Development of a New Scale to Assess Students' Autodetermination At School (AAS).

The Autodetermination At School (AAS) hetero-evaluative scale was created and validated in a French teacher population with the aim of quantifying, in an ecological way, the commitment at school of elementary students. After establishing the scale's face validity, AAS was tested with an exploratory factor analysis, a confirmatory factor analysis, a convergent validity analysis, a test-retest analysis and an inter-individual analysis. The EFA highlighted three distinct factors and the CFA validated the reliability of a three-factor model for AAS with relevant fits and indices. The first dimension concerns teacher perception of academic commitment, reflecting both child performance and autonomous motivation. The second and third ones reflect teacher perception of the child's social commitment, to their peers as well as to their teacher. Consequently, AAS is a useful, reliable and robust psychometric instrument that emphases how intrinsic motivation and performance are closely linked. It also considers the importance of social child commitment at school. The inter-individual analysis revealed trends of grade, gender and school environment effects.

Can subjective symptoms predict objective findings in gastroesophageal reflux disease patients?

INTRODUCTION: Medical therapy is the first-line treatment for gastroesophageal reflux disease, but surgical options are available and shown to be effective when medical management fails. There is no consensus for when a surgical evaluation is indicated. We set out to determine if the GERD-HRQL questionnaire scores correlate to objective findings found in patients undergoing anti-reflux surgery to predict when surgical consultation could be warranted. METHODS: A prospectively gathered database was used for patients undergoing anti-reflux surgery from January 2014 to September 2020. Inclusion criteria required a diagnosis of GERD and comprehensive esophageal workup with the GERD-HRQL questionnaire, EGD, esophageal manometry, and ambulatory pH monitoring. Analysis of the GERD-HRQL scores was compared to objective endpoints to see correlation and predictability. Logistic regression analysis was used to assess relationship between the presence of objective findings and GERD-HRQL questionnaire scores. RESULTS: There were 246 patients meeting inclusion criteria. There was no significant correlation between GERD-HRQL score and DeMeester score (correlation coefficient = 0.23), or presence of a hiatal hernia, regardless of size (p = 0.89). Patients with esophagitis had significantly higher average GERD-HRQL scores compared to those without esophagitis (40.1 ± 18.9 vs 30.4 ± 19.1, p < 0.0001). Patients with a score of 40 or greater had a 42% to 65% probability of having esophagitis versus a score of 30 or less, lowering the chances of having esophagitis to less than 35%. CONCLUSION: Usage of a GERD-HRQL questionnaire score can potentially show the correlation between subjective and objective findings in the workup of a patient for anti-reflux surgery. Specifically, patients with a GERD-HRQL score of 40 or greater have an increased probability of esophagitis compared to those with a score of 30 or less. Using these scores can help referring clinicians identify those patients failing medical therapy and allow for prompt referral for surgical evaluation.

Laparoscopic repair of large diaphragmatic hernia after left ventricular assist device implantation followed by orthotopic heart transplantation.

In patients with advanced heart failure and deteriorating clinical status, a left ventricular assist device (LVAD) can be used as a bridge to transplantation or as an alternative to transplantation. An uncommon complication of orthotopic heart transplant or LVADs is diaphragmatic hernia during implantation or explantation of the device. We describe a patient with a diaphragmatic hernia with incarcerated colon and small bowel treated previously with a HeartMate 3 LVAD and subsequent transplantation. This case highlights the need to consider the diagnosis of diaphragmatic hernia based on symptoms after HeartMate 3 implantation and/or subsequent transplantation, as well as the ability to manage these hernias with a minimally invasive laparoscopic approach to minimize postoperative morbidity and mortality.

Portion size can be used strategically to increase intake of vegetables and fruits in young children over multiple days: a cluster-randomized crossover trial.

BACKGROUND: Although dietary guidelines recommend that vegetables and fruits make up half the diet, it is unclear whether serving vegetables and fruits in larger portions will have sustained effects on children's intake over multiple days. OBJECTIVES: This study tested the effects on children's intake of 2 strategies for increasing the proportion of vegetables and fruits: either adding or substituting extra portions as side dishes at meals and snacks over 5 d. METHODS: In a cluster-randomized crossover design with 3 periods, we provided all meals and snacks for 5 d to 53 children aged 3-5 y in classrooms in their childcare centers. In the Control condition, we served typical portions for all food groups. In the Addition condition we increased portions of low-energy-dense vegetables and fruits by 50%, and in the Substitution condition we increased portions of vegetables and fruits by 50% and also reduced portions of other foods by an equivalent weight. RESULTS: For vegetables, the Addition strategy increased daily intake compared with Control by 24% (mean ± SEM = 12 ± 3 g/d; P = 0.0002), and the Substitution strategy increased intake compared with Control by 41% (22 ± 3 g/d; P < 0.0001). For fruits, consumption increased by similar amounts: Addition by 33% (60 ± 6 g/d) and Substitution by 38% (69 ± 8 g/d; both P < 0.0001). Both strategies increased vegetable and fruit intakes compared with Control across all 5 days (all P < 0.004), although the increase in fruit consumption with Addition declined over time (P < 0.0001). Daily energy intake compared with Control increased by 5% with Addition (57 ± 17 kcal; P = 0.001) but decreased by 6% with Substitution (-64 ± 21 kcal; P = 0.004). CONCLUSIONS: Both the Addition and Substitution strategies promoted increases in vegetable and fruit intake over 5 d in preschool children. When excess energy intake is a concern, substituting vegetables and fruits for other foods is a better option than simply serving more.This trial was registered at http://www.clinicaltrials.gov as NCT03242863 (https://clinicaltrials.gov/ct2/show/NCT03242863), where the protocol is available.

Abstract Graphic Creativity, Feelings about School, and Engagement in the School Environment: What Are the Interindividual Differences between Gifted and Non-Gifted Children?

This study examines interindividual differences between gifted and non-gifted children in the school environment. Three distinct measurement tools were used to enable a multimodal approach of gifted and non-gifted children with abstract graphic creativity, feelings about school and engagement in the school environment being considered. The results obtained from 328 children (including 45 gifted children) revealed that the gifted children obtained scores significantly higher than non-gifted children in terms of self-determination, feelings about school, and creativity. In addition, a gap appears among gifted children between their significantly higher scores for motivation and intellectual skills versus standard scores for their socio-affective development. Such results are consistent with the idea of asynchronous development, which is characteristic of gifted children (cognitive and conative vs. socio-affective sphere), offering perspectives for more adapted support for these pupils in elementary school.

Promoting vegetable intake in preschool children: Independent and combined effects of portion size and flavor enhancement.

This study investigated the independent and combined effects on preschool children's vegetable intake of serving a larger portion of vegetables and enhancing their flavor. In a crossover design, lunch was served in childcare centers once a week for four weeks to 67 children aged 3-5 y (26 boys, 41 girls). The meal consisted of two familiar vegetables (broccoli and corn) served with fish sticks, rice, ketchup, applesauce, and milk. Across the four meals, we varied the portion of vegetables (60 or 120 g total weight, served as equal weights of broccoli and corn) and served them either plain or enhanced (6.6% light butter and 0.5% salt by weight). All meals were consumed ad libitum and were weighed to determine intake. Doubling the portion of vegetables led to greater consumption of both broccoli and corn (both p < 0.0001) and increased meal vegetable intake by 68% (mean ± SEM 21 ± 3 g). Enhancing vegetables with butter and salt, however, did not influence their intake (p = 0.13), nor did flavor enhancement modify the effect of portion size on intake (p = 0.10). Intake of other meal components did not change when the vegetable portion was doubled (p = 0.57); thus, for the entire meal, the increase in vegetable consumption led to a 5% increase in energy intake (13 ± 5 kcal; p = 0.02). Ratings indicated that children had similar liking for the plain and enhanced versions of each vegetable (both p > 0.31). All versions of vegetables were well-liked, as indicated by ≥ 76% of the children rating them as "yummy" or "just okay". Serving a larger portion of vegetables at a meal was an effective strategy to promote vegetable intake in children, but when well-liked vegetables were served, adding butter and salt was not necessary to increase consumption.

Complications Following Robotic Hiatal Hernia Repair Are Higher Compared to Laparoscopy.

BACKGROUND: The use of robotic platforms in surgery is becoming increasingly common in both practice and residency training. In this study, we compared the perioperative outcomes between robotic platforms and traditional laparoscopy in paraesophageal hernia repair. METHODS: A retrospective population-based analysis was performed using the National Inpatient Sample for the period of 2010-2015. Adult patients (≥18 years old) who underwent laparoscopic or robotic paraesophageal hernia repairs were included. Weighted multivariable random intercept linear and logistic regression models were used to assess the effects of robotic surgery on patient outcomes. RESULTS: A total of 168,329 patients were included in the study. The overall adjusted rate of complications was significantly higher in patients who underwent robotic paraesophageal hernia (PEH) repair compared to laparoscopic PEH OR (95% CI) = 1.17 (1.07, 1.27). Specifically, respiratory failure OR (95% CI) = 1.68 (1.37, 2.05) and esophageal perforation OR (95% CI) = 2.19 (1.42, 3.93) were higher in robotic PEH patients. A subset analysis was performed looking at high-volume centers (>20 operations per year), and, although the risk of complications was lower in the high volume centers compared to intermediate volume centers, complication rates were still significantly higher in the robotic surgery group compared to laparoscopic. Overall charges per surgery were significantly higher in the robotic group. CONCLUSION: Robotic PEH repair is associated with significantly more complications compared to laparoscopic paraesophageal hernia repair even in high-volume centers.

Family History of GERD Does Not Predict Anti-Reflux Surgery Outcomes.

BACKGROUND AND OBJECTIVES: Gastroesophageal reflux disease is a common disease and there is little known about the role family history plays in its disease process and incidence. Our study was designed to compare the patients with first degree relatives with and without the disease and see if there was any difference in patients needing antireflux surgery, the outcomes after antireflux surgery, and whether they needed redo surgery. METHODS: An institutional review board approved registry for patients undergoing antireflux surgery at a single institution was used. Patients were asked specific questions about their family history of gastroesophageal reflux disease at their pre-operative visit. Patients with a family history and those without were compared. RESULTS: There was no statistical difference between the patients with family history of gastroesophageal reflux disease for likelihood to undergo surgery, outcomes from surgery, or the need for redo surgery. There were more females than males in the study and there were more patients with a positive family history in the study than those without. CONCLUSION: Since there is no impact of family history of gastroesophageal reflux disease on antireflux surgery, patients can be counseled that their decision to undergo antireflux surgery is independent from the response of their first degree relatives.

Hiatal hernia repair and magnetic sphincter augmentation to treat laryngopharyngeal reflux aiding the prevention of recurrent laryngeal cancer.

Laryngopharyngeal reflux (LPR) is a difficult disease to treat and can result in mucosal injury in the pharynx and larynx. This typically results in symptoms such as cough, hoarseness, and globus sensation, but the manifestation of cancer is a possibility. We present a patient with a squamous cell cancer of the larynx who was diagnosed with gastroesophageal reflux disease (GERD) and found to have LPR. The cancer was treated locally and GERD was eradicated with magnetic sphincter augmentation. After 15 months of follow-up, there was no residual cancer. This case highlights the role that untreated LPR may play in patients' risk of developing laryngeal cancer.

Portion size has sustained effects over 5 days in preschool children: a randomized trial.

BACKGROUND: Although short-term studies have found that serving larger portions of food increases intake in preschool children, it is unknown whether this portion size effect persists over a longer period or whether energy intake is moderated through self-regulation. OBJECTIVES: We tested whether the portion size effect is sustained in preschool children across 5 consecutive days, a period thought to be sufficient for regulatory systems to respond to the overconsumption of energy. METHODS: With the use of a crossover design, over 2 periods we served the same 5 daily menus to 46 children aged 3-5 y in their childcare centers. In 1 period, all foods and milk were served in baseline portions, and in the other period, all portions were increased by 50%. The served items were weighed to determine intake. RESULTS: Increasing the portion size of all foods and milk by 50% increased daily consumption: weighed intake increased by a mean ± SEM of 143 ± 21 g/d (16%) and energy intake increased by 167 ± 22 kcal/d (18%; both P < 0.0001). The trajectories of intake by weight and energy across the 5-day period were linear and the slopes did not differ between portion conditions (both P > 0.13), indicating that there were sustained increases in intake from larger portions without compensatory changes over time. Children differed in their response to increased portions: those with higher weight status, lower ratings for satiety responsiveness, or higher ratings for food responsiveness had greater increases in intake from larger portions (all P < 0.03). CONCLUSIONS: This demonstration that preschool children failed to adjust their intake during prolonged exposure to larger portions challenges the suggestion that their self-regulatory behavior is sufficient to counter perturbations in energy intake. Furthermore, overconsumption from large portions may play a role in the development of overweight and obesity, as the magnitude of the effect was greater in children of higher weight status. This trial was registered at www.clinicaltrials.gov as NCT02963987.

Both increases and decreases in energy density lead to sustained changes in preschool children's energy intake over 5 days.

BACKGROUND AND OBJECTIVE: To investigate preschool children's ability to self-regulate their energy intake, we assessed their response to increases or decreases in dietary energy density (ED) over 5 consecutive days, a period likely long enough for compensatory behavior. METHODS: Using a crossover design, over 3 periods we served the same 5 daily menus to 49 children aged 3-5 y in their childcare centers. During each 5-day period, 3 main dishes and 1 snack per day were systematically varied in ED, from baseline ED to either higher ED (increased by 20%) or lower ED (decreased by 20%). All of the served items were weighed to determine individual intakes. RESULTS: Modifying the ED of 4 dishes per day had a significant and sustained effect on preschool children's daily energy intake across 5 days. In the baseline condition, children's intakes were similar to daily energy needs (98 ±â€¯2%), but serving higher-ED foods increased energy intake by 84 ±â€¯16 kcal/d (to 105 ±â€¯2% of needs) and serving lower-ED foods decreased energy intake by 72 ±â€¯17 kcal/d (to 89 ±â€¯2% of needs; both P < .0001). The patterns of daily energy intake over the 5 days did not differ across conditions (P = .20), thus there was no evidence that either surfeits or deficits in energy intake led to adjustment over this time period. Furthermore, the response to ED varied, as children with a higher weight status had greater amounts of overconsumption when served higher-ED foods and of underconsumption when served lower-ED foods compared to children with a lower weight status. CONCLUSIONS: These findings counter the suggestion that preschool children's regulatory systems can be relied on to adjust intake in response to energy imbalances. Increasing or decreasing the ED of several foods per day leads to sustained changes in the energy intake of preschool children.

Comparing the portion size effect in women with and without extended training in portion control: A follow-up to the Portion-Control Strategies Trial.

Following a 1-year randomized controlled trial that tested how weight loss was influenced by different targeted strategies for managing food portions, we evaluated whether the effect of portion size on intake in a controlled setting was attenuated in trained participants compared to untrained controls. Subjects were 3 groups of women: 39 participants with overweight and obesity from the Portion-Control Strategies Trial, 34 controls with overweight and obesity, and 29 controls with normal weight. In a crossover design, on 4 different occasions subjects were served a meal consisting of 7 foods that differed in energy density (ED). Across the meals, all foods were varied in portion size (100%, 125%, 150%, or 175% of baseline). The results showed that serving larger portions increased the weight and energy of food consumed at the meal (P < .0001), and this effect did not differ across groups. Increasing portions by 75% increased food intake by a mean (±SEM) of 111 ±â€¯10 g (27%) and increased energy intake by 126 ±â€¯14 kcal (25%). Across all meals, however, trained participants had lower energy intake (506 ±â€¯15 vs. 601 ±â€¯12 kcal, P = .006) and lower meal ED (1.09 ±â€¯0.02 vs. 1.27 ±â€¯0.02 kcal/g; P = .003) than controls, whose intake did not differ by weight status. The lower energy intake of trained participants was attributable to consuming meals with a greater proportion of lower-ED foods than controls. These results further demonstrate the robust nature of the portion size effect and reinforce that reducing meal ED is an effective way to moderate energy intake in the presence of large portions.

Computerized Dose Range Checking Using Hard and Soft Stop Alerts Reduces Prescribing Errors in a Pediatric Intensive Care Unit.

OBJECTIVE: An enhanced dose range checking (DRC) system was developed to evaluate prescription error rates in the pediatric intensive care unit and the pediatric cardiovascular intensive care unit. METHODS: An enhanced DRC system incorporating "soft" and "hard" alerts was designed and implemented. Practitioner responses to alerts for patients admitted to the pediatric intensive care unit and the pediatric cardiovascular intensive care unit were retrospectively reviewed. RESULTS: Alert rates increased from 0.3% to 3.4% after "go-live" (P < 0.001). Before go-live, all alerts were soft alerts. In the period after go-live, 68% of alerts were soft alerts and 32% were hard alerts. Before go-live, providers reduced doses only 1 time for every 10 dose alerts. After implementation of the enhanced computerized physician order entry system, the practitioners responded to soft alerts by reducing doses to more appropriate levels in 24.7% of orders (70/283), compared with 10% (3/30) before go-live (P = 0.0701). The practitioners deleted orders in 9.5% of cases (27/283) after implementation of the enhanced DRC system, as compared with no cancelled orders before go-live (P = 0.0774). Medication orders that triggered a soft alert were submitted unmodified in 65.7% (186/283) as compared with 90% (27/30) of orders before go-live (P = 0.0067). After go-live, 28.7% of hard alerts resulted in a reduced dose, 64% resulted in a cancelled order, and 7.4% were submitted as written. CONCLUSIONS: Before go-live, alerts were often clinically irrelevant. After go-live, there was a statistically significant decrease in orders that were submitted unmodified and an increase in the number of orders that were reduced or cancelled.

Immunosuppression in pediatric liver transplant recipients: Unique aspects.

Pediatric liver transplantation has experienced improved outcomes over the last 50 years. This can be attributed in part to establishing optimal use of immunosuppressive agents to achieve a balance between minimizing the risks of allograft rejection and infection. The management of immunosuppression in children is generally more complex and can be challenging when compared with the use of these agents in adult liver transplant patients. Physiologic differences in children alter the pharmacokinetics of immunosuppressive agents, which affects absorption, distribution, metabolism, and drug excretion. Children also have a longer expected period of exposure to immunosuppression, which can impact growth, risk of infection (bacterial, viral, and fungal), carcinogenesis, and likelihood of nonadherence. This review discusses immunosuppressive options for pediatric liver transplant recipients and the unique issues that must be addressed when managing this population. Further advances in the field of tolerance and accommodation are needed to relieve the acute and cumulative burden of chronic immunosuppression in children. Liver Transplantation 23 244-256 2017 AASLD.

Does milk matter: Is children's intake affected by the type or amount of milk served at a meal?

Increasing the energy density (ED) and portion size of foods promotes additional energy intake, but the effect of similar changes in milk is unknown. Using a crossover design, we tested the effect of varying the ED and portion size of milk served with lunch on preschool children's intake. Lunch was served in childcare classrooms on 4 days to 125 children aged 3-5 y (67 boys; 58 girls). Across the meals, milk was varied in ED (lower-ED [1% fat]; higher-ED [3.25% fat]) and portion size (100% [183 g]; 150% [275 g]). Foods in the meal were not varied; children ate as much of the meal as they wanted. Serving higher-ED milk did not affect milk intake by weight, but increased energy intake from milk by 31 ± 2 kcal compared to serving lower-ED milk (P < 0.0001). Serving the 150% portion of milk increased milk intake by 20 ± 3 kcal compared to serving the 100% portion (P < 0.0001). Increases in both ED and portion size combined to increase milk intake by 49 ± 4 kcal (63%; P < 0.0001). Across all children, food intake decreased when higher-ED rather than lower-ED milk was served, but meal energy intake (food + milk) did not change significantly. This response varied by sex: for boys, serving higher-ED milk decreased food intake by 43 ± 8 kcal (P < 0.0001) but did not affect meal energy intake, while for girls, higher-ED milk did not reduce food intake so that meal energy intake increased by 24 ± 10 kcal (P = 0.03). Thus, boys adjusted food intake in response to changes in ED of milk consumed with lunch, but girls did not. Serving milk in larger portions promotes intake of this nutrient-dense beverage, but the effects of milk ED on meal intake vary between children.

Review of indicators and field methods for monitoring biodiversity within national forest inventories. Core variable: deadwood.

Deadwood is one of the four elements taken into account in this review of indicators and field methods and is often considered as a key indicator of forest biodiversity. We have analysed the main types of surveys and have realised how greatly the needs and constraints used to monitor deadwood can vary among them. For instance, classical National Forest Inventories usually tend to avoid time-consuming collecting methods. In the wide variety of existing definitions of deadwood, such inventories require simple and clear definitions, especially in terms of quantified thresholds. Thus, deadwood is properly described by characterising several components, such as snags, logs, stumps, branches and fine woody debris. Deadwood sampling methods alter depending on the different components and dimensions considered (standing dead trees, lying dead trees and branches, etc. assessed quantitatively). Attributes such as tree species and stage of decay are used mainly to qualify the deadwood components. The deadwood volume estimations are usually based on classical approaches already applied to living or felled trees: volume equations and/or formulas giving the volumes of common geometric solids. The purpose of this paper is to focus on different deadwood assessment techniques and to provide the information necessary to identify the most relevant methods for collecting deadwood data. The latter is used to build indicators that characterise the evolution of forest biodiversity at the scale of large forest territories.