are a primary regulator of neuronal proliferation, and that previously-demonstrated hormonal and activity-driven influences over neurogenesis may be secondary events in a complex circadian control pathway.

PDIs were identified often through hospital-initiated follow-up contact. Most PDIs were related to appointments. Hospitals caring for children may find this information useful as they strive to optimize their processes for follow-up contact after discharge.

No abstract

S uicide is a leading cause of death among 10-to 34-year-olds in the United States. 1,2 During the past two decades, the youth suicide death rate has risen by 24%, and more than 5,000 young people die from suicide each year. 3 Suicide ideation (SI) and suicide attempts (SAs) are well-established risk factors for suicide death and a source of morbidity for patients and families. One-third of youth with SI attempt suicide at some point in their lifetime. 4 Approximately 11% of youth SAs result in suicide death, and 2% of youth who attempt suicide subsequently go on to die from suicide after recovering from a prior SA. 5 More than 60,000 youth are hospitalized for SI or SA each year, 6 and young people hospitalized for SA are at high short-term risk of repeat SA and suicide death. 7 Hospitals need strategies for measuring the quality of SI and SA hospitalizations, monitoring postdischarge outcomes, and identifying the patients at the highest risk of poor outcomes. Readmissions are a useful hospital quality measure that can indicate re-emergence of SI, repeat SA, or inadequate community-based mental health (MH) treatment, and interventions designed for patients with readmissions can potentially avert morbidity or mortality. The National Committee on Quality Assurance recommends measurement of quality metrics for 30-day MH follow-up after psychiatric hospitalizations, 30-day readmissions after adult (but not pediatric) psychiatric hospitalizations, and 30-day readmissions in pediatric medical and surgical hospitalizations. Readmission measures are not consistently used to evaluate pediatric psychiatric hospitalizations, and psychiatric quality measures are not used to evaluate medical or surgical hospitalizations for SA. Recent research has investigated transfers to postacute care, 8 readmission prevalence, variation in hospital readmission performance, and risk factors for readmissions after pediatric psychiatric hospitalizations. 9-11 However, no national study has investigated 30-day

The Academic Pediatric Association fully endorses the Pediatric Hospitalist Medicine Core Competencies to define the knowledge skills and attitudes necessary to provide the highest quality of inpatient care for our nation's children. We will continue to lead and collaborate in projects to develop, implement and evaluate educational projects to disseminate the Competencies.

MHCs are associated with a higher likelihood of hospital readmission in children admitted for medical conditions and procedures. Understanding the influence of MHCs on readmissions could guide strategic planning to reduce unplanned readmissions for children with cooccurring physical and mental health conditions.

Children with RI who are most likely to use PAC have a high prevalence of multiple chronic conditions, multiple medications, and medical technology. Future investigations should assess the supply of PAC against the demand of hospitalized children with RI who might need it.