Coordination of interdisciplinary care in the PAC resulted in a reduction of hospital charges realized through reduction in clinic- and anesthesia-related visits. Reductions in episodes of anesthesia may also reduce neurocognitive risks associated with multiple anesthetic exposures. Other nontangible benefits associated with the coordination of care, such as caregiver satisfaction, warrant further study.

Previous studies have shown that deficiencies in selenium (Se) and/or vitamin E (VE) can exacerbate the infectivity and pathogenesis of coxsackievirus B3 and influenza. Both Se and VE play a role in immune function and antioxidant defense. To determine whether these deficiencies would affect the normal course of infection with a metazoan parasite, mice were made deficient in Se and/or VE and inoculated with the gastrointestinal nematode parasite Heligmosomoides polygyrus. Both primary and secondary infections were assessed. Although the course of a primary infection with H. polygyrus was unaffected by diet, diets deficient in Se, VE, and both Se and VE (Se/VE double-deficiency) all caused delayed adult worm expulsion and increased fecundity during a secondary infection; suggesting an impaired intestinal response. H. polygyrus-induced IL-4 levels were diet-independent; but Se/VE double-deficiency blocked the H. polygyrus-induced IL-4 receptor-associated decrease in sodium-dependent glucose absorption in the jejunum that contributes to worm expulsion. In contrast, Se/VE double-deficiency had no effect on the infection-induced, IL-4R-associated increase in epithelial cell permeability that accompanies the infection. These results suggest that both Se and VE are required for specific IL-4-related changes in intestinal physiology that promote host protection against H. polygyrus.

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A cohort of children with aerodigestive disease experienced a shift from inpatient to outpatient care with an overall 20% reduction in patient charges when the years before and after MPACT enrollment were compared. Available ICD-9 data suggest potential demand for MPACT services.

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Objectives: A pilot study to determine the effectiveness of injection laryngoplasty (IL) as a predictor for success of subsequent endoscopic laryngeal cleft repair (ELCR). Study Design: Case series with chart review. Setting: Tertiary care academic hospital. Methods: Retrospective analysis of children with type I laryngeal clefts who underwent IL and/or ELCR from September 2009 to January 2013. Results: Thirty-six patients underwent IL with or without subsequent ELCR, and 11 underwent ELCR alone. Of those who underwent isolated ELCR, 8/11 (72.7%) had complete resolution of presenting symptoms. Of those who underwent IL, 29/36 (81%) had adequate follow-up and 21/29 (72.4%) experienced compete resolution of presenting symptoms, similar to those undergoing ELCR ( P = 0.679). Fourteen with complete response and 1 with partial response to IL underwent subsequent ELCR with adequate follow-up. In all cases, response to ELCR was predicted by response to IL; 14 experienced complete resolution and 1 had partial resolution of presenting symptoms. While the rate of full resolution of symptoms following ELCR was better in the children undergoing previous successful diagnostic IL, it did not reach statistical significance ( P = 0.072) due to the limited sample size. Conclusions: Diagnostic IL is an effective indicator for successful ELCR. This suggests that IL may be a useful diagnostic method to determine the degree of pathology presented by a type I laryngeal cleft in symptomatic patients and to predict the degree of success of subsequent ELCR. Future studies employing a larger sample size are recommended to confirm this relationship.