Piriform fossa sinus tract - a 15-year retrospective review with a focus on atypical neonatal presentations.

BACKGROUND: Third and fourth branchial anomalies are rare, accounting for less than 10% of all branchial anomalies. The piriform fossa sinus tract (PFST) typically presents with left-side suppurative thyroiditis, although it can present earlier in neonates as a non-inflamed cystic neck mass. PFST poses a considerable diagnostic challenge with variable clinical and imaging features, leading to long delays to definitive diagnosis and appropriate management. OBJECTIVE: To analyse the patterns of presentation and imaging findings in children with PFST, with a particular focus on neonatal presentation. MATERIALS AND METHODS: This was a retrospective review of the clinical presentation, imaging findings and management in 16 cases of PFST presenting to our tertiary children's hospital between 2003 and 2018. Cases were identified by medical records and picture archiving and communication system (PACS) search using relevant International Classification of Diseases (ICD)-10 coding. RESULTS: Age at presentation ranged from prenatal to 16 years, with a male-to-female ratio of 2:1. All patients presented with neck swelling. Thirteen patients (81%) had suppurative thyroiditis at initial presentation. Two patients had severe thyroiditis/mediastinitis that required intensive care unit admission. Three neonates presented with noninfected, asymptomatic large cystic neck masses; two of these were detected prenatally and misdiagnosed as lymphatic malformations with subsequent spontaneous clinical resolution that later represented with evidence of PFST. The PFST was on the left side in 15/16 (94%) patients. All patients had neck imaging before definitive diagnosis. Imaging studies included radiographs, ultrasound, computed tomography, magnetic resonance imaging and barium esophagram studies. No single modality was diagnostic of PFST in all patients. Seventy-five percent of patients had multimodal imaging before diagnosis. All PFSTs were confirmed by endoscopic visualisation. Management of PFST was by endoscopic cauterisation in 13 patients and open surgery in 2. One patient did not require surgical correction. CONCLUSION: Our study highlights the complex nature of PFST. The anomaly is uncommon, has variable clinical and imaging features and may have a lengthy, complicated course if not considered at initial presentation. An episode of suppurative thyroiditis in a child should prompt investigation for PFST. We describe atypical presentations with cystic masses in neonates that appear to resolve but represent later as typical clinical features of PFST.

Chest Radiograph Alone Is Sufficient as the Foreign Body Survey for Children Presenting With Coin Ingestion.

OBJECTIVES: Radiographic survey of the entire aerodigestive tract (nares to anus) is common practice in children presenting to the emergency department following coin ingestion. The purpose of our study was to determine the optimal protocol for radiographic survey post-coin ingestion. We hypothesized that for children presenting with a clear history of coin ingestion a frontal chest radiograph including the entire esophagus is adequate to guide treatment. METHODS: We reviewed the clinical history and radiographic surveys of 134 patients presenting with suspected or witnessed coin ingestion to the emergency department of a tertiary care pediatric hospital between January 2012 and June 2016. Patient demographics, presenting symptoms, anatomic coverage of survey, type, number and location of radiopaque foreign bodies, intervention, and follow-up were recorded. RESULTS: Coins were identified on radiographic surveys in 109 of 134 patients; 25 of 134 patients had no coin. Of those with coins, none of 109 had coin(s) in the airway, 42 of 109 had coin(s) in the esophagus, and 67 of 109 had coin(s) distal to the esophagus. Of those with esophageal coins, 35 of 42 reported symptoms, 7 of 42 were asymptomatic, 40 of 42 underwent endoscopic coin removal, and 2 of 42 had no intervention. Of 92 of 134 surveyed patients with no coin or coin distal to the esophagus, 30 of 92 reported symptoms, 62 of 92 were asymptomatic, 90 of 92 had no further intervention, and 2 of 92 eventually underwent endoscopic coin removal for specific indications (abdominal pain, delayed passage). When there was no coin found in the esophagus, the negative predictive value for intervention was 97.8%. CONCLUSIONS: Following a clear history of coin ingestion, a frontal chest radiograph including the entire length of the esophagus provides sufficient information to direct patient management.

Neutralising the meat paradox: Cognitive dissonance, gender, and eating animals.

Meat eating is a common behaviour, despite many people claiming to like, love, and care about animals. The apparent disconnection between not wanting animals to suffer, yet killing them for food, has been termed the 'meat paradox.' In this experimental study (N = 460), participants completed pre-affect, post-affect, meat attachment, and attitude towards animals questionnaires, under two conditions: exposure to the life of an Australian meat lamb, and information about the nutritional benefits of meat. A factorial MANOVA revealed that negative affect was significantly greater when participants were exposed to the meat-animal connection; however, more entrenched attitudes towards animals and attachment to meat remained unaffected. Significant gender effects were found across all variables: most notably, meat attachment differed according to gender, decreasing in women and increasing in men when exposed to the meat-animal condition. Open-ended responses were subjected to content analysis to understand participants' future meat-consumption preferences and accompanying reasoning strategies. Findings from the present study contribute to understanding how cognitive dissonance and inconsistencies are rationalised by meat consumers.

Not appropriate dinner table conversation? Talking to children about meat production.

Although Australians on average consume large quantities of meat, their attitudes to farm animal welfare are poorly understood. We know little about how farm animal production is discussed in Australian households or how children learn about the origins of meat. This study consisted of an online survey completed by 225 primary carers throughout Australia recruited through social media. Findings include that conversations about the origin of meat were generally stimulated by meal preparation within the home rather than visits to agricultural shows or similar activities. Parents preferred to initiate conversations with children about meat production before they were 5 years of age. Urban parents were more likely than rural parents to reveal that they were conflicted about eating meat and would be more empathetic to children who chose to stop eating meat. Rural parents were more likely than urban parents to feel that children should eat what they are given and that talking about meat is not a major issue. Both groups felt that it was important that children should know where their food comes from. The findings of this study suggest that parental attitudes to meat production and consumption influence conversations about meat origins with children.

Transdisciplinary science and the importance of Indigenous knowledge.

As we move ever closer to the brink of global environmental collapse, it is vital that we work collaboratively and collectively as global, national, and local communities to design multiscale change. Protecting future generations and reversing (or substantively slowing) the current trends require rapid sustainable progress at the required scale. It is more urgent than ever that we understand and more fully realize the power of transdisciplinary (Td) research to support sustainable practice. A defining factor of Td is the focus on collaboration and codesign and the extent that participation and attention to local context is integral to the knowledge building. Specifically, there is greater ability for community knowledge, values, and aspirations to influence and shape research inquiries to effect meaningful change in real-world decision-making and outcomes. Business-as-usual (BAU) approaches that perpetuate unequal knowledge sharing and dismiss other forms of knowledge beyond traditional science no longer suffice. Transdisciplinary approaches seek to achieve and support sustainable change, but the extent of transformation required to meet ecological protection and regenerative sustainability requires very different operating models for knowing and doing science than the limited traditions of positivist science. However, these powerful defaults and operating paradigms are more deeply ingrained than we might realize, and so challenges persist. This article illustrates how Td science differs from typical research paradigms, particularly in terms of the underlying epistemology; the focus on knowledge and/or power; attention to boundaries and scope; and the degree to which local knowledge, context, and community participation underpin the research process. Active conversations are required to better identify and overcome fundamental challenges for science and Td research approaches to support the necessary transformational change. Importantly, we suggest that Indigenous partnerships, knowledge, and values are vital in achieving the potential of Td research to provide transformational interventions to address complex social and environmental issues such as pollution. Integr Environ Assess Manag 2024;20:805-816. © 2023 SETAC.

Values of Australian Meat Consumers Related to Sheep and Beef Cattle Welfare: What Makes a Good Life and a Good Death?

There has been growing global interest in livestock animal welfare. Previous research into attitudes towards animal welfare has focused on Europe and the United States, with comparatively little focus on Australia, which is an important location due to the prominent position of agriculture economically and culturally. In this article, we present results from qualitative research on how Australian meat consumers conceptualise sheep and beef cattle welfare. The study was conducted in two capital cities (Melbourne, Victoria and Adelaide, South Australia) and a much smaller rural centre (Toowoomba, Queensland) using focus groups (involving 40.9% of participants) and mall-intercept interviews (59.1% of participants), totalling 66 participants. Qualitative analysis highlights that participants had clear ideas of what it means for an animal to live a 'good life' and experience a 'good death,' with their beliefs strongly tied to their expectations and cultural understandings of what Australian agriculture 'should be.' In response to open-ended questions, participants expressed attitudes that relied on romanticised visions of the 'rural idyll' as seen in frequent discussions about what is 'normal' for sheep meat and beef production, and relatedly, what count as 'natural behaviours.' Many participants rejected anything associated with the 'other,' classifying it as not 'normal': we argue that which is not considered normal, including intensive production, foreign ownership, and halal slaughter practices, appear to place participants' conceptualizations of an animal's 'good death,' and in turn the potential for a 'good life,' at risk.

Approach to the postnatal sonographic evaluation of prenatally detected abdominopelvic cysts.

Prenatally detected abdominal and pelvic masses are commonly cystic in morphology and usually seen on mid-trimester sonography. Sonography is the favored imaging modality for the postnatal evaluation of these lesions in newborns, given its availability, low cost, lack of ionizing radiation, lack of sedation, and high spatial resolution in small patients. The differential diagnosis of abdominopelvic cystic masses in newborns is broad given that they can arise from many organs and may have overlapping features on imaging. This article illustrates an approach to the postnatal sonographic evaluation of prenatally detected cystic abdominal and pelvic masses based on their anatomic location and distinctive sonographic characteristics, which can aid in an accurate diagnosis and guide appropriate management.

Improving the diagnostic accuracy of appendicitis using a multidisciplinary pathway.

BACKGROUND/PURPOSE: Improvement opportunities exist in the accuracy and timeliness of the diagnosis of childhood appendicitis. The purpose of our study was to conduct a post-implementation audit of a diagnostic pathway for children with suspected appendicitis presenting to our pediatric emergency department. METHODS: We adopted a diagnostic pathway that utilized a validated risk of appendicitis stratification tool (Alvarado Score) with protocolized use of abdominal ultrasound for moderate risk patients. We conducted a 10% convenience sample audit of pathway patients treated over the subsequent 18-month period. Outcome measures included false negative and positive rates, sensitivity, specificity, and overall pathway accuracy. RESULTS: One hundred thirty-four pathway patients, of which 22 (16.4%) had appendicitis confirmed pathologically, were evaluated. The risk group distribution of patients was: low risk (29%), moderate risk (60%), and high risk (11%). The negative appendectomy rate was 4.4% (reduced from 14% pre-pathway), and the false negative (missed appendicitis) rate was 3.0%. No patients received CT scans. Pathway sensitivity was 81.8%% (95% CI 59.7% to 94.8%), specificity-92.9%% (95% CI 86.4%-96.9%), and overall accuracy-91.0% (95% CI 84.9%-95.3%). CONCLUSION: Implementation of a diagnostic pathway achieved a high level of accuracy and reduced our institutional negative appendectomy rate by 67%. The audit identified additional pathway improvement opportunities. LEVELS OF EVIDENCE: Level IV.

"I Feel Sorry for Them": Australian Meat Consumers' Perceptions about Sheep and Beef Cattle Transportation.

Concern for livestock welfare is significantly increasing in many parts of the world. One area of concern is the transportation of livestock. Using qualitative research methods, this research explores the concerns of Australian meat consumers related to livestock transportation practices, both on land by truck and on sea by ship. Participants were predominantly concerned about animals being "crammed" into trucks and ships, and the long distances over which livestock were transported. Likely contributors to these reactions are the high visibility of truck transport in urban areas, and recent media and political attention to the live-export issue in Australia. We argue that participants' concerns about transport are arising for a variety of reasons, including anthropomorphic tendencies, genuine concern for the welfare of farm animals, and emotional responses related to the discomfort experienced by meat consumers when they are reminded of the meat-animal connection. Given the importance of transport to the red-meat production industry, these results suggest that the sector may need to reconsider some of their practices and increase transparency and communication about the practices, which they utilise to ensure good animal welfare.

Australian Consumers' Awareness and Acceptance of Insects as Food.

Insects have long been consumed as part of the diets of many Asian, African, and South American cultures. However, despite international agencies such as the Food and Agriculture Organization of the United Nations advocating the nutritional, environmental, and economic benefits of entomophagy, attitudinal barriers persist in Western societies. In Australia, the indigenous ‘bush tucker’ diet comprising witchetty grubs, honey ants, and Bogong moths is quite well known; however, in most Australian locales, the consumption of insects tends to occur only as a novelty. Therefore, this study aimed to investigate the awareness and acceptance of insects as food. An online survey of 820 consumers found that 68% of participants had heard of entomophagy, but only 21% had previously eaten insects; witchetty grubs, ants, grasshoppers, and crickets were the most commonly tasted insects. Taste, appearance, safety, and quality were identified as the factors that were most likely to influence consumer willingness to try eating insects, but consumer attitudes towards entomophagy were underpinned by both food neophobia (i.e., reluctance to eat new or novel foods) and prior consumption of insects. Neophobic consumers were far less accepting of entomophagy than neophilic consumers, while consumers who had previously eaten insects were most accepting of insects as food. Incorporating insects into familiar products (e.g., biscuits) or cooked meals also improved their appeal. Collectively, these findings can be used by the food industry to devise production and/or marketing strategies that overcome barriers to insect consumption in Australia.

Embryonal rhabdomyosarcoma as a second malignancy following multimodal therapy for advanced-stage neuroblastoma.

Second malignancy as a long-term complication in survivors of advanced-stage neuroblastoma is rare, but it is becoming recognized more frequently. We report an unusual case of a soft-tissue sarcoma developing within a retroperitoneal primary following previous extensive treatment for metastatic neuroblastoma using multimodality imaging including PET/CT.