Efficacy of Preoperative Chemotherapy in Treatment of Children With Wilms’ Tumor: A Meta-Analysis

Context: To assess the efficacy of preoperative chemotherapy in Wilms’ tumor patients and explore its true value for specific subgroups. Objectives: In the presence of these controversies, a meta-analysis that examines the efficacy of preoperative chemotherapy in Wilms’ tumor patients and specific subgroups is needed to clarify these issues. The objective of this meta-analysis is to assess the efficacy of preoperative chemotherapy in Wilms’ tumor patients and explore its true value for specific subgroups. Data Sources: Computer-based systematic search with “preoperative chemotherapy”, “Neoadjuvant Therapy” and “Wilms’ tumor” as search terms till January 2013 was performed. Study Selection: No language restrictions were applied. Searches were limited to randomized clinical trials (RCTs) or retrospective studies in human participants under 18 years. A manual examination of references in selected articles was also performed. Data Extraction: Relative Risk (RR) and their 95% Confidence Interval (CI) for Tumor Shrinkage (TS), total Tumor Resection (TR), Event-Free Survival (EFS) and details of subgroup analysis were extracted. Meta-analysis was carried out with the help of the software STATA 11.0. Finally, four original Randomized Clinical Trials (RCTs) and 28 retrospective studies with 2375 patients were included. Results: For preoperative chemotherapy vs. up-front surgery (PC vs. SU) group, the pooled RR was 9.109 for TS (95% CI: 5.109 - 16.241; P < 0.001), 1.291 for TR (95% CI: 1.124 - 1.483; P < 0.001) and 1.101 for EFS (95% CI: 0.980 - 1.238; P = 0.106). For subgroup short course vs. long course (SC vs. LC), the pooled RR was 1.097 for TS (95% CI: 0.784 - 1.563; P = 0.587), 1.197 for TR (95% CI: 0.960 - 1.493; P = 0.110) and 1.006 for EFS (95% CI: 0.910 - 1.250; P = 0.430). Conclusions: Short course preoperative chemotherapy is as effective as long course and preoperative chemotherapy only benefits Wilms’ tumor patients in tumor shrinkage and resection but not event-free survival.

Deflazacort Versus Prednisolone: Randomized Controlled Trial in Treatment of Children With Idiopathic Nephrotic Syndrome

Background: Corticosteroids are the main therapy of nephrotic syndrome and goal of corticosteroid therapy is to obtain maximum clinical benefit with minimum adverse effects. Children are more vulnerable to side effects of corticosteroids related to growth and adrenal suppression, so a search for an alternative steroid with fewer side-effects is underway. Deflazacort is an oxazoline derivative and preliminary data suggest reduced osteoporosis, lesser growth retardation and weight gain with deflazacort. Objectives: This study was done to compare the effectiveness and safety of deflazacort in idiopathic nephrotic syndrome. Patients and Methods: Twenty five children with age between 2 to 12 years, with idiopathic nephrotic syndrome were enrolled. They were randomly assigned to receive deflazacort (Group A, n = 12) or prednisolone (Group B, n = 13) and were followed up for six months. Results: All children of group A and 11 of group B had remission. Two children from group B were steroid resistant. Mean time taken to induce remission was significantly (P = 0.012) less in group A (10.25 ± 2.41 days) than group B (12.55 ± 1.44 days). One patient in group A had relapse on follow up as compared to 3 in group B (P = 0.58). Statistically significant difference (P = 0.03) in change in mean height was found between group A (2.13 ± 0.50cm) and B (1.44 ± 0.45 cm), with group B gaining less height. Conclusions: Remission rate in both groups was comparable although time taken to induce remission was shorter in deflazacort group and there was a significant difference in change of mean height on follow up with prednisolone group gaining lesser height.

Outcomes of Second Look Exploration in Testicular Torsion of Children

Background: Testicular torsion (TT), or twisting of the testicle resulting in a strangulation of the blood supply, occurs in men whose tissue surrounding the testicle is not well attached to the scrotum. It is important to emphasize that testicular torsion is a medical emergency. Objectives: The aim of this study is to evaluate the second look exploration and outcomes in TT. Patients and Methods: Seventy boys out of 124 patients underwent early exploration and 48 hours later second look exploration due to TT. All patients were checked with preoperative color-doppler ultrasonography (CDU) and intraoperative bleeding test. Data included age at admission, side of pathology, relation of TT with season of year, duration of preoperative history, degree of testicular torsion, CDU findings, and degree of bleeding; results of second look exploration, follow-up, and outcomes were analyzed. Results: Totally 70 patients were included in this study within five years, of which mean age was 28.6 ± 32.9 months (range 1 to 144), 48% of our patients had nausea and vomiting. Preoperative CDU showed absent/weak flow in 50 (71%) cases. Winter showed most frequently (44%) referred cases of testicular torsion. Orchidopexy was performed in 44 (63%) and orchidectomy in 26 (37%) cases after second look exploration. Mean follow-up duration was 3.1 ± 1.4 years. 4 (9%) cases in orchidopexy group developed testicular atrophy during follow-up, all four cases had a history of longer than 12 hours and grade II testicular bleeding test intra-operatively. Other orchidopexy patients salvaged. 26 patients, who were in grade III, underwent orchidectomy in second look exploration. Conclusions: TT requires emergency attention. The ischemia time of the testis is traditionally after 6 hours, and imaging or other diagnostic modality should not be a cause of delay. Early surgical exploration is modality of choice, and second look exploration after 48 hours can be more effective and salvageable in these patients.

The constitutional rights of children and the Prevention of Organised Crime Act 121 of 1998

The Prevention of Organised Crime Act 121 of 1998 [POCA] embodies a serious attempt by the South African government to effectively police and curb organised crime, money laundering and criminal gang activities in South Africa. The Act provides inter alia for a range of crippling fines and for orders such as confiscation and forfeiture. Asset forfeiture and confiscation orders can affect the rights of third parties directly and indirectly in a number of ways. Young persons and children can beaffected indirectly because asset forfeiture and confiscation orders may violate the right to parental care of the dependent young persons and children of the person who is subject to the order. This brief article will investigate aspects of the protection afforded to the rights of children when such orders are made in terms of the provisions of the Prevention of Organised Crime Act.

Taste preferences of children

In this book, the authors present topical research data in the study of the sense of taste

Physical activity of children: a global matrix of grades comparing 15 countries

The Active Healthy Kids Canada (AHKC) Report Card on Physical Activity for Children and Youth has been effective in poweringthe movement to get kids moving by influencing priorities, policies, and practice in Canada. The AHKC Report Card process wasreplicated in 14 additional countries from 5 continents using 9 common indicators (Overall Physical Activity, Organized SportParticipation, Active Play, Active Transportation, Sedentary Behavior, Family and Peers, School, Community and Built Environment,and Government Strategies and Investments), a harmonized process and a standardized grading framework. The 15 ReportCards were presented at the Global Summit on the Physical Activity of Children in Toronto on May 20, 2014. The consolidatedfindings are summarized here in the form of a global matrix of grades. There is a large spread in grades across countries for mostindicators. Countries that lead in certain indicators lag in others. Overall, the grades for indicators of physical activity (PA) aroundthe world are low/poor. Many countries have insufficient information to assign a grade, particularly for the Active Play and Familyand Peers indicators. Grades for Sedentary Behaviors are, in general, better in low income countries. The Community and BuiltEnvironment indicator received high grades in high income countries and notably lower grades in low income countries. There wasa pattern of higher PA and lower sedentary behavior in countries reporting poorer infrastructure, and lower PA and higher sedentarybehavior in countries reporting better infrastructure, which presents an interesting paradox. Many surveillance and researchgaps and weaknesses were apparent. International cooperation and cross-fertilization is encouraged to tackle existing challenges,understand underlying mechanisms, derive innovative solutions, and overcome the expanding childhood inactivity crisis.

Pediatric donation after circulatory determination of death: Respecting the interests of children through routine consideration of donation opportunities

Overby and colleagues (2015) highlight the complexities of consent to or authorization for organ procurement in the setting of controlled donation after circulatory determination of death (cDCDD). They note that decision making about cDCDD is complicated by clinical uncertainties and ethical controversies regarding protocols for the determination of death by circulatory criteria and the use of perimortem interventions to support organ procurement, and that these uncertainties and controversies may be exacerbated in the pediatric context. Suggesting that parents and clinicians may “unconsciously” compromise the best interests of their own children and patients in order to achieve organ procurement goals, Overby and colleagues argue that children are at risk of instrumentalization when the option of cDCDD is presented. This claim is further grounded in their belief that children lack autonomy and can have no interest in becoming organ donors. In this commentary, we contest these assumptions, the implications of which extend beyond cDCDD and threaten to undermine programs of pediatric deceased donation, including donation after the neurologic determination of death (DNDD). We argue that routine consideration of the possibility of organ donation by critically ill children is consistent with respect for children&rsquo;s best interests and, most importantly, their human dignity.

‘Cemented in their cells’: a human rights analysis of Blessington, Elliott and the life imprisonment of children in New South Wales

In 2010, two Australians, convicted in childhood of rape and murder, lodged a joint submission with the United Nations Human Rights Committee, claiming that successive changes to sentencing legislation in New South Wales breached their human rights by denying them any meaningful prospect of release. In this article, we examine the political, legislative and procedural moves that have resulted in Australian children being sentenced to life without parole or release. We argue that successive legislative changes in various Australian jurisdictions have resulted in a framework for sentencing decisions that is considerably out of step with international legal standards for criminal justice. These increasingly punitive legislative changes exacerbate Australia’s already declining record of cooperation with UN processes, and reveal Australia’s reluctance to respect the legitimacy and authority of international law. Against this troubling context, the views of the Human Rights Committee serve as a much-needed reminder about the importance of a principled approach to child sentencing that forecloses neither the goal of rehabilitation nor the prospect of release and reintegration.

Evaluation of a comprehensive interactive training system for investigative interviewers of children

 Ms Benson's thesis focused on evaluating a new, innovative, interactive online training program for investigative interviewer's of child victims. The results were overwhelmingly positive, showing that online training can be implemented in large organisations, and improve trainees' practical interviewing skills and knowledge.

Global citizenship incorporated: competing responsibilities in the education of global citizens

Interest in the education of young people to be ‘responsible global citizens’ has grown exponentially since the turn of the century, led by increasingly diverse networks of sectors, including government, community, business and philanthropy. These networks now have a significant influence on education policy and practice, indicative of wider changes in governance and processes of globalisation. Yet little of the academic literature on global citizenship education specifically examines the impact of these networks on the production of knowledge about young global citizens. This paper addresses this gap by analysing the discourses of global citizenship that underpin recent work by a youth organisation that works closely with a network of sectors in Australia. The paper finds that a particular kind of entrepreneurial global citizen is favoured, one that is simultaneously responsible for themselves, for the rights of others and for ensuring Australia's future economic prosperity.

A telephone survey to determine the experiences of children and their parents/carers, following the initiation of a new medicine

Objective: To determine what issues are experienced during the first few weeks of therapy by patients, and their parents/carers, when a child/young person has been prescribed a new medicine. Method: One hundred patients aged ≤18 years of age prescribed a new medicine for ≥6 weeks were recruited from a single UK National Health Service specialist paediatric hospital outpatient pharmacy. Six weeks after the first dispensing of their new medicine the patient or their parent/carer received telephone follow-up by a researcher and verbally completed a questionnaire containing both open and closed questions. Patient or parent/carer experiences were identified and analysed using thematic analysis and descriptive statistics. Results: Eighty-six participants were available for telephone follow-up. Six (7%) had not started their medicine. Paediatric patients and their parents/carers experienced a range of issues during the first few weeks after starting a new medicine. These included additional concerns/questions (24/80, 30%), administration issues (21/80, 26.3%), adverse effects (29/80, 36.3%) and obtaining repeat supplies (12/80, 15%). The Morisky Medication Adherence Scale indicated that 34/78 (43.6%) participants had a high adherence rating, 35/78 (44.9%) medium and 9/78 (11.5%) a low rating. Conclusions: Paediatric patients and their parents/carers experience a range of issues during the first few weeks after starting a new medicine. Further research is required to determine the type of interventions that may further support medicines use in this group of patients.

Educational software in english to the awareness in a preschool education supervised context

Information and communication technologies play an increasingly important role in society, in the sense that all areas and professions make use of digital resources. The school can not be brushed off this reality, aim to create full subjects and integrated in society today. Educational software can be used very early in the education of children, but they must be carefully and monitoring. This article aims to present the results of the use of educational software in English to the awareness of context with children of pre-school education in kindergarten, nursery center Redemptorist Fathers - The smallest fox in White Castle, a 21 group children under 5 years. Early awareness of foreign language such as English can be started with digital multimedia capabilities and various software available on the market. However, the small study described the case reveals some resistance from parents and educators, in the preparation of these to choose and monitor the use of ICT by children, in addition to also highlight the self-interest of the children involved and their learning a few words in English language in different contexts of daily worked. The study opens perspectives on close monitoring needs of such uses and training of educators in the field of use of resources multilingual awareness in pre-school education.

Consumers knowledge about dietary fibre : Results of a survey questionnaire in Hungary and Romania

Dietary fi bres (DFs) are essential components of the balanced diet. Even though the adequate level of their consumption can be ensured from several natural (e.g. fruit, vegetables, legumes) and ‘artifi cial’ sources (e.g. functional foods), the consumed levels are below the recommendations. To analyse the Hungarian and Romanian consumers’ knowledge level, their perceptions of the health benefi ts associated with fi bre, as well as the recognition of the potential information sources, a survey questionnaire was conducted with the total of 713 consumers. Results showed that the level of knowledge about DFs was not adequate. Internet was found to be widely used and identifi ed as one of the most appropriate information sources to encourage the consumption of DF. It was a favourable result that three-quarter of the respondents was interested in the topic of healthy food consumption; however, just less than half of them took into consideration the label information during their shopping decisions. To increase the consumption of DF and to support the responsibility and conscious consumer decisions steps must to be done (e.g. education of children, pointing out of the sources). For this purpose, modern information technology and communication channels fi tting to the consumers’ cultural and personal particularities can be utilized.

Educated to Learn : How to enhance the education of computer science and informatics

The very nature of computer science with its constant changes forces those who wish to follow to adapt and react quickly. Large companies invest in being up to date in order to generate revenue and stay active on the market. Universities, on the other hand, need to imply same practices of staying up to date with industry needs in order to produce industry ready engineers. By interviewing former students, now engineers in the industry, and current university staff this thesis aims to learn if there is space for enhancing the education through different lecturing approaches and/or curriculum adaptation and development. In order to address these concerns a qualitative research has been conducted, focusing on data collection obtained through semi-structured live world interviews. The method used follows the seven stages of research interviewing introduced by Kvale and focuses on collecting and preparing relevant data for analysis. The collected data is transcribed, refined, and further on analyzed in the “Findings and analysis” chapter. The focus of analyzing was answering the three research questions; learning how higher education impacts a Computer Science and Informatics Engineers’ job, how to better undergo the transition from studies to working in the industry and how to develop a curriculum that helps support the previous two. Unaltered quoted extracts are presented and individually analyzed. To paint a better picture a theme-wise analysis is presented summing valuable themes that were repeated throughout the interviewing phase. The findings obtained imply that there are several factors directly influencing the quality of education. From the student side, it mostly concerns expectation and dedication involving studies, and from the university side it is commitment to the curriculum development process. Due to the time and resource limitations this research provides findings conducted on a narrowed scope, although it can serve as a great foundation for further development; possibly as a PhD research.