Johnson Center for Child Health and Development

In R (Finch) v Surrey County Council , the Supreme Court held by a 3:2 majority that Surrey County Council's decision to grant planning permission for an onshore crude oil extraction project was unlawful. The environmental assessment accompanying the application for planning permission – a legally required assessment of the ‘direct and indirect effects’ of a project on the environment – did not consider the greenhouse gas emissions that would arise from the inevitable combustion of the extracted oil. This note analyses the legal reasoning in the case and argues that the Supreme Court's decision does not provide a neat or simple story about climate change adjudication. The dispute was not a legally straightforward case to resolve and entailed deep and detailed engagement with the legislative framework, administrative law and the factual reality of climate change problems. Engaging with this legal complexity is critical to any argument about the proper role of courts in responding to climate change.

This study aims to explore the definition of career success in academic surgery. Career success in academic surgery is frequently defined as the achievement of a specific title, from full professor to department chair. This type of definition is convenient and established but potentially incomplete. The business literature has a more nuanced view of the relationship between titles and success, but this relationship has not been studied in medicine. Semi-structured interviews were conducted from May to November 2020. Data were analyzed in an iterative fashion using grounded theory methodology to develop a conceptual model. We conducted 26 semi-structured interviews with practicing surgeons differing in years of experience; 12 (46%) participants were female, mean age of 48. Participants included 5 chairs of surgery, 6 division chiefs, and 7 past or current presidents of national societies. Four themes emerged on the importance of titles: Some study participants reported that (1) titles are a barometer of success; others argued that (2) titles are not a sufficient metric to define success; (3) titles are a means to an end; and (4) there is a desire to achieve the title of a respected mentor. As the definition of career success in academic surgery changes to encompass a broader range of interests and ambitions, the traditional markers of success must come into review. Academic surgeons see the value of titles as a marker of success and as a means to achieving other goals, but overwhelmingly our interviewees felt that titles were a double-edged sword and that a more inclusive definition of academic success was needed.

Autism Spectrum Disorder (ASD) is a developmental disorder characterized by impaired communication and social interaction. Children with ASD are frequently diagnosed with gastrointestinal (GI) issues, including inflammatory bowel disease (IBD), gastroesophageal reflux, abdominal pain, diarrhea, and constipation, although the association between ASD and GI conditions is unclear. Underlying nutritional deficiencies are more common in children with ASD, and increase the risk of them developing medical conditions secondary to the behavioral diagnosis. This objective of this study was to examine the use of an elemental diet (ED) in the treatment of gastrointestinal disease in 5 children with ASD ages 2-21 years of age. In the study participants, the ED was well-tolerated with improvements in anthropometric measures, nutritional markers, and/or GI functioning reported after 12 weeks of intervention. Further research to advance the development of specific evidence-based guidelines in the management and treatment of gastrointestinal concerns in the ASD population is warranted.

Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder. Some anecdotal reports suggest that ASD is related to exposure to ethyl mercury, in the form of the vaccine preservative, thimerosal, and/or receiving the measles, mumps, rubella (MMR) vaccine. Using infant rhesus macaques receiving thimerosal-containing vaccines (TCVs) following the recommended pediatric vaccine schedules from the 1990s and 2008, we examined behavior, and neuropathology in three brain regions found to exhibit neuropathology in postmortem ASD brains. No neuronal cellular or protein changes in the cerebellum, hippocampus, or amygdala were observed in animals following the 1990s or 2008 vaccine schedules. Analysis of social behavior in juvenile animals indicated that there were no significant differences in negative behaviors between animals in the control and experimental groups. These data indicate that administration of TCVs and/or the MMR vaccine to rhesus macaques does not result in neuropathological abnormalities, or aberrant behaviors, like those observed in ASD.

Aim To assess serum Anti-Neutrophil cytoplasmic Antibody (ANCA—PR3 and MPO) and Anti-Saccharomyces Cerevisiæ Antibody (ASCA) levels in autistic children with severe gastrointestinal (GI) disease and to test the hypothesis that there is generalized autoimmunity in a subpopulation of autistic children with severe GI disease and that this autoimmunity is associated with the severity of GI disease. Subjects and Methods Serum from 40 autistic children with chronic digestive disease (most with ileo-colonic lymphoid nodular hyperplasia (LNH) and inflammation of the colorectum, small bowel and/or stomach), and 24 controls (13 age matched autistic children with no GI disease and 11 age matched children without autism or GI disease) were tested using ELISAs designed to quantitate ANCA (PR3 and MPO) and ASCA levels. ANCA and ASCA concentration of autistic children with GI disease were compared to GI disease severity (including LNH and erythema). Results We previously reported that 6 of the 40 autistic children with GI disease in this study had anti-PR3 ANCA. All 6 of these also had anti-MPO IgG. In this study, we found that 6 of the 40 autistic children also had ASCA and 4 of these children with ASCA also had both anti-PR3 and anti-MPO ANCA. These 4 with ANCA and ASCA had significantly higher GI disease severity, particularly associated with LNH and erythema. Discussion These results suggest a general autoimmune response (ANCA and ASCA) in a sub group (high GI disease severity) of autistic children with GI disease. The presence of these autoantibodies may be a useful biomarker for autistic children with severe GI disease.

A controlled clinical trial designed to evaluate the effects of breathing exercises on the pulmonary function of a group of children with pseudohypertrophic muscular dystrophy is described. The rationale for the selection of the specific breathing exercises is discussed, and pretreatment and posttreatment results of standardized pulmonary function testing are reported.