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From autism to Zoom® — Developments in management of spina bifida

Amsterdam, NL, February 21, 2023 – Open spina bifida (SB), a neural tube defect (NTD), also known as myelomeningocele, remains the most complex congenital…



Amsterdam, NL, February 21, 2023 – Open spina bifida (SB), a neural tube defect (NTD), also known as myelomeningocele, remains the most complex congenital abnormality of the central nervous system compatible with long term survival. It gives rise to well known comorbidities and interventions, such as executive function challenges, urinary and bowel incontinence, and ventriculoperitoneal shunting. In this annual special issue published in the Journal of Pediatric Rehabilitation Medicine, noted experts review the most recent findings in the SB-related care of many comorbidities.

Credit: Journal of Pediatric Rehabilitation Medicine.

Amsterdam, NL, February 21, 2023 – Open spina bifida (SB), a neural tube defect (NTD), also known as myelomeningocele, remains the most complex congenital abnormality of the central nervous system compatible with long term survival. It gives rise to well known comorbidities and interventions, such as executive function challenges, urinary and bowel incontinence, and ventriculoperitoneal shunting. In this annual special issue published in the Journal of Pediatric Rehabilitation Medicine, noted experts review the most recent findings in the SB-related care of many comorbidities.


NTDs are an important cause of morbidity and mortality globally. Although many nations have introduced preventive legislation to fortify staple cereal grains with folic acid, there are still widely varying rates of NTDs among the world’s populations. Globally, nearly 300,000 babies are born with NTDs including SB each year. In North America, the prevalence is estimated at 39 infants per 100,000 live births.

The 15 research studies and reviews in this special issue, guest-edited by Jonathan Castillo, MD, MPH, Heidi Castillo, MD, Judy K. Thibadeau, RN, MN, and Timothy Brei, MD, highlight the most recent findings in the SB-related care of many comorbidities, from amputations and scoliosis to sleep related breathing disorders.

“Spina bifida gives rise to emerging comorbidities and interventions, for example, increasing autism spectrum disorder rates have been reported among individuals with SB utilizing a population-based birth cohort of 32,220 subjects,” explained co-Guest Editor Jonathan Castillo, MD, MPH, Department of Pediatrics, Meyer Center for Developmental Pediatrics, Texas Children’s Hospital and the Baylor College of Medicine, Houston, TX, USA, and colleagues in an introductory Editorial. “Alongside new clinical observations, telecommunication platforms such as Zoom® have evolved as SB-related clinical and research tools; new technologies such as telemedicine and customized electronic medical records continue to be adapted for service in SB care.”

The topics in this issue include:

  • Variability in lower extremity motor function in SB only partially associated with spinal motor level
  • Association of ethnicity and adaptive functioning with health-related quality of life in pediatric SB
  • A retrospective study in Arkansas of sleep-related breathing disorders in the SB population (ages 1–20 years old)
  • Functional level of lesion scale: Validating 14 years of research with the national SB patient registry
  • Exploratory study of the provision of academic and health-related accommodations to transition-age adolescents and emerging adults with SB
  • Follow-up of brace-treated scoliosis in children with cerebral palsy and SB
  • Acquired amputations in patients with SB
  • Parents’ report on the health care management of SB in early childhood
  • Antibiotic use for asymptomatic bacteriuria in children with neurogenic bladder
  • Assessment of preterm birth risk in women with skeletal dysplasia and short stature
  • Family challenges in personal transportation of children with medical complexity
  • Limitations of current developmental tests to measure functional independence of children

As revealed in one study, children with SB who have a shunt have more SB-related medical visits, more visits to a specialist, and a greater number of different types of specialists than those without a shunt. The findings on health care use suggest there are high levels of monitoring and care coordination that parents of children with a shunt need to navigate to care for their child. The results of another study demonstrated that persistent issues were identified by parents/adolescents regarding the provision of school-related accommodations. “This is a relevant area for clinical practice to ensure students with special health care needs and those with SB receive appropriate academic and health-related accommodations,” noted the Guest Editors.

The COVID-19 pandemic posed distinctive challenges for children and adolescents living with SB, as well as carers and health care workers. This issue includes several COVID-19 related articles including:

  • A report of a national survey of COVID-19 vaccination in individuals with SB
  • First-year impacts of the COVID-19 pandemic on pediatric physiatrists
  • Pandemic decrease of in-person physiotherapy as a factor in parent-perceived decline in function in children with neuromuscular disorders

A survey of the impact of the COVID-19 pandemic on pediatric physiatrists revealed that while only a small percentage of pediatric physiatrists contracted COVID-19 during the first year of the pandemic, nearly all experienced workflow changes brought about by changed work patterns. Nearly all (96.5%) of pediatric physiatrists reported using telehealth during the pandemic compared to 14% prior to the pandemic. They reported numerous changes to their clinical operations, and 50% reported not having adequate personal protective equipment available for themselves or their staff all of the time. Fifteen pediatric physiatrists (5.9%) reported being furloughed, and three reported job loss during the first year of the pandemic.

“From autism to mortality, from middle America to work in Africa, SB care and research are undergoing tremendous changes,” noted Dr. Jonathan Castillo. “JPRM is a well-established platform for work accomplished through collaboration across the National Spina Bifida Patient Registry. Education and advocacy can be accomplished through dialog around emerging issues in SB care. One of the anticipated challenges of a fast-growing international research community is the danger of parallel and disjointed work.  It is anticipated that the upcoming Spina Bifida Association’s World Congress to be held March 22-25, 2023, in Tucson, Arizona, will aid in providing a place for connecting and developing ongoing relationships across centers. The Congress represents an international opportunity for dialog and collaboration and will include preconference activities fostering transnational partnership including the first global health symposium.”

Editor-in-Chief Elaine L. Pico, MD, FAAP, FAAPM&R, UCSF Benioff Children’s Hospital Oakland, CA, USA, welcomes the collaboration between the journal and the World Congress. “JPRM has aided professionals at home and abroad in keeping abreast of the latest investigational inquiries and their findings from institutions around the globe. We are delighted to publish the World Congress abstracts open access and fully participate in this worldwide dissemination of critical information on SB health care and related issues.”


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Leftist Media Call Trump-Supporters “Far-Right”… For What?

Leftist Media Call Trump-Supporters "Far-Right"… For What?

Authored by Jack Hellner via,

As far as I can tell, anyone…



Leftist Media Call Trump-Supporters "Far-Right"... For What?

Authored by Jack Hellner via,

As far as I can tell, anyone who supports Trump - say, Jim Jordan - is labeled hard right. 

So which policies made Trump far-right, according to the media and other Democrats?

Enforcing border laws that Congress passed and building a wall?  The public seems to support that, so that would be a middle-of-the-road policy. 

Opposes sanctuary cities and states.  It appears that the leftists who claimed they were sanctuaries are rethinking their disastrous policies.

Being tough on crime instead of supporting soft-on-crime D.A.s.  That is not unpopular. 

Supporting limits on abortion.  Two thirds of Americans support limiting abortion to the first thirteen or fifteen weeks, just like Europe. 

Supporting lower tax rates and fewer regulations.  Those are not unpopular positions.  In fact, they lifted up the people at the bottom of the economic ladder.  Real wages rose rapidly, and poverty hit a record low at the end of 2019.  How can that be hard right? 

Opposing the teaching that the U.S. is a racist country.

Trump repeatedly denounced white supremacists just like almost all Americans. 

Trump didn’t want people to be fired for refusing to take a vaccine just like most Americans. 

Trump moved rapidly to get schools and businesses back open after the initial shutdown.  That is certainly not a far-right position. 

Trump supports school choice for the poor, just like the majority of Americans, especially minorities.  

Trump opposes allowing men to compete against women, just like most Americans.  He opposes allowing men to expose themselves in women’s locker rooms.

Trump supported drilling and energy independence.  That kept inflation low and helped the poor, the middle class, and small businesses. 

Trump does not believe that climate change is the greatest existential threat. 

Trump sought to make NATO pay what they were supposed to.  Why would that be an unpopular policy or far-right? 

Trump moved the U.S. embassy to Jerusalem, just as Congress and previous presidents had promised. 

Trump put a squeeze on Iran.  Why would it be far-right to cut off funding from a country that pledges death to America and death to Israel? 

Trump and his son-in-law made great progress in the Middle East with the Abraham accords.  That certainly is not hard-right. 

Trump challenged the 2020 election, just like how Democrats challenged the 2000, 2004, and 2016 election.  There is nothing far-right about challenging elections. 

Trump told people to march peacefully and patriotically to the capital to protest the election.  What is far-right about peace and patriotism?

Trump told the Germans they were stupid to rely on Russia for their energy.  He was right. 

Putin has attacked Ukraine while Obama and Biden were president, not Trump. 

Trump asked Ukraine to investigate the Bidens for corruption.  It would be a dereliction of duty for a president to learn of corruption and not investigate.  Sadly, the media and other Democrats impeached him for doing his job. 

Basically, Republicans like Trump and Jordan are called far-right by the media and other Democrats to intentionally mislead the public, just as they did with the fictional Russian collusion story. 

Democrats don’t want to debate their leftist policies because they are unpopular so they always go to the same playbook.  Call Republicans sexists, bigots, racists, and far- or hard-right.  They sure don’t care that the corrupt Clintons and Bidens have lined their pockets with illegal kickbacks for years. 

Tyler Durden Sat, 10/14/2023 - 18:40

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Deadliest day for Jews since the Holocaust spurs a crisis of confidence in the idea of Israel – and its possible renewal

Israel’s foundational social contract – that the government would keep Israelis safe – was severed with the deadly attacks by Hamas on Oct. 7, 2…




Family and friends of those taken hostage by Hamas during an attack on Israel react during a press conference on Oct. 13, 2023, in Tel Aviv, Israel. Leon Neal/Getty Images

Living for 75 years within a hostile neighborhood has required the state of Israel to provide security against external threats to all its citizens.

That responsibility is a social contract between citizens and the state: The state is obligated to provide security for its people, especially those who live near its borders, that makes living there safe. In return, young Israelis must serve in the army.

That unwritten contract was abruptly shattered for Israelis in the morning hours of Oct. 7, 2023. And with it, the very premise and promise that led to the establishment of the state was suddenly put in doubt.

That Saturday, when a surprise assault by Hamas stunned Israel, has been recognized as a date that will live in infamy – recalling U.S. President Franklin D. Roosevelt’s memorable words about Dec. 7, 1941, when the Japanese bombed Pearl Harbor – in the annals of the state of Israel, indeed even in the annals of much older Jewish history.

Over 1,300 Israelis lost their lives in acts of mass killing on that day, mostly civilians. They were all murdered – executed, slaughtered, tortured, burned – by Hamas terrorists who launched a pogrom-like onslaught on Israeli villages on a scale never seen before. About 150 people, mostly Israeli civilians, were brutally kidnapped on that day by the attackers.

I am an Israeli historian, specializing in Israel’s nuclear history. I believe that to recognize the full meaning of Oct. 7, 2023, for Israel and Israelis, it must be placed in historical perspective, both Israeli and Jewish. There are other perspectives, including historical ones, but this essay is an attempt to portray the events of Oct. 7, 2023 – and their profound significance – as Israelis experienced them.

Mourners crying and placing flowers at a grave site.
The Oct. 11, 2023, funeral in Gan Haim, Israel, of May Naim, 24, murdered by Hamas militants at the ‘Supernova’ festival near the Israeli-Gaza border. Amir Levy/Getty Images

‘Never again’ was the state’s promise

Almost every Israeli citizen now is only one degree of separation from the victims of Oct. 7, 2023. For Israel, this is truly a national calamity in Biblical terms.

During the Holocaust, the Nazi killing machine executed thousands of Jews every day for years. But since then, there has never been a day in the 75 years of Israeli history that such a large number of Jews were killed, including the most horrific days of the 1973 Yom Kippur War.

Zionism as a national-political movement to establish a Jewish homeland came into being due to the pogroms – violent, usually murderous attacks in Europe – and the antisemitism of the late 19th century. By 1939, nobody could tell whether Zionism would succeed or fail. But it was the Shoah – Hebrew for “Holocaust” – that decisively unleashed the impetus among the Jewish people and internationally to create the state of Israel as a Jewish state, which stood as the triumph of Zionism.

The raison d'être – the purpose, justification, and international legitimacy – of the creation of Israel in 1948 was that it would be a safe homeland for the Jews as a fundamental response to the lesson of the Holocaust: Jews should no longer be victims.

So Israel came into being along with the national avowal “Never Again,” made by both the survivors and their rescuers, as its founding ethos. For Israelis and their supporters around the world, the triumph of Israel is the extraordinary transformation from Holocaust to national revival or, in Hebrew, from Shoah to Tekuma.

Over its life as a new state, Israel has built itself as a blend of the pen and the sword. On the sword side, Israel is the region’s military powerhouse. On the pen side, Israel has become a cultural force both within and beyond its borders, a hub of academic excellence and perhaps most known as a “startup nation,” a center of high-tech innovation.

Four men - three in uniform - salute something.
From its establishment, Israel promised to defend its citizens. Here, founding Prime Minister David Ben Gurion inspects troops in Tel Aviv along with Gen. Yigal Allon (far left) and Gen. Yigal Yadin (second from left), in October 1948. United States Holocaust Memorial Museum, courtesy of National Archives and Records Administration

Government fails its part of the contract

By now it is clear that the multi-faceted surprise Hamas onslaught – by sea, air and land – along the entire 40-mile long Gaza barrier demonstrated the colossal failure of all elements of the vaunted Israeli defense systems, including intelligence collection and warning, military deployment and readiness, command and control systems.

Indeed, Israeli military planners never even considered such an all-out attack as a worst-case scenario, as now openly acknowledged by former senior military officials.

Israel’s supposedly formidable border walla ground barrier that cost over a billion dollars and was completed in 2021 – was rendered useless almost instantly. Within minutes, the attackers overwhelmed some 30 sites on the other side of it – civilian settlements, military bases and even an outdoor concert site.

There were almost no Israeli troops deployed in the area in the first place to defend the many points of attack, in part due to the holiday and lack of advanced warning, and in part due to the complacent confidence in the wall and its high-tech support system.

Furthermore, since almost all military communication was cut off by Hamas knocking out the communication towers, Israeli military and political leaders for hours had only a vague idea of the unfolding calamity.

That colossal military failure reminded many Israelis of the dismal shock the country experienced in the 1973 Yom Kippur war. The resemblance seems obvious – then and now, Israelis witnessed catastrophic intelligence and operational blunders that cost so many lives due to complacency and arrogance.

But in some key respects, the catastrophe in 2023 seems even more traumatic – it shakes the very foundations of Israel as the embodiment of Zionism, a safe Jewish homeland. In 1973, the casualties of the blunder were almost all soldiers; the civilians were kept far from the fighting and safe.

Yet on Oct. 7, this was not the case.

‘We are being slaughtered’

If the founding commitment of the state to its citizens was “Never again,” the brutal new reality that emerged on Oct. 7 was “Never before.”

For long hours on that day, countless Israeli civilians were crying for help that in too many cases didn’t arrive in time. Never before in Israeli history had so many civilians been left for so long without the help of the army.

“We are being slaughtered. There is no army. It has been six hours,” one kibbutz resident said in desperation. “People are begging for their lives.”

Never before had Israelis found themselves whispering desperately to TV studios and social media, not knowing who else to call, while terrorists were inside their houses.

Now, Israel has mobilized the largest reserve army it has ever amassed – a response that reflects its attempt to re-commit to the idea, and the reality, of never again being so vulnerable.

Yet this national trauma will be reckoned for in generations to come. How could such a calamity happen? Who is responsible for such a catastrophe? How is it possible that a powerful nation was so complacent?

The official Israeli response to those soul-searching questions is that for now the nation must wage war and those questions must and will be thoroughly studied. But, they say, not now. Investigate this later, after the war is won.

Yet those questions are simmering and boiling within the Israeli psyche; it is impossible to resist them. There is clarity and confidence that once the war is over, professional and judicial investigations will be thoroughly conducted, but some have already accepted moral responsibility. This movement toward both demanding and accepting responsibility demonstrates a renewed faith among Israelis about the future for their country.

Most prominently, the Israeli military’s Chief of Staff, Lt. Gen. Herzi Halevi, has acknowledged publicly the failure of the army and took responsibility for that failure to provide security to the citizens of Israel.

The sole Israeli national figure who has acknowledged nothing about responsibility is the one on whose watch it all happened, Prime Minister Benjamin Netanyahu. Indeed, except for a few taped statements, in the week after the war began, Netanyahu had avoided meeting members of the public as well as taking questions from the press.

The rage against Netanyahu in the Israeli public is mounting.

Avner Cohen does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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Bob Menendez Is A Symptom

Bob Menendez Is A Symptom

Authored by John Tamny via RealClear Wire,

In 1988, Pulitzer Prize-winning New York Times reporter Hedrick Smith…



Bob Menendez Is A Symptom

Authored by John Tamny via RealClear Wire,

In 1988, Pulitzer Prize-winning New York Times reporter Hedrick Smith authored “The Power Game: How Washington Works.” It was a fascinating, if unflattering, portrait of the nation’s capital that not only has proven prescient, but remains relevant today.  

Having arrived in Washington in 1962, Smith charted what he called “stunning transformations” in the previous two and a half decades. These ranged from “the new congressional assertiveness” engendered by Richard Nixon’s resignation and the revolt by young members against the seniority system, to how the utter supremacy of television had warped the system and produced “a new generation of video politicians whose medium was the tube rather than the political clubhouse.”  

These words were written, mind you, when Matt Gaetz was seven years old – and two years before Alexandria Ocasio-Cortez was born. But the most significant change Smith documented was the stunning proliferation of lobbyists, hangers-on, and congressional aides.  

Many of these aides were not just career politicians, but men and women who’d never had any other career other than politics. One of the subjects highlighted in Smith’s book had worked on Capitol Hill as a staffer, only to run for Congress. He won. His quip to Smith upon reaching Congress as a back-bencher (lightly paraphrased) was that “never has one individual so willingly given up so much power.”    

Sen. Robert Menendez is a poster boy for this new ethos. He ran for student body president in high school and won, and never really stopped angling for office. While still in college, he served as an aide to the mayor of Union City, N.J. At 20, he was elected to the local school board. A few years later, he ran against the mayor he worked for. Menendez lost that first campaign, but won the rematch in 1986. The following year, he ran and won a seat in the state legislature, and in a sign of the avaricious nature that would later get him indicted, he kept the mayor’s office (and salary) serving in both posts at once.  

From there, it was the state Senate in Trenton, a House seat in Washington, and in 2006, he was appointed to the U.S. Senate seat he still holds, at least for now. And while the greed alleged in a criminal indictment filed last month by federal prosecutors has alienated even his fellow Democrats who have called for his resignation, there’s a case to be made that Bob Menendez isn’t the problem as much as he’s a symptom of the problem of a system dominated and warped by career politicians.   

Consider a description from the New York Times about how Menendez has operated:   

“He accepted rides on private plans, luxurious vacations, and other perks from wealthy friends while freely using his office to advance their interests.”    

Contrast that description with the Hedrick Smith anecdote about a newly elected pol. While until recently Menendez was the picture of power, including routine visits to the smoking porch at Morton’s (his annual bill at the steak chain alone was reported to be $16,000) where he enjoyed the best of the best cigars, the newbie in Congress was a bit of a nobody. Well, of course.                

This may be Menendez’s nature, as reporters haven’t yet gotten around to digging into what he was up to for all those years in Union City and Trenton. But one thing is clear. He certainly learned the ways of Washington: getting to know the right people (elected and unelected) while perfecting the skill of moving money to the programs and projects desired by those with money, or who wanted to attain it. Menendez, the New York Times also noted, helped bring home the bacon for his constituents as well, from a Hudson County light-rail network to billions of dollars in federal aid to rebuild after Hurricane Sandy ravaged the state in 2012. Recently, he’s credited with securing funding for a new rail tunnel beneath the Hudson River, currently the nation’s largest public works project.    

Little of the federal funding Menendez directed to New Jersey could have been secured by a rookie senator. But Menendez learned, and learned well, the ways of Washington over time. As former New Jersey Gov. James McGreevey put it to the Times, “Bob labored intensely to master detail.” This political mastery is what made him such a magnet for money, as those who can move billions of dollars around tend to be.    

“No man’s life, liberty, or property are safe while the Legislature is in session,” is an old saw of American politics. It’s even truer for Congress. And one moral of the Menendez story, whether he beats the rap or is convicted, is that term limits would limit the time spent in Washington, time in elected office that is so instrumental in one’s ability to grow government. 

It’s something to think about. The easy, politically expedient thing to do is make political hay of Menendez’s obnoxious ethical lapses. But if the desire is to at least try to fix the system, one solution might be limiting time in office so that elected officials don’t have the time to amass the power and learn the skills that it takes to act unethically.    

Tyler Durden Sat, 10/14/2023 - 17:30

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