The importance of dedicated colorectal team participation in the management of spina bifida and spinal cord injury patients.

PURPOSE: In September 2020, the colorectal team of the International Center for Colorectal and Urogenital Care joined the spina bifida and spinal cord injury multidisciplinary clinic at Children's Hospital Colorado. Many important lessons were learned. METHODS: A retrospective review of patients seen in the spina bifida and spinal cord injury multidisciplinary clinic from September 2020 to May 2021 was conducted. Data collected included demographics, diagnosis, pre or post-natal repair for those with myelomeningocele, whether the patient was previously seen by the colorectal team, wheelchair usage, voluntary bowel control vs. fecal incontinence, urinary control vs. clean intermittent catheterization, characteristics of contrast enema, and our proposed intervention. RESULTS: Overall, 189 children were seen during the study period, ranging from 3 months to 20 years of age (average = 9.5 years). One hundred and two were males and 87 were females. Diagnosis included myelomeningocele (n = 153), spinal cord injury (n = 18), transverse myelitis (n = 7), sacral agenesis (n = 5), diastematomyelia (n = 2), spinal stenosis (n = 2), and tethered cord with lipoma (n = 2). Fifteen patients with myelomeningocele were repaired in-utero. One hundred and sixty patients were new to the colorectal team. Eighty-one patients were wheelchair users. One hundred and twenty-three patients suffered from fecal incontinence and needed enemas to be artificially clean for stool and thirty-eight patients had voluntary bowel movements and were clean with laxatives, suppository, or rectal stimulations. Twenty-eight patients were younger than three years of age and still in diapers. Despite a non-dilated colon on contrast enema, this population has a hypomotile colon. One hundred and twenty-eight patients required clean intermittent catheterization. CONCLUSION: Joining the spina bifida and spinal cord injury multidisciplinary clinic allowed us to better serve this population and gave us enormous satisfaction to contribute to improve the quality of life of the patients and their parents. LEVEL OF EVIDENCE: III.

Intraarticular Pain Catheter Is Not a Necessary Modality for Postoperative Pain Control After Total Knee Arthroplasty.

BACKGROUND: Effective pain control balanced with maintaining physical function and minimizing medication side effects is essential to accelerated recovery after total knee arthroplasty (TKA). Multimodal pain management regimens combining oral medications as well as local analgesia have shown promise in facilitating these goals. Some regimens use anesthetics delivered via a local infiltration catheter while others use periarticular injections (PAIs). However, it is uncertain if an infiltration catheter provides additional pain relief or decreases opioid consumption when compared with conventional PAI alone. METHODS: Fifty patients undergoing TKA at one institution were randomized equally into 2 groups for a prospective trial. Group I received an intraarticular catheter (On-Q∗) in combination with injection of 30 ml of 0.5% bupivacaine the day after surgery before removal. Group II received no pain catheter. Both groups received a conventional intraoperative PAI and postoperative oral pain medication. Pain scores were measured with visual analog scale and opioid medication consumption in morphine milligram equivalents (mgs). RESULTS: There were no differences in pain scores or opioid consumption in the first 48-hours postoperatively (P = .05). Reported maximum pain scores were low in both groups; 3.33 in group I and 2.97 in group II. Although not statistically significant in this cohort, there was increased opioid consumption in the catheter group: 14.78 mg vs 12.76 mg. CONCLUSION: An intraarticular pain catheter in conjunction with a multimodal approach with intraoperative PAI after TKA does not improve 48-hour pain scores or opioid consumption compared with PAI alone in this randomized controlled trial. Overall pain scores were very low.

Total Knee Replacement Sizing: Shoe Size Is a Better Predictor for Implant Size than Body Height.

BACKGROUND: Various sizes of implants need to be available during surgery. The purpose of this paper is to compare body height and shoe size with implant sizes in patients who underwent total knee replacement surgery to see which biomarker is a better predictor for preoperative planning to determine implant size. METHODS: A total of 100 knees, belonging to 50 females and 50 males, were observed. Participants' body height and shoe size were collected and correlated to implant sizes of a current, frequently used, standard total knee replacement (TKR) implant. The femoral anteroposterior and mediolateral width and the tibial anteroposterior and mediolateral width were correlated with height and shoe size. RESULTS: The correlation between shoe size and the four knee implant dimensions, femoral AP, ML, and tibial AP and ML were higher than the correlations between height and the same four dimensions. CONCLUSION: The results indicated that shoe size is a better predictor of component dimensions than is body height.Level of evidence: III.

Linking functional diversity and social actor strategies in a framework for interdisciplinary analysis of nature's benefits to society.

The crucial role of biodiversity in the links between ecosystems and societies has been repeatedly highlighted both as source of wellbeing and as a target of human actions, but not all aspects of biodiversity are equally important to different ecosystem services. Similarly, different social actors have different perceptions of and access to ecosystem services, and therefore, they have different wants and capacities to select directly or indirectly for particular biodiversity and ecosystem characteristics. Their choices feed back onto the ecosystem services provided to all parties involved and in turn, affect future decisions. Despite this recognition, the research communities addressing biodiversity, ecosystem services, and human outcomes have yet to develop frameworks that adequately treat the multiple dimensions and interactions in the relationship. Here, we present an interdisciplinary framework for the analysis of relationships between functional diversity, ecosystem services, and human actions that is applicable to specific social environmental systems at local scales. We connect the mechanistic understanding of the ecological role of diversity with its social relevance: ecosystem services. The framework permits connections between functional diversity components and priorities of social actors using land use decisions and ecosystem services as the main links between these ecological and social components. We propose a matrix-based method that provides a transparent and flexible platform for quantifying and integrating social and ecological information and negotiating potentially conflicting land uses among multiple social actors. We illustrate the applicability of our framework by way of land use examples from temperate to subtropical South America, an area of rapid social and ecological change.

Leisure activities and adolescent psychological well-being.

We examined the validity of the reported link between well-being and leisure participation in adolescents. Nine hundred and forty-seven, Year 10 students from 19 schools in Adelaide, South Australia, were recruited. Participants completed a questionnaire concerning participation in social, non-social and unstructured leisure activities as well as measures of personality. As expected, personality variables were better predictors of adolescent well-being than spare-time use, although engagement in less structured leisure activities was associated with poorer psychological well-being and substance use. These findings support previous personality research which suggests that spare-time use may be related to well-being only insofar as individuals who are psychologically healthy tend to be involved in structured leisure activities. The implications of these findings for school policy and future research concerning the links between leisure involvement and psychological well-being are discussed.

Directional changes in ecological communities and social-ecological systems: a framework for prediction based on Alaskan examples.

In this article we extend the theory of community prediction by presenting seven hypotheses for predicting community structure in a directionally changing world. The first three address well-studied community responses to environmental and ecological change: ecological communities are most likely to exhibit threshold changes in structure when perturbations cause large changes in limiting soil or sediment resources, dominant or keystone species, or attributes of disturbance regime that influence community recruitment. Four additional hypotheses address social-ecological interactions and apply to both ecological communities and social-ecological systems. Human responsiveness to short-term and local costs and benefits often leads to human actions with unintended long-term impacts, particularly those that are far from the site of decision making or are geographically dispersed. Policies are usually based on past conditions of ecosystem services rather than expected future trends. Finally, institutions that strengthen negative feedbacks between human actions and social-ecological consequences can reduce human impacts through more responsive (and thus more effective) management of public ecosystem services. Because of the large role that humans play in modifying ecosystems and ecosystem services, it is particularly important to test and improve social-ecological hypotheses as a basis for shaping appropriate policies for long-term ecosystem resilience.

Policy strategies to address sustainability of Alaskan boreal forests in response to a directionally changing climate.

Human activities are altering many factors that determine the fundamental properties of ecological and social systems. Is sustainability a realistic goal in a world in which many key process controls are directionally changing? To address this issue, we integrate several disparate sources of theory to address sustainability in directionally changing social-ecological systems, apply this framework to climate-warming impacts in Interior Alaska, and describe a suite of policy strategies that emerge from these analyses. Climate warming in Interior Alaska has profoundly affected factors that influence landscape processes (climate regulation and disturbance spread) and natural hazards, but has only indirectly influenced ecosystem goods such as food, water, and wood that receive most management attention. Warming has reduced cultural services provided by ecosystems, leading to some of the few institutional responses that directly address the causes of climate warming, e.g., indigenous initiatives to the Arctic Council. Four broad policy strategies emerge: (i) enhancing human adaptability through learning and innovation in the context of changes occurring at multiple scales; (ii) increasing resilience by strengthening negative (stabilizing) feedbacks that buffer the system from change and increasing options for adaptation through biological, cultural, and economic diversity; (iii) reducing vulnerability by strengthening institutions that link the high-latitude impacts of climate warming to their low-latitude causes; and (iv) facilitating transformation to new, potentially more beneficial states by taking advantage of opportunities created by crisis. Each strategy provides societal benefits, and we suggest that all of them be pursued simultaneously.

Peer and teacher bullying/victimization of South Australian secondary school students: prevalence and psychosocial profiles.

This study examined the nature and prevalence of bullying/victimization by peers and teachers reported by 1,284 students (mean age = 15.2 years) drawn from a representative sample of 25 South Australian government and private schools. Students completed a self-report survey containing questions relating to teacher and peer-related bullying, measures of psychosocial adjustment, and personality. The results showed that students could be clearly differentiated according to the type of victimization they had experienced. Students reporting peer victimization typically showed high levels of social alienation, poorer psychological functioning, and poorer self-esteem and self-image. By contrast, victims of teacher victimization were more likely to be rated as less able academically, had less intention to complete school and were more likely to be engaged in high-risk behaviours such as gambling, drug use and under-age drinking. Most bullying was found to occur at school rather than outside school and involved verbal aggression rather than physical harm. Boys were significantly more likely to be bullied than girls, with the highest rates being observed amongst boys attending single-sex government schools. Girls were more likely to be subject to bullying if they attended coeducational private schools. The implications of this work for enhancing school-retention rates and addressing psychological distress amongst adolescent students are discussed.