Not Ready for Prime Time: A Response to “Universal Basic Income: Policy Options at National, State, and Local Levels”

Dave Canarie responds to Michael Howard’s commentary on universal basic income

Maine’s Journey into the Arctic: Why the Arctic Council Matters to Maine

High-level Arctic officials from the United States and seven other nations in the Arctic region, and representatives of indigenous people from the Arctic, gathered in Portland October 4–6, 2016, to discuss issues of importance to the region. In this commentary, Dave Canarie describes what the Arctic Council is and why it matters to Maine

Community health workers identify children requiring health center admission in Northern Uganda: prehospital risk prediction using vital signs and advanced point-of-care tests

BackgroundOver five million children die annually from preventable and treatable illnesses. Most of these deaths occur in sub-Saharan Africa, predominantly in socioeconomically deprived regions. With nearly half of pediatric mortality occurring at the community level, serious illnesses must be detected early in the prehospital setting. The purpose of this 18-month, prospective, observational pilot study was to introduce the first use of the proinflammatory biomarker, CRP, in the prehospital setting to community health workers and to develop a prehospital predictive model to identify sick children requiring health center admission.MethodsWe recruited 636 children presenting to one of four community health worker teams who completed a prehospital evaluation and referred each child to the closest health center. The primary outcome for this study was admission at the health center for more than 24 h. We used logistic regression to quantify the area under the receiver operating characteristic curve (AUC).ResultsWe found poor discrimination of danger signs and CRP, with AUCs of 0.55 (95% CI 0.52-0.57) and 0.52 (95% CI 0.47-0.57), respectively. A model comprising vital signs demonstrated superior discrimination, with an AUC of 0.66 (95% CI 0.62-0.71), which improved with the addition of danger signs (AUC 0.69; 95% CI 0.64-0.73), and when restricted to children who tested negative for malaria (n = 327; AUC 0.71; 95% CI 0.65-0.77).ConclusionsWe demonstrate that performing advanced point-of-care tests is feasible in resource-limited community settings and present one of the first prehospital prediction models developed with community health workers

Universal Basic Income Roundtable

The Margaret Chase Smith Policy Center invited local, regional, and international experts on universal basic income (UBI) to participate in a new feature: Maine Policy Perspectives. In total, the perspectives of seven individuals are included in this roundtable regarding UBI.https://digitalcommons.library.umaine.edu/mcspc_perspectives/1000/thumbnail.jp

Constipation and duration of mechanical ventilation in the Pediatric ICU.

Introduction Constipation is common in critically ill children in pedi- atric intensive care units (PICU). In this study, we ex- plore the association between constipation and longer pe- riods of mechanical ventilation in the PICU. Material and methods We performed a retrospective cohort study of patients in the PICU on invasive mechanical ventilation for more than 2 days, exploring the association between constipa- tion, defined as no bowel movements in > 3 days, and duration of mechanical ventilation. Results A total of 258 patients met inclusion criteria. Nearly half the patients suffered from constipation and those who did, and survived admission, required 2 additional days of invasive ventilation. Conclusions Constipation was associated with longer dependence on mechanical ventilation in critically ill children. Given this association, and possible links with other PICU com- plications, constipation should be prevented in mechani- cally ventilated PICU patients

Antibiotics and Antimicrobial Resistance in the COVID-19 Era: Perspective from Resource-Limited Settings

The dissemination of COVID-19 around the globe has been followed by an increased consumption of antibiotics. This is related to the concern for bacterial superinfection in COVID-19 patients. The identification of bacterial pathogens is challenging in low and middle income countries (LMIC), as there are no readily-available and cost-effective clinical or biological markers that can effectively discriminate between bacterial and viral infections. Fortunately, faced with the threat of COVID-19 spread, there has been a growing awareness of the importance of antimicrobial stewardship programs, as well as infection prevention and control measures that could help reduce the microbial load and hence circulation of pathogens, with a reduction in dissemination of antimicrobial resistance. These measures should be improved particularly in developing countries. Studies need to be conducted to evaluate the worldwide evolution of antimicrobial resistance during the COVID-19 pandemic, because pathogens do not respect borders. This issue takes on even greater importance in developing countries, where data on resistance patterns are scarce, conditions for infectious pathogen transmission are optimal, and treatment resources are suboptimal

Enteral feeding of children on noninvasive respiratory support : a four-centre European study

Objective: To explore enteral feeding practices and the achievement of energy targets in children on Non-invasive respiratory support (NRS), in four European Pediatric Intensive Care Units (PICUs). Design: A four centre retrospective cohort study Setting: Four PICUs: Bristol UK, Lyon France, Madrid Spain, Rotterdam the Netherlands. Patients: Children in PICU who required acute NRS in the first 7 days. The primary outcome was achievement of standardised kcal/goal. Interventions: Nil Measurements and Main Results: 325 children were included (Bristol 104; Lyon 99; Madrid 72; Rotterdam 50). The median (IQR) age and weight were 3 months (1-16) and 5 Kg (4-10) respectively, with 66% admitted with respiratory failure. There were large between-centre variations in practices. Overall, 190/325 (58.5%) received NRS in order to prevent intubation and 41.5% after extubation. The main modes of NRS used were high-flow nasal cannula 43.6%, bilevel positive airway pressure 33.2% and continuous positive airway pressure 21.2% Most children (77.8%) were fed gastrically (48.4% continuously) and the median time to first feed after NRS initiation was 4 hours (IQR 1-9). The median percentage of time a child was nil per oral whilst on NRS was 4 hours (2-13). Overall, children received a median of 56% (25%-82%) of their energy goals compared to a standardised target of 0.85 of the recommended dietary allowance. Patients receiving step-up NRS (p=<0.001), those on BLPAP or CPAP (compared to HFNC) (p =<0.001) and those on continuous feeds (p =<0.001) achieved significantly more of their kcal goal. GI complications varied from 4.8 – 20%, with the most common reported being vomiting in 54/325 (16.6%), other complications occurred in 40/325 (12.3%) children, but pulmonary aspiration was rare 5/325 (1.5%). Conclusions: Children on NRS tolerated feeding well, with relatively few complications, but prospective trials are now required to determine the optimal timing and feeding method for these children

Barriers to delivery of enteral nutrition in pediatric intensive care : a world survey

Objective To explore the perceived barriers by pediatric intensive care healthcare professionals (nurses, dieticians and physicians) in delivering enteral nutrition (EN) to critically ill children across the world. Design Cross-sectional international online survey adapted for use in pediatric settings. Setting and subjects Pediatric Intensive Care physicians, nurses and dietitians across the world Interventions The 20-item adult intensive care ‘Barriers to delivery of enteral nutrition’ survey was modified for pediatric settings, tested and translated into ten languages. The survey was distributed online to pediatric intensive care nurses, physicians and dieticians via professional networks in March – June 2019. Professionals were asked to rate each item indicating the degree to which they perceived it hinders the provision of EN in their pediatric intensive care unit (PICUs) with a 7-point Likert scale from 0 ‘‘not at all a barrier’’ to 6 ‘‘an extreme amount’’. Measurement and Main Results 920 pediatric intensive care professionals responded from 57 countries; 477/920 (52%) nurses, 407/920 (44%) physicians and 36/920 (4%) dieticians. Sixty-two percent had more than five years PICU experience and 49% worked in general PICUs, with 35% working in combined cardiac and general PICUs. The top three perceived barriers across all professional groups were: (1) enteral feeds being withheld in advance of procedures or operating department visits, (2) none or not enough dietitian coverage on weekends or evenings, (3) not enough time dedicated to education and training on how to optimally feed patients. Conclusions This is the largest survey that has explored perceived barriers to the delivery of enteral nutrition across the world by physicians, nurses and dietitians. There were some similarities with adult intensive care barriers. In all professional groups, the perception of barriers reduced with years PICU experience. This survey highlights implications for PICU practice around more focussed nutrition education for all PICU professional groups

The management of diabetic ketoacidosis in children

The object of this review is to provide the definitions, frequency, risk factors, pathophysiology, diagnostic considerations, and management recommendations for diabetic ketoacidosis (DKA) in children and adolescents, and to convey current knowledge of the causes of permanent disability or mortality from complications of DKA or its management, particularly the most common complication, cerebral edema (CE). DKA frequency at the time of diagnosis of pediatric diabetes is 10%–70%, varying with the availability of healthcare and the incidence of type 1 diabetes (T1D) in the community. Recurrent DKA rates are also dependent on medical services and socioeconomic circumstances. Management should be in centers with experience and where vital signs, neurologic status, and biochemistry can be monitored with sufficient frequency to prevent complications or, in the case of CE, to intervene rapidly with mannitol or hypertonic saline infusion. Fluid infusion should precede insulin administration (0.1 U/kg/h) by 1–2 hours; an initial bolus of 10–20 mL/kg 0.9% saline is followed by 0.45% saline calculated to supply maintenance and replace 5%–10% dehydration. Potassium (K) must be replaced early and sufficiently. Bicarbonate administration is contraindicated. The prevention of DKA at onset of diabetes requires an informed community and high index of suspicion; prevention of recurrent DKA, which is almost always due to insulin omission, necessitates a committed team effort