Laparoscopic Versus Open Nissen Fundoplication in Infants After Neonatal Laparotomy

BACKGROUND: Nissen fundoplication is an effective treatment of gastroesophageal reflux in infants. Laparoscopic procedures after previous laparotomy are technically more challenging. The role of laparoscopic Nissen fundoplication after neonatal laparotomy for diseases unrelated to reflux is poorly described. METHODS: This was a retrospective review of open vs laparoscopic Nissen fundoplication in infants after neonatal laparotomy. Of 32 infants who underwent neonatal laparotomy, 26 required a surgical antireflux operation within the first year of life. Twelve infants underwent laparoscopic Nissen fundoplication versus 14 infants who underwent open Nissen fundoplication. Parameters like age, weight, operative time, number of previous operations, length of stay following fundoplication, time to feedings, and complications were compared between the 2 groups. RESULTS: No statistically significant differences existed between most of the parameters compared following laparoscopic vs open Nissen fundoplication. No conversions to open procedures were necessary in infants undergoing laparoscopic fundoplication, and these infants resumed enteral feeds earlier than those who underwent the open procedure. CONCLUSION: Laparoscopic compared with open Nissen fundoplication performed in infants after a neonatal laparotomy were comparable procedures across most data points studied. However, a laparoscopic fundoplication did allow for earlier return to enteral feeds compared with the open approach. Laparoscopic Nissen fundoplication is technically feasible, safe, and effective in the treatment of gastroesophageal reflux in infants with a previous neonatal laparotomy

Software for Automation of Real-Time Agents, Version 2

Version 2 of Closed Loop Execution and Recovery (CLEaR) has been developed. CLEaR is an artificial intelligence computer program for use in planning and execution of actions of autonomous agents, including, for example, Deep Space Network (DSN) antenna ground stations, robotic exploratory ground vehicles (rovers), robotic aircraft (UAVs), and robotic spacecraft. CLEaR automates the generation and execution of command sequences, monitoring the sequence execution, and modifying the command sequence in response to execution deviations and failures as well as new goals for the agent to achieve. The development of CLEaR has focused on the unification of planning and execution to increase the ability of the autonomous agent to perform under tight resource and time constraints coupled with uncertainty in how much of resources and time will be required to perform a task. This unification is realized by extending the traditional three-tier robotic control architecture by increasing the interaction between the software components that perform deliberation and reactive functions. The increase in interaction reduces the need to replan, enables earlier detection of the need to replan, and enables replanning to occur before an agent enters a state of failure

Impact of the 2014–2016 marine heatwave on US and Canada West Coast fisheries: Surprises and lessons from key case studies

Marine heatwaves are increasingly affecting marine ecosystems, with cascading impacts on coastal economies, communities, and food systems. Studies of heatwaves provide crucial insights into potential ecosystem shifts under future climate change and put fisheries social-ecological systems through “stress tests” that expose both vulnerabilities and resilience. The 2014–16 Northeast Pacific heatwave was the strongest and longest marine heatwave on record and resulted in profound ecological changes that impacted fisheries, fisheries management, and human livelihoods. Here, we synthesize the impacts of the 2014–2016 marine heatwave on US and Canada West Coast fisheries and extract key lessons for preparing global fisheries science, management, and industries for the future. We set the stage with a brief review of the impacts of the heatwave on marine ecosystems and the first systematic analysis of the economic impacts of these changes on commercial and recreational fisheries. We then examine ten key case studies that provide instructive examples of the complex and surprising challenges that heatwaves pose to fisheries social-ecological systems. These reveal important insights into improving the resilience of monitoring and management and increasing adaptive capacity to future stressors. Key recommendations include: (1) expanding monitoring to enhance mechanistic understanding, provide early warning signals, and improve predictions of impacts; (2) increasing the flexibility, adaptiveness, and inclusiveness of management where possible; (3) using simulation testing to help guide management decisions; and (4) enhancing the adaptive capacity of fishing communities by promoting engagement, flexibility, experimentation, and failsafes. These advancements are important as global fisheries prepare for a changing oceanWe are grateful to Nate Mantua, Manuel Hidalgo, Kiva Oken, and Cori Lopazanski for feedback on manuscript drafts. We thank Jean Lee for sharing a non-confidential version of the Gulf of Alaska commercial fisheries landings data and Evan Damkjar and John Davidson for sharing non-confidential versions of British Columbia's commercial and recreational fisheries landings data. CMF was funded by The Nature Conservancy, California. BM was partially supported by the Future Seas II project under NOAA's Climate and Fisheries Adaptation Program (NA20OAR431050). The scientific results and conclusions, as well as any views or opinions expressed herein, are those of the author(s) and do not necessarily reflect the views of NOAA or the Department of Commerce.Ye

Narcissism and the strategic pursuit of short-term mating : universal links across 11 world regions of the International Sexuality Description Project-2.

Previous studies have documented links between sub-clinical narcissism and the active pursuit of short-term mating strategies (e.g., unrestricted sociosexuality, marital infidelity, mate poaching). Nearly all of these investigations have relied solely on samples from Western cultures. In the current study, responses from a cross-cultural survey of 30,470 people across 53 nations spanning 11 world regions (North America, Central/South America, Northern Europe, Western Europe, Eastern Europe, Southern Europe, Middle East, Africa, Oceania, Southeast Asia, and East Asia) were used to evaluate whether narcissism (as measured by the Narcissistic Personality Inventory; NPI) was universally associated with short-term mating. Results revealed narcissism scores (including two broad factors and seven traditional facets as measured by the NPI) were functionally equivalent across cultures, reliably associating with key sexual outcomes (e.g., more active pursuit of short-term mating, intimate partner violence, and sexual aggression) and sex-related personality traits (e.g., higher extraversion and openness to experience). Whereas some features of personality (e.g., subjective well-being) were universally associated with socially adaptive facets of Narcissism (e.g., self-sufficiency), most indicators of short-term mating (e.g., unrestricted sociosexuality and marital infidelity) were universally associated with the socially maladaptive facets of narcissism (e.g., exploitativeness). Discussion addresses limitations of these cross-culturally universal findings and presents suggestions for future research into revealing the precise psychological features of narcissism that facilitate the strategic pursuit of short-term mating

Nonmotorized Scooters: A Source of Significant Morbidity in Children

BACKGROUND:Nonmotorized scooters have increased rapidly in popularity over the past year. However, the morbidity associated with this new type of recreational vehicle is poorly defined. This study examined the pattern of scooter-related injuries sustained in children admitted to a level 1 pediatric trauma center. METHODS:The records of all children admitted to the authors’ institution after a scooter-related injury between January 1, 2000 and December 31, 2001 were reviewed. Information regarding patient demographics, mechanism of injury, type of injury sustained, and hospital course was prospectively collected and retrospectively analyzed. RESULTS:During the study period, 27 children were admitted with scooter-related injures. The average age of the patients was 9.1 ± 1.9 years, and 63% were boys. The average Injury Severity Score (ISS) was 7.9 ± 6. The most common mechanism of injury was a fall. However, 26% of the patients were involved in a scooter collision with a motor vehicle. Injuries to the head occurred most frequently, followed by extremity injuries. Only 10 of the children (37%) were wearing a helmet at the time of injury. CONCLUSIONS:Scooters are an increasingly popular form of recreational vehicle among children. However, they can result in serious injury, particularly to the head and extremities. The authors recommend that all children riding scooters wear protective equipment and avoid riding in areas that have moving motor vehicles

Abdominal and pelvic trauma in children

Trauma is the leading cause of death and disability in children. More than 90% of pediatric trauma admissions are the result of a blunt mechanism. Although injury to the abdomen and pelvis account for only 10% of injuries sustained by victims of pediatric trauma, they can be potentially life threatening. Optimal evaluation of the injured child may require the use of multiple diagnostic modalities. The spleen is the most frequently injured intra-abdominal organ, followed by the liver, intestine, and pancreas. Fortunately, the majority of injuries to the spleen and liver can be treated nonoperatively. Conversely, injuries involving the intestine and pancreas often require operative intervention

Duodenal injuries in children: beware of child abuse

It is frequently overlooked that child abuse may result in significant intraabdominal injury, particularly to the duodenum. The authors hypothesized that a significant number of duodenal injuries in young children would be the result of nonaccidental trauma. An 8-year (1995 through 2002) retrospective review of a pediatric level I trauma center database was performed after Institutional Review Board approval was obtained, and information regarding patients with duodenal injury was abstracted. Demographic variables, injury severity, length of stay, mortality rate, and mechanism of injury were examined. Statistical analysis was performed using descriptive statistics and Student’s t test. Statistical significance was defined as P less than .05. Over the 8-year study period, 8,968 patients were admitted, 2,179 (24%) were less than 3 years of age. Thirty children (0.3%) suffered injury to the duodenum, with 20 hematomas and 10 perforations. Patients were overwhelmingly boys (80%), with an average age of 7.6 ± 4.4 years and Injury Severity Score (ISS) of 14 ± 10. No patients died. Children were injured by a variety of mechanisms, including collisions involving motor vehicles (n = 9), bicycles (n = 4), and ATVs (n = 2). However, all children less than 4 years of age (n = 8) were victims of nonaccidental trauma, 2.8% of all child abuse admissions. Three of these children suffered perforations of the duodenum. Among the entire population, those children who suffered perforations had a significantly higher ISS (23.7 ± 7.2 v 9.6 ± 7.3; P < .0003) and longer length of stay (27.1 ± 15.3 v 12.6 ± 11.7; P < .007) than those with hematomas Injury to the duodenum is unusual in the pediatric trauma patient but does result in significant injury severity and prolonged hospitalization. In the young child, one must maintain a high index of suspicion regarding the etiology of the injury, because a large percentage is potentially the result of child abuse

Evaluation of a mobile safety center’s impact on pediatric home safety behaviors

Abstract Background A Mobile Safety Center (MSC) provides safety resources to families to prevent pediatric injury. The primary objective of this study was to assess the impact of an MSC on home safety behaviors. Methods We conducted a prospective observational study with 50 parents and guardians recruited at community events attended by an MSC. Participants completed a pre-test assessing demographics and home safety behaviors prior to participating in the MSC’s home safety educational program. We conducted follow-up with participants 4 weeks (follow-up 1) and 6 months (follow-up 2) after their visit to the MSC to reassess home safety behaviors. We used descriptive statistics in addition to Friedman, Wilcoxon sum-rank, and Fisher’s exact testing to analyze respondent demographics and changes in home safety practices. Friedman and Wilcoxon sum-rank testing was performed only for participants who completed all surveys. Results Of our 50 participants, 29 (58%) completed follow-up 1, 30 (60%) completed follow-up 2, and 26 (52%) completed both. Participants were more likely to have a fire-escape plan at follow-up 1 than on the pre-test (p = 0.014). They were also more likely to have the Poison Control Hotline number accessible in their cellphone or near a home phone at follow-up 1 compared to the pre-test (p = 0.002) and follow-up 2 compared to the pre-test (p < 0.001). Families with at least one household member who smoked or used e-cigarettes at any point during the study (n = 16 for the total population, n = 9 for those who completed both surveys) were less likely to have more than two smoke detectors installed at home during the pre-test (p = 0.049). However, this significantly changed across timepoints (p = 0.018), and while 44.4% reported more than two detectors during the pre-test, 88.9% reported this at both follow-ups. Conclusions Home safety education through an MSC positively changed some reported safety behaviors and maintained these changes at long-term follow-up. By encouraging the adoption of better home safety practices, education at an MSC may decrease pediatric injury rates