Incidence and Clinical Outcomes of Streptococcus anginosus in Acute Complicated Sinusitis: A Pediatric Cohort.

We conducted a retrospective cohort study of 160 hospitalized children admitted for acute complicated sinusitis and compared children with S anginosus-associated infection to children with other or no pathogens identified. The incidence of S anginosus-associated infections increased 12% per year, and infections with S anginosus are associated with increased morbidity.

Unusual Neuroimaging in a Case of Rapidly Progressive Juvenile-Onset Krabbe Disease.

Krabbe disease is a progressive neurologic disorder caused by deficiency of the lysosomal enzyme galactocerebrosidase. The disease commonly has an early-infantile onset, but can have late-infantile, juvenile, or adult-onset phenotypes. Classic computed tomography (CT) and magnetic resonance imaging (MRI) findings in Krabbe have been well described. We report a patient, ultimately diagnosed with juvenile-onset Krabbe, who presented with atypical CT imaging and rapid disease progression. Our patient was a previously healthy and developmentally appropriate female who presented at 3 years 4 months of age with ataxia and motor regression that had progressed over the course of 6 weeks without an identifiable catalyst. CT, performed in the emergency setting, demonstrated extensive white matter hyperdensity. Subsequent MRI showed T2 hyperintensity of the white matter corresponding to the areas of hyperdensity on the CT, as well as enhancement of multiple cranial nerves bilaterally, suggestive of Krabbe disease. Enzymatic testing demonstrated low galactocerebrosidase activity and molecular testing of GALC revealed compound heterozygosity for 2 known pathogenic mutations, consistent with a diagnosis of Krabbe Disease. This included the common 30-kb deletion and a known pathogenic mutation associated with juvenile/adult-onset disease. Our patient's diffuse hyperdensity on CT offers a new radiographic finding to include in the repertoire of Krabbe imaging, and thus aide in the diagnostic evaluation. The rapidity of progression our patient demonstrated is additionally unique and should be considered in the identification of juvenile Krabbe as well as the complicated decision-making process regarding potential treatments.

ED and Inpatient Management of Headache in Children and Adolescents.

PURPOSE OF REVIEW: Pediatric migraine is common, and appropriate abortive treatment is important to limit impact on school performance and mental health. This review will describe the latest evidence for abortive treatment in the emergency department and inpatient settings. RECENT FINDINGS: It is recognized that a protocol for emergency department treatment can increase efficacy and prevent admissions. These protocols commonly include a non-opioid analgesic and dopamine receptor antagonist. A novel approach to treatment with valproic acid is use of a continuous infusion. Administration of ketamine or propofol and peripheral nerve blocks could add more expedited treatment options to the armamentarium for pediatric migraine. There is increasing variety in the abortive treatment of pediatric migraine, but continued research is necessary for validation of these approaches.

Scale and co-management outcomes: assessing the impact of collaborative forest management on community and household resilience in Ghana.

Co-management - institutional arrangements that involve the sharing of power, rights and responsibilities between states and resource users - provides a framework for managing common pool resources across multiple scales. However, the scale concept has not received widespread recognition in the assessment of co-management outcomes. This study employed a mixed methods research approach to assess the impacts of collaborative forest management (CFM) on social-ecological resilience at the community and household levels in two forest-dependent communities in the Ashanti region of Ghana. Analysis of qualitative data at the community level indicated that although specific impacts of the CFM program varied within and across the various types of capital assets that shape community resilience, the overall impact of the program on both communities has been positive. At the household level, a statistical comparison of past and current household capital assets showed varying levels of decline in household conditions across the two communities during the implementation of the CFM program. It appears the modest gains from the CFM program at the community level may not have been equitably distributed at the household level. These results suggest that the impact of co-management and other conservation policies may be sensitive to the level at which observation is done. Greater recognition of the importance of scale and cross-scale interactions is needed to inform the formulation of forest policies that contribute to building social-ecological resilience across scales.

Determinants of the process and outcomes of household participation in collaborative forest management in Ghana: a quantitative test of a community resilience model.

This study tested a proposed community resilience model by investigating the role of institutions, capital assets, community and socio-demographic variables as determinants of households' participation in Ghana's collaborative forest management (CFM) program and outcomes of the program. Quantitative survey data were gathered from 209 randomly selected households from two forest-dependent communities. Regression analysis shows that households' participation in the CFM program was predicted by community location, past connections with institutions, and past bonding social capital. Community location and past capitals were the strongest predictors of the outcomes of the CFM program as judged by current levels of capitals. Participation in the CFM program also had a positive effect on human capital but had minimal impact on the other capitals influencing household well-being and resilience, suggesting that the impact of co-management on household resilience may be modest. In all, the findings highlight the need for co-management policies to pay attention to the historical context of community interaction processes influencing access to capital assets and local institutions to successfully promote equitable resilience.

Barriers to collaborative forest management and implications for building the resilience of forest-dependent communities in the Ashanti region of Ghana.

Community resilience, the capacity of a community to adapt to change in ways that result in positive impacts on its well-being, is increasingly used as a framework for understanding and enhancing the sustainability of forest-dependent communities as social-ecological systems. However, studies linking community resilience to the implementation of forest management programs are limited. This study uses community resilience literature and analyzes data collected from interviews to study barriers of forest-dependent communities of collaborative forest management (CFM) in two forest-dependent communities in the Ashanti region of Ghana. Analysis revealed the barriers in community response to CFM programs in these two communities comprise institutional shortfalls in the design and implementation of the CFM program that have constrained the incentives, capacity and opportunities for communities to successfully adapt to the program. The paper offers recommendations on how the CFM program can contribute to building the resilience of communities in managing their forests. The first is to build institutional capacity of communities to play an active role in forest governance, and the second is the prioritization of well-being and livelihood enhancement as forest management goals.

Optimum number of sessions for depression and anxiety.

AIM: To examine the relationship between the number of psychological treatment sessions completed by patients (1-5 sessions, 6-8 sessions, >8 sessions) and the change in self-rated depressive and anxiety symptoms using the Hospital Anxiety and Depression Scale (HADS). METHOD: Recording demographic characteristics and various clinical outcome measures for all referrals to the service and examining the relationship between changes in self-reported anxiety and depression symptoms. RESULTS: For depression, the study shows that having 6-8 sessions offers more benefit than 1-5 sessions. Having more than eight sessions does not confer any additional benefit. Indeed, there is little difference between 1-5 sessions and more than eight sessions for depression. For anxiety, symptoms appear to continue to improve with increasing numbers of treatment sessions. CONCLUSION: Beyond eight treatment sessions, there appears to be no additional improvement. This is not the case for anxiety, where continuing treatment sessions appear to reduce symptoms.