bluuebunny/crossref_metadata_2025 huggingface dataset:
Variables That Influence Collaboration Between Parents and Service Coordinators
Authors: DINNEBEIL LAURIE A. , RULE SARAH
Published: December 2008

Within the field of early intervention, collaboration between professionals and parents is highly valued (Zipper, Weil, & Rounds, 1991). Although practitioners have emphasized the importance of building partnerships with parents, little is known about the variables that affect partnership strength. The purpose of this investigation was to explore variables that either enhance or detract from successful partnerships. Using structured interviews, we found a number of characteristics and behaviors of parents and service coordinators that each group perceived as productive or unproductive. We also asked five experts to describe variables that either enhance or detract from collaboration. The results of this research have strong implications for early intervention practitioners and point to a need for validation of these results with a larger sample.
The Role of Directives in Early Language Intervention
Authors: McCATHREN REBECCA B. , YODER PAUL J. , WARREN STEVEN F.
Published: December 2008

The purpose of this paper is to discuss the appropriate role for directives in language intervention. Three types of directives are defined: follow-in, redirectives, and introductions. Two conceptual models for the role of directives in language development are then presented. The research supports the hypothesis that follow-in directives facilitate language development and can play a useful role in intervention. Redirectives are either negatively or nonsignificantly associated with language development and have a less useful role in language intervention. The role of introductions is less clear, and more research needs to be done. Finally, 3 issues, the possible covariation of directiveness and responsiveness, cultural differences in the use of directives, and a useful role for redirectives separate from language development, are discussed.
Parent-Professional Congruence
Authors: SUEN HOI K. , LOGAN CANDICE R. , NEISWORTH JOHN T. , BAGNATO STEPHEN
Published: December 2008

Considerable attention has been given to the issue of parent-professional congruence, specifically in connection with reliability of assessments. Concerns regarding the trustworthiness of parental assessments have guided research to focus on the conventional issues of interrater reliability and rater interchangeability. However, this conventional perspective may be misdirected and counterproductive. It is argued that the focus should be the reliability of the pooled assessment information from parents and professionals. A more appropriate generalizability theoretic model, which would maximize social, ecological, and construct validity, is proposed. An illustration with data from an early childhood assessment system is provided.
Parents as Co-Instructors in Preservice Training
Authors: McBRIDE SUSAN L. , SHARP LISA , HAINS ANN HIGGINS , WHITEHEAD AMY
Published: December 2008

The joint participation of family members and faculty in training activities has been an effective strategy for assisting both faculty and students in gaining knowledge and skills for implementation of family-centered practice. This article describes faculty-parent co-instruction in preservice settings. Coals for co-instruction and implementation issues such as recruitment and selection of parents, preparation for co-instruction roles, student evaluation in co-instruction settings, supports for parents and faculty in co-instruction roles and diversity issues are addressed. The experiences of several co-instruction teams are described as well as the benefits and challenges of this approach for teaching about family-centered practice.
The Generalized Effects of Training Trainers to Teach Parents to Implement Milieu Teaching
Authors: HESTER PEGGY P. , KAISER ANN P. , ALPERT CATHY L. , WHITEMAN BARBARA
Published: December 2008

This study examined the effects of training 3 individuals to teach parents of preschool children with disabilities to implement milieu language teaching. In a multiple baseline design across trainers and families, 4 key strategies for effective parent training were taught. The systematic apprenticeship-type training increased the frequency and correctness with which the trainers used the parent-training strategies. Trainer generalization was evaluated with 3 additional families in a second multiple baseline. All trainers generalized the parent-training skills to a 2nd family. When parent-training was implemented effectively by the trainers, all 6 parents acquired the targeted milieu language teaching skills and generalized their use to home. All 6 children increased their use of target language skills in training sessions and showed modest changes in communication at home.
Preschool Language Facilitation Methods and Child Characteristics
Authors: COLE KEVIN N. , MILLS PAULETTE E. , DALE PHILIP S. , JENKINS JOSEPH R.
Published: December 2008

This paper reports the results of 2 studies in which the relative effectiveness of classroom based language intervention models were examined. In the 1st study, a developmentally based language facilitation program was compared to a direct language facilitation program in integrated preschool classrooms for young children with developmental delays. In the 2nd study, the developmentally based model was compared to a program using both the developmental and direct methods during discrete time periods throughout the day. Results of both studies indicated that no program was better overall. Disordinal Aptitude x Treatment Interactions indicated that children benefited differentially from the interventions. The differential effects of intervention could be predicted by the child's language ability before intervention.
Social-Emotional Assessment in Early Childhood
Authors: MERRELL KENNETH W.
Published: December 2008

The Preschool and Kindergarten Behavior Scales (RKBS) was developed to address the lack of psychometrically sound behavioral assessment instruments available for use with the early childhood/preschool population and because of the desirability of assessing both social skills and problem behaviors with a single measure. The PKBS was standardized with a diverse sample of 2,855 child ratings. Factor analyses indicate the presence of a stable factor structure for both scales. Reliability studies indicate the PKBS has adequate to strong stability. Explorations of within-scale relationships yielded evidence of content validity as well as 2 forms of construct validity. The PKBS appears to be a psychometrically sound and clinically relevant instrument for screening and assessing social skills and social-emotional problems of young children.
Factors Associated With Perceived Control Appraisals in a Family-Centered Early Intervention Program
Authors: TRIVETTE CAROL M. , DUNST CARL J. , HAMBY DEBORAH W.
Published: December 2008

Findings from 2 studies investigating sources of variations in perceived control appraisals of parents involved in a family-centered early intervention/family support program are described. Results indicated that parent, family, and child characteristics were not related to differences in control appraisals. Practitioner help-giving styles and, to a lesser extent, staff disciplines were the only factors associated with the degree to which participants indicated they had control over needed services, resources, and supports. Implications for improving family-centered practices are described.
VALUING DIVERSITY
Authors: WASHINGTON VALORA
Published: December 2008

This keynote address was presented at the International Division for Early Childhood Conference on Children With Special Needs in Orlando, Florida, on November 2, 1995.
Assessing the Comfort Zone of Child Care Teachers in Serving Young Children With Disabilities
Authors: BUYSSE VIRGINIA , WESLEY PATRICIA , KEYES LYNETTE , BAILEY DONALD B.
Published: December 2008

This study employed 2 methods to assess the attitudes of 52 general early childhood teachers serving young children with disabilities in inclusive early childhood settings. The first consisted of a structured interview using an index of functional child characteristics to assess professional comfort in serving an individual child. The second consisted of a rating scale to assess global attitudes toward the benefits and drawbacks of inclusion. Findings indicated significant differences in teachers' comfort levels as a function of severity of the child's disability across all domains. Predicted comfort scores were lowest when the child was reported to have severe to profound disabilities in the areas of leg functioning, muscle tone, and appropriate behavior.
The Evolution of a Personnel Preparation Program
Authors: CAPONE ANGELA M. , DIVENERE NANCY
Published: December 2008

The family-centered approach represents a dramatic departure from traditional child-centered early intervention efforts and requires service providers to adjust services to respond to family-identified priorities, rather than asking families to adjust to system policies and practices (Raver & Kilgo, 1991). To meet the need for early interventionists prepared to work in partnership with families, the Early Childhood Special Education graduate program at the University of Vermont established a partnership with Parent to Parent of Vermont. This partnership set a context for the preparation of family-centered practitioners by modeling the qualities of a collaborative relationship between families and professionals and developing a family-centered model for personnel preparation.
What's Natural About Naturalistic Language Intervention?
Authors: HEPTING NANCY H. , GOLDSTEIN HOWARD
Published: December 2008

This review sought to identify the characteristics of child language intervention approaches described as "naturalistic" in the research literature. Thirty-four interventions were analyzed. We identified an exhaustive list of the treatment techniques or components that were included in at least 8 of the studies. Each intervention was analyzed according to the inclusion of 8 teaching techniques that manipulated antecedent stimuli and 3 techniques that manipulated consequences. Results demonstrated that naturalistic language interventions varied considerably in the teaching techniques included. A continuum highlighting the degree to which interventions included adult-directed and child-directed strategies is presented. In addition, ratings of naturalness of intervention contexts were derived. These analyses revealed an apparent lack of agreement on what constitutes "naturalistic" language intervention.
On the Edge of Change?
Authors: Lazar Irving
Published: December 2008

This is the first of two invited reviews of Guralnick, M. (Ed.) (1997). The effectiveness of early intervention. Baltimore, MD: Paul H. Brookes Publishing.
We Make a Difference: No Nobel Prizes Though
Authors: Gallagher James J.
Published: December 2008

This is the second of two invited reviews of Guralnick, M. (Ed.) (1997). The effectiveness of early intervention. Baltimore, MD: Paul H. Brookes Publishing Co.
Emergent Literacy and Intellectual Disabilities
Authors: SAINT-LAURENT LISE , GIASSON JOCELYNE , COUTURE CAROLE
Published: December 2008

The purpose of this study was to evaluate the impact of a home-based emergent literacy program for children with intellectual disabilities. Twenty preschool children equally distributed between an experimental and comparison group participated in the study. Children were given a pretest and a posttest 8 months later. Assessment of children's progress included measurement of emergent literacy knowledge, abilities and attitudes. Results show that the only item for which children in the experimental group had higher scores was pretend reading. Treatment effect is modest but promising considering the population studied. Benefits of the program are also discussed. Emergent literacy behaviors in the children in the study are compared with those reported for nondisabled students.
The Nature and Meaning of Social Integration for Young Children With Mild Developmental Delays in Inclusive Settings
Authors: GURALNICK MICHAEL J.
Published: December 2008

This paper examines fundamental conceptual, methodological, and outcome issues with respect to the social integration of preschool-age children with mild developmental delays in inclusive early childhood settings. Cast within a developmental-ecological framework, social integration is evaluated in terms of three constructs: (1) the connectedness of peer interactions; (2) the quality of interpersonal relationships; and (3) the nature of adjustments that occur during social exchanges. A general model of factors that influence social integration and their interrelationships is presented as a means of organizing future intervention activities to promote social integration.
Promoting Children's Conversations During Play With Adult Prompts
Authors: FILLA ANNELEISA , WOLERY MARK , ANTHONY LESLIE
Published: December 2008

Two interventions (environmental modification and adult prompting) were evaluated for promoting conversations between preschoolers with and without disabilities. Nine children (3 with and 6 without disabilities) participated. A multiple baseline design was used with three conditions: classroom baseline, theme boxes with restricted space and partners, and system of least prompts. The rates of conversations and the number of turns per conversation did not increase for all children with disabilities when they played with theme boxes with restricted space and partners. Use of the system of least prompts produced increases in their rates of conversations, the number of turns per conversation, and the rate but not percent of initiations without responses. Implications for future research and practice are discussed.
Maternal Responsivity Mediates the Relationship Between Prelinguistic Intentional Communication and Later Language
Authors: YODER PAUL J. , WARREN STEVEN F.
Published: December 2008

Intentional communication may be related to later language development, in part, because intentional communication is a relatively clear communicative cue, which may elicit language-facilitating maternal responses. As a first step in testing this model, this study was conducted to determine whether the relationship between early intentional communication and later language is in part due to covariation with maternal responsivity. The participants were 58 children with developmental disabilities in the prelinguistic period of development and their mothers. Children's intentional prelinguistic communication, mothers' responses, and children's language were measured at entry into the study, 6 months later, and 12 months later, respectively. The results support the model that the relationship between intentional communication and later language was, in part, due to the covarying relationship with maternal responsivity. Implications for future research are discussed.
Effects of Group Composition, Materials, and Developmental Level on Play in Preschool Children With Disabilities
Authors: McCABE JOAN ROTH , JENKINS JOSEPH R. , MILLS PAULETTE E. , DALE PHILIP S. , COLE KEVIN N.
Published: December 2008

This study examined the effects of play group composition (segregated or integrated) and category of play materials (functional, constructive, or dramatic) on the cognitive level of play, and the relation of level of play to developmental level and language use. Participants were 24 preschool children with developmental disabilities, half assigned randomly to play groups with other children with disabilities (segregated) and half to groups with typically developing peers (integrated). All groups played on separate occasions with each category of materials. Videotaped sessions were transcribed and coded for cognitive level of play. There were no effects for play group composition, but category of play materials, and individual toys within each category, significantly influenced the type of play. Further, the percent children engaged in each level of play, summed across category of materials, was significantly related to measures of cognitive development. In addition, number of different words spoken during play was related to the amount of dramatic play in which children engaged when developmental level was controlled.
On the Forms of Inclusion
Authors: ODOM SAMUEL L. , HORN EVA M. , MARQUART JULES M. , HANSON MARCI J. , WOLFBERG PAMELA , BECKMAN PAULA , LIEBER JOAN , LI SHOUMING , SCHWARTZ ILENE , JANKO SUSAN , SANDALL Susan
Published: December 2008

This paper describes multiple forms of inclusion for preschool children with and without disabilities. Researchers used a range of qualitative and quantitative methods to create case studies and summaries of 16 inclusive programs from 4 regional locations in the U.S. These programs varied on the 2 dimensions of organizational context and individualized service delivery models. Organizational contexts included community-based child care, Head Start, 3 public school contexts, and dual enrollment. The individualized service models that programs followed were itinerant-direct service, itinerant-collaborative consultative, team teaching, early childhood, early childhood special education, and integrative or inclusive activities.
Collaborative Investigation of Inclusive Early Education Practices
Authors: GETTINGER MARIBETH , STOIBER KAREN CALLAN , LANGE JENNY
Published: December 2008

This paper describes the rationale, development, and first-year implementation of Wisconsin's Preschool Action Research and Development Initiative (PARDI) which evolved from a desire to enhance the utility of research on early childhood inclusion through collaboration between teachers and researchers. PARDI is a school-university partnership that creates opportunities for researchers and teachers to work collaboratively while examining issues related to early childhood inclusion. Specifically, 38 teachers from 22 inclusive early childhood classrooms in Wisconsin participated in 2 collaborative research activities: (a) systematic recording and analysis of critical incidents (CIs); and, (b) quarterly meetings for analysis of CIs by researchers and teachers. In addition to describing PARDI's collaborative research model and methodology, this paper presents preliminary findings concerning the impact of PARDI on teachers' thinking and classroom practices.
Effects of First Aid Training Using Small Group Instruction With Young Children With Disabilities
Authors: TIMKO TAMARA C. , SAINATO DIANE M.
Published: December 2008

Nine children, ages 41 to 69 months, participated in this study examining the effects of a first aid training procedure on the acquisition, maintenance and generalization of seeking adult assistance in response to simulated injuries. A multiple baseline probe design across children was used to measure number of response steps completed correctly, duration of responding, and obtaining adult assistance. First aid training was conducted in triads consisting of one target learner and two non-target group learners. Generalization probes were conducted in the school gym and school playground. Results indicate all participants were successful in acquiring the response and obtaining adult assistance as well as responding quickly, completing the response within 1 minute. Findings extend previous research by demonstrating the effectiveness of incorporating generalization strategies into training and the use of small group instruction for first aid training with young children with disabilities.
Preventing Community-Associated Methicillin-Resistant Staphylococcus aureus Among Student Athletes
Authors: Many Patricia S.
Published: December 2008

Methicillin-resistant Staphylococcus aureus (MRSA) was once thought to be a bacterium causing infections in only hospitalized patients. However, a new strain of MRSA has emerged among healthy individuals who have not had any recent exposure to a hospital or to medical procedures. This new strain is known as community-associated MRSA. Studies have shown the rates of MRSA infection are increasing throughout the United States and that some populations are at greater risk of acquiring these infections. One population at greater risk is athletes. Educating student athletes, parents, coaches, and administrators about the seriousness of this infection and how to prevent and manage it in the school setting is an important role of the school nurse. The goal of this education is to prevent the spread of MRSA organisms, thereby reducing student absenteeism and the related costs of treating MRSA infections.
Qualitative Inquiry and the IRB
Authors: Leisey Monica
Published: December 2008

Implications of Institutional Review Board (IRB) decisions, especially for qualitative inquirers, may be that already marginalized voices continue to go unvoiced. Using a constructivist inquiry as a case study, this article examines IRB assessment of risk for interpretive qualitative research.
`Becoming Participant'
Authors: Renold Emma , Holland Sally , Ross Nicola J. , Hillman Alexandra
Published: December 2008

This article problematizes the slippery notion of `informed consent' and its negotiation in participatory longitudinal ethnographic research with children and young people. It does so within the context of new ethical bureaucracies (Boden et al., in press; Hammersley, 2006). Drawing upon an Economic and Social Research Council (ESRC) funded methodological research project exploring the everyday lives and identities of eight children and young people in care, the article reinvigorates the intersubjective, situated and negotiated approach to research ethics as ongoing dialogue in everyday fieldwork relations. We consider the concept of `becoming participant' to foreground the micro-ethical moments of complex and ambivalent engagements and disengagements within the research process. The notion of `becoming participant', we suggest, may provide a conceptual language of description to analyse the complex terrain of consent, as always-in-process and unfinished. Drawing upon episodes of recorded fieldwork relations, we apply this notion to explore what it means to undertake participatory research where consent is `iterative and uncertain . . . and open to revision and questioning' (Economic and Social Research Council [ESRC], 2005: 24). We do not aim to resolve this dilemma, but instead aim to invite and reinvite questioning of what it means to negotiate informed consent in participatory research with young people.
THE QUIETUS OF POLITICAL INTEREST
Authors: Griffiths Paul J.
Published: December 2008

Quietists aim to bring something to rest, to move it from activity to quiescence. This essay depicts and advocates a quietism of political interest, which is to say a divorce of political action from interest in the outcome of such action. Its principal interlocutor is Pascal, whose 1657 letter to Périer argues, on theological and epistemological grounds, for exactly such a separation. The essay argues that a quietism of political interest has several advantages over ordinary consequentialist political advocacy and action, the most important among which is that the former can acknowledge that in a complex political system we are ordinarily unable to predict the results of enacting what we advocate, while the latter must occlude that fact. Quietists of political interest must replace concern with outcome by something else as a motive or cause for political advocacy and action; and while there are many possibilities here, in the West the only lively form of such quietism has been Christian-theological, in which political advocacy and action are, ideal-typically and sometimes actually, undertaken under the threefold assumption that: (1) advocacy of a political proposal assumes that justice in the political sphere is not attainable but must nonetheless be sought; (2) advocacy of a political proposal assumes that while Christian advocates can act unjustly, they cannot suffer injustice; and (3) advocacy of a political proposal proceeds always without concern for the outcome.
LEBANON II
Authors: Isaacs Alick
Published: December 2008

This memoir is a detailed and reflective (though highly subjective) account of the author's experiences in the summer of 2006. Starting with the outbreak of the Second Lebanese War, it moves on to describe his call-up and conscription, border service at the IDF outpost in Metulla and participation in the combat inside southern Lebanon. The narrative follows the progress of an infantry unit from its point of entry on the Israel-Lebanese border, through the villages of Raj-A-Min, Sham'a and on to the coastal position it held until the end of the war at Ras-Bayada. The memoir draws particular attention to the paradoxes and ironies of the war from the point of view of a civilian reserve foot soldier and father of five serving in a frontline infantry unit. Significant sections of this narrative are dedicated to the moral, ethical, and religious questions that he grappled with during the war and to the intuitive political and religious conclusions that he reached. It is these intuitions that he refers to at the end “as the rethinking of his religion” that ultimately develops into the suggestion that a softer and more peaceful notion of theology is essential to the acquisition of peace.
Alendronate Treatment of the Brtl Osteogenesis Imperfecta Mouse Improves Femoral Geometry and Load Response Before Fracture but Decreases Predicted Material Properties and Has Detrimental Effects on Osteoblasts and Bone Formation
Authors: Uveges Thomas E , Kozloff Kenneth M , Ty Jennifer M , Ledgard Felicia , Raggio Cathleen L , Gronowicz Gloria , Goldstein Steven A , Marini Joan C
Published: December 2008

Long courses of bisphosphonates are widely administered to children with osteogenesis imperfecta (OI), although bisphosphonates do not block mutant collagen secretion and may affect bone matrix composition or structure. The Brtl mouse has a glycine substitution in col1a1 and is ideal for modeling the effects of bisphosphonate in classical OI. We treated Brtl and wildtype mice with alendronate (Aln; 0.219 mg/kg/wk, SC) for 6 or 12 wk and compared treated and untreated femora of both genotypes. Mutant and wildtype bone had similar responses to Aln treatment. Femoral areal BMD and cortical volumetric BMD increased significantly after 12 wk, but femoral length and growth curves were unaltered. Aln improved Brtl diaphyseal cortical thickness and trabecular number after 6 wk and cross-sectional shape after 12 wk. Mechanically, Aln significantly increased stiffness in wildtype femora and load to fracture in both genotypes after 12 wk. However, predicted material strength and elastic modulus were negatively impacted by 12 wk of Aln in both genotypes, and metaphyseal remnants of mineralized cartilage also increased. Brtl femoral brittleness was unimproved. Brtl osteoclast and osteoblast surface were unchanged by treatment. However, decreased mineral apposition rate and bone formation rate/bone surface and the flattened morphology of Brtl osteoblasts suggested that Aln impaired osteoblast function and matrix synthesis. We conclude that Aln treatment improves Brtl femoral geometry and load to fracture but decreases bone matrix synthesis and predicted material modulus and strength, with striking retention of mineralized cartilage. Beneficial and detrimental changes appear concomitantly. Limiting cumulative bisphosphonate exposure of OI bone will minimize detrimental effects.
A Simple Risk Score for the Assessment of Absolute Fracture Risk in General Practice Based on Two Longitudinal Studies
Authors: Pluijm Saskia MF , Koes Bart , de Laet Chris , Van Schoor Natasja M , Kuchuk Natalia O , Rivadeneira Fernando , Mackenbach Johan P , Lips Paul , Pols Huibert A , Steyerberg Ewout W
Published: December 2008

The aim of this prospective study was to develop a risk score, based on putative risk factors in current guidelines, which can be used to identify women at high risk of fractures in general practice. The study sample included 4157 women ≥60 yr of age (mean ± SD: 74.1 ± 9.1 yr), with a median follow-up of 8.9 yr of the Rotterdam Study (ERGO), and 762 women ≥65 yr of age (mean ± SD: 76.0 ± 6.7.yr), with a median follow-up of 6.0 yr of the Longitudinal Aging Study Amsterdam (LASA). Potential risk factors were those proposed in risk scores of three recent guidelines on osteoporosis: age, family history of fractures, prior fracture, low body weight/body mass index (BMI), serious immobility, rheumatoid arthritis, current smoking, alcohol consumption >2 units daily, prevalent vertebral fracture, and systemic corticosteroid use. Five-year absolute risk of hip fracture was 3.9% in the Rotterdam Study and 3.1% in LASA, and 10-yr absolute risk of hip fracture was 8.4% in the Rotterdam Study. Using Cox regression analysis, age (70–79 and 80+ versus <60–69) and four other risk factors were included in the risk profiles of hip fractures and fragility fractures: any prior fracture after age 50, body weight <64 kg, use of a walking aid as a proxy measure of serious immobility, and current smoking. Estimated 10-yr absolute risk of hip fracture ranged from 1.4% in women, age 60–69 years, without any of these predictors to 29% in women, ≥80 yr of age, having two or more positive risk factors. A simple risk score can satisfactorily identify older women at high risk of osteoporotic fractures in general practice. Future studies are needed to validate this score.
Retreatment With Teriparatide One Year After the First Teriparatide Course in Patients on Continued Long-Term Alendronate
Authors: Cosman Felicia , Nieves Jeri W , Zion Marsha , Barbuto Nancy , Lindsay Robert
Published: December 2008

Patients treated with teriparatide after prior and ongoing alendronate therapy experience spine BMD increases; however, some continue to be at high risk for fracture, based on persistently low BMD and/or fracture history. The objective of this study was to determine whether a second discrete retreatment course with teriparatide could produce similar biochemical and BMD changes as seen during the first teriparatide course. In the original treatment study, 126 women on alendronate for ≥1 yr were randomized to continue alendronate and receive daily teriparatide, cyclic teriparatide (3-mo cycles), or alendronate alone for 15 mo. Of the 72 patients who completed either original teriparatide regimen, 49 completed a 12-mo follow-up on continued alendronate alone. At that time, 32 patients, who remained at high risk of future fracture, were recruited into the retreatment protocol and 27 completed another course of teriparatide administered daily for 15 mo (including 15 from the original daily treatment group and 12 from the original cyclic treatment group). Bone formation indices (propeptide of type I procollagen and osteocalcin) increased during both teriparatide courses with median 3-mo increments of 120% and 72% above baseline during the original course and 60% and 40% above baseline during retreatment, respectively. Mean spine BMD increments were 6.2% after the first daily course and 4.7% after retreatment and 4.1% after the first course of cyclic teriparatide and 4.9% after retreatment. We conclude that retreatment with teriparatide stimulates bone formation and increases spine BMD to a similar extent as seen during the original teriparatide course. Retreatment with teriparatide may be a viable option for some patients with severe osteoporosis who have received prior teriparatide therapy.
Increased Bone Resorption Is Associated With Higher Mortality in Community-Dwelling Men ≥50 Years of Age: The MINOS Study
Authors: Szulc Pawel , Maurice Christelle , Marchand François , Delmas Pierre D
Published: December 2008

Low BMD, high concentration of 17β-estradiol (17βE2), and decreased level of 25-droxycholecalciferol [25(OH)D] predict mortality. Our hypothesis is that high levels of biochemical bone turnover markers (BTMs) are independent predictors of mortality in home-dwelling men. In 781 men ≥50 yr of age followed up prospectively for 10 yr, we studied the association of BTMs with mortality after adjustment for confounders including BMD, major osteoporotic fractures, and concentrations of 17βE2 and 25(OH)D. Men who died had lower BMD and higher BTM levels. In multivariate models, mortality was higher in men with low BMD (lowest quartile) at the total hip, whole body, and ultradistal radius (HR = 1.49–1.70, p < 0.05). After exclusion of the first 3 yr, higher levels (fourth quartile) of bone resorption markers (free and total deoxypyridinoline and urinary and serum type I collagen C-telopeptide) predicted mortality in multivariate models adjusted for age, BMI, smoking habits, alcohol intake, physical performance and activity, comorbidities, total hip BMD, major osteoporotic fractures, creatinine clearance, season, and concentrations of 17βE2 and 25(OH)D (HR = 1.58–2.44, p < 0.05–0.001). In conclusion, in older community-dwelling men, increased bone resorption markers levels predicted mortality regardless of age and other confounders. Thus, in older men, high bone resorption may reflect poor current health status and poor aging.
Genetic Regulation of Bone Traits Is Influenced by Sex and Reciprocal Cross in F2 Progeny From GK and F344 Rats
Authors: Lagerholm Sofia , Li Luo-Sheng , Jiao Hong , Park Hee-Bok , Ohlsson Claes , Åkesson Kristina , Luthman Holger
Published: December 2008

A genome-wide linkage analysis to identify quantitative trait loci (QTLs) for bone phenotypes was performed in an F2 intercross of inbred spontaneously type 2 diabetic GK and normoglycemic F344 rats (108 males and 98 females). The aim of the study was to locate genome regions with candidate genes affecting trabecular and cortical bone and to investigate the effects of sex and reciprocal cross. pQCT was used to determine tibial bone phenotypes in the F2 rats, comprising reciprocal crosses with divergent mitochondrial (mt) DNA. Sex and reciprocal cross-separated QTL analyses were performed followed by assessment of specific interactions. Four genome-wide significant QTLs linked to either cortical vBMD, tibia length, body length, or metaphyseal area were identified in males on chromosomes (chr) 1, 8, and 15. In females, three significant QTLs linked to cortical BMC or metaphyseal total vBMD were identified on chr 1 and 2. Several additional suggestive loci for trabecular and cortical traits were detected in both males and females. Four female-specific QTLs on chr 2, 3, 5, and 10 and four reciprocal cross-specific QTLs on chr 1, 10, and 18 were identified, suggesting that both sex and mt genotype influence the expression of bone phenotypes.
Vertebral Fracture Risk Is Reduced in Women Who Lose Femoral Neck BMD With Teriparatide Treatment
Authors: Watts Nelson B , Miller Paul D , Kohlmeier Lynn A , Sebba Anthony , Chen Peiqi , Wong Mayme , Krohn Kelly
Published: December 2008

Response to osteoporosis therapy is often assessed by serial BMD testing. Patients who lose BMD without secondary causes of bone loss may be considered to be “nonresponders” to treatment. We examined vertebral fracture (VF) risk, change in lumbar spine (LS) BMD, and change in amino-terminal extension peptide of procollagen type I (PINP) in postmenopausal women whose femoral neck (FN) BMD decreased, increased, or was unchanged after receiving teriparatide (TPTD) or placebo (PL) in the Fracture Prevention Trial. FN and LS BMD were measured at baseline and 12 mo. VFs were assessed by lateral spine radiographs at baseline and study endpoint. A BMD change from baseline of >4% was considered to be clinically significant. Decreases of >4% FN BMD were less common in women receiving TPTD (10%) versus PL (16%, p < 0.05), yet women on TPTD who lost FN BMD still had significant reductions in VF risk compared with PL (RR = 0.11; 95% CI = 0.03–0.45). VF risk reduction with TPTD compared with PL was similar across categories of FN BMD change from baseline at 12 mo (loss >4%, loss 0–4%, gain 0–4%, or gain >4%; interaction p = 0.40). Irrespective of FN BMD loss or gain, TPTD-treated women had statistically significant increases in LS BMD and PINP compared with PL. In both groups, losses or gains in FN BMD at 12 mo corresponded to losses or gains in BMC rather than changes in bone area. In conclusion, loss of FN BMD at 12 mo in postmenopausal women with osteoporosis treated with TPTD is nevertheless consistent with a good treatment response in terms of VF risk reduction.
Restoration of Bone Mass and Strength in Glucocorticoid-Treated Mice by Systemic Transplantation of CXCR4 and Cbfa-1 Co-Expressing Mesenchymal Stem Cells
Authors: Lien Chun-Yang , Chih-Yuan Ho Kevin , Lee Oscar K , Blunn Gordon W , Su Yeu
Published: December 2008

Transplantation of gene-modified mesenchymal stem cells (MSCs) in animals for bone regeneration therapy has been evaluated extensively in recent years. However, increased endosteal bone formation by intravenous injection of MSCs ectopically expressing a foreign gene has not yet been shown. Aside from the clearance by lung and other tissues, the surface compositions of MSCs may not favor their bone marrow (BM) migration and engraftment. To overcome these hurdles, a gene encoding the chemokine receptor largely responsible for stromal-derived factor-1 (SDF-1)-mediated BM homing and engraftment of hematopoietic stem cells (HSCs), CXCR4, was transduced into mouse C3H10T1/2 cells by adenovirus infection. A dose-dependent increase of CXCR4 surface expression with a parallel enhanced chemotaxis toward SDF-1 in these cells after virus infection was clearly observed. Higher BM retention and homing of CXCR4-expressing MSCs were also found after they were transplanted by intramedullary and tail vein injections, respectively, into immunocompetent C3H/HeN mice. Interestingly, a full recovery of bone mass and a partial restoration of bone formation in glucocorticoid-induced osteoporotic mice were observed 4 wk after a single intravenous infusion of one million CXCR4-expressing C3H10T1/2 cells. In the meantime, complete recovery of bone stiffness and strength in these animals was consistently detected only after a systemic transplantation of CXCR4 and Cbfa-1 co-transduced MSCs. To our knowledge, this is the first report to show unequivocally the feasibility of ameliorating glucocorticoid-induced osteoporosis by systemic transplantation of genetically manipulated MSCs.
Genome-Wide Haplotype Association Mapping in Mice Identifies a Genetic Variant in CER1 Associated With BMD and Fracture in Southern Chinese Women
Authors: Tang Paul LF , Cheung Ching-Lung , Sham Pak C , McClurg Philip , Lee Bob , Chan Shut-Yan , Smith David K , Tanner Julian A , Su Andrew I , Cheah Kathryn SE , Kung Annie WC , Song You-Qiang
Published: December 2008

BMD is a heritable trait and risk indicator for osteoporosis. In this study, we used a genome-wide haplotype association mapping (HAM) approach to identify a haplotype block within Cer1 that partitions inbred mice strains into high and low BMD groups. A cohort of 1083 high and low BMD human subjects were studied, and a nonsynonymous SNP (rs3747532) in human CER1 was identified to be associated with increased risk of both low BMD in premenopausal women (OR: 2.2; 95% CI: 1.0–4.6; p < 0.05) and increased risk of vertebral fractures (OR: 1.82, p = 0.025) in the postmenopausal cohort. We also showed that Cer1 is expressed in mouse bone and growth plate by RT-PCR, immunohistochemistry, and in situ hybridization, consistent with polymorphisms potentially influencing BMD. Our successful identification of an association with CER1 in humans together with our mouse study suggests that CER1 may play a role in the development of bone or its metabolism. Our study highlights the use of publicly available databases for rapidly surveying the genome for quantitative trait loci.
Impact of Fundoplication Versus Gastrojejunal Feeding Tubes on Mortality and in Preventing Aspiration Pneumonia in Young Children With Neurologic Impairment Who Have Gastroesophageal Reflux Disease
Authors: Srivastava Rajendu , Downey Earl C. , O'Gorman Molly , Feola Peter , Samore Matthew , Holubkov Richard , Mundorff Michael , James Brent C. , Rosenbaum Peter , Young Paul C. , Dean Jonathan M.
Published: December 2008

OBJECTIVE. Aspiration pneumonia is the most common cause of death in children with neurologic impairment who have gastroesophageal reflux disease. Fundoplications and gastrojejunal feeding tubes are frequently employed to prevent aspiration pneumonia in this population. Which of these approaches is more effective in preventing aspiration pneumonia and/or improving survival is unknown. The objective of this study was to compare outcomes for children with neurologic impairment and gastroesophageal reflux disease after either a first fundoplication or a first gastrojejunal feeding tube.

PATIENTS AND METHODS. This was a retrospective, observational cohort study of children with neurologic impairment who had either a fundoplication or gastrojejunal feeding tube between January 1997 and December 2005 at a tertiary care children's hospital. Main outcome measures were postprocedure aspiration pneumonia–free survival and mortality. Propensity analyses were used to control for bias in treatment assignment and prognostic imbalances.

RESULTS. Of the 366 children with neurologic impairment and gastroesophageal reflux disease, 43 had a first gastrojejunal feeding tube and 323 underwent a first fundoplication. Median length of follow-up was 3.4 years. Children who received a first fundoplication had similar rates of aspiration pneumonia and mortality after the procedure compared with those who had a first gastrojejunal feeding tube, when adjusting for the treatment assignment using propensity scores.

CONCLUSIONS. Aspiration pneumonia and mortality are not uncommon events after either a first fundoplication or a first gastrojejunal feeding tube for the management of gastroesophageal reflux disease in children with neurologic impairment. Neither treatment option is clearly superior in preventing the subsequent aspiration pneumonia or improving overall survival for these children. This complex clinical scenario needs to be studied in a prospective, multicenter, randomized control trial to evaluate definitively whether 1 of these 2 management options is more beneficial.
Reduction in the Incidence of Chronic Lung Disease in Very Low Birth Weight Infants: Results of a Quality Improvement Process in a Tertiary Level Neonatal Intensive Care Unit
Authors: Birenbaum Howard J. , Dentry Abby , Cirelli Jane , Helou Sabah , Pane Maria A. , Starr Karen , Melick Clifford F. , Updegraff Linda , Arnold Cynthia , Tamayo Angela , Torres Virma , Gungon Norma , Liverman Stephen
Published: December 2008

OBJECTIVE. Our objective was to reduce the incidence of chronic lung disease by introducing potentially better practices in our delivery room and NICU.

METHODS. We compared the incidences of chronic lung disease in infants with birth weights of 501 to 1500 g in 2002 and 2005, after implementation of the changes. Medical records for infants of 501 to 1500 g who were born in 2002 and 2005 were reviewed for maternal characteristics, care of the infant in the delivery room and the NICU (including surfactant usage, duration of ventilation, duration of continuous positive airway pressure therapy, and duration of oxygen treatment), length of stay, and short-term clinical outcomes (eg, pneumothorax, severe intracranial hemorrhage, retinopathy of prematurity, and weight gain).

RESULTS. There was a significant reduction in our incidence of chronic lung disease, from 46.5% in 2002 to 20.5% in 2005. The number of infants discharged from the hospital with oxygen therapy also decreased significantly, from 16.4% in 2002 to 4.1% in 2005. The overall relative risk reduction for chronic lung disease in 2005, compared with 2002, was 55.8%.

CONCLUSIONS. By using a quality improvement process that included avoidance of intubation, adoption of new pulse oximeter limits, and early use of nasal continuous positive airway pressure therapy, we demonstrated a significant reduction in the incidence of chronic lung disease in infants with birth weights of <1500 g in 2005, in comparison with 2002. These results have persisted to date. There were no significant short-term complications.
Predicting Stuttering Onset by the Age of 3 Years: A Prospective, Community Cohort Study
Authors: Reilly Sheena , Onslow Mark , Packman Ann , Wake Melissa , Bavin Edith L. , Prior Margot , Eadie Patricia , Cini Eileen , Bolzonello Catherine , Ukoumunne Obioha C.
Published: December 2008

OBJECTIVES. Our goals were to document (1) the onset of stuttering and (2) whether specific child, family, or environmental factors predict stuttering onset in children aged up to 3 years.

METHODS. Participants included a community-ascertained cohort of 1619 2-year-old Australian children recruited at 8 months of age to study the longitudinal development of early language. The main outcome measure was parental telephone report of stuttering onset, verified by face-to-face expert diagnosis. Preonset continuous measures of the child's temperament (approach/withdrawal) and language development were available. Information on a range of predictor measures hypothesized to be associated with stuttering onset was obtained (maternal mental health and education levels, gender, premature birth status, birth weight, birth order, twinning, socioeconomic status, family history of stuttering).

RESULTS. By 3 years of age, the cumulative incidence of stuttering onset was 8.5%. Onset often occurred suddenly over 1 to 3 days (49.6%) and involved the use of word combinations (97.1%). Children who stuttered were not more shy or withdrawn. Male gender, twin birth status, higher vocabulary scores at 2 years of age, and high maternal education were associated with stuttering onset. The multivariable model, however, had low predictive strength; just 3.7% of the total variation in stuttering onset was accounted for.

CONCLUSIONS. The cumulative incidence of stuttering onset was much higher than reported previously. The hypothesized risk factors for stuttering onset together explained little of the variation in stuttering onset up to 3 years of age. Early onset was not associated with language delay, social and environmental factors, or preonset shyness/withdrawal. Health professionals can reassure parents that onset is not unusual up to 3 years of age and seems to be associated with rapid growth in language development.
Growth-Curve Standards and the Assessment of Early Excess Weight Gain in Infancy
Authors: vanDijk Christel Evellen , Innis Sheila Margaret
Published: December 2008

OBJECTIVES. Increasing overweight and obesity are growing problems among children worldwide. Prevention requires an understanding of when excess weight gain begins and the determinants that place children at risk. The aim of our study was to illustrate how the growth curve used to assess growth influences the interpretation of weight gain and the age of onset of higher weight gains in infancy.

METHODS. This was a longitudinal study of Canadian infants from birth to 18 months of age. Infant feeding pattern was recorded monthly, and weight and length of 73 infants were measured at 8 different ages. Weight, length, weight for length, and BMI z scores were compared with the Centers for Disease Control and Prevention 2000 growth curves and World Health Organization growth standard.

RESULTS. Comparison with the Centers for Disease Control and Prevention growth curves showed that Canadian infants grew similarly or slightly slower than their US counterparts. Using the World Health Organization growth standard, an increase in body weight occurred between 6 and 9 months of age, associated with a change from breastfeeding to formula feeding and introduction of solid foods. When compared with the World Health Organization standards, breastfed infants followed the standards, but formula-fed infants deviated with higher weight for age. When compared with the Centers for Disease Control and Prevention charts, breastfed infants showed an apparent decline in weight for age beginning at ∼6 months.

CONCLUSIONS. The choice of growth curve is important to interpreting infant growth and identifying the onset of excess weight gain. Identification of the prevalence and age of onset of early excess weight gains among Canadian infants will be best achieved by using the World Health Organization growth standards.