bluuebunny/crossref_metadata_2025 huggingface dataset:
Underimmunization of American Indian and Alaska Native Children
Authors: Groom Amy V. , Washington Michael L. , Smith Philip J. , Bryan Ralph T.
Published: May 2008

OBJECTIVE. The goal was to determine whether disparities in childhood immunization coverage exist between American Indian/Alaska Native children and non-Hispanic white children.

METHODS. We compared immunization coverage with the 4 diphtheria-tetanus-pertussis, 3 poliovirus, 1 measles-mumps-rubella, 3 Haemophilus influenza type b, and 3 hepatitis B(4:3:1:3:3) series and its individual vaccine components (≥4 doses of diphtheria, tetanus, and pertussis vaccine; ≥3 doses of oral or inactivated polio vaccine; ≥1 dose of measles, mumps, and rubella vaccine; ≥3 doses of Haemophilus influenzae type b vaccine; and ≥3 doses of hepatitis B vaccine) between American Indian/Alaska Native children and non-Hispanic white children from 2000 to 2005, using data from the National Immunization Survey.

RESULTS. Although immunization coverage increased for both populations from 2001 to 2004, American Indian/Alaska Native children had significantly lower immunization coverage, compared with non-Hispanic white children, over that time period. In 2005, coverage continued to increase for American Indian/Alaska Native children but decreased for non-Hispanic white children, and no statistically significant disparity in 4:3:1:3:3 coverage was evident in that year.

CONCLUSIONS. Disparities in immunization coverage for American Indian/Alaska Native children have been present, but unrecognized, since 2001. The absence of a disparity in coverage in 2005 is encouraging but is tempered by the fact that coverage for non-Hispanic white children decreased in that year.
Variability in Pediatric Brain Death Determination and Documentation in Southern California
Authors: Mathur Mudit , Petersen LuCyndi , Stadtler Maria , Rose Colleen , Ejike J. Chiaka , Petersen Floyd , Tinsley Cynthia , Ashwal Stephen
Published: May 2008

OBJECTIVES. Because the concept of brain death is difficult to define and to apply, we hypothesized that significant variability exists in pediatric brain death determination and documentation.

METHODS. Children (0–18 years of age) for whom death was determined with neurologic criteria between January 2000 and December 2004, in southern California, were included. Medical charts were reviewed for documented performance of 14 specific elements derived from the 1987 brain death guidelines and confirmatory testing.

RESULTS. A total of 51.2% of children (142 of 277 children) referred to OneLegacy became organ donors. Care locations varied, including PICUs (68%), adult ICUs (29%), and other (3%). One patient was <7 days, 6 were 7 days to 2 months, 22 were 2 months to 1 year, and 113 were >1 year of age. The number of brain death examinations performed was 0 (4 patients), 2 (122 patients), 3 (14 patients), or 4 (2 patients). Recommended intervals between examinations were followed for 18% of patients >1 year of age and for no younger patients. A mean of only 5.5 of 14 examination elements were completed by neurologists and pediatric intensivists and 5.8 by neurosurgeons. No apnea testing was recorded in 60% of cases, and inadequate Paco2 increase occurred in more than one half. Cerebral blood flow determination was performed as a confirmatory test 74% of the time (83 of 112 cases), compared with 26% (29 of 112 cases) for electroencephalography alone.

CONCLUSIONS. Children suffering brain death are cared for in various locations by a diverse group of specialists. Clinical practice varies greatly from established guidelines, and documentation is incomplete for most patients. Physicians rely on cerebral blood flow measurements more than electroencephalography for confirmatory testing. Codifying clinical and testing criteria into a checklist could lend uniformity and enhance the quality and rigor of this crucial determination.
Diagnostic and Therapeutic Challenges of Childhood Brucellosis in a Nonendemic Country
Authors: Shen Mark W.
Published: May 2008

OBJECTIVE. We sought to define the current epidemiology, clinical manifestations, and course of childhood brucellosis in the United States.

METHODS. A retrospective chart review was performed of 20 patients who received a diagnosis of brucellosis over a period of 13 years at a large, tertiary care children's hospital in Dallas, Texas. Diagnostic criteria, epidemiology, clinical presentations, and outcomes were recorded.

RESULTS. Ninety-five percent of the patients had a recent history of either travel to Mexico or ingestion of unpasteurized milk products from Mexico. Fever was an initial complaint in 80% of the patients, and 50% of the patients presented with arthritis. Diagnosis was made via the identification of Brucella melitensis in the blood cultures of 18 patients. Five patients experienced relapse, and 3 experienced treatment failure.

CONCLUSIONS. Childhood brucellosis in the United States is now an imported disease, primarily from Mexico. In the context of this epidemiologic link, the diagnosis should be entertained for a patient who presents with signs of systemic inflammation and arthritis. Therapeutic challenges remain.
Effectiveness of Zinc Supplementation Plus Oral Rehydration Salts Compared With Oral Rehydration Salts Alone as a Treatment for Acute Diarrhea in a Primary Care Setting: A Cluster Randomized Trial
Authors: Bhandari Nita , Mazumder Sarmila , Taneja Sunita , Dube Brinda , Agarwal RC , Mahalanabis Dilip , Fontaine Olivier , Black Robert E. , Bhan Maharaj K.
Published: May 2008

OBJECTIVE. The purpose of this work was to evaluate whether education about zinc supplements and provision of zinc supplements to caregivers is effective in the treatment of acute diarrhea and whether this strategy adversely affects the use of oral rehydration salts.

PATIENTS AND METHODS. Six clusters of 30 000 people each in Haryana, India, were randomly assigned to intervention and control sites. Government and private providers and village health workers were trained to prescribe zinc and oral rehydration salts for use in diarrheal episodes in 1-month-old to 5-year-old children in intervention communities; in the control sites, oral rehydration salts alone was promoted. In 2 cross-sectional surveys commencing 3 months (survey 2) and 6 months (survey 3) after the start of the intervention, care-seeking behavior, drug therapy, and oral rehydration salts use during diarrhea, diarrheal and respiratory morbidity, and hospitalization rates were measured.

RESULTS. In the 2 surveys, zinc was used in 36.5% (n = 1571) and 59.8% (n = 1649) and oral rehydration salts in 34.8% (n = 1571) and 59.2% (n = 1649) of diarrheal episodes occurring in the 4 weeks preceding interviews in the intervention areas. In control areas, oral rehydration salts were used in 7.8% (n = 2209) and 9.8% (n = 2609) of episodes. In the intervention communities, care seeking for diarrhea reduced by 34% (survey 3), as did the prescription of drugs of unknown identity (survey 3) and antibiotics (survey 3) for diarrhea. The 24-hour prevalences of diarrhea and acute lower respiratory infections were lower in the intervention communities (survey 3). All-cause, diarrhea, and pneumonia hospitalizations in the preceding 3 months were reduced in the intervention compared with control areas (survey 3).

CONCLUSIONS. Diarrhea is more effectively treated when caregivers receive education on zinc supplementation and have ready access to supplies of oral rehydration salts and zinc, and this approach does not adversely affect the use of oral rehydration salts; in fact, it greatly increases use of the same.
Challenges Associated With Prolonged Survival of Patients With Thalassemia: Transitioning From Childhood to Adulthood
Authors: Musallam Khaled , Cappellini Maria D. , Taher Ali
Published: May 2008

Thalassemia is a chronic condition that presents a range of clinical and psychosocial challenges. Although recent advances in the treatment of thalassemia can prolong patient life spans, problems may arise when patients are transferred from pediatric health care settings to adult health care settings. These issues and our recommendations for handling them are discussed.
Social-Emotional Screening Status in Early Childhood Predicts Elementary School Outcomes
Authors: Briggs-Gowan Margaret J. , Carter Alice S.
Published: May 2008

OBJECTIVE. The goal was to examine whether children who screen positive for social-emotional/behavioral problems at 12 to 36 months of age are at elevated risk for social-emotional/behavioral problems in early elementary school.

METHODS. The sample studied (N = 1004) comprised an ethnically (33.3% minority) and socioeconomically (17.8% living in poverty and 11.3% living in borderline poverty) diverse, healthy, birth cohort from a metropolitan region of the northeastern United States. When children were 12 to 36 months of age (mean age: 23.8 months; SD: 7.1 months), parents completed the Brief Infant-Toddler Social and Emotional Assessment and questions concerning their level of worry about their child's behavior, emotions, and social development. When children were in early elementary school (mean age: 6.0 years; SD: 0.4 years), parents completed the Child Behavior Checklist and teachers completed the Teacher Report Form regarding behavioral problems. In a subsample (n = 389), parents reported child psychiatric status.

RESULTS. Brief Infant-Toddler Social and Emotional Assessment screen status and parental worry were associated significantly with school-age symptoms and psychiatric disorders. In multivariate analyses that included Brief Infant-Toddler Social and Emotional Assessment status and parental worry, Brief Infant-Toddler Social and Emotional Assessment scores significantly predicted all school-age problems, whereas worry predicted only parent reports with the Child Behavior Checklist. Children with of-concern scores on the problem scale of the Brief Infant-Toddler Social and Emotional Assessment were at increased risk for parent-reported subclinical/clinical levels of problems and for psychiatric disorders. Low competence scores predicted later teacher-reported subclinical/clinical problems and parent-reported disorders. Worry predicted parent-reported subclinical/clinical problems. Moreover, the Brief Infant-Toddler Social and Emotional Assessment identified 49.0% of children who exhibited subclinical/clinical symptoms according to teachers and 67.9% of children who later met the criteria for a psychiatric disorder.

CONCLUSIONS. Screening with a standardized tool in early childhood has the potential to identify the majority of children who exhibit significant emotional/behavioral problems in early elementary school.
Achievement of Targeted Saturation Values in Extremely Low Gestational Age Neonates Resuscitated With Low or High Oxygen Concentrations: A Prospective, Randomized Trial
Authors: Escrig Raquel , Arruza Luis , Izquierdo Isabel , Villar Gema , Sáenz Pilar , Gimeno Ana , Moro Manuel , Vento Máximo
Published: May 2008

OBJECTIVE. Extremely low gestational age neonates have very low oxygen saturation in utero and an immature antioxidant defense system. Abrupt increases in oxygen saturation after birth may cause oxidative stress. We compared achievement of a targeted oxygen saturation of 85% at 10 minutes of life when resuscitation was initiated with low or high fractions of inspired oxygen and levels were adjusted according to preductal pulse oxygen saturation values.

METHODS. A prospective, randomized, clinical trial was performed in 2 level III neonatal referral units. Patients of ≤28 weeks of gestation who required active resuscitation were randomly assigned to the low-oxygen group (fraction of inspired oxygen: 30%) or the high-oxygen group (fraction of inspired oxygen: 90%). Every 60 to 90 seconds, the fraction of inspired oxygen was increased in 10% steps if bradycardia occurred (<100 beats per minute) or was decreased in similar steps if pulse oxygen saturation reached values of >85%. Preductal pulse oxygen saturation was continuously monitored.

RESULTS. The fraction of inspired oxygen in the low-oxygen group was increased stepwise to 45% and that in the high-oxygen group was reduced to 45% to reach a stable pulse oxygen saturation of ∼85% at 5 to 7 minutes in both groups. No differences in oxygen saturation in minute-to-minute registers were found independent of the initial fraction of inspired oxygen used 4 minutes after cord clamping. No differences in mortality rates in the early neonatal period were detected.

CONCLUSIONS. Resuscitation can be safely initiated for extremely low gestational age neonates with a low fraction of inspired oxygen (∼30%), which then should be adjusted to the infant's needs, reducing the oxygen load to the neonate.
Spectrum of Medium-Chain Acyl-CoA Dehydrogenase Deficiency Detected by Newborn Screening
Authors: Hsu Ho-Wen , Zytkovicz Thomas H. , Comeau Anne Marie , Strauss Arnold W. , Marsden Deborah , Shih Vivian E. , Grady George F. , Eaton Roger B.
Published: May 2008

OBJECTIVE. Our goal was to describe the clinical spectrum of medium-chain acyl-CoA dehydrogenase deficiency detected by routine newborn screening and assess factors associated with elevations of octanoylcarnitine in newborns and characteristics associated with adverse clinical consequences of medium-chain acyl-CoA dehydrogenase deficiency.

METHODS. The first 47 medium-chain acyl-CoA dehydrogenase deficiency cases detected by the New England Newborn Screening Program were classified according to initial and follow-up octanoylcarnitine values, octanoylcarnitine-decanoylcarnitine ratios, medium-chain acyl-CoA dehydrogenase genotype, follow-up biochemical parameters, and feeding by breast milk or formula.

RESULTS. All 20 patients who were homozygous for 985A→G had high initial octanoylcarnitine values (7.0–36.8 μM) and octanoylcarnitine-decanoylcarnitine ratios (7.0–14.5), whereas the 27 patients with 0 to 1 copy of 985A→G exhibited a wide range of octanoylcarnitine values (0.5–28.6 μM) and octanoylcarnitine-decanoylcarnitine ratios (0.8–12.7). Initial newborn octanoylcarnitine values decreased by days 5 to 8, but the octanoylcarnitine-decanoylcarnitine ratio generally remained stable. Among 985A→G homozygotes, breastfed newborns had higher initial octanoylcarnitine values than newborns who received formula. Adverse events occurred in 5 children, 4 985A→G homozygotes and 1 compound heterozygote with a very high initial octanoylcarnitine: 2 survived severe neonatal hypoglycemia, 1 survived a severe hypoglycemic episode at 15 months of age, and 2 died as a result of medium-chain acyl-CoA dehydrogenase deficiency at ages 11 and 33 months.

CONCLUSION. Newborn screening for medium-chain acyl-CoA dehydrogenase deficiency has detected cases with a wide range of genotypes and biochemical abnormalities. Although most children do well, adverse outcomes have not been entirely avoided. Assessment of potential risk and determination of appropriate treatment remain a challenge.
Ibuprofen-Induced Patent Ductus Arteriosus Closure: Physiologic, Histologic, and Biochemical Effects on the Premature Lung
Authors: McCurnin Donald , Seidner Steven , Chang Ling-Yi , Waleh Nahid , Ikegami Machiko , Petershack Jean , Yoder Brad , Giavedoni Luis , Albertine Kurt H. , Dahl Mar Janna , Wang Zheng-ming , Clyman Ronald I.
Published: May 2008

OBJECTIVE. The goal was to study the pulmonary, biochemical, and morphologic effects of a persistent patent ductus arteriosus in a preterm baboon model of bronchopulmonary dysplasia.

METHODS. Preterm baboons (treated prenatally with glucocorticoids) were delivered at 125 days of gestation (term: 185 days), given surfactant, and ventilated for 14 days. Twenty-four hours after birth, newborns were randomly assigned to receive either ibuprofen (to close the patent ductus arteriosus; n = 8) or no drug (control; n = 13).

RESULTS. After treatment was started, the ibuprofen group had significantly lower pulmonary/systemic flow ratio, higher systemic blood pressure, and lower left ventricular end diastolic diameter, compared with the control group. There were no differences in cardiac performance indices between the groups. Ventilation index and dynamic compliance were significantly improved with ibuprofen. The improved pulmonary mechanics in ibuprofen-treated newborns were not attributable to changes in levels of surfactant protein B, C, or D, saturated phoshatidylcholine, or surfactant inhibitory proteins. There were no differences in tracheal concentrations of cytokines commonly associated with the development of bronchopulmonary dysplasia. The groups had similar messenger RNA expression of genes that regulate inflammation and remodeling in the lung. Lungs from ibuprofen-treated newborns were significantly drier (lower wet/dry ratio) and expressed 2.5 times more epithelial sodium channel protein than did control lungs. By 14 days after delivery, control newborns had morphologic features of arrested alveolar development (decreased alveolar surface area and complexity), compared with age-matched fetuses. In contrast, there was no evidence of alveolar arrest in the ibuprofen-treated newborns.

CONCLUSIONS. Ibuprofen-induced patent ductus arteriosus closure improved pulmonary mechanics, decreased total lung water, increased epithelial sodium channel expression, and decreased the detrimental effects of preterm birth on alveolarization.
Impact of Immunization at Sick Visits on Well-Child Care
Authors: Fiks Alexander G. , Hunter Kenya F. , Localio A. Russell , Grundmeier Robert W. , Alessandrini Evaline A.
Published: May 2008

OBJECTIVE. We assessed the impact of immunization at sick visits on subsequent and overall well-child care.

METHODS. We performed a retrospective cohort study using electronic health record data from 4 urban practices affiliated with an academic medical center. Participants included all children born between September 1, 2003, and July 31, 2004, with a visit at a study practice before 6 weeks of age and ≥1 sick visit (n = 1675). The main outcome measures were (1) attendance at a well-child visit within 60 days after an index sick visit by children due for vaccines and preventive care and (2) the overall number of well-child visits kept by children between 6 weeks and 13 months of age.

RESULTS. Among all demographic and health-related factors considered, immunization receipt at a sick visit was associated most strongly with decreased subsequent well-child care. Among children already delayed (late) for vaccines, 31% returned for well-child care if immunizations were given at eligible sick visits, compared with 47% of those who received no vaccines (risk difference, with adjustment for covariates: −16%). Among those without immunization delay, 42% of children who received vaccines returned for well-child care, compared with 73% of those who received no vaccines (risk difference: −31%). Although 5 well-child visits are recommended, children with no immunizations at sick visits had an adjusted predicted number of 3.8 well-child visits, those with 1 sick visit with immunizations had 3.3 visits, and those with ≥2 sick visits with immunizations had 2.8 visits between 6 weeks and 13 months of age.

CONCLUSIONS. Immunization at sick visits was associated with decreased rates of well-child care, especially among those without previous vaccine delay. This strong association between immunization at sick visits and well-child care should be considered in any plan to restructure pediatric preventive care.
Nurse Opinions and Pulse Oximeter Saturation Target Limits for Preterm Infants
Authors: Nghiem Tuyet-Hang , Hagadorn James I. , Terrin Norma , Syke Sally , MacKinnon Brenda , Cole Cynthia H.
Published: May 2008

OBJECTIVE. The objectives of this study were to compare pulse oximeter saturation limits targeted by nurses for extremely preterm infants during routine care with nurse opinions regarding appropriate pulse oximeter saturation limits and with policy-specified pulse oximeter saturation limits and to identify factors that influence pulse oximeter saturation limits targeted by nurses.

METHODS. We surveyed nurses in US NICUs with neonatal-perinatal fellowships in 2004. Data collected included pulse oximeter saturation limits targeted by nurses and by NICU policy when present, nurses' opinions about appropriate pulse oximeter saturation limits, and NICU and nurse characteristics. Factors associated with pulse oximeter saturation limits targeted by nurses were identified with hierarchical linear modeling.

RESULTS. Among those eligible, 2805 (45%) nurses in 59 (60%) NICUs responded. Forty (68%) of 59 NICUs had a policy that specified a pulse oximeter saturation target range for extremely preterm infants. Among 1957 nurses at NICUs with policies, 540 (28%) accurately identified the upper and lower limits of their NICU's policy and also targeted these values in practice. NICU-specific SDs for individual nurse target limits were less at NICUs with versus without a policy for both upper and lower limits. Hierarchical linear modeling identified presence of pulse oximeter saturation policy, NICU-specific nurse group opinion, and individual nurse opinion as factors significantly associated with individual pulse oximeter saturation target limits. For each percentage point increase in individual opinion upper limit, the individual target upper limit increased by 0.41 percentage point at NICUs with a policy compared with 0.6 percentage point at NICUs with no policy.

CONCLUSIONS. Presence of policy-specified pulse oximeter saturation limits, nurse group opinion, and individual nurse opinion were independently associated with individual nurse pulse oximeter saturation target limits during routine care of extremely preterm infants. The presence of a policy reduced the influence of individual nurse opinion on targeted pulse oximeter saturation limits and reduced variation among nurse target limits within NICUs.
Behavioral Therapy for Childhood Constipation: A Randomized, Controlled Trial
Authors: van Dijk Marieke , Bongers Marloes E. J. , de Vries Giel-Jan , Grootenhuis Martha A. , Last Bob F. , Benninga Marc A.
Published: May 2008

OBJECTIVE. It has been suggested that the addition of behavioral interventions to laxative therapy improves continence in children with functional fecal incontinence associated with constipation. Our aim was to evaluate the clinical effectiveness of behavioral therapy with laxatives compared with conventional treatment in treating functional constipation in childhood.

PATIENTS AND METHODS. In this randomized, controlled trial conducted in a tertiary hospital in the Netherlands, 134 children aged 4 to 18 years with functional constipation were randomly assigned to 22 weeks (12 visits) of either behavioral therapy or conventional treatment. Primary outcomes were defecation frequency, fecal incontinence frequency, and success rate. Success was defined as defecation frequency of ≥3 times per week and fecal incontinence frequency of ≤1 times per 2 weeks irrespective of laxative use. Secondary outcomes were stool-withholding behavior and behavior problems. Outcomes were evaluated at the end of treatment and at 6-months follow-up. All of the analyses were done by intention to treat.

RESULTS. Defecation frequency was significantly higher for conventional treatment. Fecal incontinence frequency showed no difference between treatments. After 22 weeks, success rates did not differ between conventional treatment and behavioral therapy (respectively, 62.3% and 51.5%), nor did it differ at 6 months of follow-up (respectively, 57.3% and 42.3%). The proportion of children withholding stools was not different between interventions. At follow-up, the proportion of children with behavior problems was significantly smaller for behavioral therapy (11.7% vs 29.2%).

CONCLUSION. Behavioral therapy with laxatives has no advantage over conventional treatment in treating childhood constipation. However, when behavior problems are present, behavioral therapy or referral to mental health services should be considered.
Taking a Stand Against Nuclear Proliferation: The Pediatrician's Role
Authors: Newman Thomas B.
Published: May 2008

Nuclear weapons pose a grave threat to the health of children. The Nuclear Nonproliferation Treaty, which for almost 40 years has limited the spread of nuclear weapons, is in danger of unraveling. At the 2000 Nuclear Nonproliferation Treaty Review Conference, 180 countries, including the United States, agreed on 13 practical steps to implement Article VI of the treaty, which calls for nuclear disarmament. However, the United States has acted in contravention of several of those disarmament steps, with announced plans to develop new nuclear weapons and to maintain a large nuclear arsenal for decades to come. Pediatricians, working individually and through organizations such as the American Academy of Pediatrics and International Physicians for the Prevention of Nuclear War, can educate the public and elected officials regarding the devastating and irremediable effects of nuclear weapons on children and the need for policies that comply with and strengthen the Nuclear Nonproliferation Treaty, rather than undermining it. For the children of the world, our goal must be a nuclear weapons convention (similar to the chemical and biological weapons conventions) that would prohibit these weapons globally.
Verbal Autopsy Methods to Ascertain Birth Asphyxia Deaths in a Community-based Setting in Southern Nepal
Authors: Lee Anne CC. , Mullany Luke C. , Tielsch James M. , Katz Joanne , Khatry Subarna K. , LeClerq Steven C. , Adhikari Ramesh K. , Shrestha Shardaram R. , Darmstadt Gary L.
Published: May 2008

OBJECTIVES. The goals of this study were to (1) develop an approach to ascertain birth asphyxia deaths by using verbal autopsy data from a community-based setting in Nepal, and (2) explore variations in birth asphyxia mortality fractions by using different birth asphyxia case definitions and hierarchical classifications.

PATIENTS AND METHODS. Data were prospectively collected during a cluster-randomized, community-based trial of health interventions on neonatal mortality in Sarlahi, Nepal from 2002 to 2006. To assign cause of death, 4 computer-assigned, symptom-based asphyxia case definitions; Nepali physician classification; and our independent review of verbal autopsy open narratives were used. Various hierarchical classification approaches to assign cause of death were also explored.

RESULTS. Birth asphyxia specific mortality ranged from 26% to 54%, depending on the computer case definition used. There was poor agreement between computer and physician classification of birth asphyxia. By comparing computer results, physician results, and our independent ascertainment of cause of death, we identified 246 cases of birth asphyxia (32% of neonatal deaths). Allowing for >1 cause of death, 30% and 42% of asphyxia cases also met criteria for prematurity and serious infection, respectively. When a hierarchy was used to assign a single cause of death, the birth asphyxia proportionate mortality was reduced to 12% when identification of deaths because of congenital anomalies, prematurity, and serious infections preceded birth asphyxia.

CONCLUSIONS. The use of various verbal autopsy definitions and hierarchical approaches to assign cause of death may substantially affect estimates of birth asphyxia-specific mortality and analyses of risk factors. Verbal autopsy methods need to be standardized and validated to generate accurate global estimates to direct policy and resource allocation in low-middle–income countries.
Cancer-Related Symptoms Most Concerning to Parents During the Last Week and Last Day of Their Child's Life
Authors: Pritchard Michele , Burghen Elizabeth , Srivastava Deo Kumar , Okuma James , Anderson Lisa , Powell Brent , Furman Wayne L. , Hinds Pamela S.
Published: May 2008

OBJECTIVE. Studies of symptoms in children dying a cancer-related death typically rely on medical chart reviews or parental responses to symptom checklists. However, the mere presence of a symptom does not necessarily correspond with the distress it can cause the child's parents. The purpose of this study was to identify the cancer-related symptoms that most concerned parents during the last days of their child's life and the strategies parents identified as helpful with their child's care.

METHODS. Sixty-five parents of 52 children who had died a cancer-related death within the previous 6 to 10 months participated in telephone interviews. Eligibility criteria included being the parent or guardian of a child aged 0 to 21 years who had died within the previous 6 to 10 months after being treated at a pediatric cancer center, having been with their child during the last week of the child's life, speaking English, being willing to participate, and having access to a telephone.

RESULTS. Eighteen symptoms of concern were identified as occurring during their child's final week and final day of life. The most frequently reported symptoms at both times included changes in behavior, changes in appearance, pain, weakness and fatigue, and breathing changes. The proportion of reported symptoms did not differ according to patient gender, disease, or location of death (intensive care, elsewhere in the hospital, or home). The most helpful strategies used by health care professionals to assist the child or parents included giving pain and anxiety medications, spending time with the child or family, providing competent care, and giving advice.

CONCLUSIONS. This knowledge can guide professionals in preparing parents for the symptoms that a child imminently dying of cancer is likely to experience and in providing care that will be helpful to parents.
Decreased Full Breastfeeding, Altered Practices, Perceptions, and Infant Weight Change of Prepregnant Obese Women: A Need for Extra Support
Authors: Mok Elise , Multon Clarisse , Piguel Lorraine , Barroso Emmanuelle , Goua Valérie , Christin Patricia , Perez Marie-José , Hankard Régis
Published: May 2008

OBJECTIVE. The purpose of this work was to compare breastfeeding practices, perceptions, and infant weight change of prepregnant obese versus normal-weight mothers in the first 3 months postpartum.

PATIENTS AND METHODS. For the prospective case-control study, obese mothers (prepregnant BMI ≥ 30 kg/m2) were matched with normal-weight mothers (18.5 ≤ prepregnant BMI < 25 kg/m2) according to initial infant feeding, parity, maternal age, ethnicity, and education. Participants completed an oral questionnaire in the hospital and a telephone interview at 1 and 3 months postpartum.

RESULTS. Of 1432 mothers who had given birth at a university hospital in France, 10% were obese. Breastfeeding initiation was lower for obese (48%) versus normal-weight (64%) mothers. A total of 111 of 141 obese mothers were paired with 111 normal-weight mothers. Infant birth weight was similar for newborns of obese and normal-weight mothers. Among mothers who initiated breastfeeding, infant weight gain from 0 to 1 month was lower in breastfed infants of obese mothers compared to normal-weight mothers. Obese mothers were less likely to maintain full breastfeeding at 1 month and 3 months. The percentage of mothers breastfeeding to any extent did not differ between obese and reference women. Obese mothers more often felt uncomfortable breastfeeding in public at 3 months. Fewer obese mothers perceived that their milk supply was sufficient at 1 month and 3 months. Despite greater breastfeeding difficulties, obese mothers were less likely to seek support for breastfeeding in the first 3 months postpartum.

CONCLUSIONS. Pediatricians and health professionals should recognize that obese mothers have different breastfeeding practices and perceptions. Extra support and intervention are needed among obese mothers during prenatal and early postnatal periods so that their children can benefit from breastfeeding.
Reducing Inappropriate Hospital Use on a General Pediatric Inpatient Unit
Authors: Mahant Sanjay , Peterson Rishita , Campbell Maggie , MacGregor Daune L. , Friedman Jeremy N.
Published: May 2008

OBJECTIVE. Studies have documented high rates of inappropriate hospital use in children. We assessed the effectiveness of an audit-and-feedback intervention at reducing inappropriate hospital days on a general pediatric inpatient unit.

METHODS. A prospective observational study, using a before-and-after design, was conducted at a tertiary care pediatric hospital in Canada between March 2005 and August 2006. The appropriateness of all hospital days for all admissions was evaluated by a nurse trained in using a utilization review tool. This tool classifies hospital days as “qualified” or “nonqualified” on the basis of the nature of the inpatient services that are used. Reasons for nonqualified days were classified. The intervention consisted of (1) weekly feedback to attending physicians of which patients were nonqualified and (2) dissemination of summary reports to attending physicians. Comparisons were made between the preintervention (March 2005 to August 2005) and intervention (March 2006 to August 2006) phases.

RESULTS. The intervention was associated with a significantly lower risk of inappropriate hospital days. Of the 7246 hospital days in the 6-month intervention phase, 2413 (33%) were nonqualified versus 3859 (47%) of 8228 hospital days in the 6-month preintervention phase. A total of 7.35 hospital days would have to be reviewed, combined with weekly feedback, to prevent 1 nonqualified hospital day. The 48-hour readmission rate in the intervention phase and preintervention phase was 1.0% and 1.6%, respectively. The proportion of nonqualified days to total hospital days that were attributable to “finishing intravenous antibiotics,” “awaiting tests,” “providing nutrition,” “observation only,” “tapering treatment,” and “teaching” decreased significantly, whereas the “lack of an alternate level of care” increased significantly.

CONCLUSIONS. An audit-and-feedback intervention directed at attending physicians was associated with a lower risk of inappropriate hospital days without an increase in the readmission rate. The utilization review tool also identified processes that impact on inappropriate hospital days.
Use of Soy Protein-Based Formulas in Infant Feeding
Authors: Bhatia Jatinder , Greer Frank ,   and the Committee on Nutrition
Published: May 2008

Soy protein-based formulas have been available for almost 100 years. Since the first use of soy formula as a milk substitute for an infant unable to tolerate a cow milk protein-based formula, the formulation has changed to the current soy protein isolate. Despite very limited indications for its use, soy protein-based formulas in the United States may account for nearly 25% of the formula market. This report reviews the limited indications and contraindications of soy formulas. It will also review the potential harmful effects of soy protein-based formulas and the phytoestrogens contained in these formulas.
Communicating With Children and Families: From Everyday Interactions to Skill in Conveying Distressing Information
Authors: Levetown Marcia ,   and the Committee on Bioethics
Published: May 2008

Health care communication is a skill that is critical to safe and effective medical practice; it can and must be taught. Communication skill influences patient disclosure, treatment adherence and outcome, adaptation to illness, and bereavement. This article provides a review of the evidence regarding clinical communication in the pediatric setting, covering the spectrum from outpatient primary care consultation to death notification, and provides practical suggestions to improve communication with patients and families, enabling more effective, efficient, and empathic pediatric health care.
Early Marine Growth of Pink Salmon in Prince William Sound and the Coastal Gulf of Alaska During Years of Low and High Survival
Authors: Cross Alison D. , Beauchamp David A. , Myers Katherine W. , Moss Jamal H.
Published: May 2008

Although early marine growth has repeatedly been correlated with overall survival in Pacific salmon Oncorhynchus spp., we currently lack a mechanistic understanding of smolt‐to‐adult survival. Smolt‐to‐adult survival of pink salmon O. gorbuscha returning to Prince William Sound was lower than average for juveniles that entered marine waters in 2001 and 2003 (3% in both years), and high for those that entered the ocean in 2002 (9%) and 2004 (8%). We used circulus patterns from scales to determine how the early marine growth of juvenile pink salmon differed (1) seasonally during May‐October, the period hypothesized to be critical for survival; (2) between years of low and high survival; and (3) between hatchery and wild fish. Juvenile pink salmon exhibited larger average size, migrated onto the continental shelf and out of the sampling area more quickly, and survived better during 2002 and 2004 than during 2001 and 2003. Pink salmon were consistently larger throughout the summer and early fall during 2002 and 2004 than during 2001 and 2003, indicating that larger, faster‐growing juveniles experienced higher survival. Wild juvenile pink salmon were larger than hatchery fish during low‐survival years, but no difference was observed during high‐survival years. Differences in size among years were determined by some combination of growing conditions and early mortality, the strength of which could vary significantly among years.
A Robust Deterministic Model Describing the Bomb Radiocarbon Signal for Use in Fish Age Validation
Authors: Hamel Owen S. , Piner Kevin R. , Wallace John R.
Published: May 2008

The bomb radiocarbon chronometer has become a standard tool for assessing the accuracy of otolith‐based fish age estimates. Use of the chronometer depends upon the increase in 14C that occurred due to the atmospheric testing of nuclear weapons in the middle of the 20th century. In previous analyses, a variety of ad hoc methods have been used to compare test chronologies with reference chronologies. This paper proposes a deterministic coupled‐functions model that describes bomb radiocarbon chronologies and standardizes and facilitates comparisons within and across species. In this model, a Gaussian pulse of radiocarbon over time is assumed, and dispersion and dilution are described by continuous exponential decay. The model simplifies to the product of a cumulative normal function and an exponential function; despite its simplicity, the model approximates the observed changes in oceanic radiocarbon quite well. It also allows for statistical testing of the timing of increase between different time series and thus permits quantitative aging validation as well as analysis of geographical differences in the timing of the bomb radiocarbon signal. Estimated model parameters describe the timing of the onset and temporal midpoint of the bomb‐related increase in 14C and the rate of 14C dispersion or dilution, which corresponds to the observed rate of decline during the postbomb period. Nine published chronologies are used to demonstrate the model and compare it with other published methods of summarizing bomb radiocarbon data for age validation purposes.
Downdip-Oil Potential for an Onshore Abu Dhabi Petroleum System
Authors: Pottorf R. J. , Hussenoeder K. L. , Petersen K. , Tseng H. , Davis C. L. , Richardson M. , Pietraszek-Mattner S. , Moore D. W. , El Agrab A. F. , Khouri A. A.
Published: May 2008

A combination of fluid-inclusion and geochemical analyses was conducted on rocks and reservoir fluids to develop an improved understanding of downdip-oil potential in a mature exploration play, onshore Abu Dhabi, UAE. Exploration for oil in the region is complicated by low-permeability carbonate reservoirs, poor seismic imaging, and complex hydrocarbon-maturation and -migration histories. In addition, a broad range of fluid properties, including gas, condensate, and high-°API oil, makes evaluation of the reservoir fluid phase difficult.

In this challenging environment, geochemical and fluid-inclusion techniques are effective tools for identifying downdip oil potential from gas-cap fluids and reservoir-rock samples. Fluid-inclusion data are used to develop a hydrocarbon-emplacement history, which constrains the distribution of fluids throughout the exploration area. In some areas, undersaturated gas inclusions trapped at present-day temperatures suggest a low chance for downdip oil. Conversely, other structures contain oil inclusions that have been displaced recently by saturated gas, suggesting good potential for downdip oil. Geochemical analyses of recovered fluids were used independently to predict the likelihood of down-dip oil. These combined techniques were placed in a geologic framework to regionally risk the potential for downdip oil throughout the exploration area. This framework enables improved resource evaluation and prioritization of exploration efforts in areas of the play where a high probability of downdip oil exists.
Application of Integrated Reservoir Studies and Techniques To Estimate Oil Volumes and Recovery—Tengiz Field, Republic of Kazakhstan
Authors: Dehghani K. , Jenkins S. , Fischer D. J. , Skalinski M.
Published: May 2008

Recent technical studies and probabilistic techniques have been integrated to build reservoir models for Tengiz field. Tengiz is one of the deepest supergiant oil fields in the world and is on the shore of the Caspian Sea within the Republic of Kazakhstan. Knowledge of the uncertainties inherent in oil recovery is a key to proper reservoir management of this important oil field.

Probabilistic techniques gave insights into the importance and ranking of key reservoir uncertainties. This ranking is used to reduce reservoir uncertainties and to guide reservoir management activities.

A structured Monte Carlo Technique has been used to construct several thousand static models of Tengiz field. Construction of Monte-Carlo models is fast and allows the impact of key uncertainties to be explored. Static reservoir uncertainties investigated include wireline log calibration, structural elevation, geostatistical parameters (such as variogram length), water saturation, and location of the boundary between facies intervals.

Investigating the uncertainty in the dynamic performance of the model is computationally intensive. Experimental design techniques were used to minimize the number of computationally expensive simulation runs. Key dynamic variables investigated include: oil in place (OIP), gas/oil relative permeability, permeability enhancements, vertical-to-horizontal permeability ratio, well productivity, the water/oil contact (WOC) depth, and production capacity.

The methodology for generating the range of possible outcomes for some development scenarios in Tengiz is discussed here. The application of Monte Carlo and experimental design techniques to identify the high impact static and dynamic parameters is reviewed.

The construction of a probabilistic distribution of OIP and recoveries is demonstrated for one development alternative for Tengiz field. This study found that for this development alternative, the OIP, gas/oil relative permeability, and ratio of vertical to horizontal permeability have the greatest impact on the estimated oil recoveries.
Modeling Dependence Among Geologic Risks in Sequential Exploration Decisions
Authors: Bickel J. Eric , Smith James E. , Meyer Jennifer L.
Published: May 2008

Prospects in a common basin are likely to share geologic features. For example, if hydrocarbons are found at one location, they may be more likely to be found at other nearby locations. When making drilling decisions, we should be able to exploit this dependence and use drilling results from one location to make more informed decisions about other nearby prospects. Moreover, we should consider these informational synergies when evaluating multiprospect exploration opportunities. In this paper, we describe an approach for modeling the dependence among prospects and determining an optimal drilling strategy that takes this information into account. We demonstrate this approach using an example involving five prospects. This example demonstrates the value of modeling dependence and the value of learning about individual geologic risk factors (e.g., from doing a postmortem at a failed well) when choosing a drilling strategy.
An Accurate Method for Determining Oil PVT Properties Using the Standing-Katz Gas Z-Factor Chart
Authors: Sutton Robert P.
Published: May 2008

An accurate technique for estimating oil pressure/volume/ temperature (PVT) properties using the Standing-Katz Z-factor chart has been developed. Prior work to derive tuned gas-pseudocritical-property values that provide consistent and accurate compressibility factors has been extended to oils.

Data from 1,099 worldwide oil PVT reports with 11,960 density measurements have been analyzed. The oils studied have API gravities ranging from 10.6 to 63, with gas/oil ratios ranging from 5 to 4,631 scf/STB. Bubblepoint formation volume factors (FVFs) range from 0.98 to 4.58 bbl/STB. Saturation pressures ranged from 60 to 10,326 psia at temperatures ranging from 50 to 332°F with pressure differentials to 18,491 psi.

The resulting work shows that oil pseudocritical properties can be correlated with molecular weight, as with gases. The resulting relationships can be used to determine saturated-and undersaturated-oil density accurately. Oil PVT properties, such as FVF and isothermal compressibility, can then be derived from fundamental relationships with density.

Because the new method correlates properties with the molecular weight of the wellstream, the chemical nature of the oil (e.g., whether naphthenic or paraffinic) is considered. Existing correlations (30 for bubblepoint oil FVF and 17 for isothermal compressibility) have been identified in the literature. These methods are tested against the database along with the new method to determine accuracy and recommended procedures. Isothermal oil compressibility has proved difficult to correlate historically, with errors typically in excess of 30%. The proposed method significantly reduces the error in calculated isothermal compressibility in comparison to traditional methods.
Simulation of Inflow While Underbalanced Drilling With Automatic Identification of Formation Parameters and Assessment of Uncertainty
Authors: Friedel Torsten , Mtchedlishvili George , Voigt Hans-Dieter , Häfner Frieder
Published: May 2008

Underbalanced drilling (UBD) is defined as a drilling operation in which the pressure of the circulating drilling fluid is lower than the pore pressure of the target formation of interest. The most widely recognized benefit of UBD is the reduction of formation damage by minimizing the drilling-mud leakoff and fines migration into the formation. It also facilitates the possibility for reservoir characterization during drilling. The purpose of this paper is to present (1) how to use the inflow data for the evaluation of formation properties, and (2) how to cope with the uncertainty of the results.

An in-house multiphase reservoir simulator is used for the simulation of the formation reservoir-fluid flow during UBD. The model incorporates discrete consideration of the well with appropriate time-varying UBD boundary conditions. Capillary forces, which facilitate countercurrent imbibition of the drilling mud into the formation, are taken into account.

The production rates during UBD depend on the formation properties and the drilling conditions. The inflow information is analogous to transient test data and can be used for the estimation of the reservoir-model parameters. With the progression of the drilling process, the amount of available inflow data increases and allows for a sequential history-match procedure. Statistical analysis of the inverse problem can then be utilized to determine the optimal level of parameterization that is justified by the quality and quantity of the measured data.

This paper highlights (1) the use of a reservoir simulator to derive the inflow of fluids in heterogeneous reservoirs, and (2) its coupling with gradient-based optimization techniques for determination of unknown reservoir parameters. The simulation-whiledrilling approach proposed is fully automated and can be set up on a known or totally unknown reservoir model, introducing an iterative and automatic updating process of the reservoir model.