bluuebunny/crossref_metadata_2025 huggingface dataset:
Measuring Urban Communication
Authors: Allison Mary Ann
Published: May 2008

This article is a response to the Urban Communication Foundation's call for papers contributing to the development of criteria for a Communicative City Award. Drawing on the domains of Complex Systems Theory, Models of Global Structural Coupling and the Literature on Wicked Problems, the author presents a framework for evaluating proposed criteria. To support practical application of the Communicative City Program goals, the author suggests adapting the balanced scorecard methodology and including ideas from Bhutan's work on Gross National Happiness indicators. The article concludes with a preliminary design for a Communicative City Balanced Scorecard intended to trigger additional suggestions and further collaboration.
Stage-specific gene expression during urediniospore germination in Puccinia striiformis f. sp tritici
Authors: Zhang Yonghong , Qu Zhipeng , Zheng Wenming , Liu Bo , Wang Xiaojie , Xue Xiaodan , Xu Liangsheng , Huang Lili , Han Qingmei , Zhao Jie , Kang Zhensheng
Published: May 2008

Background

Puccinia striiformisf. sp.triticiis an obligate biotrophic pathogen that causes leaf stripe rust on wheat. Although it is critical to understand molecular mechanisms of pathogenesis in the wheat stripe rust fungus for developing novel disease management strategies, little is known about its genome and gene functions due to difficulties in molecular studies with this important pathogen. To identify genes expressed during early infection stages, in this study we constructed a cDNA library with RNA isolated from urediniospores ofP. striiformisf. sp.triticigerminated for 10 h.

Results

A total of 4798 ESTs were sequenced from the germinated urediniospore library and assembled into 315 contigs and 803 singletons. About 23.9% and 13.3% of the resulting 1118 unisequences were homologous to functionally characterized proteins and hypothetical proteins, respectively. The rest 62.8% unisequences had no significant homologs in GenBank. Several of these ESTs shared significant homology with known fungal pathogenicity or virulence factors, such as HESP767 of the flax rust andPMK1,GAS1, andGAS2of the rice blast fungus. We selected six ESTs (Ps28, Ps85, Ps87, Ps259, Ps261, and Ps159) for assaying their expression patterns during urediniospore germination and wheat infection by quantitative real-time PCR. All of them had the highest transcript level in germinated urediniospores and a much less transcript level in un-germinated urediniospores and infected wheat tissues (1–7 dpi). The transcript level of Ps159 increased at later infection stages (6–7 dpi). Our data indicated that these genes were highly expressed in germinated urediniospores and may play important roles in fungal-plant interactions during early infection stages in the wheat stripe rust fungus.

Conclusion

Genes expressed in germinated urediniospores ofP. striiformisf. sp.triticiwere identified by EST analysis. Six of them were confirmed by quantitative real-time PCR assays to be highly expressed in germinated urediniospores.
Quantitative correlation between promoter methylation and messenger RNA levels of the reduced folate carrier
Authors: Yang Rui , Li Wei-Wei , Hoang Bang H , Kim Hansoo , Banerjee Debabrata , Kheradpour Albert , Healey John H , Meyers Paul A , Bertino Joseph R , Gorlick Richard
Published: May 2008

Background

Methotrexate (MTX) uptake is mediated by the reduced folate carrier (RFC). Defective drug uptake in association with decreased RFC expression is a common mechanism of MTX resistance in many tumor types. Heavy promoter methylation was previously identified as a basis for the complete silencing of RFC in MDA-MB-231 breast cancer cells, its role and prevalence in RFC transcription regulation are, however, not widely studied.

Methods

In the current study, RFC promoter methylation was assessed using methylation specific PCR in a panel of malignant cell lines (n = 8), including MDA-MB-231, and M805, a MTX resistant cell line directly established from the specimen of a patient with malignant fibrohistocytoma, whom received multiple doses of MTX. A quantitative approach of real-time PCR for measuring the extent of RFC promoter methylation was developed, and was validated by direct bisulfite genomic sequencing. RFC mRNA levels were determined by quantitative real-time RT-PCR and were related to the extent of promoter methylation in these cell lines.

Results

A partial promoter methylation and RFC mRNA down-regulation were observed in M805. Using the quantitative approach, a reverse correlation (correlation coefficient = -0.59, p < 0.05) was identified between the promoter methylation and RFC mRNA levels in this a panel of malignant cell lines.

Conclusion

This study further suggests that promoter methylation is a potential basis for MTX resistance. The quantitative correlation identified in this study implies that promoter methylation is possibly a mechanism involved in the fine regulation of RFC transcription.
Suicide among adults aged 30–49: A psychological autopsy study in Hong Kong
Authors: Wong Paul WC , Chan Wincy SC , Chen Eric YH , Chan Sandra SM , Law YW , Yip Paul SF
Published: May 2008

Background

A surge in suicide rates in middle age people in Hong Kong and many Asian countries was recently observed. However, there is a paucity of suicide research on this subgroup of people in Asia.

Methods

The next-of-kin of 85 suicide cases and 85 community subjects aged 30–49 years were interviewed by a psychological autopsy approach. Information was triangulated by interview notes, coroner's court files, and police investigation reports.

Results

A multiple logistic regression analysis identified the following risk factors for suicide among the middle age people in Hong Kong: the presence of at least one psychiatric disorder (OR = 37.5, 95% CI 11.5–121.9, p < 0.001), indebtedness (OR = 9.4, 95% CI 2.2–40.8, p < 0.01), unemployment (OR = 4.8, 95% CI 1.3–17.5, p < 0.05), never married (OR = 4.2, 95% CI 1.1–16.3, p < 0.05), and lived alone (OR = 3.9, 95% CI 1.2–13.4, p < 0.05).

Conclusion

The data show that socio-economical factors had a strong impact on suicide in the target group. Further research is needed to explore any positive qualities that protect the middle-aged from suicide. The prevention of suicide in the middle-aged requires multiple strategies.
Fainting Passengers: The Role of Cabin Environment
Authors: Simons Ries , de Ree Hans
Published: May 2008

Reported percentages of in-flight medical incidents caused by syncope, the medical term for fainting, vary between 15 % and 22 %. Syncope is usually a benign medical event, but it may cause fear and distress among passengers and the individual involved. Incorrectly diagnosed benign syncope may lead to unnecessary flight diversions. In this context, the incidence of in-flight syncope and possible relationships with cabin environmental and passenger factors were studied. In September 2005, questionnaires were handed out to the senior purser on all KLM long haul flights. Pursers were asked to record all cases of in-flight syncope and to answer questions concerning cabin climate. Literature data were analyzed concerning in-flight and passenger factors that may cause or elicit syncope. With a response rate of 79 %, 1625 forms were analyzed. The in-flight syncope risk was 3–9 per 1000 passenger flight hours, depending on type of aircraft. The frequency of syncopal events was weakly correlated with cabin climate conditions. Literature analysis provides evidence that hypoxia is a sufficient cause for syncope in a sub-set of healthy airline passengers. There is evidence that cabin pressure and temperature may contribute to the occurrence of syncope. The syncope risk appears to be higher aboard an aircraft than on the ground. Hypoxia is a sufficient cause for syncope in a sub-set of healthy airline passengers. Airline passengers may become considerably hypoxic due to reduced pulmonary ventilation caused by immobility, drowsiness, and gastro-intestinal distension. In-flight hypoxia may reach levels sufficient to cause syncope. High cabin temperature may further trigger this reaction.
American Ethnological Society
Authors: Davidson Joanna
Published: May 2008

•State of the Section
 David Nugent
Association for Feminist Anthropology
Authors: Upton Rebecca
Published: May 2008

•A Greeting from the New President
 Cheryl Rodriguez  •The AFA Forman Prize and Zora Neale Hurston Travel Grant Support Feminists! •AFA is Celebrating 20 Years as Section!
Council for Museum Anthropology
Authors: Herold Joyce
Published: May 2008

•Looking at Our Other Side: The American Museums Meeting
 
•Choosing a Conference
General Anthropology Division
Authors: Lassiter Luke Eric
Published: May 2008

•GAD Committees and Interest Groups
 
•The Federation of Small Anthropology Programs
 John Rhoades
Middle East Section
Authors: Spadola Emilio
Published: May 2008

•Inscribing the Body: Tattoos in Traditional and Modern Cultures
 el‐Sayed el‐Aswad
National Association of Student Anthropologists
Authors: Chio Jenny
Published: May 2008

•Let me See Your Grill: Dental Modification in the Past and Present
 Sarah R Taylor
Society for Anthropology in Community Colleges
Authors: Miller Lloyd
Published: May 2008

•Virtual Reality
Society for the Anthropology of Consciousness
Authors: McBride Lawrence B
Published: May 2008

•Anthropological Concept of Consciousness Will Frame Future Research
 Peter N Jones
Society for Latin American and Caribbean Anthropology
Authors: Caballero‐Arias Hortensia
Published: May 2008

•UN Declaration on the Rights of Indigenous Peoples
Society for Visual Anthropology
Authors: Diaz‐Barriga Miguel
Published: May 2008

•Research in a Politically Changing Caucasus
 Hulya Sakarya
Forkhead-Associated Domain of Yeast Xrs2, a Homolog of Human Nbs1, Promotes Nonhomologous End Joining Through Interaction With a Ligase IV Partner Protein, Lif1
Authors: Matsuzaki Kenichiro , Shinohara Akira , Shinohara Miki
Published: May 2008

DNA double-strand breaks (DSB) are repaired through two different pathways, homologous recombination (HR) and nonhomologous end joining (NHEJ). Yeast Xrs2, a homolog of human Nbs1, is a component of the Mre11-Rad50-Xrs2 (MRX) complex required for both HR and NHEJ. Previous studies showed that the N-terminal forkhead-associated (FHA) domain of Xrs2/Nbs1 in yeast is not involved in HR, but is likely to be in NHEJ. In this study, we showed that the FHA domain of Xrs2 plays a critical role in efficient DSB repair by NHEJ. The FHA domain of Xrs2 specifically interacts with Lif1, a component of the ligase IV complex, Dnl4-Nej1-Lif1 (DNL). Lif1, which is phosphorylated in vivo, contains two Xrs2-binding regions. Serine 383 of Lif1 plays an important role in the interaction with Xrs2 as well as in NHEJ. Interestingly, the phospho-mimetic substitutions of serine 383 enhance the NHEJ activity of Lif1. Our results suggest that the phosphorylation of Lif1 at serine 383 is recognized by the Xrs2 FHA domain, which in turn may promote recruitment of the DNL complex to DSB for NHEJ. The interaction between Xrs2 and Lif1 through the FHA domain is conserved in humans; the FHA domain Nbs1 interacts with Xrcc4, a Lif1 homolog of human.
Immune Modification to Prevent Nosocomial Sepsis in Hospitalized Newborns
Authors: Soltau Thomas D. , Schelonka Robert L.
Published: May 2008

Preterm infants receiving intensive care have high rates of nosocomial infections. Developmental facets of host defense, medical interventions, and the hospital environment contribute to septicemia rates exceeding 40% in extremely low-birthweight infants. Septicemia is an important cause of morbidity and mortality in these fragile infants. This review focuses on the neonate's relative deficiencies of innate and humoral immunity and describes strategies to modify the immune response to prevent nosocomial infection. Human milk feeding is an effective immune modifier and decreases infection rates in hospitalized preterm infants. Results of studies of pharmacologic agents such as polyclonal intravenous immune globulin and colony-stimulating factors to reduce nosocomial infections have been mixed. Specifically targeted immunotherapy with monoclonal antibodies and probiotics are being investigated and may become effective tools to reduce nosocomial infections in the future.
Neonatal Lupus and Related Autoimmune Disorders of Infants
Authors: Frankovich Jennifer , Sandborg Christy , Barnes Pat , Hintz Susan , Chakravarty Eliza
Published: May 2008

Neonatal lupus syndromes are caused by maternal antibodies targeting proteins displayed on apoptotic blebs. Mothers frequently are healthy and unaware of their autoantibody status. Manifestations in infants include rashes, cytopenias, hepatobiliary disease, heart block, and rarely, cardiomyopathies. Cerebral dysmaturation, ventriculomegaly, and lenticulostriate vasculopathy are recently described manifestations. Rhizomelic chondrodysplasia punctata, pneumonitis, nephritis, and multiorgan failure are rare. Coexisting antithyroid and antiphospholipid antibodies may complicate the presentation. Symptoms typically disappear with the clearance of maternal antibodies from the neonatal circulation, except in cases where the disease is extensive or involves vulnerable tissues. Early diagnosis, close monitoring, and appropriate intervention with immunosuppressive treatment may subvert organ-threatening disease in select cases.
Neonatal Respiratory Failure: A 12-Month Clinical Epidemiologic Study From 2004 to 2005 in China
Authors: Qian Liling , Liu Cuiqing , Zhuang Wanzhu , Guo Yunxia , Yu Jialin , Chen Hanqiang , Wang Sannan , Lin Zhenlang , Xia Shiwen , Ni Liming , Liu Xiaohong , Chen Chao , Sun Bo ,   and the Chinese Collaborative Study Group for Neonatal Respiratory Diseases
Published: May 2008

OBJECTIVES. In the past decade, neonatal special care services in China have been established, during which time various therapies for neonatal respiratory failure have been introduced. The objective of this study was to investigate the incidence, management, outcome, and cost of neonatal respiratory failure treated by mechanical ventilation in 23 tertiary NICUs of major hospitals in southeastern and midwestern China.

METHODS. Data were collected over 12 consecutive months from 2004 to 2005 for neonates with neonatal respiratory failure. Eligible infants were those who required endotracheal intubation and mechanical ventilation and/or nasal continuous positive airway pressure for at least 24 hours and infants who died within 24 hours of ventilation during their first 7 days of life. Data characterized demographics, antenatal and perinatal history, illness severity score, primary disease, respiratory care, complications, survival, and clinical burden.

RESULTS. From a total of 13070 NICU admissions, there were 1722 (13.2%) cases of neonatal respiratory failure with respiratory distress syndrome, pneumonia/sepsis, and meconium aspiration syndrome as major causes. For infants who survived until discharge, the median length of ventilation was 70 hours. Overall, in-hospital mortality for neonatal respiratory failure was 32.1%. Logistic regressions showed that lower gestational age, vaginal delivery, fetal distress before delivery, presence of a major anomaly, and high severity score in preterm infants were associated with an increased risk for death. In term and postterm infants, only the presence of a major anomaly and a high severity score were significant risk factors for death. Mean length and cost of stay in hospital were 19.2 ± 14.6 days and 14966 ± 13465 Yuan in the survivors.

CONCLUSIONS. Neonatal respiratory failure in the NICU of the provincial cities of China has high mortality and cost that are linked to geographic variability, a male predominance, and low proportion of very preterm infants, characteristic of sociocultural confounding background.
Quality of Life in Children With Heart Disease as Perceived by Children and Parents
Authors: Uzark Karen , Jones Karen , Slusher Joyce , Limbers Christine A. , Burwinkle Tasha M. , Varni James W.
Published: May 2008

OBJECTIVES. The aims of this study were to evaluate and compare the parent-reported and self-reported quality of life of children who have cardiovascular disease with the healthy pediatric population across age groups and to determine the relationship between perceived quality of life and severity of cardiovascular disease.

METHODS. The Pediatric Quality of Life Inventory (PedsQL) Generic Core Scales and Cardiac Module were administered to 475 families including 347 children with cardiovascular disease during a pediatric cardiology outpatient visit. The PedsQL scores reported by children with cardiovascular disease and their parents were compared with pediatric population norms. The relationship between Pediatric Quality of Life Inventory scores and patient characteristics was examined.

RESULTS. By self-report, mean PedsQL scores for children with cardiovascular disease were significantly lower than healthy child norms for physical and psychosocial functioning. Psychosocial quality of life scores were classified as significantly impaired as reported by 21% of children ≥8 years of age. Even among children with less severe cardiovascular disease, 19.2% reported significantly impaired psychosocial quality of life. By parental report, overall PedsQL scores were not significantly different from healthy children except in the teenage group, and both the 8- to 12-year-old and teenage groups had lower mean psychosocial quality of life scores than healthy peers. Parent-reported mean PedsQL scores for both physical and psychosocial quality of life were significantly lower in children with more severe cardiovascular disease. Children with more severe cardiovascular disease reported lower mean scores for physical functioning, but smaller differences in psychosocial quality of life scores were observed related to disease severity.

CONCLUSIONS. Overall, children with cardiovascular disease perceived lower quality of life than healthy children across all age groups. As perceived by parents, overall quality of life was not significantly different in young children with cardiovascular disease, but children with more severe cardiovascular disease have worse physical and psychosocial quality of life. One in 5 children with cardiovascular disease perceives impaired psychosocial functioning, including children with mild disease severity.
Pulse Oxygen Saturation Levels and Arterial Oxygen Tension Values in Newborns Receiving Oxygen Therapy in the Neonatal Intensive Care Unit: Is 85% to 93% an Acceptable Range?
Authors: Castillo Armando , Sola Augusto , Baquero Hernando , Neira Freddy , Alvis Ramiro , Deulofeut Richard , Critz Ann
Published: May 2008

OBJECTIVE. Our aim was to define the relationship of Pao2 and pulse oxygen saturation values during routine clinical practice and to evaluate whether pulse oxygen saturation values between 85% and 93% were associated with Pao2 levels of <40 mmHg.

METHODS. Prospective comparison of Pao2 and pulse oxygen saturation values in 7 NICUs at sea level in 2 countries was performed. The Pao2 measurements were obtained from indwelling arterial catheters; simultaneous pulse oxygen saturation values were recorded if the pulse oxygen saturation values changed <1% before, during, and after the arterial gas sample was obtained.

RESULTS. We evaluated 976 paired Pao2/pulse oxygen saturation values in 122 neonates. Of the 976 samples, 176 (18%) from infants breathing room air had a mean pulse oxygen saturation of 93.9 ± 4.3% and a median of 95.5%. The analysis of 800 samples from infants breathing supplemental oxygen revealed that, when pulse oxygen saturation values were 85% to 93%, the mean Pao2 was 56 ± 14.7 mmHg and the median 54 mmHg. At this pulse oxygen saturation level, 86.8% of the samples had Pao2 values of 40 to 80 mmHg, 8.6% had values of <40 mmHg, and 4.6% had values of >80 mmHg. When the pulse oxygen saturation values were >93%, the mean Pao2 was 107.3 ± 59.3 mmHg and the median 91 mmHg. At this pulse oxygen saturation level, 39.5% of the samples had Pao2 values of 40 to 80 mmHg and 59.5% had values of >80 mmHg.

CONCLUSIONS. High Pao2 occurs very rarely in neonates breathing supplemental oxygen when their pulse oxygen saturation values are 85% to 93%. This pulse oxygen saturation range also is infrequently associated with low Pao2 values. Pulse oxygen saturation values of >93% are frequently associated with Pao2 values of >80 mmHg, which may be of risk for some newborns receiving supplemental oxygen.
Patterns of Brain Injury in Neonates Exposed to Perinatal Sentinel Events
Authors: Okereafor Akudo , Allsop Joanna , Counsell Serena J. , Fitzpatrick Julie , Azzopardi Denis , Rutherford Mary A. , Cowan Frances M.
Published: May 2008

OBJECTIVES. We studied (1) the pattern of brain injury in term neonates with encephalopathy with evidence of a preceding hypoxic sentinel event, (2) prenatal and perinatal risk factors, and (3) the correlation between neuroimaging findings and developmental outcomes.

METHODS. We identified, among 500 term neonates with encephalopathy who were studied with MRI between 1992 and 2005, 48 infants with evidence of a preceding acute hypoxic event, and we reviewed their MRI scans retrospectively. Prenatal and perinatal data were compared with those for term normal low-risk infants. Neurodevelopmental outcomes were assessed at a minimum of 12 months.

RESULTS. Five patterns of brain injury were identified, as follows: pattern I, basal ganglia and thalami lesions associated with severe white matter damage (n = 6; 14%); pattern II, basal ganglia and thalami lesions with mild or moderate white matter changes (n = 24; 56%); pattern III, isolated thalamic injury (n = 2; 5%); pattern IV, moderate white matter damage only (n = 1; 2%); pattern V, mild white matter changes or normal findings (n = 10; 23%). No scan showed evidence of long-standing injury. The internal capsule was abnormal in 93% of infants with patterns I and II, and 86% of those infants died or developed cerebral palsy. Infants with patterns III and IV had developmental delay and diplegic cerebral palsy, respectively. Pattern V was associated with normal outcomes. Case infants were significantly more often of African descent, born to pluriparous or hypertensive mothers. Uterine rupture followed previous cesarean section in 8 of 11 cases. Cord prolapse accompanied undiagnosed breech presentation in 4 of 9 cases.

CONCLUSIONS. Basal ganglia and thalami lesions are the imaging signature in term neonates exposed to hypoxic-ischemic sentinel events. Patterns of central gray matter and secondary white matter injury were associated with higher risks of severe morbidity and death. Affected infants did not seem intrinsically different from our low-risk population. These data support the need for anticipating sentinel events and expediting delivery.
Presence of Diabetic Ketoacidosis at Diagnosis of Diabetes Mellitus in Youth: The Search for Diabetes in Youth Study
Authors: Rewers Arleta , Klingensmith Georgeanna , Davis Cralen , Petitti Diana B. , Pihoker Catherine , Rodriguez Beatriz , Schwartz I. David , Imperatore Giuseppina , Williams Desmond , Dolan Lawrence M. , Dabelea Dana
Published: May 2008

OBJECTIVE. The purpose of this work was to determine the prevalence and predictors of diabetic ketoacidosis at the diagnosis of diabetes in a large sample of youth from the US population.

PATIENTS AND METHODS. The Search for Diabetes in Youth Study, a multicenter, population-based registry of diabetes with diagnosis before 20 years of age, identified 3666 patients with new onset of diabetes in the study areas in 2002–2004. Medical charts were reviewed in 2824 (77%) of the patients in a standard manner to abstract the results of laboratory tests and to ascertain diabetic ketoacidosis at the time of diagnosis. Diabetic ketoacidosis was defined by blood bicarbonate <15 mmol/L and/or venous pH < 7.25 (arterial/capillary pH < 7.30), International Classification of Diseases, Ninth Revision, code 250.1, or listing of diabetic ketoacidosis in the medical chart.

RESULTS. More than half (54%) of the patients were hospitalized at diagnosis, including 93% of those with diabetic ketoacidosis and 41% without diabetic ketoacidosis. The prevalence of diabetic ketoacidosis at the diagnosis was 25.5%. The prevalence decreased with age from 37.3% in children aged 0 to 4 years to 14.7% in those aged 15 to 19 years. Diabetic ketoacidosis prevalence was significantly higher in patients with type 1 (29.4%) rather than in those with type 2 diabetes (9.7%). After adjusting for the effects of center, age, gender, race or ethnicity, diabetes type, and family history of diabetes, diabetic ketoacidosis at diagnosis was associated with lower family income, less desirable health insurance coverage, and lower parental education.

CONCLUSION. At the time of diagnosis, 1 in 4 youth presents with diabetic ketoacidosis. Those with diabetic ketoacidosis were more likely to be hospitalized. Diabetic ketoacidosis was a presenting feature of <10% of youth with type 2. Young and poor children are disproportionately affected.
Economic Evaluation of the US Environmental Protection Agency's SunWise Program: Sun Protection Education for Young Children
Authors: Kyle Jessica W. , Hammitt James K. , Lim Henry W. , Geller Alan C. , Hall-Jordan Luke H. , Maibach Edward W. , De Fabo Edward C. , Wagner Mark C.
Published: May 2008

OBJECTIVE. The SunWise School Program is a school-based sun safety education program that was developed by the US Environmental Protection Agency and aims to teach children how to protect themselves from overexposure to the sun. The objectives of this study were to assess the health benefits of the SunWise School Program and use economic analysis to determine the program's net benefits and cost-effectiveness.

METHODS. Standard cost/benefit and cost-effectiveness analysis methods were used. Intervention costs were measured as program costs estimated to be incurred by the US government, which funds SunWise, using 3 funding scenarios. Health outcomes were measured as skin cancer cases and premature mortalities averted and quality-adjusted life-years saved. These health outcomes were modeled using an effectiveness evaluation of SunWise based on pretest and posttest surveys administered to students who participated in the program and the Environmental Protection Agency's peer-reviewed Atmospheric and Health Effects Framework model. Costs averted were measured as direct medical costs and costs of productivity losses averted as a result of SunWise. Net benefits were measured as the difference between costs averted and program costs.

RESULTS. Economic analysis indicated that if the SunWise School Program continues through 2015 at current funding levels, then it should avert >50 premature deaths, nearly 11000 skin cancer cases, and 960 quality-adjusted life-years (undiscounted) among its participants. For every dollar invested in SunWise, between approximately $2 and $4 in medical care costs and productivity losses are saved, depending on the funding scenario.

CONCLUSIONS. From a cost/benefit and cost-effectiveness perspective, it is worthwhile to educate children about sun safety; small to modest behavioral impacts may result in significant reductions in skin cancer incidence and mortality.
Human Leukocyte Antigen and Cytokine Receptor Gene Polymorphisms Associated With Heterogeneous Immune Responses to Mumps Viral Vaccine
Authors: Ovsyannikova Inna G. , Jacobson Robert M. , Dhiman Neelam , Vierkant Robert A. , Pankratz V. Shane , Poland Gregory A.
Published: May 2008

OBJECTIVES. Mumps outbreaks continue to occur throughout the world, including in highly vaccinated populations. Vaccination against mumps has been successful; however, humoral and cellular immune responses to mumps vaccines vary significantly from person to person. We set out to assess whether HLA and cytokine gene polymorphisms are associated with variations in the immune response to mumps viral vaccine.

METHODS. To identify genetic factors that might contribute to variations in mumps vaccine–induced immune responses, we performed HLA genotyping in a group of 346 healthy schoolchildren (12–18 years of age) who previously received 2 doses of live mumps vaccine. Single-nucleotide polymorphisms (minor allele frequency of >5%) in cytokine and cytokine receptor genes were genotyped for a subset of 118 children.

RESULTS. Median values for mumps-specific antibody titers and lymphoproliferative stimulation indices were 729 IU/mL and 4.8, respectively. Girls demonstrated significantly higher mumps antibody titers than boys, indicating gender-linked genetic differences in humoral immune response. Significant associations were found between the HLA-DQB1*0303 alleles and lower mumps-specific antibody titers. An interesting finding was the association of several HLA class II alleles with mumps-specific lymphoproliferation. Alleles of the DRB1 (*0101, *0301, *0801, *1001, *1201, and *1302), DQA1 (*0101, *0105, *0401, and *0501), and DQB1 (*0201, *0402, and *0501) loci were associated with significant variations in lymphoproliferative immune responses to mumps vaccine. Additional associations were observed with single-nucleotide polymorphisms in the interleukin-10RA, interleukin-12RB1, and interleukin-12RB2 cytokine receptor genes. Minor alleles for 4 single-nucleotide polymorphisms within interleukin-10RA and interleukin-12RB genes were associated with variations in humoral and cellular immune responses to mumps vaccination.

CONCLUSIONS. These data suggest the important role of HLA and immunoregulatory cytokine receptor gene polymorphisms in explaining variations in mumps vaccine–induced immune responses.
Adolescent Use of Insulin and Patient-Controlled Analgesia Pump Technology: A 10-Year Food and Drug Administration Retrospective Study of Adverse Events
Authors: Cope Judith U. , Morrison Audrey E. , Samuels-Reid Joy
Published: May 2008

OBJECTIVES. From January 1, 2005, through December 31, 2005, the Food and Drug Administration received 5 adolescent death reports associated with the use of insulin pumps, raising concerns about use of this device in this age group. To understand better the types of infusion pump–related problems in adolescents, we performed a comprehensive evaluation of insulin and patient-controlled analgesic pump–related adverse events reported for adolescents that were received by the Food and Drug Administration from 1996 to 2005.

METHODS. A search for medical device adverse event reports from January 1, 1996 through December 31, 2005, involving insulin pumps or patient-controlled analgesic pumps used by patients who were aged 12 to 21 years was conducted in the Food and Drug Administration's Manufacturer and User Facility Device Experience Database. Reports were reviewed for demographic characteristics, type of adverse event, and patient morbidity, and potential contributory factors were classified from narratives in the reports.

RESULTS. A total of 1674 reports were identified: 1594 for insulin pumps and 53 for patient-controlled analgesic pumps. In reports of insulin pump events, there were 13 reported deaths, 2 reports that indicated possible suicide attempts, and several additional reports indicating severe hypoglycemic or hyperglycemic events that seemed to be device-related. A total of 102 (6.4%) insulin-pump reports highlighted factors that may have contributed to the adverse event, including problems associated with compliance, education, sports-related activities, and dropping or damaging the pump. Eighty-two percent of cases involving the insulin pump resulted in hospitalization. Half of the reports involving patient-controlled analgesic pumps indicated that the patient received an excess of medication; tampering and noncompliance were evident in some cases.

CONCLUSIONS. Adolescents are a special population who deserve careful consideration of risk and benefit for use of device technology. Studies need to further identify safety problems in this age group.
Association of Functional Limitation With Health Care Needs and Experiences of Children With Special Health Care Needs
Authors: Nageswaran Savithri , Silver Ellen Johnson , Stein Ruth E. K.
Published: May 2008

OBJECTIVE. The goal was to evaluate whether having a functional limitation was associated with health care needs and experiences of children with special health care needs.

METHODS. We used caregivers' responses in the National Survey of Children with Special Health Care Needs (2001). Functional limitation was categorized as severe, some, or no limitation. We performed analyses of the relationships of functional limitation to measures of health care needs and experiences.

RESULTS. Children with special health care needs with severe functional limitation were more likely to have received specialized educational services, to have had physician visits, and to have needed health services, compared with those with no limitation. They had significantly greater odds of delayed care, unmet health care and care-coordination needs, referral problems, dissatisfaction, and difficulty using health services, compared with those without limitation. Caregivers of children with special health care needs with severe limitation were twice as likely as those with no limitation to report that providers did not spend enough time, listen carefully, provide needed information, and make family members partners in the child's care. Compared with children with special health care needs without limitation, those with severe limitation had worse health insurance experiences, in terms of insurance coverage, copayments, being able to see needed providers, and problems with health insurance. The impact on families (financial problems, need to provide home care, or need to stop or to cut work) of children with special health care needs with severe functional limitation was much greater than the impact on families of children with special health care needs without limitation. For most measures examined, results for some limitation were between those for severe limitation and no limitation.

CONCLUSIONS. Functional limitation is significantly associated with the health care needs and experiences of children with special health care needs.
Cost-effectiveness of Competing Strategies for the Treatment of Pediatric Empyema
Authors: Cohen Eyal , Weinstein Michael , Fisman David N.
Published: May 2008

BACKGROUND. The optimal management of pediatric empyema is controversial. The purpose of this decision analysis was to assess the relative merits in terms of costs and clinical outcomes associated with competing treatment strategies.

METHODS. A cost-effectiveness analysis was conducted using a Bayesian tree approach. Probability and outcome estimates were derived from the published literature, with preference given to data derived from randomized trials. Costing was based on published estimates from Great Ormond Street Hospital (London, United Kingdom), supplemented by American and Canadian data. Five strategies were evaluated: (1) nonoperative; (2) chest tube insertion; (3) repeated thoracentesis; (4) chest tube insertion with instillation of fibrinolytics; or (5) video-assisted thorascopic surgery. The model was used to project overall costs, survival in life-years, and incremental cost-effectiveness ratios for competing strategies.

RESULTS. In the base-case analysis, chest tube with instillation of fibrinolytics was the least expensive therapy, at $7787 per episode. This strategy was projected to cost less but provide equivalent health benefit when compared with all of the competing strategies except repeated thoracentesis, which had an incremental cost-effectiveness ratio of approximately $6 422 699 per life-year gained relative to chest tube with instillation of fibrinolytics. In univariable and multivariable sensitivity analyses, thorascopic surgery was preferred only when the length of stay associated with chest tube with instillation of fibrinolytics exceeded 10.3 days or when the probability of dying as a result of this strategy exceeded 0.2%, assuming a threshold willingness to pay of $75 000 per life-year gained. Chest tube with instillation of fibrinolytics was preferred in >58% of Monte Carlo simulations.

CONCLUSIONS. On the basis of the best available data, chest tube with instillation of fibrinolytics is the most cost-effective strategy for treating pediatric empyema. Video-assisted thorascopic surgery would be preferred to chest tube with instillation of fibrinolytics if the differential in length of stay between these 2 strategies were proven to be greater than that suggested by currently available data.
Absence of an Increase in Cardiorespiratory Events After Diphtheria-Tetanus-Acellular Pertussis Immunization in Preterm Infants: A Randomized, Multicenter Study
Authors: Carbone Tracy , McEntire Betty , Kissin Dmitry , Kelly Dorothy , Steinschneider Alfred , Violaris Kimon , Karamchandani Nilima
Published: May 2008

OBJECTIVE. The American Academy of Pediatrics recommends immunization of preterm infants at 2 months' chronological age with diphtheria-tetanus-acellular pertussis vaccine, regardless of birth weight and gestational age. Several investigators have reported an increased incidence of cardiorespiratory events in preterm infants after immunization. Consequently, many primary care providers do not adhere to American Academy of Pediatrics guidelines. The purpose of this study was to reexamine the relationship between diphtheria-tetanus-acellular pertussis and cardiorespiratory events in preterm infants by using a random control study design and an objective assessment of cardiorespiratory events.

METHODS. Ten hospitals enrolled 191 infants who were born at <37 weeks' gestational age at 56 to 60 days' chronological age. Infants were randomly assigned to a group that received diphtheria-tetanus-acellular pertussis immunization (n = 93) or a control group that did not (n = 98). Recording monitors were used continuously during the next 48 hours to document prolonged apnea and prolonged bradycardia. The presence and number of episodes during the 48-hour period were compared between groups by using χ2 and t tests.

RESULTS. In the diphtheria-tetanus-acellular pertussis group, 16.1% experienced at least 1 episode of prolonged apnea compared with 20.4% of control infants. One or more prolonged bradycardia events occurred in 58.1% of immunized infants and 56.1% of the control infants. The frequency of episodes was not significantly different between groups. The immunization group and the control group each had an average of 0.5 episodes of prolonged apnea. The mean number of prolonged bradycardia episodes was 2.6 in the immunization group and 2.7 in the control group.

CONCLUSIONS. Preterm infants who received diphtheria-tetanus-acellular pertussis at 2 months after birth were no more likely to experience prolonged apnea and bradycardia than were control infants. This study supports the American Academy of Pediatrics recommendation regarding diphtheria-tetanus-acellular pertussis immunization at 2 months of age for preterm infants.
Healthy Children With Frequent Fractures: How Much Evaluation Is Needed?
Authors: Olney Robert C. , Mazur John M. , Pike Leah M. , Froyen Melanie K. , Ramirez-Garnica Gabriela , Loveless Eric A. , Mandel David M. , Hahn G. Alan , Neal Kevin M. , Cummings R. Jay
Published: May 2008

OBJECTIVE. We performed a case-control study to determine whether occult bone disease is associated with a history of frequent fractures in children.

METHODS. Healthy children with ≥2 incidences of low-energy fractures were recruited (n = 68). Children with no history of fractures served as control subjects (n = 57). Food logs, activity surveys, physical examinations, laboratory tests, and dual-energy radiographic absorptiometry were used.

RESULTS. Bone mineral density z scores were significantly reduced in case subjects, compared with control subjects. Three case subjects (4.3%) and 1 control subject (1.8%) had bone mineral density z scores below the expected range. Of those 4 subjects, 2 had dairy avoidance and 2 had delayed puberty. An additional case subject had evidence of vitamin D deficiency. A significant number of subjects (20% of case subjects and 23% of control subjects) had idiopathic hypercalcuria, based on 24-hour urine collections. Among the case subjects, bone mineral density z scores were significantly lower for those with idiopathic hypercalcuria. Among the control subjects, the presence of idiopathic hypercalcuria did not affect bone mineral density. The case subjects with idiopathic hypercalcuria accounted for virtually all of the differences in bone mineral density between the case and control groups. Analysis of parathyroid hormone and 1,25-dihydroxy-vitamin D levels showed that children with frequent fractures and hypercalcuria had renal hypercalcuria, whereas children with no fractures and hypercalcuria had absorptive hypercalcuria.

CONCLUSIONS. We identified a significant association between a history of frequent fractures and hypercalcuria in children. We propose that the appropriate screening evaluation for children who present with a history of frequent fractures consists of a dietary history targeted at calcium and vitamin D intakes, a physical examination to assess for pubertal delay, and urinary calcium concentration/creatinine ratio determination to assess for hypercalcuria. Children with abnormalities in this screening should undergo dual-energy radiographic absorptiometry and appropriate evaluation.
Improving Transition From Pediatric to Adult Cystic Fibrosis Care: Lessons From a National Survey of Current Practices
Authors: McLaughlin Suzanne Elizabeth , Diener-West Marie , Indurkhya Alka , Rubin Haya , Heckmann Rebekah , Boyle Michael Patrick
Published: May 2008

OBJECTIVES. More than 500000 adolescents with special health care needs age into adulthood each year in the United States, and there is growing recognition of the need for support of their transition to adult-oriented health care. Because of improved survival, cystic fibrosis has experienced this increasing transition need, and cystic fibrosis policy leaders responded by mandating the transition of adults with cystic fibrosis to adult-focused cystic fibrosis care programs by 2000. The primary objective of this study was to characterize in detail recent transition practices at US cystic fibrosis programs, to identify areas for improvement and to serve as a model for other diseases. A secondary objective of this study was to develop and validate a survey for formal assessment of transition practices.

METHODS. A 105-question survey on key aspects of transition was administered to cystic fibrosis care team members from all 195 US Cystic Fibrosis Care programs. Rates of adherence to recommended components of transition care were measured.

RESULTS. A total of 448 surveys were obtained from 170 (87%) of 195 cystic fibrosis programs. Although transfer of care occurs at a median age of 19 years, initial discussion of transition does not occur until a median age of 17 years, limiting time to foster self-care skills. Only half of programs consistently perform a transition readiness assessment, 28% of centers offer visits focused on transition, and <10% have a written list of desirable self-management skills.

CONCLUSIONS. There is significant variability in transition support provided to young adults with cystic fibrosis, but there are simple steps that may lead to more consistent delivery of transition services. Methods of assessment and lessons learned from transitioning young adults at US cystic fibrosis programs may serve to improve transition for individuals with other childhood diseases.
Comparison of Two Approaches to Observation Therapy for Acute Otitis Media in the Emergency Department
Authors: Chao Jennifer H. , Kunkov Sergey , Reyes Lilia B. , Lichten Stephanie , Crain Ellen F.
Published: May 2008

OBJECTIVE. This study compared parental adherence to delayed antibiotic therapy for acute otitis media with and without a written prescription in a pediatric emergency department.

PATIENTS AND METHODS. Children aged 2 to 12 years who met criteria for delayed antibiotic treatment were randomly assigned to observation therapy with or without a prescription. Patients randomly assigned to observation therapy without prescription were instructed to seek follow-up care if symptoms persisted for 2 to 3 days. Patients assigned to observation therapy with a prescription were discharged with an antibiotic prescription, and instructed to fill it if their child's symptoms persisted 2 to 3 days. A research assistant who was blinded to group assignment called parents 7 to 10 days after the visit to assess adherence to observation therapy.

RESULTS. Of 117 children assigned to the observation therapy group, 100 completed follow-up; of 115 assigned to the observation therapy with a prescription group, 106 completed follow-up. In the observation therapy group, 87 parents reported no antibiotic use within the 3-day observation period compared with 66 parents in the prescription group. During the entire study period, 81% of the observation therapy group reported no use of antibiotics compared with 53% in the prescription group. These groups did not differ in satisfaction with the visit; 91% and 95% were very or extremely satisfied, respectively. No complications were reported.

CONCLUSIONS. Observation therapy with and without a prescription were both well accepted by parents of children diagnosed with acute otitis media in an urban pediatric emergency department. Adherence to delayed antibiotic therapy was better for those not offered a prescription. These data suggest that, in the pediatric emergency department setting, observation therapy reduces antibiotic use without compromising satisfaction with the visit.
Promoting the Participation of Children With Disabilities in Sports, Recreation, and Physical Activities
Authors: Murphy Nancy A. , Carbone Paul S. ,   and the Council on Children With Disabilities
Published: May 2008

The benefits of physical activity are universal for all children, including those with disabilities. The participation of children with disabilities in sports and recreational activities promotes inclusion, minimizes deconditioning, optimizes physical functioning, and enhances overall well-being. Despite these benefits, children with disabilities are more restricted in their participation, have lower levels of fitness, and have higher levels of obesity than their peers without disabilities. Pediatricians and parents may overestimate the risks or overlook the benefits of physical activity in children with disabilities. Well-informed decisions regarding each child's participation must consider overall health status, individual activity preferences, safety precautions, and availability of appropriate programs and equipment. Health supervision visits afford pediatricians, children with disabilities, and parents opportunities to collaboratively generate goal-directed activity “prescriptions.” Child, family, financial, and societal barriers to participation need to be directly identified and addressed in the context of local, state, and federal laws. The goal is inclusion for all children with disabilities in appropriate activities. This clinical report discusses the importance of physical activity, recreation, and sports participation for children with disabilities and offers practical suggestions to pediatric health care professionals for the promotion of participation.