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Displaying date and time in Java ME
This code snippet demonstrates different ways to display date and time in Java ME.
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Contents |
Java ME contains time and date in the Date class. There are different ways to display date and time:
- The main way is to use the DateField UI control (see the outputDateUsingDateField method in this snippet). This control gets an instance of the Date class and displays its date and time in a formatted way, also allowing the changing of particular parts of this date.
- The other way is to use the Date.toString() method. This method returns a textual representation of the date in string form, which can be used to display it or for other purposes. See the outputDateUsingToString method in this snippet.
- If custom formatting of the date string is needed, the Calendar class can be used. For example, the outputDateUsingCalendar method of this snippet constructs a textual representation of the specified date, using the Calendar class to get particular parts of the date and using the StringBuffer class to construct a string from these parts of the date. It is not possible to create a textual representation of the date from a pattern string (such as "dd/mm/yyyy") in J2ME, but it can be easily implemented using the Calendar class.
Source file: DateAndTimeMidlet.java
* Sets up the main form.
private void setupMainForm() {
mainForm = new Form("Date and time");
// Get current date and output it by several ways.
Date date = new Date();
* Shows specified date using DateField UI control.
* @param date - date for showing
private void outputDateUsingDateField(Date date) {
DateField field = new DateField("Using DateField",
* Converts specified date to string using Date.toString() method and
* shows it using StringItem.
* @param date
private void outputDateUsingToString(Date date) {
StringItem item = new StringItem("Using .toString()", date.toString());
* Constructs textual representation of specified date using Calendar class
* for getting particular parts of date and using StringBuffer class
* to construct string from these parts of date.
* @param date
private void outputDateUsingCalendar(Date date) {
Calendar calendar = Calendar.getInstance();
StringBuffer sb = new StringBuffer();
int day = calendar.get(Calendar.DAY_OF_MONTH);
int month = calendar.get(Calendar.MONTH) + 1;
StringItem item = new StringItem("Using Calendar", sb.toString());
* Utility method. Converts number to string and adds '0' before it if this
* number is less than 10.
* @param value number to convert.
* @return textual representation of value.
private String numberToString(int value) {
String valStr = Integer.toString(value);
return (value < 10) ? "0" + valStr: valStr;
After launching the snippet - several controls are placed on the form of this snippet demonstrating different ways to create a textual representation of date and time and to display it for the user.
Supplementary material
This code snippet is part of the stub concept, which means that it has been patched on top of a template application in order to be more useful for developers. The version of the Java ME stub application used as a template in this snippet is v1.1.
- The patched, executable application that can be used to test the features described in this snippet is available for download at Media:DisplayingDateAndTime.zip.
- You can view all the changes that are required to implement the above-mentioned features. The changes are provided in unified diff and colour-coded diff (HTML) formats in Media:DisplayingDateAndTime.diff.zip.
- For general information on applying the patch, see Using Diffs.
- For unpatched stub applications, see Example app stubs with logging framework.
Version Hint
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[[Category:Series 40 5th Edition (initial release)]] [[Category:Series 40 5th Edition FP1]]
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[[Category:S60 5th Edition]]
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Raising money costs money in the big race
PUBLISHED: 18 Dec 2013 10:18:26 | UPDATED: 25 Dec 2013 05:23:50PUBLISHED: 20 Dec 2013 PRINT EDITION: 20 Dec 2013Anthony Bell's race campaign has a charity arm for the fund-raising side, and an operating vehicle for the actual racing that has to show a return. Photo: Anthony Johnson
John Stensholt
Anthony Bell tries his best to run his Sydney to Hobart entrant, Perpetual Loyal, like a business.
There is an altruistic bent to Bell's entry – the venture aims to raise $1 million for his Loyal Foundation – but he still has a corporate structure for the racing side of things.
"There's a saying in sailing that only the wind is free, but nothing else is," says Bell.
"So we have a charity arm where 100¢ in the dollar from donations goes to the charity, but we also have an operating vehicle for the actual racing that has to show a return."
Bell says the budget for Perpetual Loyal is about $3 million, some of which comes from sponsors such as Perpetual, who back both the sailing and charitable sides of the venture.
However, Bell's budget pales in comparison with some, such as billionaire Bob Oatley's. Oatley is understood to spend at least five times as much as the Perpetual Loyal owner.
Oatley's Wild Oats X1 is considered the favourite for the race, and Oatley – worth an estimated $1.14 billion on this year's BRW Rich List – is also set to spend tens of millions of dollars on a tilt at the next America's Cup competition.
Sailors with Disabilities
Others with connections to the race are also combining their charitable interests with their business acumen.
Rich List member, entrepreneur Graeme Wood, has donated boats to the Sailors with Disabilities organisation.
This year, Sailors with Disabilities launched a crowd-sourcing style fund-raising campaign, where donors to the cause are able to upload pictures of themselves, their families, pets or friends that will be printed on the side of the boat competing in the race.
The patron of the Sailors with Disabilities cause is federal Minister for Communications Malcolm Turnbull.
Property identity Syd Fischer is another notable business name involved. The 86-year-old has high hopes of winning his second Sydney to Hobart race with his 100-foot yacht Ragamuffin 1000 – the same yacht used by Bell to win line honours two years ago when it was named Investec Loyal.
Property connections
Fischer is one of several entrants in the race with property connections.
Queensland property investor Peter Harburg, of Harburg Investments, has entered Black Jack, named after his friend the motor racing legend Jack Brabham.
Ed Psaltis, owner of Midnight Rambler, sits on the board of unlisted property investment company Centuria Property Trust, and Karl Kwok, owner of Beau Geste, is a Hong Kong businessman with extensive commercial property interests.
As well as race sponsor Rolex, other businesses that sponsor boats include Invest Africa, of which Rob Hersov is managing partner.
Hersov is a friend of many Sydney investment identities, including the late David Coe.
One DLL is sponsored by financial company De Lage Landen, which also has employees on the boat. TSA Management has the company's director Andrew Tompson among its crew.
The Australian Financial Review
Related News
Read more
Companies | Perpetual Ltd |
People | Bob Oatley, Graeme Wood |
Topics | Sport |

subset: commoncrawl


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text:
Behold the Ancestry of Jacob & Jennifer (Weber) WellerUpdated September 5, 2000 |
Jacob & Jennifer Weller Houston, TX 77077 United States email@example.com |
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Welcome to our page. We're having a great deal of trouble finding our Weller ancestors in the Nassau area of Germany. We're also looking for information on Chandler Hickox from New York. Most of the Weber ancestry comes from Prussia (Stettin, Pommern). This page is under major construction... we'll be adding the Weller information as soon as we receive the files from Jacob's father. WELLER Surnames: Weller Nink Kenyon Hickox Reed Ewing Esterline Phillips Boettger Brandt Ackerson Shaw Shilton Kingston Canfield Hissong... WEBER Surnames: Weber Reimann Schroeder Rakow Trantow Curtis(s) Hutchins Twaight Buntinge Camp Well(e)s Merriman Walke Weissenberg Vogel Lohrenz... |
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The content shown on this page has been submitted by a Genealogy.com customer, and is not subject to verification by Genealogy.com. Neither Genealogy.com nor its affiliates are responsible for the accuracy of any information contained on this page. The opinions expressed on this page are the author's alone and not the opinions of Genealogy.com.
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text:
Freedom of religion has also been curtailed in the new constitution. Egypt's previous constitution guaranteed the freedom of religion and religious practice. The same wording was used in earlier drafts of the new constitution. But the document that was voted on last night only promises freedom of practice for the Abrahamic religions – Islam, Christianity, and Judaism.
This leaves other religious sects in Egypt, such as Egyptian Bahai'is, stripped of the right to publicly practice their faith.
"To say that they can't even practice their religious rights is terrifying," says Ms. Morayef. She notes that the limitation could easily be appled to Baha'is, who have already fought an uphill battle in Egypt just for the right to leave the religion section of their national identity cards blank. (ID cards include citizens' religion and the options are limited to Islam, Christianity, or Judaism.)
Under former President Hosni Mubarak, Baha'is, as well as Ahmadis, Shiites, and Quranists were regularly arrested for their beliefs.
On women's rights, an article in a previous draft said women's equality was guaranteed so long as it did not contradict Islamic law. That clause was dropped completely from the final version.
But the article prohibiting discrimination fails to mention sex, or any other grounds, simply stating that "citizens are equal before the law and equal in rights and obligations without discrimination." While some rights activists feel the broader clause is better because it doesn't limit the prohibition on discrimination, Morayef says it could be detrimental for women's rights to not explicitly prohibit discrimination against them.


text: > EXPLANATIONS: > sed s/OPEN_MAX/FOPEN_MAX/ special.c > special.c~ && > mv special.c~ special.c && > Fixes a bug in the source code Do the GPM ppl know about this or do they need to? I'm not sure if the gpm ML is open to public posting, but I'll forward this there if you want > sed s/"doc contrib"/"contrib"/ Makefile > Makefile~ && > mv Makefile~ Makefile && > Prevent gpm trying to make the docs which needs TeTex > Can be ommited if TeTex is installed > > cp doc/*.1 /usr/local/man/man1/ > cp doc/*.7 /usr/local/man/man1/ > cp doc/*.8 /usr/local/man/man1/ > These commands install the manual pages (as we didn't fully > build the doc dir). If TeTex was installed, again these are not needed. This seems like an autoconf type issue to me. Maybe I'll post a question to the GPM mailing list about this also and see if testing for TeTex can/should be added into the ./configure script. ~jason -- +------------------+ | Jason at tommyk.com | +------------------+


text:
Afghan blast: Soldiers 'unlawfully killed'
Six British soldiers who died in an Afghan bomb blast claimed by the Taliban were "unlawfully killed on active service", a coroner has ruled.
The six men were on patrol in a Warrior armoured vehicle when it triggered a device on 6 March last year.
Recording a narrative verdict, Oxfordshire coroner Darren Salter said there was "nothing their comrades could have done to rescue or save them".
A series of improvements have been made to Warriors since the incident.
Sgt Nigel Coupe, 33, of 1st Battalion The Duke of Lancaster's Regiment, was killed alongside Cpl Jake Hartley, 20, Pte Anthony Frampton, 20, Pte Christopher Kershaw, 19, Pte Daniel Wade, 20, and Pte Daniel Wilford, 21, all of 3rd Battalion the Yorkshire Regiment.
After soldiers using them were killed by improvised explosive devices in Iraq, the government upgraded all Warrior vehicles used on operations.
Those used in Afghanistan were upgraded in June 2011 as part of a £40m urgent operational requirement that included more than 30 enhancements to tackle the specific threat of mines or IEDs.
These included a flexible modular armour system, enhanced seating design and cushioning to improve protection and comfort, and an improved driver vision system with an increase from one to three periscopes, providing a wider field of vision and night-vision capability.
A further £1bn upgrade was announced in October 2011, to try to ensure the vehicles' suitability for future operations to beyond 2040 by improving their firepower and manoeuvrability.
The MoD says the "Warrior provides some of the highest levels of protection available, but sadly no armoured vehicle can provide absolute protection from the very largest explosions".
All those deploying with the vehicle will be very familiar with it, and for troops arriving in Helmand, there is mandatory refresher training on how to exit an overturned armoured vehicle in the dark.
The attack, which was so powerful it turned their vehicle upside down and blew off its gun turret, was the biggest single loss of life in an enemy attack for UK Afghanistan forces since 2001.
Two Warriors left on a patrol from a base at Lashkar Gah, southern Afghanistan, just after 18:30 local time.
Soon after, the Warrior travelling in front triggered a pressure plate which detonated an improvised explosive device (IEDs).
A fire broke out almost instantly, setting off ammunition inside the vehicle, the inquest heard.
Fellow soldiers tried, in vain, to put out the fire and get into the bombed vehicle.
The inquest heard evidence from pathologists who said the men were likely to have been killed or rendered unconscious immediately by the blast.
"This, of course, is a tragic loss of these six soldiers and these young lives," Mr Salter said.
"At least it is very clear from the evidence of the two pathologists and the evidence of those who witnessed the strike that they did not suffer."
He said he was "not going to second-guess decisions of commanders in a courtroom today; that is not the purpose of an inquest".
"These are experienced commanders who took decisions on the ground, balancing the risks and exercising judgements," he added.
He said it was clear "significant steps" had been taken to improve the vehicles.
'Good' vehicle"Start Quote
End Quote Maj Douglas NelsonOf any vehicle, I would travel in Warrior"
Oxford Coroner's Court heard on Thursday from Warrior expert Maj Douglas Nelson who said it had been "a very large device - and what I would say is, no vehicle that we had was designed to take that".
He said that, while the Mastiff armoured vehicle was specifically designed with improvised IEDs in mind, the Warrior was "infinitely more capable" of fighting at night, when the attack took place.
Maj Nelson was among a number of soldiers who told the inquest they felt safest, when on patrol, in a warrior.
"Of any vehicle, I would travel in Warrior," he said.
"It's as good as we can make it."
"Start Quote
End Quote Monica Kershaw on her son, Pte Christopher KershawI am still struggling with this but how like him to be ready to do his duty for his fellow soldiers"
He said improvements made to the vehicles since the attack included thicker armour, better fire-fighting and detection systems and improvements to ways of getting out in an emergency.
Improved fuel tanks were also being fitted to the vehicles, he added.
The inquest heard that, when the order was given to leave at 18:00, Pte Kershaw had volunteered to take the place of another soldier, who was just returning from a shower.
Speaking after the verdict, his mother, Monica, said it was "a pure quirk of fate that Chris should have been kitted up and got into a patrol for which he was not intended".
"I am still struggling with this but how like him to be ready to do his duty for his fellow soldiers," she said.
And Emma Hickman, who has battled to prove her fiance, Pte Wade, fathered her daughter before he was killed in the incident, said: "From the struggle to establish Lexie's identity and hearing all the evidence it has been an exhausting ordeal and still we have not come to terms with our loss."
The Ministry of Defence released Pte Wade's DNA last year so Ms Hickman could prove paternity and put his name on the birth certificate of their daughter, Lexie-Mai.
Warrior armoured vehicle |
Source: British Army |
Crew: |
Three, plus seven fully equipped soldiers |
Speed: |
Max speed of 75km/h, average speed 40km/h |
Weaponry: |
Turret-mounted cannon, anti-helicopter chain gun and eight portable Light Anti-Armour (LAW) or anti-tank weapons |
Armour: |
Shielding on front, sides and underneath gives extra protection |


text:
You must earn 10,000 points to post other members' whiteboard
Happy New Year, Snoop Dog!
CelticHeart, Thanks for the info on the 200 points thats great.. but I am sure they will increase the levels as well.. Maybe not... I went to WSU 74-79.. just a couple a years ago.. :) I'm originally from Hamtramck born and raised there.. Still Toolin around.. Have a Wonderful Day!! again thanks for the Heads up... :)
Clinton Township, eh? Used to deliver papers in 48038/48035/48036. Go to church in Sterling Hts, graduated from Utica High. Grew up in Center Line and Shelby Township. When did you go to WSU? My son is a prof there. Gas buddy is upping our points on Monday, 200 for each gas price up to the first five, as usual. Opportunity for 250 extra points per day. Have a blessed day. :)
Like your avatar, same as my Facebook.
it vary's.. I'm the road at various times and places. I live in clinton twp, work in Shelby, travel all over... Why do you ask?
How do F4FF, how often do you travel by those stations on Grosbeck?
e10 is regular gas that 99 % stations sell, e15 is 15% ethanol and 85% gasoline, or 5% more ethanol. NO auto maker requires e15. But the EPA is madating more ethanol be mixed into our gas. Cars made before 2002 cannot use e15. No small engine such as lawnmowers, chainsaws and leaf blowers should use e15. Check in with Michigan discussion site for more info.
sure Forty-niner.. great number


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text:
- Limits to Growth - http://www.limitstogrowth.org -
British Woman Feels Like a Stranger in Her Own Neighborhood
Posted By Brenda Walker On January 30, 2013 @ 12:25 pm In uncategorized | Comments Disabled
In recent weeks, cumulative demographic changes have been reported in Britain [1], along with white flight [2] away from cities to escape the social conditions created by diverse immigration.
Human beings don't want diversity and prefer to be around others who speak their language and share the same culture [3]. Most don't like it when elitist liberal governments decide that the traditional beliefs like patriotism can be fixed [4] by importing a new, more grateful people. Polls from Pew [5] and Ipsos [6] indicate a cross-cultural dislike of having too many foreigners residing in their countries.
In the present example, Jane Kelly, an editor for the Salisbury Review [7], voices her unhappiness at feeling like a stranger in her own London neighborhood. The only surprise is that she would be brave enough to speak against the new secular religion of diversity being the highest good; in fact, white Britons are now a minority in London [8].
Below, sign on shops in London's Acton Vale area indicate its immigration-caused diversity.
Certainly many Americans have told similar stories about how their pleasant California neighborhoods turned into crime-filled Mexican barrios [9]. Citizens are fleeing the once-Golden State [10] for places where a culturally recognizable America remains.
The mega amnesty now being proposed would open the floodgates to a hugely Mexicanized America.
At least the London writer doesn't live in an area that has been declared a sharia zone by local Muslims [11] — yet.
'I feel like a stranger where I live' [12], by Jane Kelly, Daily Telegraph, January 29, 2013
As new figures show 'white flight' from cities is rising, one Londoner writes a provocative personal piece about how immigration has drastically changed the borough where she has lived for 17 years
"When you go swimming, it's much healthier to keep your whole body completely covered, you know." The Muslim lady behind the counter in my local pharmacy has recently started giving me advice like this. It's kindly meant and I'm always glad to hear her views because she is one of the few people in west London where I live who talks to me.
The streets around Acton, which has been my home since 1996, have taken on a new identity. Most of the shops are now owned by Muslims and even the fish and chip shop and Indian takeaway are Halal. It seems that almost overnight it's changed from Acton Vale into Acton Veil.
Of the 8.17 million people in London, one million are Muslim, with the majority of them young families. That is not, in reality, a great number. But because so many Muslims increasingly insist on emphasising their separateness, it feels as if they have taken over; my female neighbours flap past in full niqab, some so heavily veiled that I can't see their eyes. I've made an effort to communicate by smiling deliberately at the ones I thought I was seeing out and about regularly, but this didn't lead to conversation because they never look me in the face.
I recently went to the plainly named "Curtain Shop" and asked if they would put some up for me. Inside were a lot of elderly Muslim men. I was told that they don't do that kind of work, and was back on the pavement within a few moments. I felt sure I had suffered discrimination and was bewildered as I had been there previously when the Muslim owners had been very friendly. Things have changed. I am living in a place where I am a stranger.
I was brought up in a village in Staffordshire, and although I have been in London for a quarter of a century I have kept the habit of chatting to shopkeepers and neighbours, despite it not being the done thing in metropolitan life. Nowadays, though, most of the tills in my local shops are manned by young Muslim men who mutter into their mobiles as they are serving. They have no interest in talking to me and rarely meet my gaze. I find this situation dismal. I miss banter, the hail fellow, well met chat about the weather, or what was on TV last night.
More worryingly, I feel that public spaces are becoming contested. One food store has recently installed a sign banning alcohol on the premises. Fair enough. But it also says: "No alcohol allowed on the streets near this shop." I am no fan of street drinking, and rowdy behaviour and loutish individuals are an aspect of modern British "culture'' I hate. But I feel uneasy that this shopkeeper wants to control the streets outside his shop. I asked him what he meant by his notice but he just smiled at me wistfully.
Perhaps he and his fellow Muslims want to turn the area into another Tower Hamlets, the east London borough where ''suggestive'' advertising is banned and last year a woman was refused a job in a pharmacy because she wasn't veiled.
On the other hand, maybe I should be grateful. At least in Acton there is just a sign in a shop. Since the start of the year there have been several reports from around London of a more aggressive approach. Television news footage last week showed incidents filmed on a mobile phone on a Saturday night, in the borough of Waltham Forest, of men shouting "This is a Muslim area" at white Britons.
The video commentary stated: "From women walking the street dressed like complete naked animals with no self-respect, to drunk people carrying alcohol, we try our best to capture and forbid it all."
Another scene showed hooded youths forcing a man to drop his can of lager, telling him they were the "Muslim patrol" and that alcohol is a "forbidden evil". The gang then approached a group of white girls enjoying a good night out, telling them to "forbid themselves from dressing like this and exposing themselves outside the mosque".Worse, though, is film footage from last week, thought to have been taken in Commercial Street, Whitechapel, which showed members of a group who also called themselves a "Muslim patrol" harassing a man who appeared to be wearing make‑up, calling him a "bloody fag". In the video posted on YouTube last week, the passer-by is told he is "walking through a Muslim area dressed like a fag" and ordered to get out. Last Thursday, police were reported to have arrested five "vigilantes" suspected of homophobic abuse.
There are, of course, other Europeans in my area who may share my feelings but I'm not able to talk to them easily about this situation as they are mostly immigrants, too. At Christmas I spoke to an elderly white woman about the lack of parsnips in the local greengrocer, but she turned out to have no English and I was left grumbling to myself.
Poles have settled in Ealing since the Second World War and are well assimilated, but since 2004 about 370,000 east Europeans have arrived in London. Almost half the populations of nearby Ealing and Hammersmith were born outside the UK. Not surprisingly, at my bus stop I rarely hear English spoken. I realise that we can't return to the time when buses were mainly occupied by white ladies in their best hats and gloves going shopping, but I do feel nostalgic for the days when a journey on public transport didn't leave me feeling as if I have only just arrived in a strange country myself.
There are other "cultural differences" that bother me, too. Over the past year I have been involved in rescuing a dog that was kept in a freezing shed for months. The owners spoke no English. A Somali neighbour kept a dog that he told me he was training to fight, before it was stolen by other dog fighters. I have tried to re-home several cats owned by a family who refuse to neuter their animals, because of their religion.
In the Nineties, when I arrived, this part of Acton was a traditional working-class area. Now there is no trace of any kind of community – that word so cherished by the Left. Instead it has been transformed into a giant transit camp and is home to no one. The scale of immigration over recent years has created communities throughout London that never need to – or want to – interact with outsiders.
It wasn't always the case: since the 1890s thousands of Jewish, Irish, Afro-Caribbean, Asian and Chinese workers, among others, have arrived in the capital, often displacing the indigenous population. Yes, there was hateful overt racism and discrimination, I'm not denying that. But, over time, I believe we settled down into a happy mix of incorporation and shared aspiration, with disparate peoples walking the same pavements but returning to very different homes – something the Americans call "sundown segregation".
But now, despite the wishful thinking of multiculturalists, wilful segregation by immigrants is increasingly echoed by the white population – the rate of white flight from our cities is soaring. According to the Office for National Statistics, 600,000 white Britons have left London in the past 10 years. The latest census data shows the breakdown in telling detail: some London boroughs have lost a quarter of their population of white, British people. The number in Redbridge, north London, for example, has fallen by 40,844 (to 96,253) in this period, while the total population has risen by more than 40,335 to 278,970. It isn't only London boroughs. The market town of Wokingham in Berkshire has lost nearly 5 per cent of its white British population.
I suspect that many white people in London and the Home Counties now move house on the basis of ethnicity, especially if they have children. Estate agents don't advertise this self-segregation, of course. Instead there are polite codes for that kind of thing, such as the mention of "a good school", which I believe is code for "mainly white English". Not surprising when you learn that nearly one million pupils do not have English as a first language.
I, too, have decided to leave my area, following in the footsteps of so many of my neighbours. I don't really want to go. I worked long and hard to get to London, to find a good job and buy a home and I'd like to stay here. But I'm a stranger on these streets and all the "good" areas, with safe streets, nice housing and pleasant cafés, are beyond my reach. I see London turning into a place almost exclusively for poor immigrants and the very rich.
It's sad that I am moving not for a positive reason, but to escape something. I wonder whether I'll tell the truth, if I'm asked. I can't pretend that I'm worried about local schools, so perhaps I'll say it's for the chance of a conversation over the garden fence. But really I no longer need an excuse: mass immigration is making reluctant racists of us all.
Jane Kelly is consulting editor of the 'Salisbury Review'
Article printed from Limits to Growth: http://www.limitstogrowth.org
URL to article: http://www.limitstogrowth.org/articles/2013/01/30/british-woman-feels-like-a-stranger-in-her-own-neighborhood/
URLs in this post:
[1] demographic changes have been reported in Britain: http://www.limitstogrowth.org/articles/2012/12/29/britain-negative-demographic-milestones-are-noted
[2] white flight: http://www.dailymail.co.uk/news/article-2269058/British-families-self-segregate-whites-abandon-urban-areas-countryside.html#ixzz2JCMpW9Ty
[3] share the same culture: http://www.limitstogrowth.org/articles/2012/08/13/diversity-in-hard-times-violence-heats-up-over-immigration-in-greece/
[4] elitist liberal governments decide that the traditional beliefs like patriotism can be fixed: http://www.limitstogrowth.org/articles/2011/03/01/britain-labour-party-busted-for-immigration-flood
[5] Pew: http://www.pewglobal.org/2007/10/04/world-publics-welcome-global-trade-but-not-immigration/
[6] Ipsos: http://www.limitstogrowth.org/articles/2013/01/19/britain-poll-finds-immigration-considered-biggest-problem
[7] Salisbury Review: http://www.salisburyreview.co.uk/The_Salisbury_Review_Front_Page.html
[8] white Britons are now a minority in London: http://www.dailymail.co.uk/news/article-2246288/Census-2011-UK-immigrant-population-jumps-THREE-MILLION-10-years.html
[9] Americans have told similar stories about how their pleasant California neighborhoods turned into crime-filled Mexican barrios: http://www.limitstogrowth.org/articles/2010/07/22/terry-anderson-with-some-local-history
[10] once-Golden State: http://www.limitstogrowth.org/articles/2010/12/15/inland-california-is-looking-a-lot-like-mexico/
[11] declared a sharia zone by local Muslims: http://www.limitstogrowth.org/articles/2012/11/15/britain-sharia-law-expands
[12] 'I feel like a stranger where I live': http://www.telegraph.co.uk/news/uknews/immigration/9831912/I-feel-like-a-stranger-where-I-live.html
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Here's the hook: To create the perfect pizza any night of the week! Fun ideas from the likes of culinary guru Mary Martini, and her righteous recipe for this overstuffed breakfast pizza. We used ingredients from Central Market, and mark my words — it'… Continue reading
Category Archives: Lidia Bastianich
My friend Lidia Bastianich is an Italian guru, but I treasure her salads just as much! Lidia's Roasted Beet and Beet Green Salad with Apples and Goat Cheese [above] comes from her NYC eatery, Felidia. Continue reading
A Celebrity Chef's Corner — you've asked for it and we've listened! Here are some delicious dishes from your favorite chefs who've shared their recipes with Goodtaste! We'll continue to update this page with new content from our famous friends…keep … Continue reading
The new, healthier you will go the distance with these recipe ideas to incorporate into your family's meal planner. Eating healthy helps your body be at its best and your mind be on the right track. You'll just feel better! Here are a few suggestions t… Continue reading
I absolutely love this time of year – everyone's spirits soar. It's a great time to regroup with friends whether it's a formal holiday event or just entertaining at home. I have a few go to recipes on my website Goodtaste.tv that I rely on whe… Continue reading
It's all about the crust…the small raised rim around the pizza called the cornichon in Italy. When it's crispy, slightly charred and oh so thin, it's authentic Neapolitan pizza! And that's exactly what I found at Eataly — Lidia Bastianich… Continue reading


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Articles Tagged 'tax credit'
Quebec industry raises alarm on reduced film tax credits
FILMTVThe cash-strapped Quebec government has cut corporate tax credits across the board by 20%, impacting the provincial film, TV and digital sectors.
Sons of Anarchy star Kim Coates fears the Saskatchewan industry is doomed
FILMTVThe actor, who comes from Saskatoon, told Playback he's trying to stay positive as the local industry aims to end an impasse with Premier Brad Wall over their film tax credit.
Saskatchewan producers continue to decry new tax credit
FILMFUNDINGTVSMPIA president Ron Goetz talks to Playback about the FTDC and the future of the province's industry.
Local producers criticize Saskatchewan's replacement tax credit
FILMFUNDINGTVThe industry argues that the new non-refundable tax credit, a total 43 percent incentive with all bonuses included, is not a profitable business model.
Saskatchewan film and TV industry rallies for new tax incentive
FILMFUNDINGPOLICYTVIndustry reps and the government are set to meet in coming weeks to discuss possible plans for a new tax break.
McGuinty talks up film/TV industry during VFX studio visit
FILMFUNDINGTVThe premier stopped by Toronto's Mr. X to trumpet the advantages of film tax credits, after Saskatchewan last month cancelled its own.
New Brunswick unwraps new tax credit
FILMFUNDINGThe new incentive, to cover up to 30% of eligible production expenditures, replaces a 40% tax credit cancelled in March 2011.
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Discusses the principles and techniques of what makes a logo work, type-only designs, type treatments, and logo symbols.
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- 175Promote
Art Print
Collect your choice of gallery quality Giclée, or fine art prints custom trimmed by hand in a variety of sizes with a white border for framing.
The 2nd installment of my contribution to Prox Art Magazine. The issue will be realesed March 16th.
For a better look at this image check it out here http://www.facebook.com/photo.php?fbi...49&theater
I like that is colorfull.But that is not all, it takes me back on america's TV serial. Imaging that I saw them on greek TV.heh
This is such a great image that I'm pinning it to my Pinterest public S6 favorites board with the hope that it will drive more traffic to your wonderful art!
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Home → Forms, Publications & Applications → Employment Tax Returns - 2009
Employment Tax Returns - 2009 *
Note: PDF format requires the free Adobe Reader to view.
(Follow this link for 2008 forms)
Application for Tax Registration
Withholding Allowance Variance Certificate
941ME Filing for income tax withholding
Schedule 2 -- Income Tax Withholding Listing Page
941/C1-ME Combined filing for income tax withholding and unemployment contributions
Schedule 2/C1 -- Quarterly Income Tax and Unemployment Wages Listing (Form 941/C1-ME)
941BN-ME Business change notification
941A-ME Amended return of income tax withheld
C1A-ME Amended return of unemployment contributions
2009 W-3ME Annual reconciliation of income tax withheld
*This is not a complete listing of unemployment contributions forms. If a form is not listed here, visit the Department of Labor's web site or call 207-621-5120 to obtain it.


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Cornick, Martyn and Kelly, Debra (2013) Introduction: towards a history of the French in London. In: Kelly, Debra and Cornick, Martyn, (eds.) A history of the French in London: liberty, equality, opportunity. Institute of Historical Research, School of Advanced Study, University of London, London. ISBN 9781905165865
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Item Type: | Book Section |
Research Community: | University of Westminster > Social Sciences, Humanities and Languages, School of |
ID Code: | 11124 |
Deposited On: | 16 Aug 2012 11:09 |
Last Modified: | 09 Jul 2013 13:35 |
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The Village at Wild Dunes Review
Families will love:
- Resort right on the beach
- Kids' and family programs
- Studios and suites with kitchens and washer/dryers
About The Village at Wild Dunes
Wild Dunes Resort is on the furthermost tip of Isle of Palms, a laid back and beautiful barrier island off the South Carolina coast about a half-hour's drive from historic Charleston. With the Atlantic Ocean bordering one side and the Intracoastal Waterway on the other, this 1,600-acre year-round beach resort offers lots of family-friendly activities, including watersports, games and crafts, tennis, golf, biking and eco-oriented adventures that allow you to explore the area's intriguing ecosystem. The list of summer programs (including all sorts of kids' camps and sports clinics) is about a mile long, each option sounding more inviting than the next. And if you're visiting on a holiday -- whether it's July 4 or the Christmas season -- special programs and offerings themed to that holiday abound.
This sprawling resort encompasses several types of accommodations, including a 93-room hotel called the Boardwalk Inn, more than 350 one- to four-bedroom villas and three- to 11-bedroom homes, and 120 guestrooms and suites in the fairly new Village at Wild Dunes -- the best accommodation for most families. Opened in 2008, the modern, bright, beach-themed Village offers both concierge and housekeeping service to all guests who stay in its hotel-like guestrooms, studios and suites. Both the studios (which have kitchenettes) and the one-, two- and three-bedroom suites (which have full kitchens) have washer/dryers.
Resort amenities include beach access, a variety of restaurants and snack bars (from fine dining to deli take-out), several swimming pools, a fitness center, two golf courses, 17 tennis courts, a spa, miles of walking and jogging paths and valet parking.
The Village at Wild Dunes Reviews
Best for:
- Tots (0-2)
- Kids (3-6)
- Kids (7-9)
- Tweens (10-12)
- Teens (13+)
Family Interests
- Beach
- Bicycling
- Golf
- Museum/Cultural
- Water Sports
- Sailing
- Horseback Riding
Family Amenities
- Babysitting
- Children's Program
- Cribs
- DVD Player
- Family Room 5+
- Kids' Pool
- Kids'/Theme Meals
- Kitchenettes
- Laundry Service
- Onsite Dining
- Pool
Family Ratings: | |
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FREE Family Travel Newsletter
Family Travel Tips (3 New)
– Family Planning and Tips
- Deciding where to go for your next family vacation? Often it's the most popular destinations -- from mega theme parks to world-famous beach towns -- that come to mind first. It's tempting to pick a familiar place and just go with what you know, but do this and you could be missing out on some fantas...
- Join us onboard Disney Wonder's first exploration into Alaskan waters and ports as Family Vacation Critic Editor Lissa Poirot and her two tots take you on a tour. Be the first to see a sample of Disney's Alaskan Port Adventures, as well as glimpse the Disney Wonder's onboard fun, in our first-ever d...
- Away from the hectic pace of our everyday lives, any vacation is a chance for families to reconnect. There's no soccer game, no piano recital, no working late, so finally you have that precious day together. Yet, if you really want a meaningful break from your usual schedule, one that might change t...


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- About this Journal ·
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Critical Care Research and Practice
Volume 2012 (2012), Article ID 180797, 11 pages
Abdominal Decompression in Children
Division of Pediatric Critical Care, Department of Pediatrics, School of Medicine, Loma Linda University, Loma Linda, CA 92354, USA
Received 1 September 2011; Revised 17 November 2011; Accepted 30 December 2011
Academic Editor: Manu L. Malbrain
Copyright © 2012 J. Chiaka Ejike and Mudit Mathur. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abdominal compartment syndrome (ACS) increases the risk for mortality in critically ill children. It occurs in association with a wide variety of medical and surgical diagnoses. Management of ACS involves recognizing the development of intra-abdominal hypertension (IAH) by intra-abdominal pressure (IAP) monitoring, treating the underlying cause, and preventing progression to ACS by lowering IAP. When ACS is already present, supporting dysfunctional organs and decreasing IAP to prevent new organ involvement become an additional focus of therapy. Medical management strategies to achieve these goals should be employed but when medical management fails, timely abdominal decompression is essential to reduce the risk of mortality. A literature review was performed to understand the role and outcomes of abdominal decompression among children with ACS. Abdominal decompression appears to have a positive effect on patient survival. However, prospective randomized studies are needed to fully understand the indications and impact of these therapies on survival in children.
1. Introduction
Abdominal compartment syndrome (ACS) increases the risk of mortality in critically ill children [1]. It results in 100% mortality if left untreated [2, 3]. The importance of ACS is increasingly becoming appreciated in the pediatric intensive care setting. Surgical decompressive laparotomy (DL) with open abdomen management (OA) for ACS is the definitive treatment of choice when medical and less invasive therapies have failed [4–6]. Its use has shown improvement in organ function and mortality, though mortality still remains high [7–9]. DL is an invasive therapy that is challenging to manage and often associated with significant morbidity and mortality [6, 8, 9]. Surveys have suggested that some physicians are hesitant to use DL in their patients [10, 11]. Decompression of the abdomen has also been achieved in certain cases by less invasive therapies such as catheter decompression, escharotomy, and subcutaneous fasciotomies [12–15]. This article highlights conditions associated with ACS in children and focuses on the role of abdominal decompression in its management.
2. Materials and Methods
The National Library of Medicine (PUBMED) was queried for "decompressive laparotomy and children"; "decompressive laparotomy and pediatrics"; "decompression laparotomy and children"; "decompression laparotomy and pediatrics", "percutaneous drainage and abdominal compartment." These searches yielded a total of 67 articles. Eight articles were excluded for language other than English, and 37 were not selected because they were irrelevant or exclusively related to adults. Hence, 22 articles pertinent to the role of abdominal decompression in children were included for review.
3. Results and Discussion
There is a relative paucity of literature on ACS in children compared to adults. Publications related to abdominal decompression in children are lacking in their scope and generalizability of findings. ACS definitions differed among the studies which could influence outcomes by unintentionally selecting patients with ACS at varying stages of progression. The majority of publications are case reports or case series, and amongst the outcome studies reviewed, none included randomization of assigned treatment. Outcomes including mortality and postoperative complications vary widely between studies and cannot be directly compared because of small numbers, varied reporting criteria, and differences in study design. The differences seen may be due to a number of contributing factors such as the populations studied; the underlying diagnoses that led to ACS; pre-existing comorbidities such as congenital malformations or genetic syndromes; timing and type of decompression; the type of temporary abdominal closure used and the grade of IAH that the patient presented with. The reported clinical experience of abdominal decompression in children is presented in Table 1. Despite the limitations discussed above, these studies illustrate the importance of early diagnosis and timely abdominal decompression in the management of ACS. The adverse physiological effects of IAH start long before the manifestation of ACS becomes clinically evident [20]. Therefore, the question of appropriate timing for decompression is a pressing issue that remains unclear. Overall outcomes are also affected by the techniques used to decompress the abdomen, and the materials and management strategies applied to manage the OA and support dysfunctional failing organs that accompany the diagnosis of ACS.
Definitions related to IAH and ACS in children are derived from the consensus statements put forward by the WSACS (World Society of Abdominal compartment Syndrome; http://www.wsacs.org). However, these definitions are not all directly applicable in children and suggested definitions specific to children have been published and are presented in Table 2 [21].
The true incidence of ACS in children is difficult to determine because of the wide variety of illnesses it is associated with, the relative lack of consensus on the threshold IAP used to define ACS in children, and the paucity of publications. Studies have reported occurrence rates between 0.6 and 9.8% in single-center studies involving critically ill children [1, 7, 8, 17, 22].
3.1. Risk Factors and Conditions Associated with ACS in Children
Risk factors that predispose patients to IAH and ACS can be grouped into four major categories based on the pathophysiology of elevated IAP.(1)Decreased Abdominal Wall Compliance. circumferential burns involving the abdomen, constrictive dressings, or tight closure of the abdomen following abdominal surgery can lead to decreased abdominal wall compliance.(2)Increased Intraluminal Contents. the accumulation of air, stool, or fluid in the intestines as can be seen in Hirschprung's disease, toxic megacolon, or ileus can lead to elevations in IAP resulting in ACS.(3)Increased Intra-Abdominal Contents. intra-abdominal space-occupying lesions such as tumors, intraperitoneal fluid, abscesses, and intra-abdominal hemorrhages can result in ACS.(4)Capillary Leak Syndrome/Fluid Resuscitation. aggressive fluid resuscitation especially with crystalloid solutions in the critically ill or diseases associated with capillary leak syndrome can lead to the development of secondary ACS.
Some conditions reported to be associated with ACS in children are listed in Table 3.
There may be an increased risk for the development of ACS among children with congenital malformations and genetic disorders. In Steinau's series, 12 out of 26 children who developed ACS had at least one underlying congenital malformation or genetic disorder [9]. In two other pediatric studies, congenital malformations (included arthrogryposis, caudal regression syndrome, biliary atresia, and cystic fibrosis) were seen in 20% () of children with ACS [7, 17].
The WSACS recommends that IAP measurement be obtained if two or more risk factors for IAH/ACS are present. If IAH is detected, serial IAP measurements should be performed [4, 5].
3.2. IAP Measurement in Children
Techniques used to measure IAP can be divided into two groups, the direct and the indirect method. The direct method entails placing a needle or catheter directly into the peritoneal space and transducing the pressure in the abdomen. In clinical practice, its use solely for IAP measurement is limited by the potential for complications such as bowel perforation and peritoneal contamination [23]. However, direct IAP measurement can be easily performed when a peritoneal catheter is already in place or the placement of one is indicated as a therapeutic measure. Indirect methods measure IAP via routes other than the peritoneal space. The intravesical method is the gold standard for measuring IAP [23–25]. Several surveys indicate that it is currently the most commonly used technique in children and adults [10, 11, 26]. IAP is measured via a urethral catheter placed in the bladder. A debubbled fluid column is created by infusing sterile normal saline into the bladder. The optimum volume to use in children weighing 2.7 to 50 kg is 3 mL or 1 mL/kg up to a maximum of 25 mL [19]. In children weighing more than 50 kg, 25 mL can be used as the instillation volume as recommended by the WSACS for adults [4, 5]. Appropriate volumes for infants weighing less than 2.7 kg have not been determined. For accurate measurements using this method, the transducer is zeroed at the mid-axillary line with the patient in the supine position. IAP should be recorded at end expiration and when the abdominal muscles are relaxed. A period of 30–60 seconds should be allowed for equilibration of the pressure within the bladder before recording IAP [4, 5]. Other indirect methods reported in the literature include the intragastric, intrarectal, intrauterine, and venacaval methods [23, 25, 27].
3.3. Management of IAH and ACS
The main goals in management of IAH include recognizing its presence by objective IAP monitoring, treating the underlying cause, and preventing progression to ACS by lowering IAP.
Medical management strategies to lower IAP and improve organ perfusion can be guided by the following principles [4].(1)Evacuate intraluminal contents via nasogastric or rectal tubes; avoiding or minimizing enteral feeds; administering enemas or prokinetic agents; colonoscopic decompression.(2)Improve abdominal wall compliance by ensuring adequate sedation, analgesia, and neuromuscular blockade; removal of constrictive dressings and placing in the reverse Trendelenberg position.(3)Optimize fluid administration by avoiding excessive fluid resuscitation (especially with crystalloids, consider using hypertonic fluids and colloids early); aiming for a net negative or zero fluid balance by the third day from initial resuscitation and begin fluid removal through judicious diuresis, ultrafiltration, or dialysis once stable.(4)Optimize systemic and regional perfusion by goal directed fluid resuscitation, hemodynamic monitoring to guide resuscitation, and use of vasoactive medications to maintain adequate abdominal perfusion pressures.(5)Evacuate free intraperitoneal fluid or air, by paracentesis or percutaneous catheter drainage.
Identification and specific treatment of the underlying cause of IAH must be addressed concomitantly. Abdominal ultrasound or Computerized Tomography can be useful in diagnosing the underlying cause and directing management. If the underlying cause of IAH or ACS is surgical, medical management strategies should be used to stabilize the patient without delaying definitive surgery. When medical management is failing and ACS is already present, surgical DL should be performed promptly.
3.4. Decompressive Laparotomy
Decompressive laparotomy (DL) is essential and potentially lifesaving in treating IAH-induced organ failure [4]. It has resulted in improvement in physiologic parameters associated with ACS and mortality. Beck et al. retrospectively studied 10 patients with 15 episodes of ACS. They defined ACS as increasing abdominal distention with IAP of >15 mmHg, accompanied by at least three of the following major criteria: oliguria (urine output < 1 mL/kg/hr) or anuria, refractory to volume expanders or diuretics; hemodynamic instability or hypotension refractory to volume expanders; reduced chest compliance leading to increasing PaCO2 and decreasing PaO2/FiO2 ratio and requiring higher FiO2 and ventilatory pressures; metabolic acidosis with a base deficit >6 mMol/L. Physiologic parameters were compared 4 hrs before ACS development and 4 hours after abdominal decompression. Mean arterial pressure, PaO2, PaO2/FiO2 ratio, and urinary output decreased significantly, whereas PaCO2, peak inspiratory pressures (PIPs), positive end-expiratory pressures (PEEPs), and base deficit increased significantly after the development of ACS. After DL, these variables returned to pre-ACS values. Overall mortality rate in this group was 60%. Pearson et al. studied 26 children with ACS who required emergency laparotomy. They defined ACS as sustained bladder pressure >12 mmHg that was associated with new onset organ dysfunction or failure. They demonstrated improvement of the following physiologic parameters: need for fluid resuscitation, oxygen index, mean airway pressure, vasopressor score, but urine output continued to be minimal 12 hours after DL. Overall mortality was 58% in this cohort [8]. Neville et al. demonstrated decreased oxygen requirements after patch abdominoplasty performed for clinical deterioration associated with criteria defining ACS. PIP decreased also but only in ACS survivors, and oxygen requirements decreased more significantly in survivors compared to nonsurvivors in this cohort. They defined ACS as an increase oxygen requirement and elevation in PIP associated with abdominal distention, worsening renal and cardiac function. The mortality in this cohort was 34.8% [18].
DL is the treatment of choice for most patients with IAH or ACS that is refractory to nonoperative medical management strategies and it is associated with significantly improved patient survival [68, 69]. It needs to be performed before irreversible organ dysfunction occurs for better outcomes. Steinau et al. retrospectively reviewed outcomes of ACS in children using a therapeutic algorithm that focused on timely decompression. They showed a survival rate of 78.6% [9]. This is the best survival rate of ACS reported in children thus far, though their approach to abdominal decompression was proactive with IAP > 12 mmHg and only one organ dysfunction constituting triggers for DL. Optimization of conservative therapies and early decompression guided by use of a therapeutic algorithm likely contributed to improved outcomes. Cheatham and Safcsak have shown that using an evidenced based management algorithm in adult patients improved patient survival to discharge from 50 to 75%, and rates of primary fascial closure from 59 to 81% [69].
DL involves making an incision to open all layers of skin, subcutaneous tissue, fascia, and peritoneum [6]. Both midline and transverse incisions have been used in children [8, 9, 51]. Ideally, DL should be performed in the operating room. In situations where the patient is too unstable for transport or if an operating room is not readily available, DL can be performed in the pediatric intensive care unit (PICU). In Pearson et al.'s report 13 of 27 patients had DL performed at the bedside and 4 of 15 episodes of ACS in Beck et al.'s study had DL performed at the bedside [7, 8]. Successful management of ACS using DL may depend upon the use of an open abdomen management strategy.
3.5. Open Abdomen Management
DL is often supported by open abdomen (OA) management to avoid recurrence of ACS. OA management is achieved by leaving the fascia and the skin open, and temporarily covering the viscera. An OA with temporary abdominal closure (TAC) may also be necessary following operations in which edematous viscera preclude easy fascial closure, management of abdominal wall defects or in which an adult size organ has been transplanted into a small child [22, 34, 52, 53, 55, 70, 71]. The ultimate goal of OA management is to achieve prompt primary fascial closure without complications. To achieve successful primary fascial closure entails a multidisciplinary approach in management of the open abdomen [72]. The ICU team is working toward safely removing excess fluid while preserving organ function, preventing infection, and treating concurrent comorbidities. The surgical team has the task of choosing the ideal TAC technique for each patient and managing dressing changes. To avoid the development of recurrent ACS and lateral retraction of the abdominal muscles, the surgical team should constantly be seeking out the earliest optimal time for primary fascial closure. The challenge of OA management increases when delayed primary fascial closure is not achievable because abdominal wall reconstruction will need to be addressed at a later date [55]. Most pediatric studies reviewed did not focus on successful achievement of primary fascial closure after management of ACS. Three studies addressed it. A study by Steinau et al. reports 72% of patients achieved primary fascial closure in a median of 53 (range 10–63) days. Incisional hernias needing repair occurred in 27.3%, one needed closure of a stoma and another one needed relaparotomy for an ileus due to adhesions [9]. DL with OA management was used in 26 patients with ACS. Time to definitive abdominal closure averaged 8.6 days (range, 1–61 days) needing an average of 3.2 separate operations (range, 1–14) to achieve abdominal wall closure. This study did not clarify if primary fascial closure was achieved or not. Postoperative complications that could be related to DL in this study included wound infection (), fascial dehiscence (), and enterocutaneous fistula () [8]. In another study, 11 of 23 (47.8%) patients who underwent patch abdominoplasty for ACS achieved delayed primary fascial closure. Complications in this cohort included mesh infection (), recurrent ACS (), and subsequent incisional hernia for the five patients that did not achieve primary fascial closure [18].
3.6. Temporary Abdominal Closure
Temporary abdominal closure (TAC) techniques have recently been characterized into three generations reflecting the historical evolution of the devices, from simple coverings, to contain the viscera, to closure devices to cover and aid in the gradual approximation of the abdominal edges [9, 42, 70, 72, 73]. The first generation aimed at bridging the defect and covering the abdomen, using biodegradable or synthetic materials. The second generation aimed at fluid control and improved barrier function and the third generation aimed at gradual approximation of the wound by the use of gradual manual tension such as the Wittmann patch or negative pressure [72]. Several of these techniques have been reported in children and are presented in Table 4.
3.7. Catheter Decompression
Abdominal decompression by catheter decompression is gaining favor because of its less invasive quality and decreased morbidity associated with its use. Abdominal decompression has been achieved by percutaneous catheter decompression in situations in which intra-abdominal fluid plays a significant role in the underlying diagnosis [14, 31, 37, 49]. Bedsides, sonography can assist in distinguishing patients with progressive IAH predominately related to intraperitoneal fluid, from those with bowel wall edema or a space-occupying lesion, where catheter decompression will not be useful and may lead to unnecessary complications.
Percutaneous drainage (PD) of peritoneal fluid can prevent the progression of IAH to ACS altogether or may allow time to stabilize the patient for DL [14, 31, 49, 50]. Improvement in physiologic criteria has been seen with insertion of PD for IAH and ACS. A retrospective review was performed of 32 neonates who had IAP monitoring. Clinical presentation was divided into I and II grade signs. I grade signs included increased abdominal circumference, reduced abdominal wall compliance, and ultrasound confirmation of fluid in the abdominal cavity. II grade signs included necrotizing enterocolitis, septic shock, renal failure, low cardiac output, increased central venous pressure, delayed capillary refill time, acute respiratory failure, increased PaCO2, decreased PaO2, oliguria/anuria, and weak or absent femoral artery pulses. Twenty-eight patients met criteria for IAH, defined as IAP > 10 mmHg with each I grade sign and two symptoms from II grade signs while ACS was defined as IAP > 20 mmHg, with each I grade sign plus at least three symptoms of grade II signs. Insertion of a PD was performed in all cases. After insertion, resolution of symptoms was observed in all patients but with varying improvements in clinical parameters and measurements [12]. A study including 10 PICU patients with ACS reported a decrease in IAP and ventilatory parameters and an increase in urine output rapidly after abdominal decompression performed by PD in 5 patients and DL in 2 patients. The two patients with DL subsequently died while only one of the five with PD died. Overall mortality in this study was 40%. Latenser et al. in a pilot study compared PD with DL in adult and pediatric patients with greater than 40% total body surface area (TBSA) burns. There was reduction in IAP after catheter placement in all nine patients with IAH. Only 4 patients with failed PD required emergent DL after developing ACS. They concluded that PD is safe and effective as a decompression modality for decreasing IAH and preventing ACS in patients with less than 80% TBSA burns [14]. It can be very useful in patients where DL is less desirable because of a high surgical risk. PD successfully avoided the need to perform a DL in an anticoagulated-patient undergoing extracorporeal life support who developed ACS [37].
Paracentesis using angiocatheters, peritoneal dialysis catheters, and hemodialysis catheters have been reported [14, 31, 49, 74]. Needle decompression was reported in a child with ACS resulting from tension pneumoperitoneum [45]. The successful use of a Penrose drain has been reported in a very-low-birth-weight (VLBW) neonate weighing only 650 gm [75].
Complications with catheter decompression have not been well reported in the literature. Latenser et al.'s study reported peritoneal contamination that did not progress to peritonitis in one patient [14]. The VLBW neonate developed hernias at the catheter insertion sites upon removal of the Penrose drain, resulting in the need for reconstructive laparoscopic surgery [75]. Some patients have progressed to death in spite of decompression by catheter placement [49]. It is important to note that when IAH or ACS is not ameliorated by catheter decompression and aggressive medical management, DL should be performed immediately [74].
DL was widely considered the only therapeutic option for abdominal decompression in the recent past but less invasive methods of abdominal decompression like catheter decompression are gaining favor because of the decreased morbidities they may offer compared to DL with OA management. Only patients with moderate amounts of free intraperitoneal fluid and no surgical intra-abdominal pathology may benefit from this procedure. Patients with no surgical intra-abdominal pathology and insignificant amounts of intraperitoneal fluid will need other means of decompression. Minimally invasive subcutaneous fasciotomy has been described in adults but its use has not been reported in pediatrics. It entails subcutaneous division of the linea alba between cutaneous incisions or subcutaneous anterior medial rectus abdominis fasciotomy through small skin incisions (with drainage of intra-abdominal fluid) [76, 77].
Reported complications with OA management include intra-abdominal abscesses, enteroatmospheric fistulae, and herniae when primary fascial closure cannot be achieved. It is difficult to tease out morbidity or mortality associated with DL or OA management from morbidity and mortality related to the underlying cause and the progression of ACS itself. However, arguments for its benefits can be made based on the improvements in physiologic parameters and when death from ACS is imminent, in its absence [78]. Large randomized studies could help answer this question but based on the few publications that suggest benefit with its use, it might become ethically challenging not to provide DL in the control group when the need arises. Few studies have looked at long-term complications from DL and OA management. A questionnaire was sent to the parents of 22 ACS-survivors following DL with a resulting response rate of 72.7% (16/22). According to the responses to the questionnaire, the scar area brought physiological or psychological discomfort to 10 of 16 children. Of those, subjective impediment degree was put at 100% by five children, at 80% by one child, and at 50% by two [9].
An adult study looking at the long-term impact of DL on physical and mental health, quality of life, and subsequent employment showed that DL initially decreased physical, but not mental health perception compared with that of the United States general population, and that abdominal wall reconstruction restores physical and mental health to normal levels [79]. Another similar but prospective study amongst adults compared patients discharged with an incisional hernia, and primary fascial closure after DL, to the general public. It demonstrated that at 6 months postdecompression, physical and social functions were significantly decreased among the incisional hernia group but not the primary fascial closure group. By 18 months, the incisional hernia group had normal physical and mental health. The two groups had decreased but similar quality-adjusted life years and similar ability to resume employment. They concluded that ACS does not appear to have a long-term impact on physical or mental health, whether same admission primary fascial closure is possible or a chronic incisional hernia is required. ACS is not as debilitating and life altering as might be expected [80].
4. Conclusions
ACS is a potentially lethal condition associated with a wide variety of conditions some of which are seemingly innocent at presentation. Clinicians should screen children in the intensive care unit at risk for developing ACS on an ongoing basis. ACS must be recognized early. Clear consensus definitions specific to pediatric patients based on organized studies are still necessary and will help in ACS recognition. Appropriate treatment options supporting organ function and timely assessment for catheter or surgical decompression should be employed. Current therapies being utilized for abdominal decompression appear to have a positive impact on patient survival. However, prospective randomized studies are needed, to fully understand the indications and impact of therapies directed at IAH and ACS management on survival in children. A number of children who would have died without intervention may survive after management of ACS by abdominal decompression, but may acquire varying physiological and psychological complications. Long-term studies to understand the impact of abdominal decompression techniques need to be conducted in children.
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