Power, Autonomy, and the Role of Law: Nudity and the Public-Private Distinction

I ask how the public-private distinction impacts legality, particularly with respect to the “public sphere”; I use “public nudity” as a vehicle through which to understand the larger legal implications of the public-private distinction. Given that public nudity is only offensive (and subsequently illegal) because of how the body is constructed, opinions on when and whether it can be prohibited reveal the various liberal positions on the limits of the public sphere. To show how the naked body is constructed as nude (a social stigma associated with being unclothed,) I adopt a Foucauldian account of modern power, which clashes with liberal theorists’ focus on “power as law” (what Foucault calls a “juridico-discursive” theory of power.) I temporarily set aside this tension, re-adopting a juridico-discursive theory of power in order to explore the relationship between law, the public sphere, and liberal theory. Given these findings, I formulate a tentative conclusion, which relies on liberal assumptions about power as law. I subsequently deconstruct these assumptions, undermining the foundation for liberals’ presumed public-private divide altogether. I conclude by questioning how to reconceive the public-private distinction given liberal theory’s unfounded assumptions about power, autonomy, and the role of law

Early life events predispose the onset of childhood functional gastrointestinal disorders

AbstractBackgroundFunctional gastrointestinal disorders (FGIDs) are common digestive conditions characterized by chronic or recurrent symptoms in the absence of a clearly recognized gastrointestinal etiology. The biopsychosocial model, the most accepted concept explaining chronic pain conditions, proposes that the interplay of multiple factors such as genetic susceptibility, early life experiences, sociocultural issues, and coping mechanisms affect children at different stages of their lives leading to the development of different pain phenotypes and pain behaviors. Early life events including gastrointestinal inflammation, trauma, and stress may result in maladaptive responses that could lead to the development of chronic pain conditions such as FGIDs.AimsIn this review, we discuss novel findings from studies regarding the long-term effect of early life events and their relationship with childhood chronic abdominal pain and FGIDs.MethodsA bibliographic search of the PubMed database was conducted for articles published over the last 20 years using the keywords: “Functional gastrointestinal disorders”, “chronic abdominal pain”, “chronic pain”, “gastrointestinal inflammation”, and “early life events”. Forty-three articles were chosen for review.ResultsBased on the current evidence, events that take place early in life predispose children to the development of chronic abdominal pain and FGIDs. Conditions that have been studied include cow's milk protein hypersensitivity, pyloric stenosis, gastrointestinal infections, and Henoch–Schonlein purpura, among others.ConclusionsEarly events may play an important role in the complex pathogenesis of functional gastrointestinal conditions. Timely intervention may have a critical impact on the prevention of this group of chronic incapacitating conditions

Yield and Cost of Performing Screening Tests for Constipation in Children

BACKGROUND: Chronic constipation is one of the most common reasons for pediatric outpatient visits. Clinical guidelines recommend that the work-up for chronic refractory constipation include thyroid function tests, celiac serology, and measurement of calcium and lead levels. Data to justify routine screening of constipated children using these laboratory tests are lacking

Dolor abdominal funcional

Los trastornos gastrointestinales funcionales (TGF), frecuentemente afectan a los niños y están asociados con morbilidad a corto y largo término. Estos TGF asociados con dolor incluyen el Síndrome de intestino irritable (SII), la Dispepsia funcional (DF), el Dolor abdominal funcional (DAF), el Síndrome de dolor abdominal funcional (SDAF), y la Migraña abdominal. Aunque la patogénesis de dolor asociado a los TGF es poco clara, la mayoría de los investigadores están de acuerdo, en una etiología multifactorial y la presencia de una interacción alterada intestino cerebro. Una continua interrelación de factores ambientales y genéticos, parece que hacen parte del desarrollo del sistema nervioso central y entérico. El modelo biopsicosocial es el arma operacional común para los niños con TGF, y reconoce la interacción entre las influencias sociales y ambientales y los procesos psicológicos y fisiológicos. El modelo biosicosocial propone que los cambios específicos de susceptibilidad genética, las experiencias tempranas de la vida, los cambios socioculturas, y los mecanismos de imitación, podrían explicar la variabilidad en la presentación clínica y los resultados entre los individuos

Sepsis Mortality Prediction Based on Predisposition, Infection and Response

OBJECTIVE: To empirically test, based on a large multicenter, multinational database, whether a modified PIRO (predisposition, insult, response, and organ dysfunction) concept could be applied to predict mortality in patients with infection and sepsis. DESIGN: Substudy of a multicenter multinational cohort study (SAPS 3). PATIENTS: A total of 2,628 patients with signs of infection or sepsis who stayed in the ICU for >48 h. Three boxes of variables were defined, according to the PIRO concept. Box 1 (Predisposition) contained information about the patient's condition before ICU admission. Box 2 (Injury) contained information about the infection at ICU admission. Box 3 (Response) was defined as the response to the infection, expressed as a Sequential Organ Failure Assessment score after 48 h. INTERVENTIONS: None. MAIN MEASUREMENTS AND RESULTS: Most of the infections were community acquired (59.6%); 32.5% were hospital acquired. The median age of the patients was 65 (50-75) years, and 41.1% were female. About 22% (n=576) of the patients presented with infection only, 36.3% (n=953) with signs of sepsis, 23.6% (n=619) with severe sepsis, and 18.3% (n=480) with septic shock. Hospital mortality was 40.6% overall, greater in those with septic shock (52.5%) than in those with infection (34.7%). Several factors related to predisposition, infection and response were associated with hospital mortality. CONCLUSION: The proposed three-level system, by using objectively defined criteria for risk of mortality in sepsis, could be used by physicians to stratify patients at ICU admission or shortly thereafter, contributing to a better selection of management according to the risk of death

Modeling in-Hospital Patient Survival During the First 28 Days After Intensive Care Unit Admission: a Prognostic Model for Clinical Trials in General Critically Ill Patients

OBJECTIVE: The objective of the study was to develop a model for estimating patient 28-day in-hospital mortality using 2 different statistical approaches. DESIGN: The study was designed to develop an outcome prediction model for 28-day in-hospital mortality using (a) logistic regression with random effects and (b) a multilevel Cox proportional hazards model. SETTING: The study involved 305 intensive care units (ICUs) from the basic Simplified Acute Physiology Score (SAPS) 3 cohort. PATIENTS AND PARTICIPANTS: Patients (n = 17138) were from the SAPS 3 database with follow-up data pertaining to the first 28 days in hospital after ICU admission. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: The database was divided randomly into 5 roughly equal-sized parts (at the ICU level). It was thus possible to run the model-building procedure 5 times, each time taking four fifths of the sample as a development set and the remaining fifth as the validation set. At 28 days after ICU admission, 19.98% of the patients were still in the hospital. Because of the different sampling space and outcome variables, both models presented a better fit in this sample than did the SAPS 3 admission score calibrated to vital status at hospital discharge, both on the general population and in major subgroups. CONCLUSIONS: Both statistical methods can be used to model the 28-day in-hospital mortality better than the SAPS 3 admission model. However, because the logistic regression approach is specifically designed to forecast 28-day mortality, and given the high uncertainty associated with the assumption of the proportionality of risks in the Cox model, the logistic regression approach proved to be superior

Dieta com baixo teor de FODMAPs para distúrbios de dor abdominal funcional em crianças: revisão crítica do conhecimento atual (Low FODMAPs diet for functional abdominal pain disorders in children: critical review of current knowledge)

Objective: This narrative review aimed to provide practitioners a synthesis of the current knowledge on the role of a low Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols diet in reducing symptoms associated with functional abdominal pain disorders in children. This review is focused on the pathophysiology, efficacy and criticism of low Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols diet in children. / Sources: Cochrane Database, Pubmed and Embase were searched using specific terms for Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols diet interventions and functional abdominal pain disorders. / Summary of the findings: In children, only one Randomized Control Trial and one open‐label study reported positive results of low Fermentable Oligosaccharides Disaccharides Monosaccha‐rides and Polyols diet; one Randomized Control Trial showed exacerbation of symptoms with fructans in children with Irritable Bowel Syndrome; no effect was found for the lactose‐free diet whilst fructose‐restricted diets were effective in 5/6 studies. / Conclusions: In children there are few trials evaluating low Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols in functional abdominal pain disorders, with encour‐aging data on the therapeutic efficacy particularly of fructose‐restricted diet. Additional effort sare still needed to fill this research gap and clarify the most efficient way for tailoring dietary restrictions based on the patient's tolerance and/or identification of potential biomarkers of low Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols efficacy, to maintain nutritional adequacy and to simplify the adherence to diet by labeling FermentableOligosaccharides Disaccharides Monosaccharides and Polyols content in commercial products

The costs of functional gastrointestinal disorders and related signs and symptoms in infants: a systematic literature review and cost calculation for England

OBJECTIVES: To estimate the cost of functional gastrointestinal disorders (FGIDs) and related signs and symptoms in infants to the third party payer and to parents. STUDY DESIGN: To estimate the cost of illness (COI) of infant FGIDs, a two-stage process was applied: a systematic literature review and a COI calculation. As no pertinent papers were found in the systematic literature review, a 'de novo' analysis was performed. For the latter, the potential costs for the third party payer (the National Health Service (NHS) in England) and for parents/carers for the treatment of FGIDs in infants were calculated, by using publicly available data. In constructing the calculation, estimates and assumptions (where necessary) were chosen to provide a lower bound (minimum) of the potential overall cost. In doing so, the interpretation of the calculation is that the true COI can be no lower than that estimated. RESULTS: Our calculation estimated that the total costs of treating FGIDs in infants in England were at least £72.3 million per year in 2014/2015 of which £49.1 million was NHS expenditure on prescriptions, community care and hospital treatment. Parents incurred £23.2 million in costs through purchase of over the counter remedies. CONCLUSIONS: The total cost presented here is likely to be a significant underestimate as only lower bound estimates were used where applicable, and for example, costs of alternative therapies, inpatient treatments or diagnostic tests, and time off work by parents could not be adequately estimated and were omitted from the calculation. The number and kind of prescribed products and products sold over the counter to treat FGIDs suggest that there are gaps between treatment guidelines, which emphasise parental reassurance and nutritional advice, and their implementation

Probiotics for management of functional abdominal pain disorders in children

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The primary objectives are to evaluate the efficacy and safety of probiotics for the management of IBS, abdominal migraine and functional abdominal pain in children