bluuebunny/crossref_metadata_2025 huggingface dataset:
Relation of Pregnancy and Neonatal Factors to Subsequent Development of Childhood Epilepsy: A Population-Based Cohort Study
Authors: Whitehead Elizabeth , Dodds Linda , Joseph K.S. , Gordon Kevin E. , Wood Ellen , Allen Alexander C. , Camfield Peter , Dooley Joseph M.
Published: April 2006

OBJECTIVE. We examined the effect of pregnancy and neonatal factors on the subsequent development of childhood epilepsy in a population-based cohort study.

PATIENTS AND METHODS. Children born between January 1986 and December 2000 in Nova Scotia, Canada were followed up to December 2001. Data on pregnancy and neonatal events and on diagnoses of childhood epilepsy were obtained through record linkage of 2 population-based databases: the Nova Scotia Atlee Perinatal Database and the Canadian Epilepsy Database and Registry. Factors analyzed included events during the prenatal, labor and delivery, and neonatal time periods. Cox proportional hazards regression models were used to estimate relative risks and 95% confidence intervals.

RESULTS. There were 648 new cases of epilepsy diagnosed among 124207 live births, for an overall rate of 63 per 100000 person-years. Incidence rates were highest among children <1 year of age. In adjusted analyses, factors significantly associated with an increased risk of epilepsy included eclampsia, neonatal seizures, central nervous system (CNS) anomalies, placental abruption, major non-CNS anomalies, neonatal metabolic disorders, neonatal CNS diseases, previous low birth weight infant, infection in pregnancy, small for gestational age, unmarried, and not breastfeeding infant at the time of discharge from hospital.

CONCLUSIONS. Our study supports the concept that prenatal factors contribute to the occurrence of subsequent childhood epilepsy.
Breastfeeding Does Not Increase the Risk of Asthma at 14 Years
Authors: Burgess Scott W. , Dakin Carolyn J. , O'Callaghan Michael J.
Published: April 2006

OBJECTIVES. There are conflicting data regarding the impact of breastfeeding on the development of asthma in late childhood. Our aim with this study was to investigate the relationship between breastfeeding and the prevalence of asthma in children at 14 years.

METHODS. The Mater-University of Queensland Study of Pregnancy is a birth cohort of 7223 women and their infants recruited from a public antenatal clinic in Brisbane, Australia, between 1981 and 1984. Data regarding breastfeeding and the duration of breastfeeding were collected through the use of a questionnaire completed by the mother 6 months postdelivery, and the prevalence of asthma was determined through the use of a questionnaire completed by the mother 14 years postdelivery.

RESULTS. Data regarding both breastfeeding and asthma were available for 4964 children. The prevalence of asthma in children at 14 years was 28.4%. Breastfeeding for ≥4 months was not found to have a significant effect on the prevalence of asthma in 14-year-olds. The unadjusted odds ratio of developing asthma at 14 years if the child was breastfed for ≥4 months was 1.03. The odds ratio of developing asthma did not change appreciably when allowance was made for potential confounding factors.

CONCLUSION. Data from this study indicate that breastfeeding neither increases nor decreases the prevalence of asthma in children at 14 years.
Acellular Pertussis Vaccine Booster Combined With Diphtheria and Tetanus Toxoids for Adolescents
Authors: Pichichero Michael E. , Blatter Mark M. , Kennedy William A. , Hedrick James , Descamps Dominique , Friedland Leonard R.
Published: April 2006

BACKGROUND. The incidence of pertussis is increasing, especially in adolescents, attributed in part to waning of immunity after childhood immunization. Recently licensed in the United States for use in adolescents, acellular pertussis vaccines will provide an immunogenic and safe option for booster immunization against pertussis.

METHODS. This prospective, randomized, observer-blinded, multicenter, comparative study evaluated the safety and immunogenicity of a vaccine formulated with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis antigens (Tdap) compared with tetanus and diphtheria toxoids vaccine (Td) for booster immunization in adolescents. There were 4114 healthy adolescents aged 10 to 18 years who completed childhood vaccination against diphtheria, tetanus, and pertussis who were enrolled, randomized, and received study vaccine.

RESULTS. Local and general symptoms were comparable between the Tdap and Td groups. The immune response of Tdap was comparable with Td vaccine for tetanus and diphtheria seroprotection and booster responses. In addition, geometric mean concentrations of antibody to pertussis antigens, pertussis toxoid, filamentous hemagglutinin, and pertactin exceeded the antibody response elicited after infant immunization with diphtheria and tetanus toxoids and acellular pertussis antigens (DTaP) that had proven efficacy against pertussis.

CONCLUSIONS. In adolescents, the studied Tdap was safe and immunogenic and induced pertussis antibodies that were higher than those associated with efficacy in infants.
Do Parenting and the Home Environment, Maternal Depression, Neighborhood, and Chronic Poverty Affect Child Behavioral Problems Differently in Different Racial-Ethnic Groups?
Authors: Pachter Lee M. , Auinger Peggy , Palmer Ray , Weitzman Michael
Published: April 2006

OBJECTIVE. To determine whether the processes through which parenting practices, maternal depression, neighborhood, and chronic poverty affect child behavioral problems are similar or different in minority and nonminority children in the United States.

METHODS. Data from 884 white, 538 black, and 404 Latino families with children who were 6 to 9 years of age in the National Longitudinal Survey of Youth were analyzed. The outcome, child behavioral problems, was measured using the Behavior Problems Index externalizing and internalizing subscales. The effects of chronic poverty, neighborhood, maternal depression, and parenting on the outcome were analyzed using multigroup structural equation modeling.

RESULTS. Chronic poverty affected child behavioral problems indirectly through the other variables, and parenting practices had direct effects in each racial/ethnic group. The effects of maternal depression were partially mediated through parenting in the white and Latino samples but were direct and unmediated through parenting practices in the black sample. Neighborhood effects were present in the white and black samples but were not significant for the Latino sample.

CONCLUSIONS. Chronic poverty, neighborhood, maternal depression, and parenting practices have effects on child behavioral problems in white, black, and Latino children, but the processes and mechanisms through which they exert their effects differ among the groups. The differences may be related to social stratification mechanisms as well as sociocultural differences in family and childrearing practices.
Sleep-Disordered Breathing, Behavior, and Cognition in Children Before and After Adenotonsillectomy
Authors: Chervin Ronald D. , Ruzicka Deborah L. , Giordani Bruno J. , Weatherly Robert A. , Dillon James E. , Hodges Elise K. , Marcus Carole L. , Guire Kenneth E.
Published: April 2006

OBJECTIVES. Most children with sleep-disordered breathing (SDB) have mild-to-moderate forms, for which neurobehavioral complications are believed to be the most important adverse outcomes. To improve understanding of this morbidity, its long-term response to adenotonsillectomy, and its relationship to polysomnographic measures, we studied a series of children before and after clinically indicated adenotonsillectomy or unrelated surgical care.

METHODS. We recorded sleep and assessed behavioral, cognitive, and psychiatric morbidity in 105 children 5.0 to 12.9 years old: 78 were scheduled for clinically indicated adenotonsillectomy, usually for suspected SDB, and 27 for unrelated surgical care. One year later, we repeated all assessments in 100 of these children.

RESULTS. Subjects who had an adenotonsillectomy, in comparison to controls, were more hyperactive on well-validated parent rating scales, inattentive on cognitive testing, sleepy on the Multiple Sleep Latency Test, and likely to have attention-deficit/hyperactivity disorder (as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) as judged by a child psychiatrist. In contrast, 1 year later, the 2 groups showed no significant differences in the same measures. Subjects who had an adenotonsillectomy had improved substantially in all measures, and control subjects improved in none. However, polysomnographic assessment of baseline SDB and its subsequent amelioration did not clearly predict either baseline neurobehavioral morbidity or improvement in any area other than sleepiness.

CONCLUSIONS. Children scheduled for adenotonsillectomy often have mild-to-moderate SDB and significant neurobehavioral morbidity, including hyperactivity, inattention, attention-deficit/hyperactivity disorder, and excessive daytime sleepiness, all of which tend to improve by 1 year after surgery. However, the lack of better correspondence between SDB measures and neurobehavioral outcomes suggests the need for better measures or improved understanding of underlying causal mechanisms.
The Role of Parental Preferences in the Management of Fever Without Source Among 3- to 36-Month-Old Children: A Decision Analysis
Authors: Madsen Kristine A. , Bennett Jonathan E. , Downs Stephen M.
Published: April 2006

OBJECTIVES. Recent analyses assessing the impact of the conjugate pneumococcal vaccine on the care of febrile children do not reflect the role parental preferences play in physicians' decisions. The objective of this study was to identify the management strategy that would best suit parents, on the basis of their values for possible outcomes of fever of ≥39°C without source among well-appearing, 3- to 36-month-old children.

METHODS. A decision analysis was performed to compare the benefits and outcomes of 3 management options (treat: blood culture and antibiotics for all children; test: blood culture and complete blood count for all children, with antibiotics for selected children; observe: no immediate intervention). A hypothetical cohort of 100000 children with fever of ≥39°C with no obvious source of infection was modeled for each strategy. Using this model, we identified the treatment option that would best suit each parent's preferences, on the basis of parental utilities (from a prior study) for various interventions and outcomes at vaccine efficacies of 0% (ie, no vaccine) and 95%. In addition, we performed survival analyses to assess the morbidity and mortality rates associated with each treatment strategy at various vaccine efficacies.

RESULTS. At a vaccine efficacy of 0%, the majority of parents' preferences suggested the treat option, the strategy with the lowest mortality rate. At a vaccine efficacy of 95%, mortality rates were similar for all 3 management options (∼1 in 100000), but parental preferences were still aligned with different options; 50% suggested observe, 42% suggested test, and 8% suggested treat.

CONCLUSIONS. Like physicians, parents have different approaches to risk. With the conjugate pneumococcal vaccine, risks of complications from fever without source are low regardless of treatment strategy. Rather than having a “one size fits all” approach, it is reasonable to incorporate parental preferences into the treatment decision.
Cigarette Smoking in the Adolescent Children of Drug-Abusing Fathers
Authors: Brook David W. , Brook Judith S. , Rubenstone Elizabeth , Zhang Chenshu , Gerochi Connie
Published: April 2006

OBJECTIVE. This study examined the longitudinal predictors of cigarette smoking in a sample of at-risk adolescents whose fathers were drug abusers (N = 296).

METHODS. At time 1, structured interviews were administered, separately and in private, to male and female youth (X̄ age = 16.3) and their fathers; adolescents were reinterviewed ∼1 year later (at time 2). Structural equation modeling was used to examine the interrelationship of time 1 paternal tobacco and illicit drug use, father–child relations, adolescent psychological adjustment, and peer group factors and adolescent smoking at time 2. A supplementary analysis assessed the same model with control on the adolescent's age, gender, frequency of contact with the father, and the father's treatment status.

RESULTS. The structural equation model showed a mediational pathway linking paternal tobacco and drug use to a weak and conflictual father–child relationship, which was associated with greater adolescent maladjustment, which in turn was related to deviant peer affiliations, which predicted adolescent smoking at time 2. There was also a direct path from paternal tobacco and drug use to adolescent time 2 smoking. The supplementary analysis found no significant differences between the models with and without control.

CONCLUSIONS. Findings provide evidence of the mechanisms that underlie the association between paternal drug use characteristics and smoking in the adolescent child. Clinical implications suggest the importance of the father–child relationship to smoking prevention programs for at-risk youth.
Longitudinal Follow-up of Families and Young Children With Traumatic Brain Injury
Authors: Keenan Heather T. , Runyan Desmond K. , Nocera Maryalice
Published: April 2006

OBJECTIVES. To examine the stability of functional outcomes 2 years after injury among children who sustained a traumatic brain injury (TBI) before 2 years of age and to examine the characteristics of the families caring for these children.

METHODS. All North Carolina-resident children who were hospitalized between January 2000 and December 2001 in any of the state's 9 PICUs and survived a TBI that occurred on or before their second birthday were eligible to participate in the prospective cohort study. Child health status, use of ancillary medical resources, and family characteristics were assessed through maternal caregiver interviews ∼2 years after injury. Comparisons were made among injury types (inflicted versus noninflicted).

RESULTS. There were 112 children who survived a TBI during the 2-year study period. Fifty-seven (79%) of the 72 maternal caregivers who had completed an interview 1 year after the child's injury participated in the year 2 interview. Most children (67%) had an outcome of mild disability or better at year 2, with 45% functioning at an age-appropriate level. Children's outcomes did not differ significantly at year 2 according to the mechanism of injury. The majority (67%) of children retained their Pediatric Overall Performance Category scores from year 1 to year 2. Children who changed were as likely to show improvement as deterioration. Children differed very little across time, as measured with the Stein-Jessup Functional Status II (Revised) scale. Families tended to have multiple environmental factors that could put their children at risk for poor developmental outcomes, including living below the poverty level (22%) and low social capital (39%).

CONCLUSIONS. The children in this cohort had relatively stable functional outcomes from year 1 to year 2 after injury. This population of children remains very vulnerable to poor developmental outcomes secondary to the effects of their TBI and environmental factors.
Multifocal Lymphangioendotheliomatosis With Thrombocytopenia: A Rare Cause of Gastrointestinal Bleeding in the Newborn Period
Authors: Piggott Kurt D. , Riedel Phillip A. , Baron Howard I.
Published: April 2006

Severe gastrointestinal bleeding in the newborn period is a serious but uncommon phenomenon that has a broad differential diagnosis. In the following case report we describe a rare phenomenon in which a newborn presents with severe hematemesis, hematochezia, and thrombocytopenia that are resistant to repeated platelet and packed red blood cell transfusions. Previous cases have been reported, but none of the patients described presented within the first 8 days of life. The early age of presentation and refractory nature of this disease entity to multiple therapies make it a diagnostic and therapeutic dilemma for all physicians involved in the care of newborns.
A National Survey of the Acceptability of Quitlines to Help Parents Quit Smoking
Authors: Winickoff Jonathan P. , Tanski Susanne E. , McMillen Robert C. , Hipple Bethany J. , Friebely Joan , Healey Erica A.
Published: April 2006

OBJECTIVE. Provision of telephone smoking cessation counseling can increase the rate of quitting smoking. The US Public Health Service recently helped to establish a free national quitline enrollment service. No previous surveys have assessed the acceptability to parents of enrollment in quitline counseling in the context of their child's health care visits. Therefore, the objective of this study was to assess acceptability to parents of enrollment in quitline counseling and to compare that with the reported rate of actually being enrolled in any smoking cessation counseling outside the office in the context of the child's health care visit.

METHODS. Data were collected by a national random-digit-dial telephone survey of households from September to November 2004. The sample is weighted by race and gender on the basis of the current US Census to be representative of the US population.

RESULTS. Of 3615 eligible respondents contacted, 3011 (83.3%) completed surveys; 958 (31.8%) who completed the survey were parents with children under the age of 18 years. Of these parents, 187 (19.7%) were self-identified smokers. Of the parents who smoked, 113 (64.2%) said that they would accept enrollment in a telephone cessation program if the child's doctor offered it to them. In contrast, of the 122 smoking parents who accompanied their child to the doctor in the past year, only 11 (9%) had any counseling recommended to them, and only 1 (0.8%) was actually enrolled. These results did not vary by parent age, gender, race, or child age.

CONCLUSIONS. When interacting with parents who smoke, child health care providers have low rates of referring and enrolling parents in any services related to smoking. Enrollment in quitlines would be acceptable to the majority of parents in the context of their child's health care visit. Tobacco control efforts in the child health care setting should include implementation of office systems that can facilitate enrollment of parental smokers in telephone quitlines.
Targeted Short-Term Fluconazole Prophylaxis Among Very Low Birth Weight and Extremely Low Birth Weight Infants
Authors: Uko Smart , Soghier Lamia M. , Vega Melissa , Marsh Jeremy , Reinersman Gerald T. , Herring Lucille , Dave Viral A. , Nafday Suhas , Brion Luc P.
Published: April 2006

OBJECTIVES. To assess whether targeted short-term fluconazole prophylaxis reduces late-onset (>3 days of age) invasive fungal infection (IFI) among very low birth weight infants and extremely low birth weight (ELBW) infants and to assess mortality rates, toxicity, and costs associated with this intervention.

METHODS. An observational study of 2 subsequent epochs of inborn infants with birth weight of <1500 g or gestational age of <32 weeks, 1 before (control) and 1 after (fluconazole) initiation of routine targeted fluconazole prophylaxis in March 2003, was performed. Targeted fluconazole (3 mg/kg) prophylaxis was administered to infants for whom a decision was made to administer broad-spectrum antibiotics for >3 days.

RESULTS. IFI was observed for 13 (6.3%) of 206 infants in the control epoch and 2 (1.1%) of 178 in the fluconazole epoch, with a common odds ratio of 0.166. Logistic regression analysis taking into account all published factors (except for fungal colonization) showed that the fluconazole epoch was associated significantly with lower IFI rates. We observed no change in late (>3 days) mortality rates (11 of 206 infants in the control epoch vs 8 of 178 infants in the prophylaxis epoch). The mortality rate for ELBW infants with IFI was low (15%) in our study. Fluconazole was administered to 81% of ELBW infants, who received a median of 8 doses, and 41% of larger infants, who received a median of 5 doses. The intervention was cost-effective, and the effective number needed to treat to prevent 1 IFI was 10.

CONCLUSIONS. This study suggests that targeted short-course fluconazole prophylaxis in very low birth weight and ELBW infants may be efficacious and cost effective.
Effectiveness of Centers for Disease Control and Prevention Recommendations for Outcomes of Acute Otitis Media
Authors: Bauchner Howard , Marchant Colin D. , Bisbee Alice , Heeren Timothy , Wang Bingxia , McCabe Megan , Pelton Stephen ,   Boston-Based Pediatric Research Group
Published: April 2006

OBJECTIVES. To determine whether we could increase adherence to the Centers for Disease Control and Prevention (CDC) recommendations with well-accepted approaches to improving quality of care and adherence to the CDC recommendations resulted in improved outcomes for acute otitis media (AOM).

METHODS. A cluster randomization study was conducted in 12 pediatric practices (6 intervention and 6 control sites). The main outcome measures were adherence to the CDC recommendations (modified to include 2 additional antimicrobial agents) and a subsequent antibiotic prescription for AOM within 30 days after diagnosis.

RESULTS. Of 3152 patients referred to research assistants, 2584 (82%) were eligible. Of those eligible, 1368 (99%) of 1382 at the intervention sites and 1138 (99%) of 1146 at the control sites consented to participate. Rates of adherence to the CDC recommendations were not significantly higher at the intervention sites than at the control sites, for initial enrollment episodes (78.2% vs 70.6%) or second episodes (62.6% vs 59.9%). After controlling for clustering according to site and covariates, children who were not treated in adherence to the CDC recommendations for both episodes had 1.60 times the odds of a subsequent prescription within 12 days, compared with those treated in adherence at both episodes.

CONCLUSIONS. Despite using evidence-based approaches that are known to influence physician behavior, we were unable to increase adherence to the CDC recommendations for treatment of AOM. However, we did establish that prescription of antimicrobial therapy consistent with the CDC recommendations for a second episode of AOM was associated with improved outcomes, measured as the need for subsequent antibiotic prescription. Because of the selection of resistant otopathogens, adherence to the CDC recommendations is likely more important in subsequent episodes of AOM than in the initial episode.
The Apgar Score
Authors:   American Academy of Pediatrics,   Committee on Fetus and Newborn,   American College of Obstetricians and Gynecologists,   Committee on Obstetric Practice
Published: April 2006

The Apgar score provides a convenient shorthand for reporting the status of the newborn infant and the response to resuscitation. The Apgar score has been used inappropriately to predict specific neurologic outcome in the term infant. There are no consistent data on the significance of the Apgar score in preterm infants. The Apgar score has limitations, and it is inappropriate to use it alone to establish the diagnosis of asphyxia. An Apgar score assigned during resuscitation is not equivalent to a score assigned to a spontaneously breathing infant. An expanded Apgar score reporting form will account for concurrent resuscitative interventions and provide information to improve systems of perinatal and neonatal care.
Briefing: UKAS accreditation—building better standards
Authors: Talbot Graham
Published: April 2006

In today's risk-averse climate it is increasingly important for civil engineers to demonstrate that they are achieving high standards at all times. Using a United Kingdom Accreditation Service (UKAS)-accredited evaluation service is the answer, says Graham Talbot of UKAS.
Briefing: Are you sure of your footing?
Authors: Edmonds Shareena
Published: April 2006

The UK courts have served a stark warning to civil engineers about the dangers of using assumptions about ground conditions. Shareena Edmonds of UK law firm Pinsent Masons says engineers must ensure any preliminary design assumptions are verified.
Briefing: Virtual service overseas: a new way to volunteer
Authors: Khalid Simah
Published: April 2006

You can now volunteer your engineering skills to help developing and disaster-hit countries without having to put your life or career on hold. Simah Khalid introduces EngineerAid, a new engineering charity where the help is provided solely online.
Briefing: Promoting value—securing the future
Authors: Masterton Gordon
Published: April 2006

In his inaugural address as 2005/06 ICE president on 1 November 2005, Gordon Masterton set out his vision for the future of the civil engineering profession and the agenda for his year in office.
Lessons learned from tsunami damage in Sri Lanka
Authors: Dias Priyan , Dissanayake Ranjith , Chandratilake Ravihansa
Published: April 2006

Around 300 000 people were killed by the tsunami that followed the Sumatra–Andaman earthquake on Boxing Day 2004, making it one of the worst disasters in modern history. Up to 40 000 died in Sri Lanka alone, where around 80 000 houses were also destroyed when waves up to 15 m high swept ashore. This paper reports on how coastal buildings and infrastructure in Sri Lanka behaved under various tsunami wave heights and the many lessons learned for reducing vulnerability to future events. In particular, newly published national guidelines for reconstruction emphasise the importance of tying down structures against upward and lateral loads as well as the need to anticipate and reduce soil scour around foundations, especially of backfilled earth.
Project management: turning engineers into team players
Authors: Hamilton Albert
Published: April 2006

Delivering outcomes in today's business world is increasingly achieved through undertaking a collection of projects, which frequently involve teamwork with multiple experts and organisations. But not all civil engineers are naturally comfortable working in this way. For some of us it involves a potentially cataclysmic shift towards ‘softer’ sciences, increasing our behavioural skills and getting things achieved through people. This paper examines the skill range needed to be an effective project manager and reports on an on-the-job training programme that was run successfully for four years in Sweden and Ireland.
Union Chain Bridge: linking engineering
Authors: Miller Gordon
Published: April 2006

Civil and marine engineering have long been linked, but perhaps no more symbolically than by the Union Chain Bridge between Scotland and England over the River Tweed. It was built 186 years ago by Sir Samuel Brown, who made the transition from Royal Navy captain to designer of the world's longest iron suspension bridge in one single leap. This paper reports on his remarkable eight-year journey, from leaving the Royal Navy in 1812 to start an anchor-chain business to building the record-breaking Union Chain Bridge in 1820. He went on to design the Brighton Chain Pier and supply Isambard Kingdom Brunel with chains for his Great Eastern steamship, while his company remained the navy's sole chain supplier for over a century. Union Chain Bridge, which still carries road traffic today, thus serves as an inspiration to all engineers of the benefits of cross-disciplinary thinking.
Ethics: making it the heart of water supply
Authors: Sohail Muhammad , Sue Cavill
Published: April 2006

Water ethics is an important but frequently ignored aspect of water resource planning and infrastructure management. This paper sets out seven basic concerns for the water sector in developed and developing countries. These concerns are the water cycle, quality of life, equity, sustainability, human rights, externalities and governance. They are then used to develop ten ethical principals that should be taken into account by water professionals and decision makers if they are to achieve effective, efficient and ethically acceptable water resource management. Points for discussion are also raised on how ethics can play a more prominent role in ensuring water provision for all.
Dams: setting a new standard for sustainability
Authors: Bridle Rodney
Published: April 2006

Dams are important elements of water infrastructure and bring many benefits to society. The World Commission on Dams addressed concerns about them and practice is improving. The UN Millennium Development Goals aim to halve several unsatisfactory situations by 2015, and infrastructure contributing to their achievement should therefore be designed to halve current risks. Quantitative risk assessment methods have been developed to enumerate the safety of UK dams. Any quantitative assessment of risk necessarily raises the need to establish what risks are acceptable to society, and the work on dams has prompted the thought that acceptable risk could become an impartial, apolitical and conscionable means of establishing the standards of infrastructure that should be delivered. How the approach could be applied and developed is described.
Trenchless technology: a modern solution for clean-flowing cities
Authors: Downey Dec
Published: April 2006

The Indian Government is currently using trenchless technology for construction and rehabilitation of sewers in New Delhi as part of a massive programme to clean up the Yamuna river. The work is of a similar scale and concept to Joseph Bazalgette's nineteenth century London sewerage project—the main difference being that modern urban societies, whether rich or poor, can no longer afford the disruption of major open-cut construction. This paper reports on the huge take-up of trenchless techniques in both the developing and developed world, and of its increasingly vital role in cost-effective provision and renovation of water and sewage networks in today's congested cities.
Sharing water: engineering the Indus Water Treaty
Authors: Birch David , Rasheed Aslam , Drabu Iftikhar
Published: April 2006

When Pakistan and India achieved independence in 1947, their boundaries and the disputed state of Kashmir lay directly across the vast and vital Indus river basin. This quickly led to a still-simmering row over territorial rights and a similarly entrenched but more resolved conflict on water rights. During ten years of negotiations, which involved engineers rather than politicians and using the World Bank as mediator, the two countries finally concluded the Indus Water Treaty in 1960. This paper describes how the treaty was arrived at, its provisions for separate management and water sharing, the many, often massive, control schemes that have been built or attempted since and the lessons learned for future cross-border water disputes.
Water mining: the Great Man-made River, Libya
Authors: Kuwairi Adam
Published: April 2006

Libya's £14 billion Great Man-made River is one of the world's largest water-supply projects. It involves mining ancient groundwater reservoirs under the Sahara desert and piping it to the coast, where most of the country's 6 million inhabitants live. The first and largest two phases have been operating for over 10 years, two more sections are under construction and future phases will bring total deliveries to 6·6 million m3 a day. This paper provides an overview of the project to date and of the many lessons learned from its construction and operation. It also compares original environmental impact projections with impacts actually experienced—which indicate reservoir depletion is proving slower than expected such that supplies should last well into the next century.
Water for the world —why is it so difficult?
Authors: Banyard John
Published: April 2006

Lack of clean water is the single biggest cause of human illness and death in the world. One of the UN's Millennium Development Goals is to halve the proportion of people lacking access to clean water and sanitation by 2015. But, while the technology underpinning water and sanitation in developed countries has been understood for nearly a century, it is proving difficult to transfer it to developing and transitional countries. This paper examines the evolution of water supply and sanitation in developed countries and identifies the challenges they are facing, including ever-increasing demands for higher quality standards, the need to replace ageing assets and demands for sustainability. It then questions how much of this is relevant to developing countries, where ‘sustainability of water supply’ simply means what is available today will continue to be available tomorrow.
Lesotho Highlands: the socio-economics of exporting water
Authors: Tromp Leon
Published: April 2006

Lesotho Highlands water project is one of the most significant and ambitious water supply schemes under construction in the southern hemisphere. Given the relatively small size of the Lesotho economy, a project of such magnitude has inevitably had dramatic effects, particularly on human settlement patterns. This paper reports on the socio-economic challenges that had to be resolved before, during and after the implementation of the £1·5 billion phases 1A and 1B, which were completed in 1998 and 2002 respectively. It also provides the latest data on project costs and the considerable income and other benefits now being received by Lesotho.
Europe: a challenging new framework for water quality
Authors: Kay David , McDonald Adrian , Stapleton Carl , Wyer Mark , Fewtrell Lorna
Published: April 2006

By 2015 all EU member states will need to have achieved the unprecedented condition of ‘good ecological status’ throughout their national watercourses. This means managing not only point sources of pollution, like sewage outfalls, but also diffuse sources such as runoff from farmland. The new quality requirements are set out in the 2000 European Water Framework Directive, the most significant piece of environmental legislation so far produced by the EU. This paper describes the new legislation, its timeline for implementation and the many technical challenges now facing regulators, engineers, social scientists and environmental professionals throughout Europe as a result.
Clinical and Anatomical Factors Limiting Treatment Outcomes of Gingival Recession: A New Method to Predetermine the Line of Root Coverage
Authors: Zucchelli G. , Testori T. , De Sanctis M.
Published: April 2006

Complete root coverage is not always achievable, even in gingival recession with no loss of interproximal attachment and bone. The cemento‐enamel junction is the most widely used referring parameter to evaluate root coverage results. The aim of the present study was to describe the most frequent diagnostic mistakes that may lead to incomplete root coverage in Miller Class I and II gingival recessions and to suggest a method to predetermine the level/line of root coverage in non‐molar teeth.

The line of root coverage (i.e., the level/line to which the soft tissue margin will be positioned after the healing process of a root coverage surgical technique) was predetermined by calculating the ideal vertical dimension of the interdental papilla of the tooth with the recession defect. This method was applied to 120 recession‐type defects affecting non‐molar teeth of 80 young healthy subjects that were treated with root coverage surgical procedures over the last 5 years. All recessions were Miller Class I or II and were associated with at least one of the following characteristics: 1) traumatic loss of the tip of the interdental papilla(e); 2) tooth rotation; 3) tooth extrusion with or without occlusal abrasion; and 4) a cervical abrasion defect with no evidence of the cemento‐enamel junction.

The line of root coverage may be considered the clinical cemento‐enamel junction because it may substitute the anatomic cemento‐enamel junction when this is no longer clinically visible on the tooth with recession or when the ideal conditions to obtain complete root coverage are not fully represented.
Porphyromonas gingivalis‐Induced Cellular Hypertrophy and MMP‐9 Activity via Different Signaling Pathways in H9c2 Cardiomyoblast Cells
Authors: Lee Shin‐Da , Wu Cheng‐Chung , Chang Yu‐Chao , Chang Sheng‐Huang , Wu Chieh‐Hsi , Wu Jia‐Ping , Hwang Jin‐Ming , Kuo Wei‐Wen , Liu Jer‐Yuh , Huang Chih‐Yang
Published: April 2006

Background: Little is known about the pathogenesis of cardiomyocyte hypertrophy caused by periodontitis pathogens. The purpose of this study was to determine the effect of the periodontal pathogen Porphyromonas gingivalis on cardiomyocyte hypertrophy.

Methods: Matrix metalloproteinase (MMP)‐2 and MMP‐9 activities and cellular morphology were measured by gelatin zymography and immunofluorescence after P. gingivalis‐medium treatment with or without SB203580 (p38 mitogen‐activated protein kinase cascade [p38] inhibitor), U0126 (mitogen‐activated protein kinase kinase [MAPKK] inhibitor), LY294002 (phosphoinositide 3‐kinase [PI3K] inhibitor), cyclosporin A (CsA; calcineurin inhibitor), SP600125 (c‐Jun N‐terminal kinase [JNK] inhibitor), proinflammatory interleukin (IL)‐1, or anti‐inflammatory IL‐10 in cultured cardiomyoblast H9c2 cells.

Results: P. gingivalis medium increased MMP‐9 activities and cellular sizes (+87%) of H9c2 cells, whereas Actinobacillus actinomycetemcomitans medium and Prevotella intermedia medium had no effects. The increased activity of MMP‐9 treated with P. gingivalis medium was not mediated through p38, extracellular‐regulated kinase (ERK), PI3K, calcineurin, and JNK signaling pathways and was not inhibited by IL‐10. However, the hypertrophy of H9c2 cells induced with P. gingivalis medium was reduced by administration of SB203580 (−37%), U0126 (−35%), LY294002 (−49%), CsA (−49%), and SP600125 (−24%).

Conclusions: Our findings suggest that P. gingivalis medium elevated MMP‐9 activity and induced cardiomyoblast hypertrophy. However, P. gingivalis‐induced H9c2 cell hypertrophy was mediated through p38, ERK, PI3K, calcineurin, and JNK signaling pathways, which are in a totally different regulatory pathway from P. gingivalis‐elevated MMP‐9 activity. These findings provide evidence that P. gingivalis infection activated multiple factors via different pathways to induce the development of hypertrophy of H9c2 cardiomyoblast cells.
Clinical and Metabolic Changes After Conventional Treatment of Type 2 Diabetic Patients With Chronic Periodontitis
Authors: Faria‐Almeida Ricardo , Navarro Ana , Bascones Antonio
Published: April 2006

Background: The aim of this study was to compare the response to conventional periodontal treatment between patients with or without type 2 diabetes mellitus from a clinical and metabolic standpoint.

Methods: A prospective, parallel, comparative longitudinal clinical study was performed between type 2 diabetics and non‐diabetics with moderate generalized chronic periodontitis. The study period was 6 months. Conventional periodontal scaling and root planing were performed, and the response to this treatment was compared between the groups at 3 and 6 months, measuring the plaque index, bleeding on probing, probing depth, level of clinical attachment, and gingival recession. In the diabetic patients, the clinical response was related to measurements of HbA1c and glucose in blood at 3 and 6 months.

Results: An improvement in all clinical variables was observed, with no statistically significant differences between the groups, with the exception of probing depth (P <0.0207). The improvement observed in blood HbA1c levels confirmed a positive metabolic response to periodontal treatment, with a lower value for this variable at each measurement time.

Conclusions: Both groups of patients showed a clinical improvement after basic non‐surgical periodontal treatment. The diabetic patients showed improved metabolic control (lower HbA1c) at 3 and 6 months after periodontal treatment.
Locally Delivered Doxycycline as an Adjunctive Therapy to Scaling and Root Planing in the Treatment of Smokers: A 2‐Year Follow‐Up
Authors: Machion Luciana , Andia Denise Carleto , Lecio Giovana , Nociti Francisco Humberto , Casati Márcio Zaffalon , Sallum Antonio Wilson , Sallum Enilson Antonio
Published: April 2006

Background: The aim of this clinical study was to evaluate the association of locally delivered doxycycline 10% with scaling and root planing in the periodontal treatment of smokers during a 2‐year period.

Methods: Forty‐eight chronic periodontitis patients, presenting a minimum of four pockets (≥5 mm) that bled on probing on anterior teeth were included. Patients were randomly assigned to receive one of the following treatments: scaling and root planing (SRP) and scaling and root planing followed by local application of doxycycline (SRP‐D). Assigned treatments were performed at baseline and at 12 months. Clinical parameters, including probing depth (PD) and relative attachment level (RAL), were recorded at baseline; 45 days; 3, 6, and 12 months (retreatment); 45 days following retreatment; and at 15, 18, and 24 months.

Results: In initially deep pockets (≥7 mm), SRP‐D showed greater PD reduction than SRP at 6 and 18 months (mean difference between groups of 1.18 and 1.73 mm, respectively; P <0.05) and greater RAL gain in all periods after 3 months (mean difference between groups of 1.16, 1.99, and 1.78 mm, at 6, 18, and 24 months, respectively; P <0.05). Also, the proportion of sites showing ≥2 mm PD reduction was greater for SRP‐D at 6 months (81.2% × 50.8%; P <0.001) and at 24 months (65.5% × 46.5%; P = 0.01). As for RAL gain, this proportion was 34.4% and 18.1% for SRP‐D and SRP at 24 months, respectively (P = 0.008).

Conclusion: The use of locally delivered doxycycline may constitute an important adjunct for the active and supportive treatments of severe periodontal disease in smokers.
Upregulation of the Expression of Epidermal Growth Factor and Its Receptor in Gingiva Upon Cyclosporin A Treatment
Authors: Chin Yu‐Tang , Chen Yen‐Teen , Tu Hsiao‐Pei , Shen E‐Chin , Chiang Cheng‐Yang , Gau Ching‐Hwa , Nieh Shin , Fu Earl
Published: April 2006

Background: To understand the roles of epidermal growth factor (EGF) and EGF receptor (EGF‐R) in cyclosporin A (CsA)‐induced gingival overgrowth, expression of EGF and EGF‐R upon CsA treatment was examined in an oral epidermoid carcinoma cell line of humans (OECM‐1) and in edentulous gingiva of rats.

Methods: In vitro study: after CsA treatment, OECM‐1 cells were harvested to evaluate their mRNA and protein expression of EGF and EGF‐R with reverse transcriptase‐polymerase chain reaction (RT‐PCR), Western blot, and immunocytochemistry (ICC). In vivo study: 3 weeks after extraction of all maxillary molars, 20 male Sprague‐Dawley rats were assigned to a CsA group (30 mg/kg, fed daily) and a control group. Five rats per group were sacrificed at weeks 1 and 4. Edentulous ridge specimens were obtained for evaluating their mRNAs and protein expression with RT‐PCR, real‐time RT‐PCR, and immunohistochemistry (IHC). In both in vitro and in vivo experiments, the proliferating potential of epithelial cells was examined by the presence of proliferating cell nuclear antigen (PCNA).

Results: In vitro: dose‐dependently increased mRNA expression of EGF and EGF‐R in OECM‐1 cells was noted after CsA treatment. Protein expressions of EGF and EGF‐R were higher in OECM‐1 with CsA treatment than without CsA. In vivo: higher mRNA and protein expressions of EGF and EGF‐R were also observed in the gingival tissues of CsA‐treated rats. In both in vitro and in vivo experiments, greater PCNA expression after CsA treatment was demonstrated.

Conclusions: Higher expression of EGF and EGF‐R upon CsA therapy was observed in OECM‐1 epithelial cells of humans and in edentulous gingiva of rats. We suggest that CsA could upregulate gene and protein expression of EGF and EGF‐R, and the upregulation may play a role in gingival overgrowth.
Factors Influencing Treatment Outcomes in Mandibular Class II Furcation Defects
Authors: Tsao Yi‐Pin , Neiva Rodrigo , Al‐Shammari Khalaf , Oh Tae‐Ju , Wang Hom‐Lay
Published: April 2006

Background: Factors influencing treatment outcomes in furcation defects remain to be studied. Therefore, the aim of the study was to evaluate the association between factors and clinical parameters that may influence treatment outcomes in mandibular Class II furcation defects.

Methods: Twenty‐seven systemically healthy subjects with a Class II buccal or lingual furcation defect in lower molars were treated. Clinical measurements (probing depth [PD], clinical attachment level [CAL], recession, mobility, plaque index [PI], and bleeding on probing [BOP]) and defect (vertical and horizontal defect depths) were obtained at initial and 6‐month reentry surgeries. Treatment modalities (e.g., nine each in the following three groups: open flap debridement [OFD] alone, bone graft [BG], and bone graft plus a bioabsorbable collagen membrane [BG + C]), anatomic factors (presence of cervical enamel projection, presence of cervical restorations/fixed prosthesis, and location of furcations [buccal or lingual sides; first or second molars]), clinical parameters (initial mobility, initial PD at furcation, initial CAL at furcation, mean initial PD of the tooth, mean initial CAL of the tooth, initial horizontal PD at furcation, initial horizontal/vertical defect depth, PI, and BOP), and background factors (endodontic status, smoking status, and surgeon's experience) were analyzed for associations with probability of clinical improvement.

Results: The anatomic factors, clinical parameters, and background information were found to have no effect in influencing treatment outcome with the exception of initial vertical defect depth. An initial vertical defect depth ≥4 mm had a borderline significance (P = 0.06) of achieving a high probability of having a 1‐mm vertical bone fill. In addition, treatment modality was found to be a major influence factor. Sites treated with BG were 16× more likely to have >50% vertical bone fill than open flap surgery. Furthermore, sites treated with BG were 64× more likely to have a 1‐mm vertical defect fill compared to sites treated with OFD and 16× more likely to have a 2‐mm vertical defect fill compared to sites treated with OFD or BG + C. However, the additional membrane does not enhance the regenerative outcomes achieved by BG alone.

Conclusions: Initial vertical defect depth (≥4 mm) and treatment modality (e.g., BG) were found to be the clinical parameter and factor that were associated with high probability of clinical improvement. Sites treated with BG, such as mineralized human cancellous allograft, were more likely to have greater vertical furcation defect fill than the conventional OFD surgery. Additional membrane placement does not enhance the treatment outcome achieved by BG alone.
Initial Presentation of Lung Sarcomatoid Carcinoma as a Metastatic Lesion in the Mandibular Gingiva
Authors: Park Ju‐Yong , Kim Hyung‐Sup , Zo Jae‐Ill , Lee Sun , Choi Sung‐Weon
Published: April 2006

Background: Sarcomatoid carcinoma of the lung is a very rare type of tumor characterized by distant metastasis. However, metastasis to the gingiva is an uncommon event. Occasionally, an oral metastatic lesion may be the preliminary clinical feature observed before the diagnosis of the primary tumor.

Methods: The clinical features of gingival metastasis as an initial presentation of lung sarcomatoid carcinoma are discussed. A 55‐year‐old male patient presented with a rapidly growing pedunculated exophytic mass on the gingiva at the left side of the lower jaw. Incisional biopsy was performed.

Results: The histologic and immunohistochemical diagnosis was metastatic carcinoma. To locate the primary tumor, we analyzed the lung lesion by chest computerized tomography (CT) scans and biopsy. The patient was ultimately diagnosed with sarcomatoid carcinoma of the lung with gingival metastasis. Palliative chemotherapy for lung cancer was administered. The gingival lesion disappeared after chemotherapy.

Conclusion: Although this case is unusual, periodontists should recognize that gingival masses similar to benign or inflammatory lesions may represent an initial sign of underlying malignant tumors.