Create a culture of experiments in environmental programs.

Organizations need a better "learning by doing" approach.

Multiple persistent ganglioneuromas likely arising from the spontaneous maturation of metastatic neuroblastoma.

A 10-year-old girl with multiple persistent ganglioneuromas originating from the spontaneous maturation of a metastatic neuroblastoma is described. Multiple biopsies confirm progressive maturation and urine catecholamines, which were initially elevated, have normalized over time. The management and risk of malignant transformation of ganglioneuromas is discussed.

Do truth-telling oaths improve honesty in crowd-working?

This study explores whether an oath to honesty can reduce both shirking and lying among crowd-sourced internet workers. Using a classic coin-flip experiment, we first confirm that a substantial majority of Mechanical Turk workers both shirk and lie when reporting the number of heads flipped. We then demonstrate that lying can be reduced by first asking each worker to swear voluntarily on his or her honor to tell the truth in subsequent economic decisions. Even in this online, purely anonymous environment, the oath significantly reduced the percent of subjects telling "big" lies (by roughly 27%), but did not affect shirking. We also explore whether a truth-telling oath can be used as a screening device if implemented after decisions have been made. Conditional on flipping response, MTurk shirkers and workers who lied were significantly less likely to agree to an ex-post honesty oath. Our results suggest oaths may help elicit more truthful behavior, even in online crowd-sourced environments.

An experimental test of fundraising appeals targeting donor and recipient benefits.

We partnered with Alaska's Pick.Click.Give. programme to implement a statewide natural field experiment with 540,000 Alaskans designed to examine two of the main motivations for charitable giving: concerns for the benefits to self (impure altruism or 'warm glow') or concerns for the benefits to others (pure altruism). Our empirical results highlight the relative importance of appeals to self: individuals who received such an appeal were 6.6% more likely to give and gave 23% more than counterparts in the control group. Yet, a message that instead appealed to recipient benefits (motivated by altruism) had no statistically significant effect on average donations relative to the control group. We also find evidence of long-run effects of warm-glow appeals in the subsequent year. Our results have import for theoreticians and empiricists interested in modelling charitable giving as well as practitioners and policymakers.

Correction: Do truth-telling oaths improve honesty in crowd-working?

[This corrects the article DOI: 10.1371/journal.pone.0244958.].

Delayed Presentation of Meconium Ileus in an Infant With Cystic Fibrosis.

Although infants with meconium ileus usually present with apparent symptoms shortly after birth, the diagnosis of meconium ileus and cystic fibrosis (CF) may be delayed, awaiting newborn screening (NBS) results. We present the case of an 11-day-old term girl with delayed passage of meconium at 48 hours who had 2 subsequent small meconium stools over the following week. There was a normal feeding history and no signs of abdominal distension or distress. She then presented with an acute abdomen, decompensated shock, bowel perforation, and peritonitis, requiring multiple intestinal surgeries. Her NBS for CF was positive, and CF was ultimately confirmed with mutation analysis. Her course was complicated by prolonged parenteral feedings and mechanical ventilation via tracheostomy. The infant was managed with soy oil, medium chain triglycerides, olive oil, fish oil lipids and experienced only transaminitis without cholestasis and no chronic liver sequelae, with subsequent normalization of her transaminases without treatment. Because her only symptom was decreased stool output and NBS results were unavailable, the CF diagnosis was delayed until she presented in extremis. Delayed meconium passage and decreased stool output during the first week of life should lead to suspicion and additional evaluation for CF while awaiting NBS results. Careful monitoring is indicated to prevent serious, life-threatening complications. The use of soy oil, medium chain triglycerides, olive oil, fish oil lipids for infants requiring prolonged parenteral nutrition may also be considered proactively to prevent cholestasis, particularly for high risk groups.

Pre- and postnatal findings in a boy with duplication of the bladder and intestine: report and review.

We describe a boy with a septated bladder and dilated bowel loop found on prenatal ultrasonography. Subsequent prenatal MRI diagnosed a probable caudal duplication anomaly. Postnatal investigations and surgical findings confirmed duplication of bladder, urethra, and bowel from distal ileum to rectum. This is the first reported case of combined bladder and colon duplication suspected antenatally with thorough imaging investigations including fetal MRI. While diagnosis of bladder duplication has been described, prenatal diagnosis of intestinal duplication has not been documented previously. This report of prenatal imaging with surgical and pathological correlation contributes to our detailed understanding of the spectrum of anatomy seen in caudal duplication anomaly.

Bile Duct Injury in Children: Is There a Role for Early Endoscopic Retrograde Cholangiopancreatography?

Introduction Liver injury is common among pediatric abdominal trauma. Nonoperative management is the standard of care in isolated stable liver injuries. Bile leak is not an uncommon complication in moderate- and high-grade injuries. Case series Three pediatric patients (age: 10-15 years) suffered grade IV liver injuries secondary to blunt abdominal trauma. All developed significant bile leak treated nonoperatively with endoscopic retrograde cholangiopancreatography (ERCP), and patients 1 and 2 were treated with bile duct stent alone. Patient 3 required laparotomy for bile peritonitis and abdominal compartment syndrome followed by interval ERCP and bile duct stent. Conclusion Traumatic bile leaks if not recognized and managed early can result in significant morbidity. This paper describes the presentation and treatment of three pediatric patients with blunt liver trauma complicated by significant bile leaks that were managed successfully with ERCP and bile duct stent. This paper demonstrates the importance of early detection of bile leak to prevent bile peritonitis. Abdominal imaging 4 to 5 days postinjury can help in detecting bile accumulation. We believe that ERCP and bile duct stent are becoming the standard of care in diagnosing and treating traumatic bile leak. This paper confirms the safety and feasibility of this technique in the pediatric population.

Indirect Reciprocity, Resource Sharing, and Environmental Risk: Evidence from Field Experiments in Siberia.

Integrating information from existing research, qualitative ethnographic interviews, and participant observation, we designed a field experiment that introduces idiosyncratic environmental risk and a voluntary sharing decision into a standard public goods game. Conducted with subsistence resource users in rural villages on the Kamchatka Peninsula in Northeast Siberia, we find evidence consistent with a model of indirect reciprocity and local social norms of helping the needy. When participants are allowed to develop reputations in the experiments, as is the case in most small-scale societies, we find that sharing is increasingly directed toward individuals experiencing hardship, good reputations increase aid, and the pooling of resources through voluntary sharing becomes more effective. We also find high levels of voluntary sharing without a strong commitment device; however, this form of cooperation does not increase contributions to the public good. Our results are consistent with previous experiments and theoretical models, suggesting strategic risks tied to rewards, punishments, and reputations are important. However, unlike studies that focus solely on strategic risks, we find the effects of rewards, punishments, and reputations are altered by the presence of environmental factors. Unexpected changes in resource abundance increase interdependence and may alter the costs and benefits of cooperation, relative to defection. We suggest environmental factors that increase interdependence are critically important to consider when developing and testing theories of cooperation.

The treatment of abdominoscrotal hydrocele: Is there a role for nonoperative management?

BACKGROUND/PURPOSE: Abdominoscrotal hydrocele (ASH) is an uncommon entity. Until now, the recommended treatment has been surgical. There is only one successful case of nonoperative management reported in literature. We report the largest series of children with ASH, and provide evidence in support of an initial nonoperative approach. METHODS: This study is a retrospective chart review of patients treated from 1994 to 2015 with ASH at a single institution. RESULTS: Thirty patients were identified with ASH, with 29 included in the analysis. Nine patients (30%) had operative management with an 80% complication rate. Twenty out of 29 patients (70%) were initially managed expectantly. Sixteen (80%) had resolution of their abdominal component, twelve (60%) of which went on to have full resolution of ASH. Four patients (20%) in this group required operative management of ASH. CONCLUSIONS: ASH should be included in the differential diagnosis of pediatric scrotal swelling. The "Springing Back Ball Sign" should be used as a screening tool. If it is positive, a dynamic ultrasound should be performed to confirm the diagnosis. We recommend observation as the first step in the management of uncomplicated ASH. It can result in avoidance of operation or at least lower the complication risk significantly if operation is required. LEVEL OF EVIDENCE: 4.

Precise synthesis of poly(macromonomer)s containing sugars by repetitive ring-opening metathesis polymerisation.

Various poly(macromonomer)s containing sugars have been prepared by ROMP of norbornene macromonomers substituted with ROMP block copolymers containing acetal-protected sugars as the side chain, which upon removal of the protecting group affords a novel amphiphilic architecture.

Sirenomelia: urological abnormalities in a surviving mermaid.

We report on a surviving four-year-old female with sirenomelia. She was born with the features of fused lower extremities, imperforate anus, colon atresia, pelvic and sacral dysplasia. Despite these severe anomalies, she had functional renal units. Maldevelopment of the genitourinary tract in patients with severe variant of caudal regression syndrome is usually incompatible with life. The case report includes the most current imaging studies of her unusual pelvic anomalies which poses a reconstructive challenge to the pediatric surgeon.

Human milk fortifier: an occult cause of bowel obstruction in extremely premature neonates.

BACKGROUND: Human milk fortifier (HMF) is used in neonatal units throughout North America to facilitate growth of preterm infants. Little data is available on the gastrointestinal side effects and potential adverse events. The purpose of this paper was to present a series of infants presenting with bowel obstruction associated with HMF. METHODS: Cases of HMF obstruction were collected between January 2010 and December 2012. Charts were reviewed and relevant data was collected. RESULTS: During the study period, 7 premature infants presented with bowel obstruction secondary to intestinal concretions of HMF. All babies were premature with gestational ages from 25 to 27 weeks. Birth weight was less than 1000 grams in all patients. Patients presented with feeding intolerance, bilious aspirates, abdominal distension, and obstipation. Four of the patients presented with acute deterioration and required urgent surgical intervention. CONCLUSIONS: HMF is an important source of nutritional support in infants, which is felt to be safe. We present a series of infants where its use has resulted in significant complications. HMF should be used with caution in infants, especially those with a history of necrotizing enterocolitis. Further research should examine the calcium, protein, and fatty acid concentration tolerable in the gastrointestinal tract of infants.

Approaches for the design of reduced toxicant emission cigarettes.

Cigarette smoking causes serious diseases through frequent and prolonged exposure to toxicants. Technologies are being developed to reduce smokers' toxicant exposure, including filter adsorbents, tobacco treatments and substitutes. This study examined the effect of modifications to filter ventilation, variations in cigarette circumference and active charcoal filter length and loading, as well as combinations of these features in a reduced-toxicant prototype (RTP) cigarette, on the yields of toxicants in cigarette smoke. An air-dilution mechanism, called split-tipping, was developed in which a band of porous paper in the centre of the filter tipping functions to minimise the loss of effective filter ventilation that occurs at the high flow rates encountered during human-smoking, and to facilitate the diffusional loss of volatile toxicants. As compared with conventional filter ventilation cigarettes, split-tipping reduced tar and volatile smoke constituent emissions under high flow rate machine-smoking conditions, most notably for products with a 1-mg ISO tar yield. Furthermore, mouth level exposure (MLE) to tar and nicotine was reduced among smokers of 1-mg ISO tar cigarettes in comparison to smokers of cigarettes with traditional filter ventilation. For higher ISO tar level cigarettes, however, there were no significant reductions in MLE. Smaller cigarette circumferences reduced sidestream toxicant yields and modified the balance of mainstream smoke chemistry with reduced levels of aromatic amines and benzo[a]pyrene but increased yields of formaldehyde. Smaller circumference cigarettes also had lower mainstream yields of volatile toxicants. Longer cigarette filters containing increased levels of high-activity carbon (HAC) showed reduced machine-smoking yields of volatile toxicants: with up to 97% removal for some volatile toxicants at higher HAC loadings. Split-tipping was combined with optimal filter length and cigarette circumference in an RTP cigarette that gave significantly lower mainstream (up to ~90%) and sidestream (predominately 20%-60%) smoke yields of numerous toxicants as compared with a commercial comparator cigarette under machine-smoking conditions. Significantly lower mainstream and sidestream smoke toxicant yields were observed for an RTP cigarette comprising several toxicant reducing technologies; these observations warrant further evaluation in clinical studies where real-world relevance can be tested using biomarkers of exposure and physiological effect.

The intrathoracic kidney: should we fix it?

BACKGROUND: Intrathoracic kidney is a rare congenital anomaly, with only 13 cases reported in the pediatric age group over the past 25 years. The relevant literature is limited to individual case reports or small case series with no follow-up data. Both operative and nonoperative management has been advocated. We report our experience in the management of children with an intrathoracic kidney as well as the efficacy of nonoperative management in select patients. METHODS: Five cases of intrathoracic kidney were collected prospectively since 1992 and carefully followed up long term. RESULTS: Two children presented with acute respiratory distress and underwent right diaphragmatic hernia repair and nephropexy. Incidental diagnosis of a left intrathoracic kidney was made in 3 children. Long-term follow-up has demonstrated normal function and development of these kidneys in all 5 children with no late bowel herniation in the nonoperative group. CONCLUSION: Intrathoracic kidney associated with bowel in the chest should undergo standard repair and nephropexy. An isolated intrathoracic kidney without evidence of bowel herniation can safely be observed. This is the largest pediatric series of intrathoracic kidney as well as the first to document the efficacy of nonoperative management with long-term follow-up.

Traumatic pseudoaneurysms of the liver and spleen in children: is routine screening warranted?

BACKGROUND: Although blunt injury to the spleen and liver can lead to pseudoaneurysm formation, current surgical guidelines do not recommend follow-up imaging. Controversy exists regarding the clinical implications of these traumatic pseudoaneurysms as well as their management. METHODS: Retrospective review of children treated nonoperatively for isolated blunt liver and spleen trauma between 1991 and 2008 was undertaken. Patient demographics, grade of injury, and follow-up Doppler ultrasound results were obtained. RESULTS: Three hundred sixty-two children were identified. One hundred eighty-six of them had splenic injuries, and 10 (5.4%) developed pseudoaneurysms. They were associated with grade III (3/39 [8%]) and grade IV (7/41 [17%]) injuries. In 7 patients, the pseudoaneurysm thrombosed spontaneously. Angiographic embolization was required in 2 children, and one underwent emergency splenectomy for delayed hemorrhage. Of the 176 patients who had liver injuries, 3 (1.7%) developed pseudoaneurysms. All 3 were associated with grade IV injuries (3/11 [27%]). One child underwent early embolization, while 2 developed delayed hemorrhage requiring emergent treatment. CONCLUSIONS: Pseudoaneurysm development after blunt abdominal trauma is associated with high-grade splenic and liver injuries. Routine screening of this group of patients before discharge from hospital may be warranted because of the potential risk of life-threatening hemorrhage.

Severe genital ulceration in an acute epstein-barr virus infection.

Genital ulceration is a rare manifestation of infectious mononucleosis caused by Epstein-Barr virus (EBV). We report a girl with severe genital ulceration and tissue necrosis during primary EBV infection that required surgical debridement. The excised genital tissue was EBV polymerase chain reaction-positive whereas in situ hybridization was negative. This suggests that the ulceration was likely because of the inflammatory response to the virus and not because of the intense viral infection of the genitalia.

Adhesive small bowel obstruction in children: should we still operate?

PURPOSE: Adhesive small bowel obstruction (ASBO) is a significant cause of postoperative morbidity, yet studies characterizing outcomes in children are limited. Our aim was to review our experience to describe the role of operative and nonoperative therapy, markers of outcome, and burden of disease in children. MATERIALS AND METHODS: Admissions for ASBO at British Columbia Children's Hospital (Vancouver, British Columbia, Canada) identified by International Classification of Disease, Ninth Revision, codes were reviewed over a 10-year period. Demographic, clinical, laboratory, and operative details were collected for all patients. RESULTS: Our study identified 165 admissions of which 32 (19%) were managed with immediate operation, whereas 133 were initially managed nonoperatively. One hundred seven patients went on to laparotomy, whereas 26 (16%) were managed nonoperatively. Absence of leukocytosis and older age appeared to be associated with successful nonoperative therapy. Tachycardia and younger age appeared to be independent risk factors for failure of nonoperative management. Delayed surgery or conservative management did not cause an increase in complications. Appendectomy, stoma formation and closure, Nissen fundoplication, and Ladd's procedures were the most common procedures leading to ASBO. CONCLUSIONS: Conservative therapy is the preferred approach in selected patients with ASBO. However, 84% eventually require surgery. This differs markedly from results in adults where most resolve nonoperatively. Younger patients were more likely to fail conservative trials and were more likely to develop advanced disease, pointing to ASBO as a distinct disease entity in children.

The design of water markets when instream flows have value.

The main objective of this paper is to design and test a decentralized exchange mechanism that generates the location-specific pricing necessary to achieve efficient allocations in the presence of instream flow values. Although a market-oriented approach has the potential to improve upon traditional command and control regulations, questions remain about how these rights-based institutions can be implemented such that the potential gains from liberalized trade can be realized. This article uses laboratory experiments to test three different water market institutions designed to incorporate instream flow values into the allocation mechanism through active participation of an environmental trader. The smart, computer-coordinated market described herein offers the potential to significantly reduce coordination problems and transaction costs associated with finding mutually beneficial trades that satisfy environmental constraints. We find that direct environmental participation in the market can achieve highly efficient and stable outcomes, although the potential does exist for the environmental agent to influence outcomes.