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Constipation is a common problem in children, accounting for about 3% of all primary care visits and up to 25% of referrals to paediatric gastroenterologists. Although polyethylene glycol often proves effective, most children require prolonged treatment and about 50% of them have at least one relapse within the first 5 years after initial recovery. When conventional treatment fails, children are considered to have refractory constipation. Children with refractory constipation deserve specialist management and guidance. Over the last decades, there has been a remarkable increase in our knowledge of normal and abnormal colonic and anorectal motility in children, and a number of different techniques to measure transit and motility have been developed. The present review analyses the possible diagnostic investigations for children with refractory constipation, focusing on their actual indications and their utility in clinical practice. Moreover, we have also analytically reviewed medical and surgical therapeutic options, which should be considered in selected patients in order to achieve the best clinical outcome. [ABSTRACT FROM AUTHOR]

In the Community-Based Inquiry (CBI) instructional method, cooperative student groups complete case study activities based on scientific literature and conduct their own laboratory investigations that address authentic community needs. This study compared critical thinking and content knowledge outcomes between traditional Introduction to Biochemistry lecture/laboratory and CBI curricula with human health case studies and local elementary school lunch nutrition laboratory investigations. CBI students experienced statistically significant critical thinking gains of medium effect size with female and male equity, whereas traditional students demonstrated no critical thinking gains with statistically significant sex disparity of medium effect size. Bifurcating student ethnicity into White and all other respondents revealed that the Other students gained statistically significantly more content knowledge in CBI than in the traditional group with a large effect size. Chemistry faculty concerned with developing both content knowledge and critical thinking skill in all students should consider using CBI not only for majors, but also for non-majors such as allied health students.

Foreign body ingestion (FBI) in children requires early identification to prevent adverse outcomes and may necessitate endoscopic or surgical intervention. This study aims to develop a nomogram that identifies children who require urgent surgical or endoscopic intervention by using the patient's medical history and clinical parameters collected at admission. This study is a retrospective review (01/2015–12/2020) of a multicenter case series of children admitted for FBI. Data from 5864 records from 24 hospitals in Italy were analyzed. Logistic regression models were used to establish the probability of requiring surgical or endoscopic intervention based on patient history and clinical characteristics. The nomogram representing the results from the multivariable model was reported to examine the propensity for surgery/endoscopy. The study identified a significant association between intervention and various factors, including type of foreign body (blunt: reference category, disk battery (odds ratio OR:4.89), food bolus (OR:1.88), magnets (OR:2.61), sharp-pointed (OR:1.65), unknown (OR:1.02)), pre-existing diseases or conditions (OR 3.42), drooling (OR 10.91), dysphagia (OR 5.58), vomiting (OR 3.30), retrosternal pain (OR 5.59), abdominal pain (OR 1.58), hematemesis (OR 2.82), food refusal/poor feeding (OR 2.99), and unexplained crying (OR 2.01). The multivariable regression model showed good calibration and discrimination ability, with an area under the ROC curve of 0.77. This study developed the first nomogram to predict the probability of the need for surgical or endoscopic intervention in children with FBI, based on the information collected at admission. The nomogram will aid clinicians in identifying children who require early intervention to prevent adverse outcomes. [ABSTRACT FROM AUTHOR]

Chemistry students appear to bring significantly higher critical-thinking skill to their nonmajors course than do biology students. Knowing student preconceptions and thinking ability is essential to learning growth and effective teaching. Of the factors investigated, ethnicity and high school physics had the largest impact on critical-thinking skill differences. Years of high school science, GPA, parents' education, and household income, commonly believed to influence academic performance, did not affect critical-thinking differences in this study. These factors should be considered when designing and assessing nonmajors courses in order to maximize learning. (Contains 5 tables and 1 figure.)

National stakeholders are becoming increasingly concerned about the inability of college graduates to think critically. Research shows that, while both faculty and students deem critical thinking essential, only a small fraction of graduates can demonstrate the thinking skills necessary for academic and professional success. Many faculty are considering nontraditional teaching methods that incorporate undergraduate research because they more closely align with the process of doing investigative science. This study compared a research-focused teaching method called community-based inquiry (CBI) with traditional lecture/laboratory in general education biology to discover which method would elicit greater gains in critical thinking. Results showed significant critical-thinking gains in the CBI group but decreases in a traditional group and a mixed CBI/traditional group. Prior critical-thinking skill, instructor, and ethnicity also significantly influenced critical-thinking gains, with nearly all ethnicities in the CBI group outperforming peers in both the mixed and traditional groups. Females, who showed decreased critical thinking in traditional courses relative to males, outperformed their male counterparts in CBI courses. Through the results of this study, it is hoped that faculty who value both research and critical thinking will consider using the CBI method. (Contains 6 tables and 2 figures.)

The WebQuest is a four-step process integrated at appropriate points in the Animal Studies unit. Through the WebQuest, students create a series of habitat maps that build on the knowledge gained from conducting the various activities of the unit. The quest concludes with an evaluation using the WebQuest rubric and an oral presentation of a final collaborative map. In creating the hypothetical habitat, students analyze, evaluate, compare, and contrast each other's work by making and justifying alternative choices. (Contains 3 figures, 1 resource and 2 online resources.)

Increasingly, national stakeholders express concern that U.S. college graduates cannot adequately solve problems and think critically. As a set of cognitive abilities, critical thinking skills provide students with tangible academic, personal, and professional benefits that may ultimately address these concerns. As an instructional method, writing has long been perceived as a way to improve critical thinking. In the current study, the researchers compared critical thinking performance of students who experienced a laboratory writing treatment with those who experienced traditional quiz-based laboratory in a general education biology course. The effects of writing were determined within the context of multiple covariables. Results indicated that the writing group significantly improved critical thinking skills whereas the nonwriting group did not. Specifically, analysis and inference skills increased significantly in the writing group but not the nonwriting group. Writing students also showed greater gains in evaluation skills; however, these were not significant. In addition to writing, prior critical thinking skill and instructor significantly affected critical thinking performance, whereas other covariables such as gender, ethnicity, and age were not significant. With improved critical thinking skill, general education biology students will be better prepared to solve problems as engaged and productive citizens. (Contains 5 tables and 4 figures.)

On the eastern edge of the Cascade Mountain range in Washington State, high school biology students have a unique opportunity to study the elusive cougar ("Felis concolor"), a large cat native to the area. Nestled in the Cascade foothills is the city of Cle Elum, a small rural community that is expected to soon experience considerable growth from development of a large resort. The community provides an excellent model for scientific study of native animals; students can study and compare the cougar's habitat and behavior before, during, and after resort development. From an instructional perspective, the study of cougars provides an ideal way to engage both introductory and advanced biology students in interdisciplinary science inquiry and problem solving. In this article, the authors describe the design and implementation of the Cougar Conservation Project (CCP), a problem-based learning (PBL) curriculum that provided students and community members with valuable interdisciplinary learning experiences. (Contains 2 figures.)

Background. The main aim of the study was to assess the association between joint hypermobility (JH) and gastrointestinal (GI) disorders in children. Methods. All children aged 4-17 years attending the clinics of the participating Pediatric Gastroenterology Centres for functional GI disorders (FGIDs) and inflammatory bowel disease (IBD) were screened for joint laxity. JH diagnosis was inferred using the Beighton Score. JHS diagnosis was inferred based on the Brighton Criteria. Rome III Diagnostic Criteria were used to diagnose possible FGIDs. Ulcerative colitis and Crohn's disease diagnoses were made according to the Porto Criteria. Age and sex-matched healthy children were enrolled as controls. Results. One-hundred-seventy children with GI disorders (70 with FGIDs, 50 with Crohn's disease, and 50 with ulcerative colitis) and 100 healthy controls were enrolled in the study. JH was reported in 7/70 (10%) children with FGIDs (p=0.26 compared to controls), 4/50 (8%) children with Crohn's disease (p=0.21 compared to controls) and 15/50 (30%) children with ulcerative colitis (p=0.09 compared to controls; p=0.01 compared to FGIDs; p=0.01 compared to Crohn's). Conclusions. JH is more prevalent in patients suffering from ulcerative colitis compared to the healthy general population, yet the difference did not reach statistical significance. Likely, a proportion of children with ulcerative colitis and JH may show connective tissue abnormalities. However, whether JH can be considered a possible feature of pediatric GI disorders deserves further investigation. [ABSTRACT FROM AUTHOR]

Foreign body and caustic ingestions in children are usually the most common clinical challenges for emergency physicians, general pediatricians and pediatric gastroenterologists. Management of these conditions often requires different levels of expertise and competence. Endoscopy is often necessary but there is a high risk of misusing this tool with incorrect timing and indications. The imprecise clinical history frequently leaves clinicians uncertain about timing and nature of the ingestion. Few clinical guidelines regarding management of these ingestions in children have been published, none of which from the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP). An expert panel of Italian endoscopists was convened by the SIGENP Endoscopy Working Group to produce the present article that outlines practical clinical approaches to the pediatric patient with a variety of foreign body and caustic ingestions. The Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO) has also endorsed the project since many adult endoscopists usually manage children with these conditions. Differently from the other published guidelines, the proposed one focuses on the role of the endoscopists (regardless of whether they are adult or pediatric gastroenterologists) in the diagnostic process of children with foreign body and caustic ingestions. [ABSTRACT FROM AUTHOR]

A causal relationship between gastro-esophageal reflux (GER) and apnea in preterm infants has been frequently hypothesized and is currently debated. The present study aims at reviewing the currently available scientific evidence, in order to clarify the role of GER on the occurrence of apnea and to help improving the clinical management of apneic preterm neonates. We performed a systematic literature search to identify all the clinical studies on preterm neonates that properly assessed the relationship between apnea and GER. Two-hundred and fifty-two papers, including 32 reviews and meta-analysis, were screened. Out of them, only 7 were included in the final analysis according to the selected criteria. Among them, 3 studies reported an increased frequency of apnea after reflux compared to reflux-free period and 4 denied a significant temporal relation. In conclusion, a minority of apneic events occurs soon after GER episodes. Whether this happens by chance or because of a causal relationship is still impossible to define. Based on the available data, empirical treatment with acid inhibitors is not recommended in neonates with apnea unless a proven temporal relation is shown by simultaneous esophageal pH-impedance and polysomnography or cardiorespiratory monitoring and in the absence of a clear clinical benefit. [ABSTRACT FROM AUTHOR]

Multichannel intraluminal impedance pH (MII-pH) monitoring currently represents the gold standard diagnostic technique for the detection of gastro-esophageal reflux (GER), since it allows to quantify and characterize all reflux events and their possible relation with symptoms. Over the last ten years, thanks to its strengths and along with the publication of several clinical studies, its worldwide use has gradually increased, particularly in infants and children. Nevertheless, factors such as the limited pediatric reference values and limited therapeutic options still weaken its current clinical impact. Through an up-to-date review of the available scientific evidence, our aim was to produce a position paper on behalf of the working group on neurogastroenterology and acid-related disorders of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) on MII-pH monitoring technique, indications and interpretation in pediatric age, in order to standardise its use and to help clinicians in the diagnostic approach to children with GER symptoms. [ABSTRACT FROM AUTHOR]