bluuebunny/crossref_metadata_2025 huggingface dataset:
The London Congestion Charge
Authors: Leape Jonathan
Published: February 2007

By the 1990s, the average speed of trips across London was below that at the beginning of the twentieth century—before the car was introduced—and by the end of that decade, public concern over levels of traffic congestion was high. In early 2003, London imposed a congestion charge—a daily charge for driving or parking a vehicle on public roads within central London between the hours of 7:00 a.m. and 6:30 p.m. on workdays. Traffic congestion has declined substantially, and the program is largely popular. This article describes the origins of the London congestion charge, how it overcame practical and theoretical difficulties, and what effects it has had. The introduction of the London congestion charge is, in important respects, a triumph of economics. It represents a high-profile public and political recognition of congestion as a distorting externality and of road pricing as an appropriate policy response.
The European Central Bank, the Euro, and Global Financial Markets
Authors: Dominguez Kathryn M. E
Published: February 2007

The economic case for European monetary union was shaky at best when it was first discussed 35 years ago. Europe's leaders felt that monetary union was the capstone to their efforts to create an integrated Europe, and much to the rest of the world's surprise, they succeeded. The introduction of the euro and the establishment of the European Central Bank (ECB) as the monetary authority of Europe went much more smoothly than many predicted. But nagging doubts about the wisdom of integration persist. The slim margins by which the Maastricht Treaty passed and the wide margin on which the European Constitution failed are reminders that Europeans are still wary of giving up their national sovereignty. This wariness also influences the ability of the ECB to efficiently take over monetary policy and limits the ability of the euro to become a true rival of the dollar in global financial markets.
Are beliefs elicited biased by question order? A theory of planned behaviour belief elicitation study about walking in the UK general population
Authors: Darker Catherine D. , French David P. , Longdon Stuart , Morris Katie , Eves Frank F.
Published: February 2007

Objectives. To elicit salient beliefs about walking for an average of 30 minutes per day, with the aims of investigating whether the order of Theory of Planned Behaviour (TPB) belief elicitation questions affects the number and types of beliefs elicited and whether affective and instrumental questions elicit different beliefs.

Design. A 3 × 2×2 × 2 mixed factorial design was employed, with order of behavioural, normative and control questions, and affective and instrumental questions as between‐subjects variables, and affective/instrumental and positive/negative questions as within‐subjects variables.

Method. Quota sampling with regards to age and gender (N = 180) was employed to obtain a sample that was broadly representative of the adult general population.

Results. The order in which behavioural, normative and control beliefs were asked had little impact on the number or type of beliefs elicited. The affective/instrumental attitude distinction was supported. Few differences were apparent between older and younger respondents and between men and women.

Conclusion. TPB belief elicitation studies are not biased by order effects. Interventions to promote walking should consider targeting affective beliefs, e.g. stress relief, in addition to beliefs about health, which is the traditional focus of health campaigns. Given the similarities in beliefs across demographic groups, ‘one size fits all’ interventions to promote walking are appropriate.
The influence of diabetes upon adolescent and young adult development: A qualitative study
Authors: Dovey‐Pearce Gail , Doherty Yvonne , May Carl
Published: February 2007

It is not clear how developmentally appropriate healthcare services for adolescents (11–15) and young adults (16–25) should be provided.

Aims.First, to describe and understand the influence of diabetes upon psychosocial development and second, to highlight the implications for healthcare teams.

Design.Given the heterogeneity of findings, lack of conceptual clarity and lack of quantitative measures, qualitative semi‐structured interviews were used, to define more clearly the constructs significant to young people.

Methods.People aged 16–25 registered with one secondary care diabetes service, across two districts in north‐east England were contacted. Nineteen interviews were conducted and analysed using a Framework Approach.

Results.Diabetes can impact upon personal identity and self‐concept. Peer support can buffer from negative effects, especially if young people control the disclosure of their diabetes. In coming to rely more on peers, participants continue to value the safe base of their family, especially at times of change and challenge. A key challenge appears to be coming to terms with risk and mortality.

Conclusion.Health care services need to support young people with self‐care but must also understand and respond to the social and personal complexities of growing‐up with a long‐term health condition. Psychologists may have a role in promoting and supporting such an approach.
Endogenous PKIγ Limits the Duration of the Anti-Apoptotic Effects of PTH and β-Adrenergic Agonists in Osteoblasts
Authors: Chen Xin , Song In-Hwan , Dennis James E , Greenfield Edward M
Published: February 2007

PKIγ knockdown substantially extended the anti-apoptotic effects of PTH and β-adrenergic agonists, whereas PKIγ overexpression decreased these effects. Therefore, inhibition of PKIγ activity may provide a useful co-therapy in combination with intermittent PTH or β-adrenergic agonists for bone loss in conditions such as osteoporosis.

Introduction: PTH has both catabolic and anabolic effects on bone, which are primarily caused by cAMP/protein kinase A (PKA) signaling and regulation of gene expression. We previously showed that protein kinase inhibitor-γ (PKIγ) is required for efficient termination of cAMP/PKA signaling and gene expression after stimulation with PTH or β-adrenergic agonists. Inhibition of osteoblast apoptosis is thought to be an important, but transient, mechanism partly responsible for the anabolic effects of intermittent PTH. Therefore, we hypothesized that endogenous PKIγ also terminates the anti-apoptotic effect of PTH.

Materials and Methods: PKIγ knockdown by antisense transfection or siRNA was used to examine the ability of endogenous PKIγ to modulate the anti-apoptotic effects of PTH and β-adrenergic agonists in ROS 17/2.8 cells.

Results: Knockdown of PKIγ substantially extended the anti-apoptotic effects of PTH, whether apoptosis was induced by etoposide or dexamethasone. In contrast, overexpression of PKIγ decreased the anti-apoptotic effect of PTH pretreatment. This study is also the first demonstration that β-adrenergic agonists mimic the anti-apoptotic effects of PTH in osteoblasts. Moreover, PKIγ knockdown also substantially extended this anti-apoptotic effect of β-adrenergic agonists. Taken together, these results show that endogenous PKIγ limits the duration of the anti-apoptotic effects of cAMP/PKA signaling in osteoblasts.

Conclusions: Because significant individual variability exists in the anabolic responses to PTH therapy in current clinical treatment of osteoporosis, inhibition of PKIγ activity may provide a useful co-therapy in combination with intermittent PTH or β-adrenergic agonists for bone loss in conditions such as osteoporosis. However, the potential use of such a co-therapy would depend on it not adversely affecting bone formation or other organ systems.
Comparison of Serum Folate Species Analyzed by LC-MS/MS with Total Folate Measured by Microbiologic Assay and Bio-Rad Radioassay
Authors: Fazili Zia , Pfeiffer Christine M , Zhang Mindy
Published: February 2007

Background: The Bio-Rad QuantaPhase II radioassay (BR), used for 25 years to measure total folate (TFOL) concentrations for the National Health and Nutrition Examination Survey (NHANES), will be discontinued in 2007. Liquid chromatography–tandem mass spectrometry (LC-MS/MS) or a microbiologic assay (MA) will be used in the future.

Methods: We measured folate species by LC-MS/MS and TFOL by MA and BR in 327 serum samples.

Results: LC-MS/MS measured 5-methyltetrahydrofolic acid (5CH3THF; 82%), folic acid (FA; 8%), 5-formyltetrahydrofolic acid (5CHOTHF; 6%), tetrahydrofolic acid (THF; 4%), and 5,10-methenyltetrahydrofolic acid (5,10CH=THF; 0%). The sum of the folate species correlated well with TFOL measured by MA (R2 = 0.97) and BR (R2 = 0.91). Compared with LC-MS/MS results, MA and BR values were significantly lower (−6% and −29%, respectively); however, these differences were concentration dependent. The MA almost completely recovered folates added to serum samples except for FA [69% (3%)] and THF [36% (10%)]. The BR underrecovered 5CH3THF [61% (9%)] and 5CHOTHF [38% (14%)] and overrecovered 5,10CH=THF [234% (32%)]. Multiple linear regression models with log-transformed data yielded a good fit for converting BR data to MA or LC-MS/MS data and MA data to LC-MS/MS data.

Conclusions: The good correspondence between the sum of folate species determined by LC-MS/MS and TFOL determined by MA makes these 2 assays interchangeable. The BR produces much lower results, on average, probably because of 5CH3THF underrecovery. The conversion equations provided could be used for future NHANES time trend analyses.
Mass Spectrometry–Based Hepcidin Measurements in Serum and Urine: Analytical Aspects and Clinical Implications
Authors: Kemna Erwin HJM , Tjalsma Harold , Podust Vladimir N , Swinkels Dorine W
Published: February 2007

Background: Discovery of the central role of hepcidin in body iron regulation has shed new light on the pathophysiology of iron disorders. Information is lacking on newer analytical approaches to measure hepcidin in serum and urine. Recent reports on the measurement of urine and serum hepcidin by surface-enhanced laser-desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS) necessitate analytical and clinical evaluation of MS-based methodologies.

Methods: We used SELDI-TOF MS, immunocapture, and tandem MS to identify and characterize hepcidin in serum and urine. In addition to diagnostic application, we investigated analytical reproducibility and biological and preanalytical variation for both serum and urine on Normal Phase 20 and Immobilized Metal Affinity Capture 30 ProteinChip arrays. We obtained samples from healthy controls and patients with documented iron-deficiency anemia, inflammation-induced anemia, thalassemia major, and hereditary hemochromatosis.

Results: Proteomic techniques showed that hepcidin-20, -22, and -25 isoforms are present in urine. Hepcidin-25 in serum had the same amino acid sequence as hepcidin-25 in urine, whereas hepcidin-22 was not detected in serum. The interarray CV was 15% to 27%, and interspot CV was 11% to 13%. Preliminary studies showed that hepcidin-25 differentiated disorders of iron metabolism. Urine hepcidin is more affected by multiple freeze-thaw cycles and storage conditions, but less influenced by diurnal variation, than is serum hepcidin.

Conclusion: SELDI-TOF MS can be used to measure hepcidin in both serum and urine, but serum requires a standardized sampling protocol.
Three Distinct Mechanisms Generate Oxygen Free Radicals in Neurons and Contribute to Cell Death during Anoxia and Reoxygenation
Authors: Abramov Andrey Y. , Scorziello Antonella , Duchen Michael R.
Published: February 2007

Ischemia is a major cause of brain damage, and patient management is complicated by the paradoxical injury that results from reoxygenation. We have now explored the generation of reactive oxygen species (ROS) in hippocampal and cortical neurons in culture in response to oxygen and glucose deprivation or metabolic inhibition and reoxygenation. Fluorescence microscopy was used to measure the rate of ROS generation using hydroethidine, dicarboxyfluorescein diacetate, or MitoSOX. ROS generation was correlated with changing mitochondrial potential (rhodamine 123), [Ca2+]c(fluo-4, fura-2, or Indo-1), or ATP consumption, indicated by increased [Mg2+]c. We found that three distinct mechanisms contribute to neuronal injury by generating ROS and oxidative stress, each operating at a different stage of ischemia and reperfusion. In response to hypoxia, mitochondria generate an initial burst of ROS, which is curtailed once mitochondria depolarize or prevented by previous depolarization with uncoupler. A second phase of ROS generation that followed after a delay was blocked by the xanthine oxidase (XO) inhibitor oxypurinol. This phase correlated with a rise in [Mg2+]c, suggesting XO activation by accumulating products of ATP consumption. A third phase of ROS generation appeared at reoxygenation. This was blocked by NADPH oxidase inhibitors and was absent in cells from gp91phox−/−knock-out mice. It was Ca2+dependent, suggesting activation by increased [Ca2+]cduring anoxia, itself partly attributable to glutamate release. Inhibition of either the NADPH oxidase or XO was significantly neuroprotective. Thus, oxidative stress contributes to cell death over and above the injury attributable to energy deprivation.
Drosophila cacophonyChannels: A Major Mediator of Neuronal Ca2+Currents and a Trigger for K+Channel Homeostatic Regulation
Authors: Peng I-Feng , Wu Chun-Fang
Published: February 2007

Thecacophony(cac) locus inDrosophilaencodes a Ca2+channel α subunit, but little is known about properties ofcac-mediated currents and functional consequences ofcacmutations in central neurons. We found that, inDrosophilacultured neurons, Ca2+currents were mediated predominantly by thecacchannels. Thecacchannels contribute to low- and high-threshold, fast- and slow-inactivating types of Ca2+currents, take part in membrane depolarization, and strongly activate Ca2+-activated K+current [IK(Ca)]. Incacneurons, unexpectedly, voltage-activated transient K+currentIAis upregulated to a level that matchesIK(Ca)reduction, implicating a homeostatic regulation that was mimicked by chronic pharmacological blockade of Ca2+currents in wild-type neurons. Among K+channel transcripts,ShakermRNA levels were preferentially increased incacflies. However, Ca2+current expression levels remained unaltered in several K+channel mutants, illustrating a key role ofcacin developmental regulation ofDrosophilaneuronal excitability.
What You See Is Not (Always) What You Hear: Induced Gamma Band Responses Reflect Cross-Modal Interactions in Familiar Object Recognition
Authors: Yuval-Greenberg Shlomit , Deouell Leon Y.
Published: February 2007

Gamma-band responses (GBRs) are hypothesized to reflect neuronal synchronous activity related to activation of object representations. However, it is not known whether synchrony in the gamma range is also related to multisensory object processing. We investigated the effect of semantic congruity between auditory and visual information on the human GBR. The paradigm consisted of a simultaneous presentation of pictures and vocalizations of animals, which were either congruent or incongruent. EEG was measured in 17 students while they attended either the auditory or the visual stimulus and performed a recognition task. Behavioral results showed a congruity effect, indicating that information from the unattended modality affected behavior. Irrelevant visual information affected auditory recognition more than irrelevant auditory information affected visual recognition, suggesting a bias toward reliance on visual information in object recognition. Whereas the evoked (phase-locked) GBR was unaffected by congruity, the induced (non-phase-locked) GBR was increased for congruent compared with incongruent stimuli. This effect was independent of the attended modality. The results show that integration of information across modalities, based on semantic congruity, is associated with enhanced synchronized oscillations at the gamma band. This suggests that gamma-band oscillations are related not only to low-level unimodal integration but also to the formation of object representations at conceptual multisensory levels.
Sensory-Motor Transformation by Individual Command Neurons
Authors: Zelenin Pavel V. , Orlovsky Grigori N. , Deliagina Tatiana G.
Published: February 2007

Animals and humans maintain a definite body orientation in space during locomotion. Here we analyze the system for the control of body orientation in the lamprey (a lower vertebrate). In the swimming lamprey, commands for changing the body orientation are based on vestibular information; they are transmitted to the spinal cord by reticulospinal (RS) neurons. The aim of this study was to characterize the sensory-motor transformation performed by individual RS neurons. The brainstem–spinal cord preparation with vestibular organs was used. For each RS neuron, we recorded (1) its vestibular responses to turns in different planes and (2) responses in different motoneuron pools of the spinal cord to stimulation of the same RS neuron; the latter data allowed us to estimate the direction of torque (caused by the RS neuron) that will rotate the animal's body during swimming. For each of the three main planes (roll, pitch, and yaw), two groups of RS neurons were found; they were activated by rotation in opposite directions and caused the torques counteracting the rotation that activated the neuron. In each plane, the system will stabilize the orientation at which the two groups are equally active; any deviation from this orientation will evoke a corrective motor response. Thus, individual RS neurons transform sensory information about the body orientation into the motor commands that cause corrections of orientation. The closed-loop mechanisms formed by individual neurons of a group operate in parallel to generate the resulting motor responses.
Neonatal Intensive Care Unit Census Influences Discharge of Moderately Preterm Infants
Authors: Profit Jochen , McCormick Marie C. , Escobar Gabriel J. , Richardson Douglas K. , Zheng Zheng , Coleman-Phox Kim , Roberts Rebecca , Zupancic John A.F.
Published: February 2007

OBJECTIVE. The timely discharge of moderately premature infants has important economic implications. The decision to discharge should occur independent of unit census. We evaluated the impact of unit census on the decision to discharge moderately preterm infants.

DESIGN/METHODS. In a prospective multicenter cohort study, we enrolled 850 infants born between 30 and 34 weeks' gestation at 10 NICUs in Massachusetts and California. We divided the daily census from each hospital into quintiles and tested whether discharges were evenly distributed among them. Using logistic regression, we analyzed predictors of discharge within census quintiles associated with a greater- or less-than-expected likelihood of discharge. We then explored parental satisfaction and postdischarge resource consumption in relation to discharge during census periods that were associated with high proportions of discharge.

RESULTS. There was a significant correlation between unit census and likelihood of discharge. When unit census was in the lowest quintile, patients were 20% less likely to be discharged when compared with all of the other quintiles of unit census. In the lowest quintile of unit census, patient/nurse ratio was the only variable associated with discharge. When census was in the highest quintile, patients were 32% more likely to be discharged when compared with all of the other quintiles of unit census. For patients in this quintile, a higher patient/nurse ratio increased the likelihood of discharge. Conversely, infants with prolonged lengths of stay, an increasing Score for Neonatal Acute Physiology II, and minor congenital anomalies were less likely to be discharged. Infants discharged at high unit census did not differ from their peers in terms of parental satisfaction, emergency department visits, home nurse visits, or rehospitalization rates.

CONCLUSIONS. Discharges are closely correlated with unit census. Providers incorporate demand and case mix into their discharge decisions.
Impact of Full Mental Health and Substance Abuse Parity for Children in the Federal Employees Health Benefits Program
Authors: Azrin Susan T. , Huskamp Haiden A. , Azzone Vanessa , Goldman Howard H. , Frank Richard G. , Burnam M. Audrey , Normand Sharon-Lise T. , Ridgely M. Susan , Young Alexander S. , Barry Colleen L. , Busch Alisa B. , Moran Garrett
Published: February 2007

OBJECTIVE. The Federal Employees Health Benefits Program implemented full mental health and substance abuse parity in January 2001. Evaluation of this policy revealed that parity increased adult beneficiaries’ financial protection by lowering mental health and substance abuse out-of-pocket costs for service users in most plans studied but did not increase rates of service use or spending among adult service users. This study examined the effects of full mental health and substance abuse parity for children.

METHODS. Employing a quasiexperimental design, we compared children in 7 Federal Employees Health Benefits plans from 1999 to 2002 with children in a matched set of plans that did not have a comparable change in mental health and substance abuse coverage. Using a difference-in-differences analysis, we examined the likelihood of child mental health and substance abuse service use, total spending among child service users, and out-of-pocket spending.

RESULTS. The apparent increase in the rate of children’s mental health and substance abuse service use after implementation of parity was almost entirely due to secular trends of increased service utilization. Estimates for children’s mental health and substance abuse spending conditional on this service use showed significant decreases in spending per user attributable to parity for 2 plans; spending estimates for the other plans were not statistically significant. Children using these services in 3 of 7 plans experienced statistically significant reductions in out-of-pocket spending attributable to the parity policy, and the average dollar savings was sizeable for users in those 3 plans. In the remaining 4 plans, out-of-pocket spending also decreased, but these decreases were not statistically significant.

CONCLUSIONS. Full mental health and substance abuse parity for children, within the context of managed care, can achieve equivalence of benefits in health insurance coverage and improve financial protection without adversely affecting health care costs but may not expand access for children who need these services.
The Use of Statins in Pediatrics: Knowledge Base, Limitations, and Future Directions
Authors: Belay Brook , Belamarich Peter F. , Tom-Revzon Catherine
Published: February 2007

The 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, or statins, effectively reduce coronary morbidity and mortality in high-risk adults. They are also some of the most widely prescribed medications in the United States. Their use in pediatrics, however, remains circumscribed. In this article we review the cholesterol hypothesis and focus on the knowledge base of the use of statins in adults and children. We pay particular attention to the known effects of statins in primary and secondary prevention of cardiovascular events. The toxicities of statins and their limitations in pediatrics are then considered. The use of statins in conjunction with noninvasive modalities of assessing atherosclerotic burden are also reviewed. Finally, we suggest methods to advance the use of statins in childhood that introduce their potential benefits to those individuals at highest risk for future events.
New York State Cystic Fibrosis Consortium: The First 2.5 Years of Experience With Cystic Fibrosis Newborn Screening in an Ethnically Diverse Population
Authors: Giusti Robert , Badgwell Ashley , Iglesias Alejandro D. ,   and the New York State Cystic Fibrosis Newborn Screening Consortium
Published: February 2007

OBJECTIVE. The purpose of this work was to report on the first 2.5 years of newborn screening for cystic fibrosis in New York.

METHODS. Directors of the 11 New York cystic fibrosis centers were asked to provide mutation data, demographic data, and selected laboratory results for each patient diagnosed by newborn screening and followed at their center. Summary data were also submitted from the New York newborn screening laboratory on the total number of patients screened, the number of positive screens, and the number of patients that were lost to follow-up. A second survey was submitted by each center regarding the availability of genetic counseling services at the center.

RESULTS. A total of 106 patients with cystic fibrosis were diagnosed through newborn screening in the first 2.5 years and followed at the 11 Cystic Fibrosis Foundation–sponsored cystic fibrosis care centers in New York. Two screen-negative infants were subsequently diagnosed with cystic fibrosis when symptoms developed. The allele frequency of ΔF508 was 57.4%, which is somewhat lower than the allele frequency of ΔF508 in the US cystic fibrosis population of 70%. There were 90 non-Hispanic white (84%), 12 Hispanic, 2 Asian, and 1 black infants diagnosed with cystic fibrosis during this period. Five patients were diagnosed secondary to a positive screen based on a high immunoreactive trypsinogen and no mutations.

CONCLUSIONS. Newborn screening for cystic fibrosis has been effectively conducted in New York using a unique screening algorithm that was designed to be inclusive of the diverse racial makeup of the state. However, this algorithm results in a high false-positive rate, and a large number of healthy newborns are referred for confirmatory sweat tests and genetic counseling. This experience indicates that it would be helpful to convene a working group of cystic fibrosis newborn screening specialists to evaluate which mutations should be included in a newborn screening panel.
Randomized Trial of a Single Repeat Dose of Prenatal Betamethasone Treatment in Imminent Preterm Birth
Authors: Peltoniemi Outi M. , Kari M. Anneli , Tammela Outi , Lehtonen Liisa , Marttila Riitta , Halmesmäki Erja , Jouppila Pentti , Hallman Mikko ,   for the Repeat Antenatal Betamethasone Study Group
Published: February 2007

BACKGROUND. A single dose of prenatal betamethasone treatment decreases neonatal morbidity rates when administered within 7 days before preterm delivery. A single repeat dose or booster dose of betamethasone before delivery has been proposed to be effective, but its efficacy has not been subjected to a randomized, blinded trial.

METHODS. Women with imminent delivery before 34.0 gestational weeks were eligible if they remained without delivery for >7 days after a single course of betamethasone. After stratification, a single repeat dose of betamethasone (12 mg) or placebo was administered. The primary outcome was survival without respiratory distress syndrome or severe intraventricular hemorrhage (grade 3 or 4).

RESULTS. A total of 249 mothers had been enrolled by the time the study was discontinued. All of the 159 infants in the betamethasone group and 167 in the placebo group were born before 36 weeks of gestation. The intact survival rate was unaffected and was lower than anticipated, because the gestational age-adjusted incidence of respiratory distress syndrome was higher than the population incidence. The requirement for surfactant therapy in respiratory distress syndrome was increased in the betamethasone group. According to posthoc analysis of the data for 206 infants who were delivered within 1 to 24 hours, the betamethasone booster tended to increase the risk of respiratory distress syndrome and to decrease intact survival rates.

CONCLUSIONS. According to this study, a single booster dose of betamethasone just before preterm birth may perturb respiratory adaptation. These results caution against uncontrolled use of a repeat dose of glucocorticoid in high-risk pregnancies.
Adolescents’ Reported Consequences of Having Oral Sex Versus Vaginal Sex
Authors: Brady Sonya S. , Halpern-Felsher Bonnie L.
Published: February 2007

OBJECTIVE. The present study examined whether adolescents’ initial consequences of sexual activity differ according to type of sexual activity and gender.

METHODS. Surveys were administered to 618 adolescents recruited from 2 public high schools in the autumn of ninth grade (2002) and at 6-month intervals until the spring of tenth grade (2004). Analyses were limited to the 275 adolescents (44%) who reported engaging in oral sex and/or vaginal sex at any assessment. Participants were 14 years of age at study entry, 56% female, and of diverse socioeconomic and ethnic backgrounds.

RESULTS. In comparison with adolescents who engaged in oral sex and/or vaginal sex, adolescents who engaged only in oral sex were less likely to report experiencing a pregnancy or sexually transmitted infection, feeling guilty or used, having their relationship become worse, and getting into trouble with their parents as a result of sex. Adolescents who engaged only in oral sex were also less likely to report experiencing pleasure, feeling good about themselves, and having their relationship become better as a result of sex. Boys were more likely than girls to report feeling good about themselves, experiencing popularity, and experiencing a pregnancy or sexually transmitted infection as a result of sex, whereas girls were more likely than boys to report feeling bad about themselves and feeling used.

CONCLUSIONS. Adolescents experience a range of social and emotional consequences after having sex. Our findings have implications for clinical practice and public health campaigns targeted toward youth.
Guidelines for Implementation of Cystic Fibrosis Newborn Screening Programs: Cystic Fibrosis Foundation Workshop Report
Authors: Comeau Anne Marie , Accurso Frank J. , White Terry B. , Campbell Preston W. , Hoffman Gary , Parad Richard B. , Wilfond Benjamin S. , Rosenfeld Margaret , Sontag Marci K. , Massie John , Farrell Philip M. , O'Sullivan Brian P.
Published: February 2007

Newborn screening for cystic fibrosis offers the opportunity for early intervention and improved outcomes. This summary, resulting from a workshop sponsored by the Cystic Fibrosis Foundation to facilitate implementation of widespread high quality cystic fibrosis newborn screening, outlines the steps necessary for success based on the experience of existing programs. Planning should begin with a workgroup composed of those who will be responsible for the success of the local program, typically including the state newborn screening program director and cystic fibrosis care center directors. The workgroup must develop a screening algorithm based on program resources and goals including mechanisms available for sample collection, regional demographics, the spectrum of cystic fibrosis disease to be detected, and acceptable failure rates of the screen. The workgroup must also ensure that all necessary guidelines and resources for screening, diagnosis, and care be in place prior to cystic fibrosis newborn screening implementation. These include educational materials for parents and primary care providers; systems for screening and for providing diagnostic testing and counseling for screen-positive infants and their families; and protocols for care of this unique population. This summary explores the benefits and risks of various screening algorithms, including complex situations that can occur involving unclear diagnostic results, and provides guidelines and sample materials for state newborn screening programs to develop and implement high quality screening for cystic fibrosis.
Risk Factors for Deformational Plagiocephaly at Birth and at 7 Weeks of Age: A Prospective Cohort Study
Authors: van Vlimmeren Leo A. , van der Graaf Yolanda , Boere-Boonekamp Magda M. , L'Hoir Monique P. , Helders Paul J.M. , Engelbert Raoul H.H.
Published: February 2007

OBJECTIVE. The purpose of this work was to identify risk factors for deformational plagiocephaly within 48 hours of birth and at 7 weeks of age.

PATIENTS AND METHODS. This was a prospective cohort study in which 380 healthy neonates born at term in Bernhoven Hospital in Veghel were followed at birth and at 7 weeks of age. Data regarding obstetrics, sociodemographics, asymmetry of the skull, anthropometrics, motor development, positioning, and care factors related to potentially provoking deformational plagiocephaly were gathered, with special interest for putative risk factors. The main outcome measure at birth and at 7 weeks of age was deformational plagiocephaly, assessed using the plagiocephalometry parameter oblique diameter difference index, a ratio variable, calculated as the longest divided by the shortest oblique diameter of the skull × 100%. A cutoff point of ≥104% was used to indicate severe deformational plagiocephaly.

RESULTS. Only in 9 of 23 children who presented deformational plagiocephaly at birth was deformational plagiocephaly present at follow-up, whereas in 75 other children, deformational plagiocephaly developed between birth and follow-up. At birth, 3 of 14 putative risk factors were associated with severe flattening of the skull: gender, birth rank, and brachycephaly. At 7 weeks of age, 8 of 28 putative risk factors were associated with severe flattening: gender, birth rank, head position when sleeping, position on chest of drawers, method of feeding, positioning during bottle-feeding, and tummy time when awake. Early achievement of motor milestones was a protective factor for developing deformational plagiocephaly. Deformational plagiocephaly at birth was not a predictor for deformational plagiocephaly at 7 weeks of age. There was no significant relation between supine sleeping and deformational plagiocephaly.

CONCLUSIONS. Three determinants were associated with an increased risk of deformational plagiocephaly at birth: male gender, first-born birth rank, and brachycephaly. Eight factors were associated with an increased risk of deformational plagiocephaly at 7 weeks of age: male gender, first-born birth rank, positional preference when sleeping, head to the same side on chest of drawers, only bottle feeding, positioning to the same side during bottle feeding, tummy time when awake <3 times per day, and slow achievement of motor milestones. This study supports the hypothesis that specific nursing habits, as well as motor development and positional preference, are primarily associated with the development of deformational plagiocephaly. Earlier achievement of motor milestones probably protects the child from developing deformational plagiocephaly. Implementation of practices based on this new evidence of preventing and diminishing deformational plagiocephaly in child health care centers is very important.
Disparities in Dental Insurance Coverage and Dental Care Among US Children: The National Survey of Children's Health
Authors: Liu Jihong , Probst Janice C. , Martin Amy B. , Wang Jong-Yi , Salinas Carlos F.
Published: February 2007

OBJECTIVES

We sought to understand disparities in dental insurance coverage and dental care among US children by race/ethnicity, urban/rural residence, and socioeconomic status.

METHODS

Linked data from the National Survey of Children's Health and Area Resource File were analyzed (N = 89 071). Multiple logistic regression analysis was used to adjust for confounders.

RESULTS

A total of 22.1% of US children lacked parentally reported dental insurance coverage in the preceding year, 26.9% did not have a routine preventive dental visit, and 5.1% had parentally perceived unmet need for preventive dental care. US born minority children were less likely to lack dental insurance than US-born white children; however, foreign-born Hispanic children were more likely to be uninsured. Rural children were more likely to be uninsured than urban children. Children with health insurance were more likely to have dental coverage. Children who lacked dental insurance were less likely to have received preventive care and more likely to have unmet need for care. Compared with US-born white children, all minority children were less likely to receive preventive care. These disparities were exacerbated among foreign-born children. Fewer race-based disparities were found for unmet need for dental care. Only black children, both US and foreign-born, had higher odds of unmet need for preventive services than US-born white children. Poor dental health was strongly associated with unmet need. Disparities in dental insurance coverage and dental care are also evident by family socioeconomic status.

CONCLUSIONS

Poor and minority children were less likely to receive preventive dental care, even when insurance status was considered. Rural children were less likely to have dental insurance than urban children. Foreign birth affected insurance status for Hispanic children and use of preventive services for all minority children.
Nativity/Immigrant Status, Race/Ethnicity, and Socioeconomic Determinants of Breastfeeding Initiation and Duration in the United States, 2003
Authors: Singh Gopal K. , Kogan Michael D. , Dee Deborah L.
Published: February 2007

OBJECTIVES. Previous research has shown substantial racial/ethnic and socioeconomic disparities in US breastfeeding initiation and duration rates. However, the role of immigrant status in understanding such disparities has not been well studied. In this study we examined the extent to which breastfeeding initiation and duration varied by immigrant status overall and in conjunction with race/ethnicity and socioeconomic status after controlling for other relevant social and behavioral covariates.

METHODS. The cross-sectional data for 33121 children aged 0 to 5 years from the 2003 National Survey of Children's Health were used to calculate ever-breastfeeding rates and duration rates at 3, 6, and 12 months by social factors. Multivariate logistic regression was used to estimate relative odds of never breastfeeding and not breastfeeding at 6 and 12 months.

RESULTS. More than 72% of mothers reported ever breastfeeding their infants, with the duration rate declining to 52%, 38%, and 16% at 3, 6, and 12 months, respectively. Ever-breastfeeding rates varied greatly among the 12 ethnic-immigrant groups included in this analysis, from a low of 48% for native black children with native parents to a high of 88% among immigrant black and white children. Compared with immigrant Hispanic children with foreign-born parents (the least acculturated group), the odds of never breastfeeding were respectively 2.4, 2.9, 6.5, and 2.4 times higher for native children with native parents (the most acculturated group) of Hispanic, white, black, and other ethnicities. Socioeconomic patterns also varied by immigrant status, and differentials were greater in breastfeeding at 6 months.

CONCLUSIONS. Immigrant women in each racial/ethnic group had higher breastfeeding initiation and longer duration rates than native women. Acculturation was associated with lower breastfeeding rates among both Hispanic and non-Hispanic women. Ethnic-immigrant and social groups with lower breastfeeding rates identified herein could be targeted for breastfeeding promotion programs.
Does Access to a Medical Home Differ According to Child and Family Characteristics, Including Special-Health-Care-Needs Status, Among Children in Alabama?
Authors: Mulvihill Beverly A. , Altarac Maja , Swaminathan Shailender , Kirby Russell S. , Kulczycki Andrzej , Ellis Dawn E.
Published: February 2007

OBJECTIVE. Our goal was to examine relationships among access to a medical home, special-health-care-needs status, and child and family characteristics in one Southern state. We hypothesized that access to a medical home is influenced by several family and child sociodemographic characteristics, including special-health-care status.

METHODS. We used data from the 2003 National Survey of Children's Health. The study sample comprised all Alabama resident children. The main dependent variable was a medical home; the primary independent variable classified children according to children-with-special-health-care-needs status. We controlled for child age, gender, race, family structure, health status, insurance coverage, household education, and poverty. We first explored means or proportions for the study variables and then estimated multivariate logistic regression models.

RESULTS. Children with special health care needs were significantly more likely than children without special health care needs to have a personal doctor or nurse, to have a preventive health care visit in the previous 12 months, and to have good communication with their provider. Children with special health care needs were also more likely to experience problems accessing specialty care, equipment, or services. Being uninsured, living at or near the federal poverty level, in a household where no one completed high school, being black, having less than excellent or good health, and living in a nontraditional family structure were characteristics associated with being less likely to have a medical home. In general, children-with-special-health-care-needs status was not related to having a medical home, but dependency on prescription medicine was.

CONCLUSIONS. Assuring that all children, irrespective of family income, have access to and are enrolled in health insurance plans will move us closer to the national goal of having a medical home for all children, especially those with a special health care need, by 2010.
Noninitiation or Withdrawal of Intensive Care for High-Risk Newborns
Authors:   Committee on Fetus and Newborn
Published: February 2007

Advances in medical technology have led to dilemmas in initiation and withdrawal of intensive care of newborn infants with a very poor prognosis. Physicians and parents together must make difficult decisions guided by their understanding of the child's best interest. The foundation for these decisions consists of several key elements: (1) direct and open communication between the health care team and the parents of the child with regard to the medical status, prognosis, and treatment options; (2) inclusion of the parents as active participants in the decision process; (3) continuation of comfort care even when intensive care is not being provided; and (4) treatment decisions that are guided primarily by the best interest of the child.
Structural characterization and mechanical properties of nanocrystal-containing Cu–Ti-based bulk metallic glass-forming alloys
Authors: Sun Y.F. , Li F.S. , Guan S.K. , Tang M.Q. , Shek C.H.
Published: February 2007

Cylindrical Cu42.5Ti41.5Ni7.5Zr2.5Hf5Si1 bulk metallic glass with a diameter of 2 mm was fabricated by copper-mold casting. X-ray diffraction and differential scanning calorimetry analysis of the material showed that the alloy has a homogenous amorphous structure and high glass-forming ability. However, detailed observation by transmission electron microscopy revealed that a kind of nanocrystal with size of about 20 nm is sparsely distributed in the glass matrix. Nanobeam electron diffraction experiments indicated that the nanocrystal has a face-centered cubic crystalline structure. Room-temperature compression tests revealed that the alloy has a high fracture strength of 2250 MPa and obvious plastic strain of about 5.3%. Nanoindentation tests revealed that the as-cast alloy exhibits obviously serrated flow over a wide range of loading rate from 0.5 to 10 mN/min.
Elastic properties of Zr-based bulk metallic glasses studied by resonant ultrasound spectroscopy
Authors: Zhang Zhiying , Keppens Veerle , Liaw Peter K. , Yokoyama Yoshihiko , Inoue Akihisa
Published: February 2007

We report measurements of the elastic properties of Zr-based bulk metallic glasses, Zr52.5Cu17.9Ni14.6Al10Ti5, Zr50Cu30Ni10Al10, and Zr50Cu40Al10 between 5 K and 300 K. Both the shear and longitudinal modulus have been measured as a function of temperature, allowing accurate determination of the Poisson’s ratio and the related ratio of bulk modulus to shear modulus, K/G. These data make it possible to assess the influence of the alloy’s composition on the mechanical properties and enable an evaluation of the correlation between the elastic moduli and the ductility of the alloys.
In situ thermographic observations on the compression behavior of a relaxed Zr-based bulk-metallic glass
Authors: Jiang W.H. , Liu F.X. , Liao H.H. , Choo H. , Liaw P.K.
Published: February 2007

Using an infrared camera, the plastic deformation of a relaxed Zr52.5Cu17.9Ni14.6Al10.0Ti5.0 bulk-metallic glass in a moderately high strain rate compression was observed in situ. The specimen exhibits an inhomogeneous deformation, which is manifested by serrated plastic flow, shear banding, and obvious work softening. Shear-banding operations were observed throughout the plastic deformation. Shear-banding operations started before the nominal yielding; shear bands could not block each other, but their interaction seems to accelerate the plastic deformation. A significant increase in the specimen’s temperature was observed due to shear banding.
Microstructure and mechanical properties of electron beam weld joints of a Zr41Ti14Cu12Ni10Be23 bulk metallic glass with Zr
Authors: Bhowmick R. , Bysakh S. , Kawamura Y. , Yamasaki M. , Ramamurty U. , Chattopadhyay K.
Published: February 2007

The electron beam welding technique was used to join Zr41Ti14Cu12Ni10Be23 bulk metallic glass (BMG) to crystalline pure Zr. Compositional, microstructural, and mechanical property variations across the welded interface were evaluated. It is shown that a crystalline layer develops close to the welding interface. Transmission electron microscopy of this layer indicates the crystalline phase to be tetragonal with lattice parameters close to that reported for Zr2Ni. However, the composition of this phase is different as it contains other alloying additions. The interface layer close to the bulk metallic glass side contains nanocrystalline Zr2Cu phase embedded in the glassy matrix. Nanoindentation experiments indicate that the hardness of the crystalline layer, although less than the bulk metallic glass, is more than the Zr itself. Commensurately, tensile tests indicate that the failure of the welded samples occurs at the Zr side rather than at the weld joint.
Dental manifestations of pregnancy
Authors: Pirie Martina , Cooke Inez , Linden Gerard , Irwin Chris
Published: February 2007

Key content

Pregnancy has significant effects on the periodontal tissues and pregnancy gingivitis is a common manifestation of this.

The host response and oral flora are affected and tooth surface loss and mobility may develop.

Further research is required to establish the association between periodontal health and adverse pregnancy outcome.

Learning objectives

To identify the main dental manifestations of pregnancy.

To be able to advise pregnant women on how to maintain good dental health.

To be aware of the need for effective communication between the dental and medical disciplines to ensure that pregnant women receive the best care possible for oral, obstetric and general health.

Ethical issues

The treatment of gingivitis and periodontitis during pregnancy is safe and effective in treating gum disease.

Please cite this article as: Pirie M, Cooke I, Linden G, Irwin C. Dental manifestations of pregnancy. The Obstetrician & Gynaecologist 2007;9:21–26.