bluuebunny/crossref_metadata_2025 huggingface dataset:
Determinants of prices increase of agricultural commodities in a global context1
Authors: Borychowski Michał , Czyżewski Andrzej
Published: February 2016

The main objective of this article is to present the determinants of increase in agricultural commodity prices after 2006. The other specific aim is to show the factors affecting agricultural raw materials and food prices in the global context. This article is a review paper of the determinants of recent commodity and food prices spikes. However, it provides an outlook on these determinants that were the most important for the increases in the last decade. The last part of the article (conclusions) to some extent is a synthesis of considerations and includes the authors’ opinions concerning determinants and an attempt to identify which ones were the most important in the growth of agricultural commodity prices. These increases in agricultural commodity prices resulted from many factors and it is very difficult to separate the individual impact of each of them, because they occurred in parallel. However, it is possible to indicate several main reasons for these price increases, which are: adverse changes in supply-demand relations in agricultural markets, increases in oil prices (and increases of the volatility of those prices), development of biofuel production from agricultural commodities (the first generation biofuels), dollar depreciation, an increase in operations of a speculative nature on commodity markets and improper economic policy that created an environment for the growth of prices of agricultural products.
Dynamical Modeling of Frequency Controlled Variable Speed Parallel Multistage Centrifugal Pumps
Authors: Khayatzadeh Farid , Ghafouri Jafar
Published: February 2016

This paper presents a development of a model of a set of multistage centrifugal electro pumps including two 4 stage stainless steel centrifugal pumps, each coupled to a 4 kW three-phase induction motor, connected to a hydraulic application running under two control strategies including constant speed and variable speed methods. Each pump provides 16 m3/hr flow rate and 58mwater head at BEP (Best Efficiency Point). Dynamicity of the model causes variations in all operational parameters of pumping system in any variation on consuming flow rate. Each electro pump has been driven with a variable frequency drive utilizing frequency control method for adjusting the rotational speed under a PID control regarding to match of pumping system operational point with the consumption point to save the energy. 83% energy saving is achieved by model in variable speed control strategy comparing to constant speed control strategy. MATLAB/SIMULINK software using ode45 solver and variable step size simulates this model.
Crystal structure of 2-[(4-fluorobenzyl)sulfanyl]-4-(2-methylpropyl)-6-oxo-1,6-dihydropyrimidine-5-carbonitrile, C16H16FN3OS
Authors: El-Emam Ali A. , Ghabbour Hazem A. , Al-Deeb Omar A. , Abdelbaky Mohammed S. M. , García-Granda Santiago
Published: February 2016

C16H16FN3OS, triclinic, P1̅ (no. 2), a = 5.6885(3) Å, b = 9.4378(4) Å, c = 15.0736(7) Å, α = 84.037(4)°, β = 81.442(4)°, γ = 74.271(4)°, V = 768.56(7) Å3, Z = 2, R
gt
(F) = 0.0518, wR
ref
(F
2
) = 0.1430, T = 100 K.
Performance Management and Performance Appraisal: Czech Self-Governments
Authors: Špalková Dagmar , Špaček David , Nemec Juraj
Published: February 2016

Managing and measuring performance became an important part of administrative reforms motivated by the New Public Management ideology. However, a badly implemented system designed for measuring and managing performance may distort the behaviours of actors. The goal of this paper is to outline the preliminary picture of the current situation of performance management generally and particularly of performance appraisal at the level of the Czech local and regional self-governments. The presented data, despite the fact that our field research covers only a non-representative samples of the “best” self-government bodies, show first that performance and quality management is not a neglected area in the Czech Republic. Its practice is rather decentralized, and the central government focuses on methodical support and coordination rather than on being strict and requiring certain tools to be implemented. The core problems revealed by the interviews are that the implementation of new instruments is usually based on a trial-and-error approach in its beginnings and that the implementation is award- and project-driven. Our preliminary data clearly indicate that the performance-appraisal situation is even more problematic - they indicate that performance-appraisal systems are introduced in only a limited number of self-government authorities. The set of criteria used in the evaluation is problematic, and the objectives of the performance appraisal are unclear for managers. As a general rule, a performance-appraisal system is not directly linked with implemented performance management and especially not with a payment system.
Tax Evasion, Tax Avoidance and The Influence of Special Interest Groups: Taxation in Iceland from 1930 to the Present
Authors: Karlsson Johannes , Matthiasson Thorolfur
Published: February 2016

This paper focuses on tax evasion and tax avoidance in Iceland, and on how special interest groups have shaped the taxation system to serve their own ends. The period covered is from 1930, when the present Icelandic system of power was established, to the present.

Tax evasion is sometimes an intended, and other times an unintended response to taxation.Willful tax evasion is more likely to occur if consensus regarding fairness and equality of the tax-code is lacking. Tax evasion is an integral part of the “underground economy”, or more formally, the Non-Observed Economy (NOE).Measuring the size and scope of the NOE in general, and tax evasion in particular, is a difficult task.We compare results from three methods for estimating the size of the Gross Domestic Product (GDP): the production approach, the expenditure approach, and the income approach. The results of applying these three methods should, in principle, be identical, but they are not. We use the difference, guided by historical facts and anecdotes, to give an idea of the magnitude of tax evasion during the 20th century.

We suggest that the construction of the tax system to serve special interest groups may have disrupted the social, judicial, political and economic balance of the Icelandic “project”.
The Vat Exemption for Health Care: Eu Law and its Impact on Swedish law
Authors: Påhlsson Robert
Published: February 2016

The general rule in EU law is that value-added tax (VAT) is to be levied on all goods and services. There are a number of exceptions, however, one of which applies to certain medical services. This paper examines the legal basis for tax exemptions in EU VAT law and in Swedish law, with particular attention to the extent to which the rapidly growing private health-care sector is covered by these tax exemptions.
Motivation for Physical Activity and Mental Health Indicators in Male Gym Attendees
Authors: Awruk Katarzyna , Janowski Konrad
Published: February 2016

The significance of physical activity for mental well-being has been discussed in detail in the literature on the subject. However, a question arises concerning the relationship between motivation to exercise and psychological functioning. The objective of the present study was to test the relationship between the types of motivation for physical activity and selected indicators of mental health.

The study involved 99 men aged between 18 and 60 years old (M=28.20, SD=9.35) who were regular attendees at several gyms in Warsaw. The study used the following methods: the General Health Questionnaire-28 (GHQ-28), developed by Goldberg, the Gym Attendance Motivation Inventory, developed by Awruk and Janowski, and the Personal Data Sheet.

A significant negative relationship between intrinsic motivation (to improve one’s physical performance) and symptoms of depression was observed. Significant positive associations were found between the period of training and scores on the Social dysfunction and Somatic symptoms subscales of GHQ-28. The remaining associations were found to be statistically insignificant. In addition, there were no significant differences in motivation to exercise between men with low and high levels of mental health symptoms. The motivational profiles identified in cluster analysis did not differentiate the subjects with respect to mental health indicators.
Solidarity in the European Union in Times of Economic Crisis
Authors: Maillo Jerónimo , Corti Justo
Published: February 2016

The present special issue of Perspectives on Federalism reflects on the nature and characteristics of solidarity within a supranational context, it explains what solidarity has meant so far in the EU, how much solidarity we had during the crisis, what type of solidarity is needed and how to build it. It focuses on the new economic governance and its solidarity mechanisms during and after the economic crisis but tackles other related fields such as its impact on services of general economic interest or the European budget, as well as other areas where solidarity is also discussed such as the free movement of persons.

This monographic issue has its origin in the International Conference “Solidarity in Hard Times. Solidarity and the European Social Model in times of economic crisis” organized by the University Institute for European Studies (IDEE) on 11-12 June 2015 in Madrid, within the Jean Monnet Network MoreEU (“More Europe to overcome the crisis”).
The European Stability Mechanism: Human Rights Concerns Without Responsibilities?
Authors: Vettorel Arianna
Published: February 2016

The current financial problems of some Euro-area Member States have been tackled by ad hoc financial institutions, formed outside of the EU as international institutions and aimed at granting financial assistance on the basis of strict conditionality measures, which seriously affect human rights (particularly social and economic rights).

The paper focuses on the impact of the actions of the European Stability Mechanism and analyses whether this institution (or the European institutions and the Member States involved in it) should bear the responsibility for such violations.
Recent developments in fabricating drag reduction surfaces covering biological sharkskin morphology
Authors: Luo Yuehao , Xu Xia , Li Dong , Song Wen
Published: February 2016

With the rapid development of science and technology, increasing research interests have been focused on environment protection, global warming, and energy shortage. At present, reducing friction force as much as possible has developed into an urgent issue. Sharkskin effect has the potential ability to lower viscous drag on the fluid-solid interface in turbulence, and therefore, how to fabricate bio-inspired sharkskin surfaces is progressively becoming the hot topic. In this review, various methods of fabricating drag reduction surfaces covering biological sharkskin morphology are illustrated and discussed systematically, mainly involving direct bio-replicated, synthetic fabricating, bio/micro-rolling, enlarged solvent-swelling, drag reduction additive low-releasing, trans-scale enlarged three-dimensional fabricating, flexible printing, large-proportional shrunken bio-replicating, ultraviolet (UV) curable painting, and stretching deformed methods. The overview has the potential benefits in better acquainting with the recent research status of fabricating sharkskin surfaces covering the biological morphology.
Experiences with Railway Regulation in Great Britain and the Czech Republic – Round Table Report1
Authors: Nash Chris , Tomeš Zdeněk , Jandová Monika
Published: February 2016

The aim of the Round Table was to compare British and Czech experiences with railway regulation and competition introduction and to determine which lessons can be learnt. Special attention was paid to the question of whether the very complex British reform can be an inspiration for further liberalisation of the railway sector in the Czech Republic or whether there are any reform mistakes that are best avoided. Based on two introductory presentations and subsequent plenary discussion, some consensus emerged. The participants agreed that there is no one-size-fits-all solution to railway regulation and that the introduction of competition should take into account the different circumstances of a particular country. Franchising in passenger operations in Britain successfully stimulated demand but also increased costs to the industry, so its implementation should be completed with care. It seems very unlikely that open-access competition would be a viable solution for the whole passenger rail market because it is limited to a few commercially attractive routes, and as Czech experience suggests, it creates many new problems. Finally, it was confirmed that a strong and dedicated regulator is needed in a newly liberalised environment in order to solve many emerging conflicts and disputes.
Correlations Between the Density of Tryptase Positive Mast Cells (DMCT) and that of New Blood Vessels (CD105+) in Patients with Gastric Cancer
Authors: Micu Gianina Viorica , Stăniceanu Florica , Sticlaru Liana Cătălina , Popp Cristiana Gabriela , Bastian Alexandra Eugenia , Gramada Eliza , Pop. G. , Mateescu R. B. , Rimbaş M. , Archip Bianca , Bleotu Coralia
Published: February 2016

Mast cells proteases, tryptase and chymase are directly involved in the growth and progression of solid tumors due to their important role in tumor angiogenesis. We examined the density of tryptase positive mast cells and the mean density of new blood vessels in gastric malignant tumors of patients with and without Helicobacter pylori infection, using immunohistochemical staining for tryptase (for mast cells) and CD 105 (for new vessels). Tryptase and CD 105 expression was detected in gastrectomy specimens. In this study, mast cell density correlates with angiogenesis and the growth and progression of gastric cancer. It also shows that the participation of Helicobacter pylori infection in the growth and progress of gastric neoplasia is due to an increase of peritumoral angiogenesis, with subsequent local and distant tumor spread and perivascular growth, but without perineural and nodal involvement.
Primary Hyperfibrinolysis as a Presentation of Extended Prostate Carcinoma
Authors: Ruiz-Sada Pablo , Nahia Arostegui-Uribe , Iker Garay-Hidalgo , Katalin Uriarte-Elguezabal
Published: February 2016

Primary hyperfibrinolysis States are rare entities associated with different clinical scenarios and can be sometimes their first presentation. PHS outcome relies on the underlying cause. We introduce the case of a man presenting with a complex clotting abnormality malignancy related. Not having an accurate diagnosis hindered us to give an easy solution and compromised the prognosis overall. Misdiagnosing a severe entity often leads to fatal outcomes. We want to highlight the rarity of our case, the challenging differential diagnosis and the importance of being aware of PHS. Because our patient appeared to have an extended carcinoma, definitive treatment was not an option on our case.When an uncommon and challenging disease is presented, having all the clues is mandatory to succeed.
Evaluation of Fracture Parameters for Cracks in Coupled Thermoelasticity for Functionally Graded Materials
Authors: Repka M. , Sládek J. , Sládek V. , Wünsche M.
Published: February 2016

The finite element method (FEM) is developed for coupled thermoelastic crack problems if material properties are continuously varying. The weak form is utilized to derive the FEM equations. In conventional fracture theories the state of stress and strain at the crack tip vicinity is characterized by a single fracture parameter, namely the stress intensity factor or its equivalent, J-integral. In the present paper it is considered also the second fracture parameter called as the T-stress. For evaluation of both fracture parameters the quarter-point crack tip element is developed. Simple formulas for both fracture parameters are derived comparing the variation of displacements in the quarter-point element with asymptotic expression of displacement at the crack tip vicinity. The leading terms of the asymptotic expansions of fields in the crack-tip vicinity in a functionally graded material (FGM) are the same as in a homogeneous one with material coefficients taken at the crack tip.
The Concept of State Terrorism in Relation to Iran
Authors: Kraus Josef
Published: February 2016

This paper analyses the concept of state terrorism in relation to the politics of the Islamic Republic of Iran. The author uses the typology elaborated by the American political scientist Gus Martin. Iranian domestic and international patronage and assistance are researched. This paper comes to the conclusion that Iran is involved in a broad spectrum of terrorist activities; however, the specific forms of terrorism are carried our autonomously and in various time periods. The most active period was during the 1980s and the least Iranian terrorist activity can be noticed in the second half of 1990s.
A New Middle Class on Old Academic Grounds: Law Students of the Cluj University in the 1930s
Authors: Pálffy Zoltán
Published: February 2016

One of the main tasks of universities of Central and Eastern Europe is that of forming loyal and reliable citizens ready to fill in the ranks of public service. Educational credentials make for social elevation into the ranks of this peculiarly state-dependent middle class. Law students make the relative majority of those engaged in higher learning in the region all through the first half of the 20th century. Where and when there is an acute need for a new middle class under a new state sovereignty, it is law studies that are notoriously perceived as meant to producing the bulk of it. The University of Cluj in the inter-war period is a case in point. The paper shall put forward a selection of data (from an ample statistical survey of elite formation via upper-level education in Central Europe) on this segment of the student population in the 1930s, setting it against a dramatically changed background (the general one and the local one, as traced in secondary sources): how do Romanians cope with the task of producing this new middle class on old grounds, and what are the unwanted side-effects of such state-related social emancipation mechanisms? And how non-Romanians behave in the new situation?
From Informal Exchanges to Dual Practices. The Shadows of the Romanian Health Care Reform
Authors: Palaga Cristine
Published: February 2016

The current frailties of the Romanian health care system are often explained by resorting to the previous regime’s institutional framework, rarely accepting that they are also the product of post-1990 reforms and the neoliberal means of system reconfiguration. This paper provides an ethnographic account of the ways in which two “products” of these reforms actively contribute to the augmentation of private medical services and to the diminishing access to quality care in the public system: the bureaucratization of primary medicine and the “dual medical practice”. More specifically, I use the concept of “informal exchanges” in order to explore the variety of transactions that occur between patients and the health care staff and to document the means through which its main social actors understand, reproduce, legitimize or blame the very existence of these practices. Then, I analyze how referrals to private medical units increasingly replace informal payments, simultaneously laying even harder obstacles in the access to health care for those in need.
Postsocialism or when ‘Having’ is another Way of ‘Being’. The Reconfiguring of Identity through Land Restitution and the Narratives of the Past
Authors: Chiorean Elena
Published: February 2016

In this paper I examine the consequences of the 1989 political overturn in Romania on the selfhood. To this purpose, I initiate a twofold analysis: the official discourse of both socio-political systems, socialism and liberalism, and the individual’s quotidian discourse. The first one will enable a comparative view, over the ’bottom-up’ constructed realities, and the second will account for the degree of pervasiveness and naturalization of ideological views and, in this way, of a “top-down” identity construction and its configurations. One of the most apprehensible provisions through which liberalism endeavoured to institutionalize its own way of setting out reality is land restitution. Thereafter, I will discuss the way re-appropriation was experienced and its various subjectivization trajectories, but also the wider frame of the postsocialist economic transformations: rethinking work, money, the state and the interrelations between them. This particular angle of sight will disclose the mechanisms through which liberalism has deconstructed the system of socialist meaning and representation, at the same time replacing it with a socio-political order which reconfigured these meanings.
Turnout Decline in Romanian National Elections: Is it that Big?
Authors: Comşa Mircea
Published: February 2016

According to official data, Romanian voter turnout decreased by half for the period 1990-2012. Gaps between official and self-reported turnout are larger than those from similar countries. Starting with these findings, this paper questions the official data regarding turnout and brings evidence that turnout in Romanian elections is increasingly underestimated. Three factors are responsible for this: the quality of the electoral registers, ineligible voters and emigration. The effect of these factors grew over time inducing the idea that turnout is sharply decreasing. In fact, the decrease is less pronounced, and most of it took place between 1990 and 2000. In the last part, I discuss the implications of the findings in three domains: theoretical debates, methodological and practical issues.
Morphological conditioning of phonological regularization
Authors: Gouskova Maria , Linzen Tal
Published: February 2016

We analyze three types of cases in which exceptional morphemes become regular in the presence of other morphemes (
Explaining vowel systems: dispersion theory vs natural selection
Authors: Vaux Bert , Samuels Bridget
Published: February 2016

We argue that the cross-linguistic distribution of vowel systems is best accounted for by grammar-external forces of learnability operating in tandem with cognitive constraints on phonological computation, as argued for other phonological phenomena by
Right dislocation and raising-to-object in Zulu
Authors: Halpert Claire , Zeller Jochen
Published: February 2016

In this paper, we analyze an unusual type of right dislocation in Zulu. We demonstrate that the construction in question combines A-movement of a DP out of an embedded finite CP into a matrix argument position (raising-to-object; RtO) with right dislocation of both the raised DP
Review of the Genus Geloemyia (Diptera, Pyrgotidae), with Discussion of its Taxonomic Position
Authors: Korneyev V. A.
Published: February 2016

Review of the Genus Geloemyia (Diptera, Pyrgotidae), with Discussion of its Taxonomic Position. Korneyev, V. A. - Species assigned to Geloemyia Hendel, 1908, Trichempodia Malloch, 1930 syn. n., Parageloemyia Hendel, 1933 syn. n., and Dicranostira Enderlein, 1942 syn. n. are shown to be congeneric. Geloemyia is refined to include eight species: Geloemyia cheni Kim, Han & Korneyev, sp. n., Geloemyia cockerelli (Malloch, 1930) comb. n. (= Trichempodia cockerelli Malloch, 1930), Geloemyia dorsocentralis (Hering, 1940) comb. n. (= Adapsilia dorsocentralis Hering, 1940), Geloemyia quadriseta Hendel, 1933, Geloemyia stylata Hendel, 1908, Geloemyia wonjuensis (Kim & Han, 2001) comb. n. (= Parageloemyia wonjuensis Kim & Han, 2001) from Eastern Asia, Geloemyia namibica sp. n., from mainland Africa (Namibia) and Geloemyia trifasciata (Enderlein, 1942) comb. n. (= Trichempodia trifasciata Enderlein, 1942) from Madagascar. Geloemyia nigrofasiata Hendel, 1933 based on a single male is supposed to be a junior synonym of G. quadriseta Hendel, 1933, based on females, but the synonymy is tentative. A key to species is provided. The genus Geloemyia belongs in the tribe Pyrgotini forming (or belonging to) a basal lineage in the subtribe Adapsiliina together with Pyrgotomyia Hendel, 1914 and Porpomastix Enderlein, 1942.
Using Ecological Niche Modeling for Biodiversity Conservation Guidance in the Western Podillya (Ukraine): Reptiles
Authors: Tytar V. , Sobolenko L. , Nekrasova O. , Mezhzherin S.
Published: February 2016

Using Ecological Niche Modeling for Biodiversity Conservation Guidance in the Western Podillya (Ukraine): Reptiles. Tytar, V., Sobolenko, L., Nekrasova, O. Mezhzherin, S. - Maximum entropy niche modeling was employed as a tool to assess potential habitat suitability for 10 reptile species and to map their potential distribution in the Western Podillya (Ukraine). We used climate, topography and human impact (assessed by the Human Footprint) as predictor variables. “Isothermality”, “temperature seasonality” and the “mean temperature of coldest month” were three most important factors in predicting habitat suitability and distribution. A profound contribution to the modeling has been displayed by the Human Footprint, meaning that human infrastructure may benefit reptile species. Areas have been distinguished that in the first place should be of interest to biodiversity conservationists targeting reptiles and maps summarizing predicted habitat suitability and species richness were produced for guiding conservation efforts.
Lax Pair, Conservation Laws, Solitons, and Rogue Waves for a Generalised Nonlinear Schrödinger–Maxwell–Bloch System under the Nonlinear Tunneling Effect for an Inhomogeneous Erbium-Doped Silica Fibre
Authors: Gao Zhe , Gao Yi-Tian , Su Chuan-Qi , Wang Qi-Min , Mao Bing-Qing
Published: February 2016

Under investigation in this article is a generalised nonlinear Schrödinger-Maxwell-Bloch system for the picosecond optical pulse propagation in an inhomogeneous erbium-doped silica optical fibre. Lax pair, conservation laws, Darboux transformation, and generalised Darboux transformation for the system are constructed; with the one- and two-soliton solutions, the first- and second-order rogue waves given. Soliton propagation is discussed. Nonlinear tunneling effect on the solitons and rogue waves are investigated. We find that (i) the detuning of the atomic transition frequency from the optical pulse frequency affects the velocity of the pulse when the detuning is small, (ii) nonlinear tunneling effect does not affect the energy redistribution of the soliton interaction, (iii) dispersion barrier/well has an effect on the soliton velocity, whereas nonlinear well/barrier does not, (iv) nonlinear well/barrier could amplify/compress the solitons or rogue waves in a smoother manner than the dispersion barrier/well, and (v) dispersion barrier could “attract” the nearby rogue waves, whereas the dispersion well has a repulsive effect on them.
Extrinsic and Intrinsic Contributions to Plasmon Peaks in Solids
Authors: Alshehabi Abbas , Kawai Jun
Published: February 2016

Intrinsic and extrinsic plasmons are defined and the contribution of each determined. It is shown that quantum interference between intrinsic and extrinsic satellites in X-ray photoelectron spectroscopy (XPS) as well as in Auger electron spectra (AES) does not occur for plasmon loss peaks higher than first order. Line widths in measured reflected electron energy loss spectra (EELS) are analysed by subtracting the Shirley background. Contrary to common understanding, extrinsic and intrinsic contributions by plasmon peaks can be experimentally distinguishable by comparison of line widths.
Design, synthesis, and biological evaluation of new series of 2-amido-1,3,4-thiadiazole derivatives as cytotoxic agents
Authors: Almasirad Ali , Firoozpour Loghman , Nejati Maliheh , Edraki Najmeh , Firuzi Omidreza , Khoshneviszadeh Mehdi , Mahdavi Mohammad , Moghimi Setareh , Safavi Maliheh , Shafiee Abbas , Foroumadi Alireza
Published: February 2016

A series of novel 1,3,4-thiadiazole derivatives bearing an amide moiety were designed, synthesized, and evaluated for their in vitro antitumor activities against HL-60, SKOV-3 and MOLT-4 human tumor cell lines by MTT assay. Ethyl 2-((5-(4-methoxybenzamido)-1,3,4-thiadiazol-2-yl)thio)acetate (5f) showed the best inhibitory effect against SKOV-3 cells, with an IC50 value of 19.5 μm. In addition, the acridine orange/ethidium bromide staining assay in SKOV-3 cells suggested that the cytotoxic activity of 5f occurs via apoptosis.
Nivel de actividad física habitual en escolares de 8-9 años de España e India
Authors: López Sánchez Guillermo Felipe , Ahmed Dilsad , Borrego Balsalobre Francisco José , López Sánchez Laura , Díaz Suárez Arturo
Published: February 2016

El nivel de actividad física de las personas es un tema prioritario a escala internacional. Sobre este tema, el objetivo del presente artículo fue analizar y comparar el nivel de actividad física habitual de escolares de 8-9 años de la región de Murcia, España y el Distrito de Karbi Anglong, Assam en India. Para ello, se administró el cuestionario PACE (Physician-based Assessment and Counseling for Exercise) a un total de 85 escolares (44 de España y 41 de India). Los resultados evidenciaron que la muestra estudiada no realiza suficiente actividad física, según las recomendaciones de la Organización Mundial de la Salud, ya que realizan al menos 60 minutos de actividad física; una media de 3.13 días/semana (DE=1.91). Los escolares de 8 años son ligeramente más activos que los de 9 años en ambos países; los niños realizan más actividad física que las niñas en ambos países; los escolares de India realizan más actividad física que los de España. Por tanto, se concluye que el nivel de actividad física es insuficiente, disminuye ligeramente con la edad y es mayor en India.
Parent and Physician Perceptions Regarding Preventability of Pediatric Readmissions
Authors: Amin Dipti , Ford Ronald , Ghazarian Sharon R. , Love Benjamin , Cheng Tina L.
Published: February 2016

OBJECTIVE:

To assess the causes and preventability of pediatric readmissions from the perspectives of parents and their physicians to guide future interventions.

METHODS:

Parent interview, physician survey, and medical record review were completed for children who were readmitted to a pediatric hospitalist service within 30 days of an index admission. Questions were asked about Health Belief Model constructs (perceived severity, susceptibility or preventability of admission, and perceived barriers), discharge readiness, and follow-up plans. Parent and physician perceptions about reasons for readmissions were examined, and responses to open-ended questions were coded.

RESULTS:

60 parent–physician pairs completed the study. The mean age of the patients was 6.43 (SD 6.42) years; 45% (n = 27) had a chronic disease, and 47% (n = 28) of patients were readmitted with the same or similar condition as in the previous hospitalization. At readmission, parents were more likely than physicians to think that the condition was serious (parent 98%, physician 76%; P < .001) and that the readmission could have been prevented (parent 59%, physician 36%; P = .04). Most parents (63%) and physicians (65%) thought it was likely that the child may have future hospitalizations. Opportunities to prevent readmission included need for parent education, improving medication access and adherence, and need for coordination of follow-up care.

CONCLUSIONS:

Many parents and physicians thought the readmission was preventable, and the majority of both thought that the patient was susceptible to another hospitalization. Parents and physicians suggest opportunities to improve care processes during hospitalization and in services provided after discharge to reduce readmissions.
Complications of Deep Sedation for Individual Procedures (Lumbar Puncture Alone) Versus Combined Procedures (Lumbar Puncture and Bone Marrow Aspirate) in Pediatric Oncology Patients
Authors: Patel Meral M. , Kamat Pradip P. , McCracken Courtney E. , Simon Harold K.
Published: February 2016

BACKGROUND AND OBJECTIVES:

Pediatric oncology patients frequently undergo procedural sedation. The goal of this study was to determine the safety of combining procedures into a single sedation encounter and to assess if the magnitude of any complication is significant enough to justify separate sedation encounters for multiple procedures.

METHODS:

This retrospective review included pediatric oncology patients sedated for lumbar puncture alone or combined procedures (lumbar puncture and bone marrow aspirate) from January 2012 to January 2014. Demographic characteristics, medication dosing, procedural success, sedation duration, and adverse events (AEs) with associated required interventions were recorded. Sedation-related complications were separated into serious adverse events (SAEs) and AEs. Data were analyzed by using multivariable modeling.

RESULTS:

Data from 972 sedation encounters involving 96 patients, each having 1 to 28 encounters (mean ± SD, 10 ± 5), were reviewed. Ninety percent were individual procedures and 10% were combined procedures. Overall, there were few SAEs, and airway obstruction was the most common SAE. Combined procedures required 0.31 mg/kg more propofol (P < .001) and took 1.4 times longer (P < .001) than individual procedures. In addition, when adjusting for possible confounding factors, the odds of having an SAE were 4.8 (95% confidence interval, 1.37–16.65); P = .014) times higher for combined procedures. All SAEs and AEs were manageable by the sedation team.

CONCLUSIONS:

Combining procedures was associated with higher propofol doses, prolonged duration, and a small increase in likelihood of SAEs compared with individual procedures. All AEs fell within the scope of management by the sedation team. Balancing the increased, but manageable, risks versus the advantages of family/patient convenience, enhanced resource utilization, and minimization of potential neurotoxicity from anesthetics supports combining procedures when possible.
Validation of Procedural Codes to Identify Infants Evaluated for Serious Bacterial Infection
Authors: Biondi Eric A. , McCulloh Russell J. , Leyenaar JoAnna K. , Shin Carmen , Van Wie Nikole , Montalbano Amanda , Williams Derek J.
Published: February 2016

OBJECTIVE:

To validate a novel coding method using Current Procedural Terminology, Fourth Edition (CPT-4) codes for identifying infants who underwent a full evaluation for serious bacterial infection (SBI).

METHODS:

We performed a multicenter, retrospective examination to determine the accuracy of a combination of CPT-4 codes for blood, cerebrospinal fluid (CSF), and urine cultures to identify previously healthy infants ≤90 days old admitted to a general care floor and fully evaluated for SBI. Full SBI evaluation was defined as blood, CSF, and urine cultures performed during the emergency department encounter or corresponding hospitalization. Cases were defined as infants who had codes for blood, CSF, and urine cultures (87040, 87070, and either 87086 or 87088), and these were compared with all other encounters. We validated these findings by comparing medical record documentation of blood, CSF, and urine cultures to the corresponding CPT-4 codes, with calculation of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

RESULTS:

We identified 8548 qualifying encounters, and 347 (4%) had a combination of CPT-4 codes 87040, 87070, and either 87086 or 87088. This combination had a sensitivity of 100% (95% confidence interval, 98.9–100) and specificity of 98.2% (95% confidence interval, 97.3–98.8) for identifying infants who underwent full SBI evaluation for an unknown source.

CONCLUSIONS:

CPT-4 codes provide an accurate means to identify infants who underwent complete SBI evaluation.
Description and Evaluation of an Educational Intervention on Health Care Costs and Value
Authors: Jonas Jennifer A. , Ronan Jeanine C. , Petrie Ian , Fieldston Evan S.
Published: February 2016

OBJECTIVE:

There is growing consensus that to ensure that health care dollars are spent efficiently, physicians need more training in how to provide high-value, cost-conscious care. Thus, in fiscal year 2014, The Children’s Hospital of Philadelphia piloted a 9-part curriculum on health care costs and value for faculty in the Division of General Pediatrics. This study uses baseline and postintervention surveys to gauge knowledge, perceptions, and views on these issues and to assess the efficacy of the pilot curriculum.

METHODS:

Faculty completed surveys about their knowledge and perceptions about health care costs and value and their views on the role physicians should play in containing costs and promoting value. Baseline and postintervention responses were compared and analyzed on the basis of how many of the sessions respondents attended.

RESULTS:

Sixty-two faculty members completed the baseline survey (71% response rate), and 45 faculty members completed the postintervention survey (63% response rate). Reported knowledge of health care costs and value increased significantly in the postintervention survey (P = .04 and P < .001). Odds of being knowledgeable about costs and value were 2.42 (confidence interval: 1.05–5.58) and 6.22 times greater (confidence interval: 2.29–16.90), respectively, postintervention. Reported knowledge of health care costs and value increased with number of sessions attended (P = .01 and P < .001).

CONCLUSIONS:

The pilot curriculum appeared to successfully introduce physicians to concepts around health care costs and value and initiated important discussions about the role physicians can play in containing costs and promoting value. Additional education, increased cost transparency, and more decision support tools are needed to help physicians translate knowledge into practice.
Diagnosis of Autism Spectrum Disorder by Developmental-Behavioral Pediatricians in Academic Centers: A DBPNet Study
Authors: Hansen Robin L. , Blum Nathan J. , Gaham Amy , Shults Justine ,   on behalf of the DBPNet Steering Committee
Published: February 2016

OBJECTIVES:

To describe the clinical practices of physicians in the Developmental-Behavioral Pediatrics Network (DBPNet) to (1) diagnose autism spectrum disorders (ASDs), identify comorbidities, and evaluate etiology and (2) compare actual practice to established guidelines.

METHODS:

A total of 56 developmental-behavioral pediatricians completed encounter forms, including demographic/clinical information, for up to 10 consecutive new-patient visits given a diagnosis of ASD. Data were summarized by using descriptive statistics. Analysis of the statistical significance of differences between sites (n = 10) used general estimating equations and mixed-effects logistic regression to adjust for clustering by clinician within site.

RESULTS:

A total of 284 ASD forms were submitted. Most assessments (56%) were completed in 1 visit (27.5% in 2 visits, 8.6% in 3 visits). Use of the Childhood Autism Rating Scale, Autism Diagnostic Observation Schedule, or Screening Tool for Autism in Toddlers and Young Children varied across sites from 28.6% to 100% of encounters (P < .001). A developmental assessment was reviewed/completed at 87.7% of encounters (range: 77.8%–100%; P = .061), parent behavior rating scales were reviewed/completed at 65.9% (range: 35.7%–91.4%; P = .19), and teacher behavior rating scales were reviewed/completed at 38.4% (range: 15%–69.2%; P = .19). Only 17.3% (95% confidence interval: 12.8%–21.7%) of evaluations were completed by an interdisciplinary team. A majority (71%) of patients had at least 1 comorbid diagnosis (31% had at least 2 and 12% at had least 3). Etiologic evaluations were primarily genetic (karyotype: 49%; microarray: 69.7%; fragile X: 71.5%).

CONCLUSIONS:

Despite site variability, the majority of diagnostic evaluations for ASD within DBPNet were completed by developmental-behavioral pediatricians without an interdisciplinary team and included a developmental assessment, ASD-specific assessment tools, and parent behavior rating scales. These findings document the multiple components of assessment used by DBPNet physicians and where they align with existing guidelines.
Pattern of Diagnosis and Co-occurring Symptoms in Adopted Children With Autism Spectrum Disorder
Authors: Ezell Jordan , Shui Amy , Sanders Kevin , Veenstra-VanderWeele Jeremy
Published: February 2016

OBJECTIVES:

To determine whether adopted children with autism spectrum disorder (ASD) differ from the general ASD population in terms of diagnosis, internalizing and externalizing behaviors, sleep problems, and medications.

METHODS:

We studied 163 adoptees in the Autism Speaks Autism Treatment Network (ATN) in comparison with 5624 nonadopted ATN participants (aged 1.5–17.6 years; mean [SD] = 6.2 [3.4] years). Gender, age, race, ethnicity, IQ, and categorical Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, ASD diagnosis were tested for differences by group (adopted versus nonadopted) by using independent-samples t tests for continuous variables and Fisher’s exact tests for categorical variables. Logistic or linear regression models were used to examine the association between adoption status and several outcome variables, after controlling for covariates.

RESULTS:

After controlling for demographics and diagnosis, there were significant differences in group characteristics, including greater propensity for externalizing behavior (P < .001), internalizing behavior (P = .001), and sleep problems (P < .001) in the adopted population. Adoptees were also prescribed psychotropic medications (P < .001) more often than the nonadoptees. Adoptees received a diagnosis of pervasive developmental disorder–not otherwise specified significantly more frequently than controls (odds ratio = 1.8; CI = 1.3–2.5; P < .001), despite no significant difference in symptoms on standardized measures.

CONCLUSIONS:

These results suggest that the population of adopted children with ASD differs from the general ASD population both with regard to diagnostic subtype and co-occurring behavioral problems. Future research should evaluate the contributions of specific factors associated with adoption such as biological family history, pregnancy history, early childhood experience, and age at adoption.
Assessment and Treatment of Anxiety in Youth With Autism Spectrum Disorders
Authors: Vasa Roma A. , Mazurek Micah O. , Mahajan Rajneesh , Bennett Amanda E. , Bernal Maria Pilar , Nozzolillo Alixandra A. , Arnold L. Eugene , Coury Daniel L.
Published: February 2016

OBJECTIVES:

Anxiety is one of the most prevalent co-occurring symptoms in youth with autism spectrum disorder (ASD). The assessment and treatment recommendations proposed here are intended to help primary care providers with the assessment and treatment of anxiety in ASD.

METHODS:

The Autism Speaks Autism Treatment Network/Autism Intervention Research on Physical Health Anxiety Workgroup, a multidisciplinary team of clinicians and researchers with expertise in ASD, developed the clinical recommendations. The recommendations were based on available scientific evidence regarding anxiety treatments, both in youth with ASD and typically developing youth, and clinical consensus of the workgroup where data were lacking.

RESULTS:

Assessment of anxiety requires a systematic approach to evaluating symptoms and potential contributing factors across various developmental levels. Treatment recommendations include psychoeducation, coordination of care, and modified cognitive-behavioral therapy, particularly for children and adolescents with high-functioning ASD. Due to the limited evidence base in ASD, medications for anxiety should be prescribed cautiously with close monitoring of potential benefits and side effects.

CONCLUSIONS:

Assessment and treatment of clinical anxiety in youth with ASD require a standardized approach to improve outcomes for youth with ASD. Although this approach provides a framework for clinicians, clinical judgment is recommended when making decisions about individual patients.
Irritability and Problem Behavior in Autism Spectrum Disorder: A Practice Pathway for Pediatric Primary Care
Authors: McGuire Kelly , Fung Lawrence K. , Hagopian Louis , Vasa Roma A. , Mahajan Rajneesh , Bernal Pilar , Silberman Anna E. , Wolfe Audrey , Coury Daniel L. , Hardan Antonio Y. , Veenstra-VanderWeele Jeremy , Whitaker Agnes H.
Published: February 2016

OBJECTIVE:

Pediatric primary care providers (PCPs) caring for patients with autism spectrum disorder (ASD) often encounter irritability (vocal or motoric outbursts expressive of anger, frustration, or distress) and problem behavior (directed acts of aggression toward other people, self, or property). The Autism Intervention Research Network on Physical Health and Autism Speaks Autism Treatment Network charged a multidisciplinary workgroup with developing a practice pathway to assist PCPs in the evaluation and treatment of irritability and problem behavior (I/PB).

METHODS:

The workgroup reviewed the literature on the evaluation and treatment of contributory factors for I/PB in ASD. The workgroup then achieved consensus on the content and sequence of each step in the pathway.

RESULTS:

The practice pathway is designed to help the PCP generate individualized treatment plans based on contributing factors identified in each patient. These factors may include medical conditions, which the PCP is in a key position to address; functional communication challenges that can be addressed at school or at home; psychosocial stressors that may be ameliorated; inadvertent reinforcement of I/PB; and co-occurring psychiatric conditions that can be treated. The pathway provides guidance on psychotropic medication use, when indicated, within an individualized treatment plan. In addition to guidance on assessment, referral, and initial treatment, the pathway includes monitoring of treatment response and periodic reassessment.

CONCLUSIONS:

The pediatric PCP caring for the patient with ASD is in a unique position to help generate an individualized treatment plan that targets factors contributing to I/PB and to implement this plan in collaboration with parents, schools, and other providers.
Improving Access to Care at Autism Treatment Centers: A System Analysis Approach
Authors: Austin June , Manning-Courtney Patricia , Johnson Meghan L. , Weber Rachel , Johnson Heather , Murray Donna , Ratliff-Schaub Karen , Tadlock Abbey Marquette , Murray Mark
Published: February 2016

OBJECTIVE:

The prevalence of autism spectrum disorder is steadily increasing and placing more demands on already overburdened diagnostic and treatment systems. A thoughtful, systematic reorganization of autism service delivery may reduce delays and better meet the growing need.

METHODS:

Two clinical centers in the Autism Intervention Research Network on Physical Health, Cincinnati Children’s Hospital Medical Center (CCHMC) and Nationwide Children’s Hospital (NCH), undertook a year-long access improvement project to reduce delays to care by using system analysis to identify sources of delay and to target changes by using a set of defined access principles. Although both sites addressed access, they focused on slightly different targets (reducing number of patients with autism spectrum disorders waiting for follow-up appointments at NCH and reducing delay to new diagnosis at CCHMC).

RESULTS:

Both sites achieved dramatic improvements in their complex, multidisciplinary systems. A 94% reduction in number of patients on the waitlist from 99 to 6 patients and a 22% reduction in median delay for a new ongoing care appointment were realized at NCH. A 94% reduction in third next available appointment for new physician visits for children 3 to 5 years old was realized at CCHMC.

CONCLUSIONS:

This article demonstrates that 2 different clinical systems improved access to care for autism diagnosis and follow-up care by identifying sources of delay and using targeted changes based on a set of access change principles. With appropriate guidance and data analysis, improvements in access can be made.