bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of a Hospitalist System on Length of Stay and Cost for Children With Common Conditions
Authors: Srivastava Rajendu , Landrigan Christopher P. , Ross-Degnan Dennis , Soumerai Stephen B. , Homer Charles J. , Goldmann Donald A. , Muret-Wagstaff Sharon
Published: August 2007

OBJECTIVE. This study examined mechanisms of efficiency in a managed care hospitalist system on length of stay and total costs for common pediatric conditions.

PATIENTS AND METHODS. We conducted a retrospective cohort study (October 1993 to July 1998) of patients in a not-for-profit staff model (HMO 1) and a non–staff-model (HMO 2) managed care organization at a freestanding children's hospital. HMO 1 introduced a hospitalist system for patients in October 1996. Patients were included if they had 1 of 3 common diagnoses: asthma, dehydration, or viral illness. Linear regression models examining length-of-stay–specific costs for prehospitalist and posthospitalist systems were built. Distribution of length of stay for each diagnosis before and after the system change in both study groups was calculated. Interrupted time series analysis tested whether changes in the trends of length of stay and total costs occurred after implementation of the hospitalist system by HMO1 (HMO 2 as comparison group) for all 3 diagnoses combined.

RESULTS. A total of 1970 patients with 1 of the 3 study conditions were cared for in HMO 1, and 1001 in HMO 2. After the hospitalist system was introduced in HMO 1, length of stay was reduced by 0.23 days (13%) for asthma and 0.19 days (11%) for dehydration; there was no difference for patients with viral illness. The largest relative reduction in length of stay occurred in patients with a shorter length of stay whose hospitalizations were reduced from 2 days to 1 day. This shift resulted in an average cost-per-case reduction of $105.51 (9.3%) for patients with asthma and $86.22 (7.8%) for patients with dehydration. During the same period, length of stay and total cost rose in HMO 2.

CONCLUSIONS. Introduction of a hospitalist system in one health maintenance organization resulted in earlier discharges and reduced costs for children with asthma and dehydration compared with another one, with the largest reductions occurring in reducing some 2-day hospitalizations to 1 day. These findings suggest that hospitalists can increase efficiency and reduce costs for children with common pediatric conditions.
Using a Computer Kiosk to Promote Child Safety: Results of a Randomized, Controlled Trial in an Urban Pediatric Emergency Department
Authors: Gielen Andrea Carlson , McKenzie Lara B. , McDonald Eileen M. , Shields Wendy C. , Wang Mei-Cheng , Cheng Yu-Jen , Weaver Nancy L. , Walker Allen R.
Published: August 2007

OBJECTIVES. The effects of a computer kiosk intervention on parents' child safety seat, smoke alarm, and poison storage knowledge and behaviors were evaluated in a pediatric emergency department serving predominantly low-income, urban families. The effects of parent anxiety and the reason for the child's emergency department visit also were examined.

METHODS. A randomized, controlled trial of a Safety in Seconds program with a 2- to 4-week follow-up interview was conducted with 759 parents of young children (4–66 months of age). The intervention group received a personalized report containing tailored, stage-based safety messages based on the precaution adoption process model. The control group received a report on other child health topics.

RESULTS. The intervention group had significantly higher smoke alarm, poison storage, and total safety knowledge scores. The intervention group was more likely to report correct child safety seat use. Neither parent anxiety nor the reason for the emergency department visit was related to the safety behaviors. Virtually all (93%) intervention parents read at least some of the report; 57% read it all, and 68% discussed it with others. Lower-income intervention parents who read all of the report and discussed it with others were more likely than control parents to practice safe poison storage. Higher-income intervention parents were more likely than control parents to report correct child safety seat use.

CONCLUSIONS. These results bode well for widespread applicability of computer technology to patient education in busy emergency departments and other child health care settings. Reducing financial barriers to certain safety behaviors should continue to be a high priority.
Upper-Tract Genitourinary Malformations in Girls With Congenital Adrenal Hyperplasia
Authors: Nabhan Zeina M. , Eugster Erica A.
Published: August 2007

OBJECTIVE. The objective of this study was to determine the incidence, specific abnormalities, and clinical significance of upper-tract genitourinary malformations in girls with congenital adrenal hyperplasia.

METHODS. Medical charts of children who received a diagnosis of congenital adrenal hyperplasia between 1985 and 2005 were reviewed.

RESULTS. Of 107 patients with congenital adrenal hyperplasia, 66 girls were identified. Of these, 14 were found to have upper-tract genitourinary abnormalities. The anomalies consisted of vesicoureteral reflux grades 1 to 3 (9), hydronephrosis (4), and duplicated collecting system (1). Two boys with congenital adrenal hyperplasia and known upper-tract genitourinary anomalies were also identified. One had ureteropelvic junction obstruction, and the other had a left malrotated kidney with hydronephrosis. Four patients (1 boy, 3 girls) underwent surgery that consisted of ureteral reimplantation (2) and ureteral stent placement (2). The reflux eventually resolved in 3 patients and worsened in 1. Hydronephrosis improved in 1 patient. None of the patients developed any impairment in renal function.

CONCLUSION. The incidence of upper-tract genitourinary anomalies in girls with congenital adrenal hyperplasia is much higher in our cohort than in the general population (21.2% vs 2%–4%). This association represents a potentially significant medical issue because some patients may require surgical intervention and antibiotic prophylaxis to prevent urinary tract infections and impairment in renal function.
Risk Factors for Persistent Pulmonary Hypertension of the Newborn
Authors: Hernández-Díaz Sonia , Van Marter Linda J. , Werler Martha M. , Louik Carol , Mitchell Allen A.
Published: August 2007

OBJECTIVE. Persistent pulmonary hypertension of the newborn, a clinical syndrome that results from the failure of the normal fetal-to-neonatal circulatory transition, is associated with substantial infant mortality and morbidity. We performed a case-control study to determine possible antenatal and perinatal predictors of persistent pulmonary hypertension of the newborn.

METHODS. Between 1998 and 2003, the Slone Epidemiology Center enrolled 377 mothers of infants with persistent pulmonary hypertension of the newborn and 836 mothers of matched control subjects. Within 6 months of delivery, study nurses interviewed participants regarding demographic, medical, and obstetric characteristics.

RESULTS. Factors that were independently associated with an elevated risk for persistent pulmonary hypertension of the newborn were infant male gender and black or Asian maternal race compared with white race. High prepregnancy BMI (>27 vs <20) was also associated with persistent pulmonary hypertension of the newborn, as were diabetes and asthma. Compared with infants who were delivered vaginally, the risk for persistent pulmonary hypertension of the newborn was higher for those who were born by cesarean section. Compared with infants who were born within 37 to 41 gestational weeks, the risk was higher for those who were born between 34 and 37 completed weeks and for those born beyond 41 weeks. Compared with infants within the 10th and 90th percentiles of birth weight for gestational age distribution, the risk was higher for infants above the 90th percentile.

CONCLUSIONS. Our findings suggest an increased risk for persistent pulmonary hypertension of the newborn associated with cesarean delivery; late preterm or postterm birth; being large for gestational age; and maternal black or Asian race, overweight, diabetes, and asthma. It remains unclear whether some of these factors are direct causes of persistent pulmonary hypertension of the newborn or simply share common causes with it; however, clinicians should be alert to the increased need for monitoring and intervention among pregnancies with these risk factors.
Epidemiologic Features of Hand-Foot-Mouth Disease and Herpangina Caused by Enterovirus 71 in Taiwan, 1998–2005
Authors: Chen Kow-Tong , Chang Hsiao-Ling , Wang Shan-Tair , Cheng Yan-Tzong , Yang Jyh-Yuan
Published: August 2007

OBJECTIVE. In 1998, an epidemic of hand-foot-mouth disease/herpangina was caused by human enterovirus 71 infection in Taiwan. The underlying factors of widespread emergence of viral infection are unclear. The purpose of this study was to assess the epidemiology of hand-foot-mouth disease/herpangina in Taiwan between March 1998 and December 2005.

METHODS. We analyzed data reported to surveillance systems at the Taiwan Center for Disease Control. Viral isolation was performed by 11 reference virus laboratories at medical centers as well as the Taiwan Center for Disease Control.

RESULTS. During the 8-year study period, the reported incidence of mild cases of hand-foot-mouth disease/herpangina varied from 0.8 to 19.9 cases per sentinel physician per week, peaking in 1998. Seasonal variations in incidence were observed, with an incidence peak observed during the summer season. Annual incidence changed significantly from 1998 to 2005. Both age-specific incidence and fatality of severe hand-foot-mouth disease/herpangina decreased as age increased. Most (93%) cases occurred in children who were aged 4 years and younger. Inpatients had a higher rate of enterovirus 71 infection than outpatients. Among severe cases, the majority (80%) had pulmonary edema/hemorrhage and encephalitis.

CONCLUSIONS. Hand-foot-mouth disease/herpangina is a common disease in Taiwan. Enterovirus 71 infection has emerged as an important public problem causing serious clinical illness and, potentially, death in young children. Vaccine development is recommended for prevention of enterovirus 71 infection in the future.
Low Superior Vena Cava Flow and Effect of Inotropes on Neurodevelopment to 3 Years in Preterm Infants
Authors: Osborn David A. , Evans Nick , Kluckow Martin , Bowen Jennifer R. , Rieger Ingrid
Published: August 2007

OBJECTIVE. The goal was to report the 1- and 3-year outcomes of preterm infants with low systemic blood flow in the first day and the effect of dobutamine versus dopamine for treatment of low systemic blood flow.

METHODS. A cohort of 128 infants born at <30 weeks of gestation underwent echocardiographic measurement of superior vena cava flow at 3, 10, and 24 hours of age. Forty-two infants with low superior vena cava flow (<41 mL/kg per minute) were assigned randomly to dobutamine or dopamine. Surviving infants underwent blinded neurodevelopmental assessments at corrected ages of 1 and 3 years.

RESULTS. Seventy-six of 87 surviving infants were seen at 1 year and 67 at 3 years. Forty-four infants had low superior vena cava flow. At 3 years, with adjustment for perinatal risk factors, death was predicted by low superior vena cava flow, lower gestational age, and low 5-minute Apgar score. Substantial reductions in the Griffiths General Quotient were associated with low superior vena cava flow and birth weight of <10th percentile. Infants with low flow had significant reductions in personal-social, hearing and speech, and performance subscales. Death or disability at 3 years was predicted by low superior vena cava flow and lower gestational age. For infants treated with inotropes, no significant differences were found in clinical outcomes, except for reduced rates of late severe periventricular/intraventricular hemorrhage in the dobutamine group. At 3 years, infants in the dopamine group had significantly more disability and a lower Griffiths General Quotient. At the latest time measured, however, combined rates of death or disability were similar.

CONCLUSIONS. Early low superior vena cava flow was associated with substantial rates of death, morbidity, and developmental impairments. No difference was found in combined rates of death and disability for infants assigned randomly to dopamine or dobutamine.
Impact of Implementing Developmental Screening at 12 and 24 Months in a Pediatric Practice
Authors: Hix-Small Hollie , Marks Kevin , Squires Jane , Nickel Robert
Published: August 2007

OBJECTIVES. The purpose of this study was to investigate the effectiveness and costs of incorporating a parent-completed developmental screening tool, the Ages and Stages Questionnaire, into the 12- and 24-month well-child visits under “real-world” conditions, using a combined in-office and mail-back data collection protocol.

METHODS. A convenience sample of 1428 caregivers and children presenting for their 12- or 24-month well-child visit between April 2005 and March 2006 participated. Children with identified delays or disorders were excluded. Board-certified pediatricians (n = 18) and nurse practitioners (n = 2) acted as secondary participants. Pediatricians were blinded to Ages and Stages Questionnaire results when completing the Pediatric Developmental Impression. Patients with delayed Ages and Stages Questionnaire or Pediatric Developmental Impression results were referred for additional evaluation.

RESULTS. Referral rates increased by 224%. Pediatrician referral on the basis of the Pediatric Developmental Impression was predicted significantly by suspected communication delay and gross motor delay. The Ages and Stages Questionnaire and Pediatric Developmental Impression results differed significantly, with overall agreement of 81.8%. Of Ages and Stages Questionnaire–delayed cases, 67.5% were not detected by pediatricians. Of the 78 patients referred on the basis of combined Ages and Stages Questionnaire and Pediatric Developmental Impression results, 53 would not have been referred on the basis of Pediatric Developmental Impression results alone; 37 patients qualified for special services, and 44 were scheduled for additional developmental monitoring. The rate of Ages and Stages Questionnaire return by caregivers/parents was 54%.

CONCLUSIONS. Referral rates increased dramatically, with the greatest increase at 12 months. Although patients with pediatrician referrals were likely to qualify for services (96%), physician referrals accounted for only 42% of total referrals, which highlights the need for pediatric developmental screening. The 54% Ages and Stages Questionnaire return rate, although acceptable under study conditions, calls for alternative implementation strategies.
A Randomized, Controlled Trial of Delivery-Room Respiratory Management in Very Preterm Infants
Authors: te Pas Arjan B. , Walther Frans J.
Published: August 2007

BACKGROUND. Initial ventilation strategy may play an important role in the development of bronchopulmonary dysplasia in very preterm infants. Early nasal continuous positive airway pressure is an accepted approach, but randomized clinical trials are lacking. Our aim was to determine whether early nasal continuous positive airway pressure, preceded by a sustained inflation, is more effective and less injurious in very preterm infants than conventional intervention.

METHODS. Two hundred seven very preterm infants were assigned randomly in the delivery room to either a sustained inflation through a nasopharyngeal tube followed by early nasal continuous positive airway pressure (early functional residual capacity intervention) or repeated manual inflations with a self-inflating bag and mask followed by nasal continuous positive airway pressure, if necessary, after arrival at the NICU. The primary outcome measure was intubation <72 hours of age and bronchopulmonary dysplasia at 36 weeks was used as secondary outcome. This trial was registered as an early functional residual capacity intervention trial (ISRCTN 12757724).

RESULTS. In the early functional residual capacity intervention group, fewer infants were intubated at <72 hours of age or received >1 dose of surfactant, and the average duration of ventilatory support was less. Infants in the early functional residual capacity intervention group developed bronchopulmonary dysplasia less frequently.

CONCLUSIONS. A sustained inflation followed by early nasal continuous positive airway pressure, delivered through a nasopharyngeal tube, is a more efficient strategy than repeated manual inflations with a self-inflating bag and mask followed by nasal continuous positive airway pressure on admission to the NICU.
Electrocardiographic Diagnosis of Myocardial Ischemia in Children: Is a Diagnostic Electrocardiogram Always Diagnostic?
Authors: Gazit Avihu Z. , Avari Jennifer N. , Balzer David T. , Rhee Edward K.
Published: August 2007

Electrocardiographic criteria for the diagnosis of cardiac ischemia in adults are well defined; however, analogous criteria for the diagnosis of cardiac ischemia in infants and children remain ambiguous. The difficulty in defining electrocardiographic criteria in pediatrics relates to age-dependent differences in the pediatric electrocardiogram, the presence or absence of congenital heart disease, and multiple and diverse etiologies of myocardial injury that lead to an ischemic pattern on the electrocardiogram. In this report, we illustrate 3 pediatric cases in which the electrocardiogram met adult diagnostic criteria for acute transmural myocardial infarction, without coronary artery abnormalities in 2 cases and with a transient coronary abnormality in the third. In conclusion, ST-segment changes diagnostic of transmural myocardial infarction in adults may be seen in pediatric patients in the absence of coronary artery occlusion.
Nerve Sheath Myxoma of the Gingiva: Report of a Rare Case and Review of the Literature
Authors: Prado José D. , Andrade Rodrigo G. , Silva‐Sousa Yara T.C. , Andrade Marília F. , Soares Fernando A. , Perez Danyel E.C.
Published: August 2007

Background: Nerve sheath myxoma (NSM) is an extremely rare benign neoplasm in the oral cavity. This paper describes the first case, to our knowledge, of NSM in the gingival mucosa of an 84‐year‐old female patient.

Methods: Intraoral examination revealed a painless and well‐defined nodule in the lingual gingival mucosa of the right mandibular lateral incisor, which measured ∼1.0 cm in diameter. The lesion was fully excised under local anesthesia, without intercurrences. Hematoxylin and eosin staining was performed in 5‐μm sections for histopathologic analysis. Immunohistochemical reactions against vimentin and S‐100 protein were carried out in 3‐μm histologic sections in accordance with manufacturers' instructions.

Results: The patient's medical history and an extraoral exam did not reveal other abnormalities. The patient wore a removable partial denture in the affected area. A trauma‐induced gingival hyperplasia was the main diagnostic hypothesis. Microscopically, the lesion was composed of an abundant myxoid matrix and stellated and spindle‐shaped cells arranged in lobules separated by fine fibrous septa. The cells presented strong positivity for vimentin and S‐100 protein. According to the histopathologic and immunohistochemical features, the diagnosis of NSM was established. After 9 months of treatment, no signs or symptoms of recurrences have been observed.

Conclusion: Although NSM is an extremely rare oral tumor, it should be considered in the clinical differential diagnosis of gingival nodules.
Microbiota of Exposed Root Surfaces After Fluoride, Chlorhexidine, and Periodontal Maintenance Therapy: A 3‐Year Evaluation
Authors: Bizhang Mozhgan , Chun Yong‐Hee P. , Heisrath Doreen , Purucker Peter , Singh Preeti , Kersten Thomas , Zimmer Stefan
Published: August 2007

Background: Fluoride and chlorhexidine (CHX) are state‐of‐the‐art preventive measures for remineralizing teeth and for preventing plaque accumulation. The aim of this study was to examine the effects of fluoride and CHX varnishes on root caries and microbiota located on root surfaces.

Methods: Thirty‐three patients from a periodontal maintenance program, having at least one tooth with gingival recession in each quadrant, participated in this study. One tooth per quadrant was assigned randomly to the control group or to one of the test groups that were treated with fluoride varnish, 1% CHX, or 40% CHX. The varnish treatment and the tooth cleaning were repeated every 3 months. Clinical examinations were performed at baseline and once a year for 3 years. Caries status and oral hygiene indices were evaluated clinically. The total cultivable microbiota and percentage of Mutans streptococci (MS), Actinomyces (ACC), and lactobacilli (LB) were analyzed.

Results: Oral hygiene was improved greatly during the course of the study. The percentage of MS, ACC, and LB of the total cultivable microbiota revealed a statistically significant reduction between baseline and final examination for each of the four groups.

Conclusion: Professional tooth cleaning alone at 3‐month intervals might be as effective in reducing MS, ACC, and LB as adjunctive treatment with fluoride or chlorhexidine.
Gingival Concentrations of Interleukin‐23 and ‐17 at Healthy Sites and at Sites of Clinical Attachment Loss
Authors: Lester S. Reid , Bain Jennifer L. , Johnson Roger B. , Serio Francis G.
Published: August 2007

Background: The presence of interleukin (IL)‐23 has not been reported within inflamed gingiva, so we evaluated its concentration within gingiva from normal sites and sites of chronic periodontal disease.

Methods: Gingiva was obtained prior to extraction of teeth. It was grouped based on clinical attachment loss (CAL): 0 to 2 mm (normal‐slight), 3 to 4 mm (moderate), and >‐ mm (severe). Tissues were solubilized, and IL‐12, ‐23, ‐6, ‐17, and ‐1β; interferon‐gamma (IFN‐γ); and tumor necrosis factor‐alpha (TNF‐α) concentrations were assessed by enzyme‐linked immunosorbent assay. Data were compared by factorial analysis of variance, post hoc Tukey test, and Pearson correlation test. Groups were defined as significantly different when P <0.05.

Results: The gingival concentrations of IL‐23, ‐17, ‐1β, and ‐6 and IFN‐γ were significantly greater at moderate CAL sites than at normal‐slight CAL sites. Gingival concentrations of IL‐23, ‐1β, ‐17, and ‐6 and TNF‐α were significantly greater at severe CAL sites than at normal‐slight CAL sites. In addition, the gingival concentrations of IL‐23, ‐17, and ‐6 and TNF‐α were significantly greater and the gingival concentrations of IL‐12 and IFN‐γ were significantly lower at severe CAL sites than at moderate CAL sites. Gingival concentrations of IL‐23, ‐17, ‐6, and ‐1β and TNF‐α correlated positively with CAL. The IL‐23 gingival concentration correlated significantly with IL‐17, ‐1β, and ‐6 and TNF‐α concentrations and correlated negatively with IL‐12 and IFN‐γ concentrations.

Conclusions: Our results suggested the possibility that the IL‐23/IL‐17 immune response was present within chronically inflamed gingiva. This is a host response that had not been reported previously in periodontal disease and may be an important factor in the chronic nature of the disease.
Bilateral Mandibular Infected Buccal Cyst: A New Image
Authors: Gallego L. , Baladrón J. , Junquera L.
Published: August 2007

Background: The mandibular infected buccal cyst is an uncommon lesion associated with the permanent mandibular first or second molar in children just prior to tooth eruption. The World Health Organization includes this lesion under the category of paradental cyst and suggests the term “mandibular infected buccal cyst” (MIBC) for lesions that occur on the buccal surface of the permanent mandibular first molar in children ∼6 to 8 years of age. We present the case of a patient with bilateral mandibular cyst affecting the second molars of an 8‐year‐old boy. To the best of our knowledge, this is the first case of bilateral MIBC published with a three‐dimensional model made using an interactive three‐dimensional (3D) implant planning system.

Methods: An 8‐year‐old boy presented with swelling over the buccal gingiva of his lower left first molar. He complained of pain on chewing. Clinical examination revealed a 10‐mm, firm, round swelling buccal to the lower left first molar. Computed tomography with multiplanar reconstruction of the jaws showed well‐defined bilateral ovoid radiolucencies at the apices of the lower left first molar and the lower right first molar. A three‐dimensional study was made using the interactive 3D implant planning system showing the presence of the cyst and its relation with the molar and the dental nerve. The treatment was to enucleate the left cyst and maintain the involved tooth.

Results: The histopathologic diagnosis of the lesion was an MIBC.

Conclusion: The objective of the present study is to 1) familiarize dentists and oral surgeons with the entity of the MIBC; 2) show new image techniques for the diagnosis; and 3) emphasize the appropriate treatment approach.
Decreased Interleukin‐1β and Elastase in the Gingival Crevicular Fluid of Individuals Undergoing Anti‐Inflammatory Treatment for Rheumatoid Arthritis
Authors: Miranda Letícia A. , Islabão Alexandre G. , Fischer Ricardo G. , Figueredo Carlos M.S. , Oppermann Rui V. , Gustafsson Anders
Published: August 2007

Background: The primary aim of this study was to compare the inflammatory activity in the gingival crevicular fluid (GCF) in a group of patients with rheumatoid arthritis (RA) and a group of matched controls. Secondarily, we aimed to evaluate the effect of rheumatologic treatment on periodontal inflammation.

Methods: Seventeen individuals with RA with a mean duration of disease of 12.1 (± 9.9) years and the same number of systemically healthy individuals matched for age, gender, periodontal status, and tobacco use were selected. Medication data were registered, and GCF was collected by means of an intracrevicular washing method. Besides clinical registrations, periodontal inflammation was assessed by analysis of the cytokines interleukin (IL)‐1β and ‐18 and of elastase activity.

Results: Amounts of IL‐1β and total elastase were significantly lower in the patient group. IL‐1β and total elastase had a significant and strong correlation in the RA group (rs = 0.883). This correlation was not observed in the control group.

Conclusion: The anti‐inflammatory treatment taken by RA patients might influence the periodontal inflammation status represented by IL‐1β and elastase in the GCF.
The Effect of Aspirin on Gingival Crevicular Fluid Levels of Inflammatory and Anti‐Inflammatory Mediators in Patients With Gingivitis
Authors: Kim David M. , Koszeghy Kristian L. , Badovinac Rachel L. , Kawai Toshihisa , Hosokawa Ikuko , Howell T. Howard , Karimbux Nadeem Y.
Published: August 2007

Background: Inflammatory and anti‐inflammatory mediators may play a significant role in patients with gingivitis. The purpose of this study was to assess the short‐term effects of the systemic administration of two different concentrations of aspirin (81 and 32‐ mg/day, by mouth) on clinical periodontal parameters and gingival crevicular fluid (GCF) levels of 15‐epi‐lipoxin A4 (15‐epi‐LXA4), lipoxin A4, leukotriene B4 (LTB4), prostaglandin E2 (PGE2), and interleukin (IL)‐6 and ‐1β in a sample of naturally occurring gingivitis patients.

Methods: At day 0, after initial screening for entry, baseline periodontal parameters, including bleeding on probing (BOP), periodontal probing depths (PDs), and plaque index (PI) were measured, and GCF was sampled from 12 intrasulcular sites with filter paper strips for the measurement of six types of inflammatory and anti‐inflammatory mediators using competitive enzyme immunoassay and enzyme‐linked immunosorbent assay (prevalues). Forty‐seven subjects were assigned randomly to one of three treatment groups: placebo (15 subjects); aspirin, 81 mg (16 subjects); and aspirin, 325 mg (16 subjects) once daily. On day 7, subjects were recalled for the measurement of periodontal parameters and collection of GCF samples for the measurement of six types of mediators (postvalues).

Results: Changes in inflammatory and anti‐inflammatory mediator levels were not statistically significant for any of the three treatment groups. However, when pre‐ and postvalues were compared in the subjects receiving aspirin, 32‐ mg, there was a negative trend in the relationship between 15‐epi‐LXA4 and PGE2, whereas the relationship between LTB4 and PGE2 was not as strong. This might indicate that the subjects responding to aspirin‐mediated PGE2 suppression effects produced higher 15‐epi‐LXA4 in GCF than non‐responders. No statistically significant differences in PD and PI between pre‐ and postvalues were found for any of the three treatment groups. However, the results demonstrated a significant increase in BOP when aspirin, 325 mg was compared to placebo (P <0.001) and aspirin, 81 mg (P = 0.001).

Conclusions: Aspirin can have an affect on BOP in naturally occurring gingivitis patients. Although most of the inflammatory mediators did not show significantly detectable changes after aspirin treatment for 7 days, the trend of aspirin‐associated increases of 15‐epi‐LXA4 implied that this recently discovered aspirin‐dependent eicosanoid may be associated with the increased incidence of BOP observed in the subjects who received aspirin therapy.
“Gray Murder”: Characteristics of Elderly Compared With Nonelderly Homicide Victims in New York City
Authors: Abrams Robert C. , Leon Andrew C. , Tardiff Kenneth , Marzuk Peter M. , Sutherland Kari
Published: August 2007

Objectives. We compared characteristics of homicides among New York City residents aged 18 years and older from 1990 to 1998 to determine differences in demographics, cause and place of death, and presence of illicit drugs and alcohol in the deceased’s system.

Methods. All medical examiner–certified homicides among New York City residents aged 18 years and older from 1990 to 1998 were studied (n = 11 850). Nonelderly (aged 18 to 64 years) and elderly (aged 65 years and older) victims were compared by gender, race/ethnicity, cause of death, place of death, and presence of illicit drugs or alcohol. Population-based homicide rates stratified by age, gender, and race were also calculated.

Results. Nonelderly homicide victims were significantly more likely to be male, non-White, to have been shot in the city streets, and to have evidence of illicit drug or alcohol use. Elderly victims were more likely to be female, White, to have been killed by nonfirearm injuries, and to have been killed in their own homes. The gender and race differences between age groups remained but were attenuated when population-based rates were compared.

Conclusions. The characteristics of homicide in nonelderly adults do not apply to elderly adults in New York City. Demographic factors and vulnerabilities of the elderly may underlie these differences, pointing to the need for oversight of isolated or homebound elderly persons and for protective interventions.
Delay of First Treatment of Mental and Substance Use Disorders in Mexico
Authors: Borges Guilherme , Wang Philip S. , Medina-Mora Maria Elena , Lara Carmen , Chiu Wai Tat
Published: August 2007

Objectives. We studied failure and delay in making initial treatment contact after the first onset of a mental or substance use disorder in Mexico as a first step to understanding barriers to providing effective treatment in Mexico.

Methods. Data were from the Mexican National Comorbidity Survey (2001–2002), a representative, face-to-face household survey of urban residents aged 18 to 65 years. The age of onset for disorders was compared with the age of first professional treatment contact for each lifetime disorder (as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition).

Results. Many people with lifetime disorders eventually made treatment contact, although the proportions varied for mood (69.9%), anxiety (53.2%), and substance use (22.1%) disorders. Delays were long: 10 years for substance use disorders, 14 years for mood disorders, and 30 years for anxiety disorders. Failure and delay in making initial treatment contact were associated with earlier ages of disorder onset and being in older cohorts.

Conclusions. Failure to make prompt initial treatment contact is an important reason explaining why there are unmet needs for mental health care in Mexico. Meeting these needs will likely require expansion and optimal allocation of resources as well as other interventions.
Reducing Road Traffic Injuries: Effectiveness of Speed Cameras in an Urban Setting
Authors: Pérez Katherine , Marí-Dell’Olmo Marc , Tobias Aurelio , Borrell Carme
Published: August 2007

Objectives. We assessed the effectiveness of speed cameras on Barcelona’s beltway in reducing the numbers of road collisions and injuries and the number of vehicles involved in collisions.

Methods. We designed a time-series study with a comparison group to assess the effects of the speed cameras. The “intervention group” was the beltway, and the comparison group consisted of arterial roads on which no fixed speed cameras had been installed. The outcome measures were number of road collisions, number of people injured, and number of vehicles involved in collisions. We fit the data to Poisson regression models that were adjusted according to trends and seasonality.

Results. The relative risk (RR) of a road collision occurring on the beltway after (vs before) installation of speed cameras was 0.73 (95% confidence interval [CI]=0.63, 0.85). This protective effect was greater during weekend periods. No differences were observed for arterial roads (RR=0.99; 95% CI=0.90, 1.10). Attributable fraction estimates for the 2 years of the study intervention showed 364 collisions prevented, 507 fewer people injured, and 789 fewer vehicles involved in collisions.

Conclusions. Speed cameras installed in an urban setting are effective in reducing the numbers of road collisions and, consequently, the numbers of injured people and vehicles involved in collisions.
Indoor Risk Factors for Cough and Their Relation to Wheeze and Sensitization in Chilean Young Adults
Authors: Potts James F. , Rona Roberto J. , Oyarzun Manuel J. , Amigo Hugo , Bustos Patricia
Published: August 2007

Objectives. We assessed the effects of indoor risk factors, including smoking, on different types of cough and on cough and wheeze in combination.

Methods. Our sample was composed of 1232 men and women residing in a semirural area of Chile. We used a standardized questionnaire, sensitization to 8 allergens, and bronchial hyperresponsiveness to methacholine to assess cough and wheeze characteristics. Information was gathered on dampness, mold, ventilation, heating, housing quality, smoking, and environmental tobacco smoke exposure.

Results. Most exposures were associated with cough alone or cough in combination with wheeze. Smoking, past smoking, and environmental tobacco smoke exposure were strongly associated with dry cough and wheeze. The use of coal for heating was associated with dry cough. Leaks, mold, and lack of kitchen ventilation were associated with cough and wheeze. Nocturnal cough and productive cough were associated with specific types of sensitization, but dry cough was not. Productive cough was associated with hyperresponsiveness to methacholine.

Conclusions. Several different types of indoor exposures, including environmental tobacco smoke exposure, are important contributors to morbidity associated with cough and wheeze. A vigorous preventive strategy designed to lower exposures to indoor risk factors would lower rates of respiratory morbidity.
Improving Disclosure and Consent
Authors: Brody Julia Green , Morello-Frosch Rachel , Brown Phil , Rudel Ruthann A. , Altman Rebecca Gasior , Frye Margaret , Osimo Cheryl A. , Pérez Carla , Seryak Liesel M.
Published: August 2007

The recent flood of research concerning pollutants in personal environmental and biological samples—blood, urine, breastmilk, household dust and air, umbilical cord blood, and other media—raises questions about whether and how to report results to individual study participants.

Clinical medicine provides an expert-driven framework, whereas community-based participatory research emphasizes participants’ right to know and the potential to inform action even when health effects are uncertain. Activist efforts offer other models.

We consider ethical issues involved in the decision to report individual results in exposure studies and what information should be included. Our discussion is informed by our experience with 120 women in a study of 89 pollutants in homes and by interviews with other researchers and institutional review board staff.
Facilitation of Risk Communication During the Anthrax Attacks of 2001: The Organizational Backstory
Authors: Chess Caron , Clarke Lee
Published: August 2007

The anthrax attacks of 2001 created risk communication problems that cannot be fully understood without appreciating the dynamics among organizations. Case studies of communication in New Jersey, consisting of interviews with a range of participants, found that existing organizational and professional networks facilitated trust among decisionmakers. This interpersonal trust improved communication among agencies and thereby risk communication with the public.

For example, “white powder scares” were a problem even in places without contamination. Professionals’ trust in each other was vital for responding productively. Conversely, organizational challenges, including conflict among agencies, hindered communication with key audiences.

Although centralization and increased control are often seen as the remedy for communicative confusion, they also can quash the improvisational responses needed during crises.
The Sequoyah Corporation Fuels Release and the Church Rock Spill: Unpublicized Nuclear Releases in American Indian Communities
Authors: Brugge Doug , deLemos Jamie L. , Bui Cat
Published: August 2007

The Three Mile Island nuclear release exemplifies why there is public and policy interest in the high-technology, highly visible end of the nuclear cycle. The environmental and health consequences of the early steps in the cycle—mining, milling, and processing of uranium ore—may be less appreciated.

We examined 2 large unintended acute releases of uranium—at Kerr McGee’s Sequoyah Fuels Corporation in Oklahoma and United Nuclear Corporation’s Church Rock uranium mill in New Mexico, which were incidents with comparable magnitude to the Three Mile Island release.

We urge exploration of whether there is limited national interest and concern for the primarily rural, low-income, and American Indian communities affected by these releases.

More attention should be given to the early stages of the nuclear cycle and their impacts on health and the environment.
Barley Amylose and β‐Glucan: Their Relationships to Protein, Agronomic Traits, and Environmental Factors
Authors: Hang An , Obert Don , Gironella Ann Inez N. , Burton Charlotte S.
Published: August 2007

Amylose and β‐glucan are important components of barley (Hordeum vulgare L.) grain. Factors such as seed yield, test weight, seed plumpness, protein content, field location, and seasonal variation may have an effect on β‐glucan and amylose concentrations, and therefore, require additional study. Twenty‐seven barley cultivars and advanced lines with varying levels of β‐glucan (4–9%) and amylose (6–27%) were grown in 2004 and 2005 in replicated plots at three locations in Idaho to evaluate agronomic traits and genotype × environment interactions. Seed yield, test weight, percentage of plump kernels, β‐glucan percentage, amylose/amylopectin ratio, and protein percentage were measured for seed samples from all plots. Estimates of variance components showed that about 49% of the variability in β‐glucan concentration and about 48% in amylose starch levels can be attributed to year, location, year × location, and their interactions with genotype. Amylose was found to be negatively correlated with protein and β‐glucan content but was positively, though weakly, correlated with seed yield and test weight; β‐glucan was positively correlated with protein and percentage plump kernels but showed a weak negative correlation with seed yield.
Genetic Diversity and Population Structure of Caragana korshinskii Revealed by AFLP
Authors: Wang Z. , Gao H. W. , Wu Y. Q. , Han J. G.
Published: August 2007

Caragana korshinskii Kom. is a perennial sandy grassland and desert deciduous shrub species, indigenous to and distributed in the northwest of China and Mongolia, and important in vegetation rehabilitation of widely degraded and degrading semiarid and arid regions because of its high ecological and economic values. To assess the genetic diversity and population structure of C. korshinskii, 10 natural populations from the Loess plateau and Inner Mongolia plateau in China were analyzed for amplified fragment length polymorphisms. Four primer combinations produced 358 bands across a total of 98 individuals. A high percentage of polymorphic loci was observed at species level (p = 93.9%). Multivariate analyses separated accessions into two regional groups corresponding to the Loess and Inner Mongolia plateaus. Based on analysis of molecular variance, 77.8% of the genetic variation of C. korshinskii was within population, 7% difference between regions, and 15.2% among collection sites within regions. An indirect estimate of the number of migrants per generation (Nm = 1.7) indicated that gene flow was high among populations of the species. A significant correlation (r = 0.58) between genetic and geographic distance was detected. Results of this study suggested that C. korshinskii has a high genetic variability and potential as a source of variation for breeding programs.
Agronomic Feasibility of a Continuous Double Crop of Winter Wheat and Soybean Forage in the Southern Great Plains
Authors: MacKown Charles T. , Heitholt James J. , Rao Srinivas C.
Published: August 2007

In the southern Great Plains, dryland double‐cropping soybean [Glycine max (L.) Merr.] after winter wheat (Triticum aestivum L.) could provide quality summer forage, partially offset mineral fertilizer N applied to winter wheat, and lessen soil erosion. Waiting for wheat grain to mature, however, delays soybean planting and subjects growth to dry and hot conditions. Planting soybean after a hay crop of wheat was investigated to determine the feasibility of the system as a source of livestock feeds and N uptake by both crops. Twelve treatment combinations of two wheat fertilizer N levels (0 and 112 kg N ha−1) and six summer management treatments (fallow: conventional and no‐till; soybean: grazed, cut for hay, green manure, and mulch) were arranged in strips across four replications. Soybean biomass ranged from 1.35 to 1.90 Mg ha−1 when soybean grazing and harvest occurred at seed fill, and crude protein ranged from 129 to 220 g kg−1 resulting in a 3‐yr average N uptake of 44 kg ha−1 Within each N fertilizer level, average wheat forage yields were not different, but yield increased 29% with N fertilizer and crude protein was inversely related to yield. Double‐cropped soybean failed to offer any yield‐enhancing N benefit to wheat or enhance soil N and C content after 3 yr, even when used as a green manure. Unless a producer is willing to accept the low productivity of soybean as a double crop with wheat, the feasibility of this dryland double‐crop forage system is limited.
Single Nucleotide Polymorphism Detection of the Rcs3 Gene for Resistance to Frogeye Leaf Spot in Soybean
Authors: Missaoui A. M. , Ha B. K. , Phillips D. V. , Boerma H.R.
Published: August 2007

Frogeye leaf spot (FLS), caused by Cercospora sojina Hara, has become a more frequent disease in soybean, Glycine max (L.) Merr., across the USA. The Rcs3 gene provides resistance to all known races of C. sojina To provide resources for efficient marker‐assisted selection (MAS) of Rcs3, we developed and evaluated several single nucleotide polymorphisms (SNP) and insertions or deletions (InDels) markers linked to Rcs3 We surveyed 13 bacterial artificial chromosome (BAC) end sequences that were anchored with simple sequence repeat (SSR) markers Satt244 and Satt547 along with the two SSRs containing clones in six soybean cultivars (Davis, Cook, and Young that have the Rcs3 allele and Blackhawk, Bragg, and Lee that have the rcs3 allele) for SNPs. A total of 19 SNPs/InDels were identified and validated, but only 11 mapped near Rcs3 in a F2 population of Davis × Blackhawk. The Rcs3 gene was positioned near Satt244 and 0.50 cM from SNPs AZ573TA150 and AZ573CA393. None of the SNPs or InDels identified appeared to contribute directly to the Rcs3 phenotype, but 11 mapped within a 3‐cM interval surrounding Rcs3 These 11 markers were further validated for association with Rcs3 and for their potential in MAS in 64 lines and cultivars. Our results suggest that the two markers AZ573TA150 and AZ573CA393 could be used in MAS for Rcs3. Allele specific oligonucleotide probes specific for MAS were developed for a direct hybridization assay on a Luminex 100 flow cytometry platform.
Characterizing Safflower Germplasm with AFLP Molecular Markers
Authors: Johnson R. C. , Kisha T. J. , Evans M. A.
Published: August 2007

Characterization of safflower (Carthamus tinctorius L.) with molecular markers is needed to enhance germplasm management and utilization. Amplified fragment length polymorphism (AFLP) analysis was completed in safflower resulting in 102 unambiguous polymorphic markers. Pairwise distances were calculated for eight diverse populations of 12 plants each, and on bulked leaf tissue of 96 accessions. The 96 accessions represented seven world regions (the Americas, China, East Africa, East Europe, the Mediterranean, South Central Asia, and Southwest Asia). A bootstrap procedure was used to compare mean distances within and between populations and regions. Mean distances within populations, a measurement of population diversity, ranged from 0.005 to 0.315 and differed in 22 of 28 possible comparisons. Regions differed in all pairwise comparisons showing that AFLP markers distinguished safflower diversity across broad geographic groups. Correlation of the AFLP distance matrix with a phenotypic data matrix with 16 attributes consisting of oil, meal, and growth characteristics was significant (r = 0.12, P < 0.05) but explained only 1.4% of the variation. This weak correspondence between AFLP and phenotypic data showed that both should be used to fully characterize safflower diversity. Amplified fragment length polymorphism markers were useful for characterizing diversity in safflower and will be valuable for germplasm management and mapping safflower traits.
A Comparative Study of Alfalfa and Medicago truncatula Stem Traits: Morphology, Chemical Composition, and Ruminal Digestibility
Authors: Schnurr Judy A. , Jung Hans‐Joachim G. , Samac Deborah A.
Published: August 2007

Alfalfa (Medicago sativa L.) is an agronomically important forage, but digestibility of stem cell wall material is low. Because the tetraploid genome of alfalfa complicates genetic dissection of complex pathways, the diploid M. truncatula Gaertn. could serve as a model for stem cell wall development in alfalfa. We compared stem morphology, chemical composition (protein, soluble carbohydrates, cell wall polysaccharides, and lignin), and in vitro ruminal cell wall polysaccharide digestibility of two alfalfa clones (Regen‐SY27 and 718) and four M. truncatula inbred lines (A17, A20, DZA315.16, and R108) in a replicated growth chamber experiment. Stem tissue development and cell wall lignification observed by light microscopy were similar between the species. While differences in stem morphology, composition, and digestibility were observed among the germplasms, there was overlap between the alfalfa and M. truncatula germplasms for all traits except protein concentration, which was greater for the two alfalfa clones. Younger stem internodes (top third of the stem) of both species had a higher protein concentration and greater cell wall polysaccharide digestibility, and lower cell wall concentration than older internodes (bottom third of stem). Based on the data presented here, it appears that M. truncatula is a suitable model for stem development, composition, and digestibility of alfalfa.