Urological anomalies in anorectal malformations in the Netherlands: Effects of screening all patients on long-term outcome

Introduction: Urological anomalies are frequently seen in patients with anorectal malformations (ARM) and can result in upper urinary tract deterioration. Whether the current method of screening is valid, adequate and needed for all patients is not clear. We, therefore, evaluated the urological screening methods in our ARM patients for changes in urological treatment, outcome and follow-up. Methods: The medical records of 331 children born with an ARM in the period 1983-2003 were retrospectively studied. Documentation of diagnosis, screening method, urological anomalies, treatment, complications, follow-up and outcome were measured. Results: The overall incidence of urological anomalies was 52%. The incidence of urological anomalies and urological follow-up time decreased with diminishing complexity of the ARM. Hydronephrosis, vesico-urethral reflux, lower urinary tract dysfunction and urinary incontinence were encountered most. Treatment invasiveness increased with the increase of complexity of an ARM. Lower urinary tract dysfunction needing urological care occurred in 43% in combination with lumbosacral or spinal cord anomalies and in 8% with no abnormalities in the lumbosacral-/spinal region. Conclusions: Urological anomalies in patients with complex ARM are more severe than in patients with less complex ARM. Ultrasonography of the urinary tract should be performed in all patients. Voiding cysto-urethrography can be reserved for patients with dilated upper urinary tracts, urinary tract infections or lumbosacral and spinal abnormalities. All patients with complex ARM need urodynamic investigations. When using these indications, the screening for urological anomalies in ARM patients can be optimized with long-term follow-up in selected patients

Duhamel versus transanal endorectal pull through (TERPT) for the surgical treatment of Hirschsprung’s disease

For the surgical treatment of Hirschsprung’s disease, several surgical techniques are used to resect the distal aganglionic colon. Two frequently used techniques are the Duhamel procedure and the transanal endorectal pull-through procedure. During the ‘8th Pediatric Colorectal Course’ in Nijmegen, November 2015, a workshop was organized to share experiences of both techniques by several experts in the field and to discuss (long term) outcomes. Specifically, the objective of the meeting was to discuss the main controversies in relation to the technical execution of both procedures in order to make an initial assessment of the limitations of available evidence for clinical decision-making and to formulate a set of preliminary recommendations for current clinical care and future research

The Role of Mass and Environment in Multiple Star Formation: A 2MASS Survey of Wide Multiplicity in Three Young Associations

We present the results of a search for wide binary systems among 783 members of three nearby young associations: Taurus-Auriga, Chamaeleon I, and two subgroups of Upper Scorpius. Near-infrared (JHK) imagery from 2MASS was analyzed to search for wide (1-30"; ~150-4500 AU) companions to known association members, using color-magnitude cuts to reject likely background stars. We identify a total of 131 candidate binary companions with colors consistent with physical association, of which 39 have not been identified previously in the literature. Our results suggest that the wide binary frequency is a function of both mass and environment, with significantly higher frequencies among high-mass stars than lower-mass stars and in the T associations than in the OB association. We discuss the implications for wide binary formation and conclude that the environmental dependence is not a direct result of stellar density or total association mass, but instead might depend on another environmental parameter like the gas temperature. We also analyze the mass ratio distribution as a function of mass and find that it agrees with the distribution for field stars to within the statistical uncertainties. The binary populations in these associations generally follow the empirical mass-maximum separation relation observed for field binaries, but we have found one candidate low-mass system (USco-160611.9-193532; Mtot~0.4 Msun) which has a projected separation (10.8"; 1550 AU) much larger than the suggested limit for its mass. (Abridged)Comment: Accepted to ApJ; 27 pages in emulateapj format. The full version of table 2 can be downloaded via http://www.astro.caltech.edu/~alk/tab2.pdf (PDF) or http://www.astro.caltech.edu/~alk/tab2.txt (text

The Economics and Politics of Contracting out with the Private Sector: Evidence from the US Transit Industry

The paper studies contracting practices in the US transit industry. It employs the methods of transaction cost economics and public choice theory to develop an empirical model of bus contracting in the US transit industry. The empirical results shed light on why transit services in the US remain largely public, despite many attempts to introduce competition by contracting out services to the private sector. The results show that the decision by transit agencies to contract out with the private sector is constrained by the transaction costs of contracting and the institutional and subsidy arrangements that govern the transit industry in the US. Services that require idiosyncratic investments to provide large densities of passengers are less likely to be contracted out than those services that are provided using standard, small vehicles. Similarly, increases in federal subsidies and dedicated subsidies are found to discourage contracting out with the private sector. On the other hand, increases in state and local subsidies, other things being equal, encourage contracting. Agencies that have high labor costs –– indicating strong labor unions –– are less likely to contract out. In light of these findings, the paper concludes that piecemeal contracting out of services is not likely to increase the role of the private sector in the provision of public transit services. Structures of subsidies and federal arrangements creates intertwined incentives that discourage contracting by transit agencies, thus foiling the attempts to increase efficiencies by establishing competition for transit markets.Institute of Transport and Logistics Studies. Faculty of Economics and Business. The University of Sydne

High resolution MRI for preoperative work-up of neonates with an anorectal malformation: a direct comparison with distal pressure colostography/fistulography

Objective: To compare MRI and colostography/fistulography in neonates with anorectal malformations (ARM), using surgery as reference standard. Methods: Thirty-three neonates (22 boys) with ARM were included. All patients underwent both preoperative high-resolution MRI (without sedation or contrast instillation) and colostography/fistulography. The Krickenbeck classification was used to classify anorectal malformations, and the level of the rectal ending in relation to the levator muscle was evaluated. Results: Subjects included nine patients with a bulbar recto-urethral fistula, six with a prostatic recto-urethral fistula, five with a vestibular fistula, five with a cloacal malformation, four without fistula, one with a H-type fistula, one with anal stenosis, one with a rectoperineal fistula and one with a bladderneck fistula. MRI and colostography/fistulography predicted anatomy in 88 % (29/33) and 61 % (20/33) of cases, respectively (p = 0.012). The distal end of the rectal pouch was correctly predicted in 88 % (29/33) and 67 % (22/33) of cases, respectively (p = 0.065). The length of the common channel in cloacal malformation was predicted with MRI in all (100 %, 5/5) and in 80 % of cases (4/5) with colostography/fistulography. Two bowel perforations occurred during colostography/fistulography. Conclusions: MRI provides the most accurate evaluation of ARM and should be considered a serious alternative to colostography/fistulography during preoperative work-up. Key Points: • High-resolution MRI is feasible without the use of sedation or anaesthesia. • MRI is more accurate than colostography/fistulography in visualising the type of ARM. • MRI is as reliable as colostography/fistulography in predicting the level of the rectal pouch. • Colostography/fistulography can be complicated by bowel perforation

The Velocity Distribution of the Nearest Interstellar Gas

The bulk flow velocity for the cluster of interstellar cloudlets within about 30 pc of the Sun is determined from optical and ultraviolet absorption line data, after omitting from the sample stars with circumstellar disks or variable emission lines and the active variable HR 1099. Ninety-six velocity components towards the remaining 60 stars yield a streaming velocity through the local standard of rest of -17.0+/-4.6 km/s, with an upstream direction of l=2.3 deg, b=-5.2 deg (using Hipparcos values for the solar apex motion). The velocity dispersion of the interstellar matter (ISM) within 30 pc is consistent with that of nearby diffuse clouds, but present statistics are inadequate to distinguish between a Gaussian or exponential distribution about the bulk flow velocity. The upstream direction of the bulk flow vector suggests an origin associated with the Loop I supernova remnant. Groupings of component velocities by region are seen, indicating regional departures from the bulk flow velocity or possibly separate clouds. The absorption components from the cloudlet feeding ISM into the solar system form one of the regional features. The nominal gradient between the velocities of upstream and downstream gas may be an artifact of the Sun's location near the edge of the local cloud complex. The Sun may emerge from the surrounding gas-patch within several thousand years.Comment: Typographical errors corrected; Five tables, seven figures; Astrophysical Journal, in pres