Search

Children with severe constipation and a neurodiverse disorder (Autism and/or developmental delay) represent a challenging bowel management group. Treatment outcomes with laxative or enema therapy remain limited and are often complicated by patient/caregiver compliance. We hypothesized that children with neurodiverse disorders and severe constipation would benefit from a bowel management program (BMP) that includes early use of antegrade enemas.Children requiring BMP in the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) registry with diagnosis of constipation and/or constipation with pseudo-incontinence were reviewed. Those with Hirschsprung disease and/or Anorectal Malformation were excluded. BMP needs in patients with a neurodiverse diagnosis were compared to those without to evaluate differences in BMP's.372 patients requiring a BMP were identified. 95 patients (58 autism spectrum, 54 developmental delay) were neurodiverse, and 277 patients were not. Neurodiverse patients had a higher prevalence of enema therapy 62.1% (59/95) vs. 54.9% (152/273) and use of antegrade enema therapy 33.7% (32/95) vs. 21.2% (58/273), p = 0.126. Neurodiverse patients were older 37.9% (36/95)12 years vs. 23.1% (63/273), p = 0.001 and 47.6% (10/21) were changed from laxative to enema therapy over time. 80% (8/10) of those changed from laxatives to enemas used antegrade therapy. 67.3% (35/52) of neurodiverse patients followed over time were on enema therapy at the most recent visit with 80% (28/35) requiring antegrade therapy.A large portion of patients with a neurodiverse disorder who fail laxative therapy use antegrade enemas to achieve effective bowel management. Early consideration of an antegrade conduit may simplify treatment in this group of children.III.

This study uses data from two state-wide surveys conducted in NSW prisons and youth justice centres in 2015 to examine the epidemiology of intergenerational incarceration. One in six (16.9%) adults in prison and over half (52.6%) of young people in youth justice centres reported that a parent had been imprisoned. For Aboriginal participants, 32.0 percent of adults and 66.4 percent of young people reported a previously incarcerated parent. Women were more than twice as likely as men to report that their mother had been in prison. Younger participants, those who had completed fewer years of schooling, and those previously in out-of-home care were more likely to report that a parent had been incarcerated. The high prevalence of intergenerational incarceration in NSW correctional settings, particularly among young people in youth justice centres and Aboriginal peoples in custody, highlights the need for interventions to support parents in prison and at-risk children whose parents are incarcerated.

Introduction: The COVID-19 (Coronavirus infectious disease 2019) pandemic has highlighted the need for alternative modalities to connect with outpatients beyond in-person clinic visits. In the present study, we evaluated the feasibility of a telephone-based teleconsultation cardiology service and compared the use of testing and outcomes between teleconsultation and traditional in-office consultations Methods: The study took place prior to the COVID-19 pandemic July 2019 to March 2020. Consult lists were reviewed by a cardiologist for patients appropriate for teleconsultation. Those patients were contacted directly and, if agreeable, a consultation was completed and any required testing was arranged. A series of patients seen in the clinic, matched for a reason for consultation and consulting a cardiologist, were compared in terms of testing frequency and outcomes. Results: Of 157 patients who felt appropriate for teleconsultation, 100 (63.7%) were successfully contacted and a teleconsultation was completed. Comparing patients undergoing teleconsultation with a matched series of patients seen in person in the clinic, there were no significant differences in testing utilization or outcomes, including emergency room or hospital admission within 30 days of consultation or death or adverse cardiac events at six months following consultation. Conclusion: Telemedicine can be successfully utilized as an alternative to traditional clinic consultation for selected patients needing cardiology consultation. This consultative modality does not appear to lead to utilization of increased testing or decreased quality or patient outcomes. Larger studies are needed to assess this mode of consultation.

Congenital diaphragmatic hernia (CDH) is a well-documented developmental abnormality in the formation of the diaphragm, resulting in herniation of bowel into the thorax causing pulmonary hypoplasia. CDH has been associated with many genetic syndromes and other anatomic anomalies including craniofacial, cardiac, skeletal, brain, ocular, renal, and abdominal wall defects. Despite this, co-occurrence of CDH and omphalocele is rare and only identified within 0.63% of neonates with CDH. Most congenital diaphragmatic hernias are located posterolateral (Bochdalek hernias) or anterior retrosternal or parasternal (Morgagni hernias); bilateral diaphragmatic hernias are rare. We describe the first documented case of concurrent Bochdalek and Morgagni hernias with an omphalocele and no other associated anatomic anomalies.

The aim of the study was to evaluate the clinical outcomes of nonselective (NS) His bundle pacing (HBP) compared with selective (S) HBP.HBP is the most physiologic form of ventricular pacing. NS-HBP results in right ventricular septal pre-excitation due to fusion with myocardial capture in addition to His bundle capture resulting in widened QRS duration compared with S-HBP wherein there is exclusive His bundle capture and conduction.The Geisinger and Rush University HBP registries comprise 640 patients who underwent successful HBP. Our study population included 350 consecutive patients treated with HBP for bradyarrhythmic indications who demonstrated ≥20% ventricular pacing burden 3 months post-implantation. Patients were categorized into S-HBP or NS-HBP based on QRS morphology (NS-HBP n = 232; S-HBP n = 118) at the programmed output at the 3-month follow-up. The primary analysis outcome was a combined endpoint of all-cause mortality or heart failure hospitalization.The NS-HBP group had a higher number of men (64% vs. 50%; p = 0.01), higher incidence of infranodal atrioventricular block (40% vs. 9%; p 0.01), ischemic cardiomyopathy (24% vs. 14%; p = 0.03), and permanent atrial fibrillation (18% vs. 8%; p = 0.01). The primary endpoint occurred in 81 of 232 patients (35%) in the NS-HBP group compared with 23 of 118 patients (19%) in the S-HBP group (hazard ratio: 1.38; 95% confidence interval: 0.87 to 2.20; p = 0.17). Subgroup analyses of patients at greatest risk (higher pacing burden or lower left ventricular ejection fraction) revealed no incremental risk with NS-HBP.NS-HBP was associated with similar outcomes of death or heart failure hospitalization when compared with S-HBP. Multicenter risk-matched clinical studies are needed to confirm these findings.

This case focuses on the financial health of Aspire, a forty-year-old nonprofit organization serving the needs of the developmentally disabled. To meet the residential, educational, and vocational needs of its clients, Aspire has grown significantly by expanding services and buying residences. As a nonprofit organization, Aspire has to consider financial implications and organizational/mission concerns as it explores the purchase of a building and the consolidation of administrative activities. The case enables students to explore the strengths and weaknesses of Aspire's financial situation, the primary financial indicators that different types of lenders would consider, as well as the financial and organizational costs and benefits to Aspire for the various lending options. The case profiles several different types of financing options, including traditional bank loans, the issuance of tax-exempt bonds, and the participation of a community development financial institution. Students are asked to do analysis and recommend a financing choice for Aspire. The case is based on work that the Illinois Facilities Fund, an Illinois community development finance institution, did with Aspire in 2000.This goal of this case is to teach students how to examine the strengths and weaknesses of a nonprofit's financial situation, show them the primary financial indicators that different types of lenders would consider, and help them weigh the financial and organizational costs and benefits of the various lending options. The case also teaches students the importance of understanding the financial implications of mission-based decisions.

Elective laparoscopic cholecystectomy (LC) pediatric patients in our institution have historically been admitted for an overnight hospital stay (OHS). The purpose of this study was to implement an ERAS protocol for elective LC in pediatric patients to promote same-day discharge (SDD) while maintaining excellent outcomes.An ERAS protocol for elective LC was implemented encompassing pre-, peri-, and postoperative management. A retrospective review of prospectively collected data from patients before (BI) and after implementation (AI) of the protocol was performed.A total of 250 patients (BI 105, AI 145) were included in the study. The AI group had significantly higher rate of SDD compared to BI (77.2% vs. 1.9%, p 0.01) and significantly decreased opioid use (morphine equivalents mg/kg AI 0.36 vs. BI 0.46, p 0.001). There were also no significant differences in the rate of total 30-day emergency department visits (BI 11.4% vs. AI 9.7%, p = 0.52) or surgery-related 30-day emergency department visits (BI 7.6% vs. AI 8.3%, p = 0.53). Factors that predisposed patients to an OHS after LC included higher ASA, later surgery start times, and longer operative times.The ERAS protocol significantly increased the rate of SDD after elective LC in pediatric patients without an associated increase in emergency department visits or readmissions.III.

Maintenance intravenous fluids (IVFs) are used to provide critical supportive care for children who are acutely ill. IVFs are required if sufficient fluids cannot be provided by using enteral administration for reasons such as gastrointestinal illness, respiratory compromise, neurologic impairment, a perioperative state, or being moribund from an acute or chronic illness. Despite the common use of maintenance IVFs, there is high variability in fluid prescribing practices and a lack of guidelines for fluid composition administration and electrolyte monitoring. The administration of hypotonic IVFs has been the standard in pediatrics. Concerns have been raised that this approach results in a high incidence of hyponatremia and that isotonic IVFs could prevent the development of hyponatremia. Our goal in this guideline is to provide an evidence-based approach for choosing the tonicity of maintenance IVFs in most patients from 28 days to 18 years of age who require maintenance IVFs. This guideline applies to children in surgical (postoperative) and medical acute-care settings, including critical care and the general inpatient ward. Patients with neurosurgical disorders, congenital or acquired cardiac disease, hepatic disease, cancer, renal dysfunction, diabetes insipidus, voluminous watery diarrhea, or severe burns; neonates who are younger than 28 days old or in the NICU; and adolescents older than 18 years old are excluded. We specifically address the tonicity of maintenance IVFs in children.The Key Action Statement of the subcommittee is as follows:1A: The American Academy of Pediatrics recommends that patients 28 days to 18 years of age requiring maintenance IVFs should receive isotonic solutions with appropriate potassium chloride and dextrose because they significantly decrease the risk of developing hyponatremia (evidence quality: A; recommendation strength: strong)

Hirschsprung's disease-associated enterocolitis (HAEC) remains the most life-threatening complication in Hirschsprung disease (HD) patients. The pathogenesis of HAEC has not been determined and many hypotheses regarding the etiology of HAEC have been proposed. These include a possible causal relationship between the abnormal enteric nervous system development in HD and the development of enterocolitis. Based on the complex genetic causes of HD that have been discovered and the resultant heterogeneous group of patients that exists, the causes of HAEC are likely multiple. New insights regarding the relationship of the role of the enteric nervous system and its interaction between intestinal barrier function, innate host immunity, and commensal microflora have been discovered, which may shed light on this perplexing problem. This review presents current known risk factors of HAEC and the proposed theories and supporting evidence for the potential etiologies of HAEC.

The article draws in relief how translators carry with them cultural and ideological horizons that necessarily imbue their literary production with distinctly situated historical, political, and personal dimensions. It does so first by examining how The New York Times's translation of Pablo Neruda's 1972 address to the PEN Club reframes (or distorts) his views on political and literary issues ranging from the negotiation of the Chilean national debt to his literary indebtedness to Walt Whitman, and then by examining how Neruda's 1955 translation of Whitman's ‘Salut Au Monde!’, refashions and relocates Whitman's work, imbuing it with a communist ethos consistent with Neruda's own.

Seven authors, all connected to the Netherlands-based International Mediation Institute, which is establishing an international credentialing program, take issue with Tony Willis's October Alternatives cover story saying the initiative is doomed to fail

In "Yo, el malacologo" [I, the Malacologist]--a part of Pablo Neruda's memoirs, Confieso que he vivido, finished shortly before his death in September 1973--Neruda recounts the day he decided to donate his seashell collection to his alma mater. With over 15,000 shells overflowing from the bookshelves and falling from tables and chairs, as well as enough books about seashells to fill his library, he boxed up his already famous collection and sent it to the University of Chile. He thought he had sealed its fate: "Como buena institucion sudamericana, mi universidad los recibio con loores y discursos y los sepulto en un sotano" (228) [Like a good South American institution, my university received my collection with speeches and fanfare and buried it in a basement]. (1) Neruda saw his self as multiple, split as an author, collector--malacologist and bibliophile--as well as donor; simultaneously a man of public and private pursuits. Indeed, at a crucial turning point in his life, Neruda declared that he planned to dedicate himself to his seashell collection and politics as poetry no longer interested him: En Mexico el Partido Comunista Mexicano organizo el 25 de Septiembre de 1941 un gran homenaje a Neruda. Juan Larrea, uno de los participantes, cuenta que la serie de homenajes dados a Neruda en Mexico, llevo a este a pensar en dedicarse a la politica. En una recepcion en casa del pintor Carlos Orozco Romero, Neruda le habria hecho una confidencia: "No se lo que tu pensaras, Juan. Pero te dire que a mi, la poesia ya no me interesa. Desde ahora pienso dedicarme a la politica y a mi coleccion de conchas." (Schidlowsky 444) (In Mexico, on September 25, 1941, the Mexican Communist Party organized a great homage for Neruda. Juan Larrea, one of the participants, recounts that the series of homages given for Neruda in Mexico, led him to think about dedicating himself to politics. In a reception at the painter Carlos Orozco Romero's house, Neruda divulged in confidence: "I don't know what you think, Juan. But I'll tell you that poetry no longer interests me. From now on I think I'll dedicate myself to politics and to my seashell collection." [my translation]) Neruda's sobering statement, reverberating with irony, both announces new pursuits and simultaneously monumentalizes and trivializes them in comparison with the history of his dedication to poetry. (2) He made this statement in the very month that he published his translation of Whitman's "Song of Myself." Set against the backdrop of a Chile falling under an increasingly xenophobic government, this claim constitutes a piece of Neruda's life that frames his acts of collecting and translating in a decidedly political manner. What Hannah Arendt asserted in reference to Walter Benjamin, that "Benjamin could understand the collector's passion as an attitude akin to that of the revolutionary" (42), echoes sympathetically with Neruda's attitude toward collecting. As Neruda reflected on his poetic transitions while living in Mexico as consul general--symbolically bound up with his increasingly official dedication to communism, and during "a moment of intellectual and artistic splendor" in Mexico (Gonzalez Echevarria 4) (3)--his approach to his collections and his comments concerning them reveal a poet grappling with the dilemmas of how to reconcile his own private act of collecting with communism's concept of property, as well as the question of the value--intimate, aesthetic, commodity, and cultural--of books themselves. And when one sees Neruda's collections housed at Isla Negra, at La Universidad de Chile, and at La Chascona--the headquarters for the Fundacion Neruda--it is clear that Neruda's bibliophilia is one of the constitutive, seminal, and traditional points of departure for literary studies of his oeuvre. Neruda's collection offers concrete evidence of the primary and secondary volumes that he read and recollected. …

The routing of the Trans-Anatolian Pipeline plays an important role in the future energy security of the European Union. The natural gas pipeline is planned to run from the natural gas fields in the Caspian Sea through Turkey. This project is a case study for a Geographic Information System (GIS) least-cost route analysis of a section of the proposed pipeline in Western Turkey. The route analysis comprised of weighting multiple types of criteria in a compiled risk assessment map that was analyzed by a least-cost algorithm to display the least hazardous route through the study area. Multiple varieties of criteria were considered such as, lithology, slope of terrain, environmental and social risk factors, e.g. proximity to natural reserves and urban centers, to provide the least hazardous route through the region. The derived least cost paths were more efficient than the proposed route in the relative cost associated with each route.

A single-camera stereo vision system offers a greatly simplified approach to image capture and analysis. In the original study by Lovegrove and Brame, they proposed a novel optical system that uses a single camera to capture two short, wide stereo images that can then be analyzed for real-time obstacle detection. In this paper, further analysis and refinement of the optical design results in two virtual cameras with perfectly parallel central axes. A new prototype camera design provides experimental verification of the analysis and also provides insight into practical construction. The experimental device showed that the virtual cameras' axes possessed a deviation from parallel of less than 12 minutes (or 0.2°). The calculation of distances to objects from the two overlapping images all showed errors smaller than the pixel resolution limitation. In addition, a barrel lens correction was used in processing the image to allow parallax distance determination in the whole horizontal view of the images.

Previous research has focused on equity as a prime determinant of mortgage default propensities. This paper extends the analysis of mortgage default to include mortgages that require no down payment from the purchaser. A continuous time hazard model is used to estimate the conditional probability of a serious delinquency, or a claim, as a function of a host of standard control variables, and indicators for the presence and source of the down payment. The data consist of a nationally representative random sample of about 5,000 FHA insured single family mortgages endorsed in Fiscal Years 2000, 2001, and 2002, observed through September 30, 2006, and samples of about 1,000 FHA loans each from the Atlanta, Indianapolis, and Salt Lake City MSAs in the same time period. The results indicate that borrowers who provide down payments from their own resources have significantly lower default propensities than do borrowers whose down payments come from relatives, government agencies, or non-profits. Borrowers with down payments from seller-funded non-profits, who make no down payment at all, have the highest default rates. Additionally, borrowers who do not make down payments from their own resources tend to have higher loss given default in the small subset of loans that had completed the property disposition process.

[No abstract]