Nutritional and gastrointestinal manifestations in Rett syndrome: long-term follow-up.

PURPOSE: Rett syndrome is a rare neurodevelopmental disorder associated with methyl CpG binding protein 2 (MECP2) gene mutations. We aimed to characterize the long-term nutritional and gastrointestinal course of Rett syndrome in a large national patient population. METHODS: We conducted a retrospective cohort study of patients followed during 1991-2021 at a national center for Rett syndrome. The data retrieved included clinical features, laboratory and genetic analyses. Continuous anthropometric measurements were calculated for the closest visit to the median ages: 2.5, 7.5, 12.5 and 17.5 years. Kaplan Meier curves were used to describe the appearance of clinical manifestations during the follow up period. Generalized estimating equation models were used to compare repeated measurements. RESULTS: Included were 141 patients (139 females), the median age at the first visit was 3.2 years (interquartile range [IQR] 2.3-5.7), and the median length of follow-up was 94.5 months (IQR 28.6-153.3). Mean weight, height and BMI Z-scores were -1.09, -1.03 and -0.56, respectively, at median age 2.5 years; and deteriorated to -3.95, -3.01 and -1.19, respectively, at median age 17.5 years (P < 0.001). Gastrointestinal features included constipation (47.5%, 67/141) and chewing/feeding difficulties (20%, 28/141) at presentation; and an additional 47 (33.3%) and 24 (17.0%), respectively, during follow up. Twenty-eight patients (20%) developed aerophagia and 44 (31.2%) gastroesophageal reflux. No relation was found between genetic mutation types and clinical manifestations. GI manifestations were more prevalent in patients with typical form of Rett syndrome. CONCLUSIONS: Anthropometric parameters were shown to deteriorate with age, regardless of the specific genetic mutation. Chewing/feeding difficulties, constipation and gastroesophageal reflux are common in Rett patients.

Leveraging AI to improve evidence synthesis in conservation.

Systematic evidence syntheses (systematic reviews and maps) summarize knowledge and are used to support decisions and policies in a variety of applied fields, from medicine and public health to biodiversity conservation. However, conducting these exercises in conservation is often expensive and slow, which can impede their use and hamper progress in addressing the current biodiversity crisis. With the explosive growth of large language models (LLMs) and other forms of artificial intelligence (AI), we discuss here the promise and perils associated with their use. We conclude that, when judiciously used, AI has the potential to speed up and hopefully improve the process of evidence synthesis, which can be particularly useful for underfunded applied fields, such as conservation science.

Hepatic extravasation of total parenteral nutrition following umbilical venous catheter insertion: A rare complication.

Umbilical venous catheters are commonly inserted in critically ill newborns and can lead to severe complications when misplaced. We report a preterm female with a prenatal diagnosis of duodenal atresia who presented 2 days after the surgical repair with abdominal distension, hemodynamic instability, elevated liver enzymes with severe cholestatic jaundice, and a hepatic collection on abdominal sonography. An urgent explorative laparotomy demonstrated a large amount of white, milky-appearing fluid in the abdominal cavity. Together with the sonographic findings, this led to the diagnosis of hepatic total parenteral nutrition extravasation. Upon removal of the umbilical venous catheter line, the infant's clinical state rapidly improved; however, cholestasis continued for months, with a very slow resolution. During follow-up, the liver enzymes normalized, and a complete resolution of the liver collection was observed, without drainage.

Effects of wind turbine noise on songbird behavior during nonbreeding season.

Anthropogenic noise is one of the fastest growing, globally widespread pollutants, affecting countless species worldwide. Despite accumulating evidence of the negative impacts of wind turbines on wildlife, little is known about how the noise they generate affects ecological systems. Songbirds may be susceptible to noise pollution due to their reliance on vocal communication and thus, in this field study, we examined how songbirds are affected by wind turbine noise. We broadcasted noise produced by one wind turbine in a migratory stopover site during the nonbreeding season. Throughout the study, we repeatedly monitored the acoustic environment and songbird community before, during, and after the noise treatments with passive acoustic monitoring and mist netting. We employed generalized linear mixed effects models to assess the impact of experimental noise treatment on birds behavior and likelihood ratio tests to compare models with variables of interest with null models. The daily number of birds in the presence of wind turbine noise decreased by approximately 30% compared with the before and after phases. This reduction had a significant spatial pattern; the largest decrease was closer to the speaker and on its downwind side, fitting measured sound propagation. Although we found no impact on species diversity, two out of three most common species showed clear avoidance behavior: 45% and 36% decrease in abundance for the lesser whitethroat (Sylvia curruca) and Sardinian warbler (Sylvia melanocephala momus), respectively. In the after phase, there were lingering effects on the lesser whitethroat. The age structure of the lesser whitethroat population was affected because only juvenile birds showed avoidance behavior. No difference in avoidance extent was found between migratory and nonmigratory species, but the impacts of displacement on migrants during stopover are especially troubling from a conservation perspective. Our results stress the need to address the impacts of noise pollution on wildlife when planning noise-generating infrastructures, such as wind turbines, to allow for sustainable development without threatening already declining songbird populations.

El ruido antropogénico es uno de los contaminantes con mayor crecimiento y distribución a nivel mundial, por lo que afecta a incontables especies en todo el mundo. A pesar de acumular evidencia sobre el impacto negativo que tienen las turbinas eólicas sobre la fauna, se sabe muy poco sobre cómo el ruido que generan afecta a los sistemas ecológicos. Las aves canoras pueden ser susceptibles a la contaminación sonora ya que dependen de la comunicación vocal y, por lo tanto, en este estudio de campo, analizamos cómo les afecta el sonido producido por las turbinas eólicas. Transmitimos ruido producido por una turbina en un punto de parada migratorio durante la temporada no reproductiva. Durante el estudio, monitoreamos repetidas veces el entorno acústico y la comunidad de aves canoras antes, durante y después de los tratamientos de ruido con monitoreo acústico pasivo y redes de niebla. Empleamos modelos de efectos lineales mixtos generalizados para evaluar el impacto del ruido experimental sobre el comportamiento de las aves y pruebas de probabilidad de proporción para comparar los modelos con variables de interés con los modelos nulos. El número diario de aves en la presencia del ruido de turbinas eólicas disminuyó aproximadamente un 30% en comparación con las fases de antes y después. Esta reducción tuvo un patrón espacial significativo: la mayor disminución ocurrió más cerca a la bocina y en el lado de sotavento, lo que se ajusta a la medida de la propagación del sonido. Aunque no encontramos impacto alguno sobre la diversidad de especies, dos de tres de las especies más comunes mostraron un comportamiento de evasión evidente: 45% y 36% de disminución en la abundancia de Sylvia curruca y Sylvia melanocephala momus, respectivamente. Durante la fase posterior al ruido, observamos efectos prolongados en S. curruca. La composición de edades de la población de S. curruca se vio afectada porque sólo los individuos juveniles mostraron un comportamiento de evasión. No encontramos una diferencia en el grado de evasión entre las especies migratorias y no migratorias, pero el impacto del traslado sobre las migrantes durante el punto de parada es de preocupación especial desde una perspectiva de conservación. Nuestros resultados acentúan la necesidad de abordar el impacto de la contaminación sonora sobre la fauna cuando se planean estructuras que producen ruido, como las turbinas eólicas, para permitir el desarrollo sustentable sin amenazar a las poblaciones de aves canoras que ya están en declive. Efectos del ruido de turbinas eólicas sobre el comportamiento de las aves canoras durante la temporada no reproductiva.

The Effect of Dexmedetomidine Sedation on Lower Gastrointestinal Motility in Children-Is It Suitable for Anorectal Manometry?

Anorectal manometry is one of the most frequently performed gastrointestinal motility studies in children. It is an important study in diagnosing Hirschsprung disease (HD). These procedures can be uncomfortable, painful and emotionally distressing. Nitrous oxide or midazolam are the only pharmacologic options available, as clinical experience suggests that they do not alter manometry readings. Our study was designed to determine whether Dexmedetomidine (DEX) could provide adequate sedation without disrupting anal and rectal pressure. The effect of DEX on anorectal function has never been studied in children. This prospective study recorded anorectal manometry (ARM) measurements prior to the administration of DEX and then repeated the measurements at 1 and 5 min after DEX. The main ARM measurements included resting intra-anal sphincter pressure (IASP) and the presence and characteristics of the recto-anal inhibitory reflex (RAIR). DEX was administered as a bolus followed by a continuous infusion. Twenty patients were included (60% female; mean age 10.8 ± 4.6 years). The RAIR became absent in 2/16 (12.5%) patients after DEX administration. DEX may alter physiologic ARM and IASP recordings necessary to diagnose gastrointestinal medical conditions.

Early and accumulated experience shape migration and flight in Egyptian vultures.

Two types of experience affect animals' behavioral proficiencies and, accordingly, their fitness: early-life experience, an animal's environment during its early development, and acquired experience, the repeated practice of a specific task.1,2,3,4,5,6,7,8 Yet, how these two experience types and their interactions affect different proficiencies is still an open question. Here, we study the interactions between these two types of experience during migration, a critical and challenging period.9,10 We do so by comparing migratory proficiencies between birds with different early-life experiences and explain these differences by testing fine-scale flight mechanisms. We used data collected by GPS transmitters during 127 autumn migrations of 65 individuals to study the flight proficiencies of two groups of Egyptian vultures (Neophron percnopterus), a long-distance, soaring raptor.11,12 The two groups differed greatly in their early-life experience, one group being captive bred and the other wild hatched.13 Both groups improved their migratory performance with acquired experience, exhibiting shorter migration times, longer daily progress, and improved flight skills, specifically more efficient soaring-gliding behavior. The observed improvements were mostly apparent for captive-bred vultures, which were the least efficient during their first migration but were able to catch up in their migratory performance already in the second migration. Thus, we show how the strong negative effects of early-life experience were offset by acquired experience. Our findings uncover how the interaction between early-life and acquired experiences may shape animals' proficiencies and shed new light on the ontogeny of animal migration, suggesting possible effects of sensitive periods of learning on the acquisition of migratory skills.

Thermal conditions determine lizards' response to oil contamination in a desert habitat.

A unique, hyper-arid habitat in southern Israel was polluted by crude oil in 2014. Surveys following the event found that some species of local lizards avoid the oil, while other species were found more frequently in polluted plots. These results raised the question: why do species react differently to oil-polluted soil? We evaluated how soil type, thermal conditions, and food availability interacted to shape habitat preferences of three lizard species. Generally, thermal conditions determined habitat selection and preferences for contaminated or clean soils, while the effects of food availability were weak. The diurnal Acanthodactylus opheodurus avoided artificial heating sources, perhaps to avoid hot soil during warm hours. Both nocturnal Stenodactylus species showed a preference for higher temperature treatments. While crude oil is considered harmful, ectotherms may not recognize it as a danger and may be attracted to it due to its thermal properties, which may create an ecological trap.

The ethics of intervening in animal behaviour for conservation.

Conservation behaviour is a growing field that applies insights from the study of animal behaviour to address challenges in wildlife conservation and management. Conservation behaviour interventions often aim to manage specific behaviours of a species to solve conservation challenges. The field is often viewed as offering approaches that are less intrusive or harmful to animals than, for example, managing the impact of a problematic species by reducing its population size (frequently through lethal control). However, intervening in animal behaviour, even for conservation purposes, may still raise important ethical considerations. We discuss these issues and develop a framework and a decision support tool, to aid managers and researchers in evaluating the ethical considerations of conservation behaviour interventions against other options.

Validation of predictive models for disease outcomes in paediatric ulcerative colitis: A multicentre prospective inception cohort.

BACKGROUND: Several studies have proposed models to predict disease outcomes in paediatric ulcerative colitis (UC), notably PROTECT, Schechter and PIBD-ahead, but none has been validated by external cohorts AIM: To explore these models in a prospective multicentre inception cohort METHODS: Children newly diagnosed with UC in 17 centres were followed at disease onset and 3 and 12 months thereafter, as well as at last visit. Outcomes included steroid-free remission (SFR) and acute severe colitis (ASC). RESULTS: Of the 223 included children, 74 (34%), 97 (43%) and 52 (23%) presented with mild, moderate and severe disease, respectively. SFR rate was 35% at 3 months and 47% at 12 months (62% of those with mild disease at diagnosis vs. 41% in moderate-severe disease; p = 0.01). Thirty-six (16%) children developed ASC during the first month after diagnosis, and 53 (24%) during the first year. The AUC of the PROTECT model for predicting SFR at 3 and 12 months was 0.78 [95% CI 0.65-0.92] and 0.57 [95% CI 0.47-0.66], respectively. The sensitivity/specificity/PPV/NPV of Schechter's criteria to predict sustained SFR at 12 months was 50%/60%/35%/74%. ASC was predicted only by the PUCAI score at diagnosis and at 3 months. CONCLUSIONS: The PROTECT model had a good predictive utility for SFR at 3 months, but not at 12 months. The other predictive models did not achieve sufficient accuracy, which was far from that reported in the original studies. This highlights the necessity for external validation of any prediction model prior to its implementation into clinical practice.

Time constraints may pace the ontogeny of movement behaviour.

During early development, juvenile animals need to acquire a diverse behavioural repertoire to interact with their environment. The ontogeny of animal behaviour, is paced by the motivation to improve, e.g. internal clocks, and limited by external constraints, e.g. weather conditions. We here evaluate how naive Egyptian vultures (Neophron percnopterus) improve in locomotor performance, measured as daily maximum displacement, prior to their first migration under three different time constraint regimes: we compared wild hatched vultures, migrating one month after fledging, with captive-hatched vultures, released in spring four months or in winter nine months before migration. We found that the time until migration paced the development of movement behaviour: wild birds rapidly increased displacement distances within the first two weeks after fledging, while spring and winter released vultures delayed movement increases by two and four months, respectively. Under relaxed time constraints captive-hatched vultures displayed diverse functional forms of performance enhancements and therefore great variability in individual ontogeny of movement behaviour. While weather conditions in winter could limit flight movements, some birds indeed moved immediately after their release, indicating that weather may not be limiting. Our findings promote the idea that relaxed ecological constraints could uncover hidden phenotypic flexibility in ontogeny, which could present a greater potential for adaptability under environmental change than currently expected.

Clinical Features and Outcomes of Paediatric Patients With Isolated Colonic Crohn Disease.

OBJECTIVES: Adult studies suggest that patients with isolated colonic Crohn disease (L2 CD) exhibit unique characteristics differentiating them from patients with ileo-caecal (L1) CD and ulcerative colitis (UC). We aimed to characterize clinical features and outcomes of paediatric patients with L2. METHODS: Retrospective data was collected through the Porto Inflammatory Bowel Disease group of the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) on Paediatric patients with L2, L1 or UC at different time-points. Outcome measures included time to first flare, hospital admissions, initiation of anti-tumor necrosis factor-alpha (TNFα) drug, stricture and surgery. RESULTS: Three hundred patients were included: 102 L1, 94 L2 and 104 UC. Rates of hematochezia at presentation were 14.7%, 44.7% and 95.2%, while rates of fever were 12.7%, 26.6% and 2.9%, for patients with L1, L2 and UC, respectively (P < 0.001 for all comparisons). Skip lesions were identified in 65% of patients with L2, and granulomas in 36%, similar to L1 patients. Rates of anti-Saccharomyces cerevisiae antibodies (ASCA) and perinuclear antineutrophil cytoplasmic (pANCA) positivity significantly differed between the three groups: 25.4% and 16.7% for patients with L2, compared with 55.2% and 2.3%, and 1.8% and 52.9% for patients with L1 and UC, respectively. Response rates to exclusive enteral nutrition were comparable between L1 and L2 (78.3-82.4%), as was the response to oral steroids (70.4-76.5%) in the three groups. While times to first flare and admission were similar between groups, patients with L1 were commenced on anti-TNFα earlier. Moreover, stricturing phenotype and need for colectomy were very rare in patients with L2. CONCLUSIONS: Significant differences are observed in the clinical presentation and outcomes of Paediatric patients with L2, compared to patients with L1 and UC.

The Impact of a Short-term Intervention on Adolescent Eating Habits and Nutritional Knowledge.

BACKGROUND: Adequate dietary habits and physical activity during childhood and adolescence may promote growth and cognitive development and contribute to the prevention of chronic disease in later life. School is considered an important social environment that can promote healthy eating habits and life-style changes. OBJECTIVES: To evaluate the effects of a school-based intervention on nutritional knowledge, eating habits, and physical activity of adolescents. METHODS: We conducted a prospective questionnaire-based study. Anonymous questionnaires were administered at the beginning of the academic year (September 2014) in one high school. During the following year, vending machines containing milk products were installed within the school facility, and students were given two informative nutrition lectures regarding proper nutrition for age, calcium requirement and importance, and physical activity. One active sports day was initiated. At the beginning of the following academic year (September 2015), the students completed the same questionnaires. RESULTS: The study was comprised of 330 teenagers, mean age 15.1 ± 1.39 years, 53% males. Response rate was 83.6% ± 0.4% to multiple choice questions, 60.7% ± 0.5% to multiple section tables, and 80.3% ± 0.9% to open questions. Post-intervention, respondents reported an increase in eating breakfast (57% vs. 47.5%, P = 0.02) and a decrease in purchasing food at school (61.6% vs. 54.3%, P = 0.03). No changes were observed in consumption of milk products, knowledge regarding calcium and vegetable consumption, or sports activities. CONCLUSIONS: Short-term high school-based interventions may lead to improvements in eating habits but are not sufficient for changing nutritional knowledge and physical activity.

A review of constraints and solutions for collecting raptor samples and contextual data for a European Raptor Biomonitoring Facility.

The COST Action 'European Raptor Biomonitoring Facility' (ERBFacility) aims to develop pan-European raptor biomonitoring in support of better chemicals management in Europe, using raptors as sentinel species. This presents a significant challenge involving a range of constraints that must be identified and addressed. The aims of this study were to: (1) carry out a comprehensive review of the constraints that may limit the gathering in the field of raptor samples and contextual data, and assess their relative importance across Europe; and (2) identify and discuss possible solutions to the key constraints that were identified. We applied a participatory approach to identify constraints and to discuss feasible solutions. Thirty-one constraints were identified, which were divided into four categories: legal, methodological, spatial coverage, and skills constraints. To assess the importance of the constraints and their possible solutions, we collected information through scientific workshops and by distributing a questionnaire to stakeholders in all the countries involved in ERBFacility. We obtained 74 answers to the questionnaire, from 24 of the 39 COST participating countries. The most important constraints identified were related to the collection of complex contextual data about sources of contamination, and the low number of existing raptor population national/regional monitoring schemes and ecological studies that could provide raptor samples. Legal constraints, such as permits to allow the collection of invasive samples, and skills constraints, such as the lack of expertise to practice necropsies, were also highlighted. Here, we present solutions for all the constraints identified, thus suggesting the feasibility of establishing a long-term European Raptor Sampling Programme as a key element of the planned European Raptor Biomonitoring Facility.

A novel approach for long-term spectral monitoring of desert shrubs affected by an oil spill.

Crude oil pollution is a global environmental concern since it persists in the environment longer than most conventional carbon sources. In December 2014, the hyper-arid Evrona Nature Reserve, Israel, experienced large-scale contamination when crude oil spilled. The overarching goal of the study was to investigate the possible changes, caused by an accidental crude oil spill, in the leaf reflectance and biochemical composition of four natural habitat desert shrubs. The specific objectives were (1) to monitor the biochemical properties of dominant shrub species in the polluted and control areas; (2) to study the long-term consequences of the contamination; (3) to provide information that will assist in planning rehabilitation actions; and (4) to explore the feasibility of vegetation indices (VIs), along with the machine learning (ML) technique, for detecting stressed shrubs based on the full spectral range. Four measurement campaigns were conducted in 2018 and 2019. Along with the various stress indicators, field spectral measurements were performed in the range of 350-2500 nm. A regression analysis to examine the relation of leaf reflectance to biochemical contents was carried out, to reveal the relevant wavelengths in which polluted and control plants differ. Vegetation indices applied in previous studies were found to be less sensitive for indirect detection of long-term oil contamination. A novel spectral index, based on indicative spectral bands, named the "normalized blue-green stress index" (NBGSI), was established. The NBGSI distinguished significantly between shrubs located in the polluted and in the control areas. The NBGSI showed a strong linear correlation with pheophytin a. Machine learning classification algorithms obtained high overall prediction accuracy in distinguishing between shrubs located in the oil-polluted and the control sites, indicating internal component differences. The findings of this study demonstrate the efficacy of indirect and non-destructive spectral tools for detecting and monitoring oil pollution stress in shrubs.

Differential survival throughout the full annual cycle of a migratory bird presents a life-history trade-off.

Long-distance migrations are among the most physically demanding feats animals perform. Understanding the potential costs and benefits of such behaviour is a fundamental question in ecology and evolution. A hypothetical cost of migration should be outweighed by higher productivity and/or higher annual survival, but few studies on migratory species have been able to directly quantify patterns of survival throughout the full annual cycle and across the majority of a species' range. Here, we use telemetry data from 220 migratory Egyptian vultures Neophron percnopterus, tracked for 3,186 bird months and across approximately 70% of the species' global distribution, to test for differences in survival throughout the annual cycle. We estimated monthly survival probability relative to migration and latitude using a multi-event capture-recapture model in a Bayesian framework that accounted for age, origin, subpopulation and the uncertainty of classifying fates from tracking data. We found lower survival during migration compared to stationary periods (ß = -0.816; 95% credible interval: -1.290 to -0.318) and higher survival on non-breeding grounds at southern latitudes (<25°N; ß = 0.664; 0.076-1.319) compared to on breeding grounds. Survival was also higher for individuals originating from Western Europe (ß = 0.664; 0.110-1.330) as compared to further east in Europe and Asia, and improved with age (ß = 0.030; 0.020-0.042). Anthropogenic mortalities accounted for half of the mortalities with a known cause and occurred mainly in northern latitudes. Many juveniles drowned in the Mediterranean Sea on their first autumn migration while there were few confirmed mortalities in the Sahara Desert, indicating that migration barriers are likely species-specific. Our study advances the understanding of important fitness trade-offs associated with long-distance migration. We conclude that there is lower survival associated with migration, but that this may be offset by higher non-breeding survival at lower latitudes. We found more human-caused mortality farther north, and suggest that increasing anthropogenic mortality could disrupt the delicate migration trade-off balance. Research to investigate further potential benefits of migration (e.g. differential productivity across latitudes) could clarify how migration evolved and how migrants may persist in a rapidly changing world.

iNaturalist insights illuminate COVID-19 effects on large mammals in urban centers.

Restricted human activity during the COVID-19 pandemic raised global attention to the presence of wildlife in cities. Here, we analyzed iNaturalist observations of prominent wildlife species around North-American urban centers, before and during the COVID-19 pandemic outbreak. We suggest that the popular notion of 'wildlife reclaiming cities' may have been exaggerated. We found that while pumas ventured deeper into urban habitats during the COVID-19 pandemic, bears, bobcats, coyotes, and moose did not. Species differential behavioral responses may highlight their evolutionary history cohabiting human habitats. Nevertheless, our results highlight the importance of urban nature for people during the pandemic. Our insights could help manage urban wildlife, better plan greenspaces, and promote positive nature engagements.

Evolutionary dynamics in the Anthropocene: Life history and intensity of human contact shape antipredator responses.

Humans profoundly impact landscapes, ecosystems, and animal behavior. In many cases, animals living near humans become tolerant of them and reduce antipredator responses. Yet, we still lack an understanding of the underlying evolutionary dynamics behind these shifts in traits that affect animal survival. Here, we used a phylogenetic meta-analysis to determine how the mean and variability in antipredator responses change as a function of the number of generations spent in contact with humans under 3 different contexts: urbanization, captivity, and domestication. We found that any contact with humans leads to a rapid reduction in mean antipredator responses as expected. Notably, the variance among individuals over time observed a short-term increase followed by a gradual decrease, significant for domesticated animals. This implies that intense human contact immediately releases animals from predation pressure and then imposes strong anthropogenic selection on traits. In addition, our results reveal that the loss of antipredator traits due to urbanization is similar to that of domestication but occurs 3 times more slowly. Furthermore, the rapid disappearance of antipredator traits was associated with 2 main life-history traits: foraging guild and whether the species was solitary or gregarious (i.e., group-living). For domesticated animals, this decrease in antipredator behavior was stronger for herbivores than for omnivores or carnivores and for solitary than for gregarious species. By contrast, the decrease in antipredator traits was stronger for gregarious, urbanized species, although this result is based mostly on birds. Our study offers 2 major insights on evolution in the Anthropocene: (1) changes in traits occur rapidly even under unintentional human "interventions" (i.e., urbanization) and (2) there are similarities between the selection pressures exerted by domestication and by urbanization. In all, such changes could affect animal survival in a predator-rich world, but through understanding evolutionary dynamics, we can better predict when and how exposure to humans modify these fitness-related traits.

The Yield of Upper Gastrointestinal Endoscopy at a Pediatric Tertiary Care Center.

BACKGROUND: The number of investigative esophagogastroduodenoscopies (EGD) in children has increased over several decades, despite their unclear diagnostic yields. OBJECTIVES: To evaluate the indications for performing EGD, their diagnostic yields, and consequences on pediatric patient management. METHODS: A retrospective chart review was performed of consecutive pediatric patients aged 0-18 years, who underwent EGD between January and August 2014. RESULTS: During the study period, 547 EGD were performed on 478 children. The most frequent indications were suspected celiac disease, chronic non-specific abdominal pain, persistent Helicobacter pylori infection, and gastrointestinal hemorrhage. The yield of the diagnostic EGD was 59.2%, and the most common new diagnoses were celiac disease (28%), Helicobacter pylori-positive gastritis (16.5%), and Crohn's disease (5.4%). Of the patients with documented follow-up, 74.1% reported improved symptoms. Procedures performed for chronic unexplained abdominal pain had significantly lower yields (26.2%) and only 39.3% improved at follow-up. CONCLUSIONS: Our findings suggest a general high diagnostic yield for EGD in pediatric patients, stemming mainly from patients in whom a specific condition was suspected a priori. However, the role of the procedure in the diagnosis and management of non-specific gastrointestinal complaints was minor suggesting that EGD may be superfluous for some of these patients.

Are both necessity and opportunity the mothers of innovations?

Baumard's perspective asserts that "opportunity is the mother of innovation," in contrast to the adage ascribing this role to necessity. Drawing on behavioral ecology and cognition, we propose that both extremes - affluence and scarcity - can drive innovation. We suggest that the types of innovations at these two extremes differ and that both rely on mechanisms operating on different time scales.