bluuebunny/crossref_metadata_2025 huggingface dataset:
Small cell carcinomas of the larynx: Results of combined modality treatments
Authors: Posner Marshall R. , Weichselbaum Ralph R. , Carrol Elaine , Fabian Richard L. , Miller Daniel , Ervin Thomas J.
Published: November 2006

Four cases of primary small cell carcinoma of the larynx are described. Two patients presented with extensive metastatic disease and two with tumor limited to the larynx. All four cases responded (3PR, ICR) to systemic combination chemotherapy. Long‐term remission was achieved in one patient with limited disease who underwent chemotherapy with a complete response followed by definitive radiotherapy. Treatment results are compared with previously reported cases. The importance of early diagnosis through staging, and combined treatment in small cell carcinoma of the larynx is discussed.
Injuries related to all‐terrain vehicular accidents: A closer look at head and neck trauma
Authors: Friedman Rick , Sitzer Matthew , Schaff Howard B. , Harris Jeffrey P. , Marshall Lawrence , Shackford Steven
Published: October 2006

Morbidity and mortality associated with all‐terrain vehicular accidents is climbing at a steady rate. These accidents frequently result in multiorgan system trauma. A retrospective study of all victims involved in three‐wheel motor vehicle accidents admitted to the UCSD Trauma Unit between July 1980 and July 1985 is presented. Injury severity was assessed using the Abbreviated Injury Scale (AIS) and the Injury Severity Score (ISS). The average patient age was 23.3 years with 30% under 16 years of age. There was a male to female ratio of 14:1. The average hospital stay was 12.4 days. Six percent died as a result of their injuries. Injuries to the head and neck were sustained by 83.3% of patients, facial injuries by 46.6%, injuries to the chest by 13.3%, and injuries to the pelvis and abdomen by 13.3%. Thirty percent suffered injuries to the extremities and over 50% had abrasions, contusions, and/or lacerations. Physicians, the public, and state and federal agencies are urged to promote safer use of these recreational vehicles.
The anterior inferior cerebellar artery in the internal auditory canal
Authors: Reisser Christoph , Schuknecht Harold F.
Published: October 2006

It has been proposed that compression of the auditory and vestibular nerve trunks by vascular loops might be the cause of otherwise unexplained hearing loss, tinnitus, and vertigo, as well as Men‐iere's disease. We studied the human temporal bone histological collection at the Massachusetts Eye and Ear Infirmary to determine whether audiovestibular symptoms could be correlated with the presence of the anterior inferior cerebellar artery within the internal auditory canal. Anterior inferior cerebellar artery loops were found within the internal auditory canals of 12.3% of 1327 temporal bones, about half the number found when preparations with intact brains are studied. This difference can be attributed to avulsion of the anterior inferior cerebellar artery during removal of the brain at autopsy. There were 5 cases of unexplained unilateral hearing loss with anterior inferior cerebellar artery loops: 3 in the opposite ear and 2 in both ears. There were 2 cases with unilateral unexplained tinnitus with anterior inferior cerebellar artery loops: 1 in the involved ear and 1 in the opposite ear. A case with bilateral tinnitus had an anterior inferior cerebellar artery loop in 1 ear. There were 29 cases of vertigo with no peripheral histo‐pathological correlate or central nervous system disorder; anterior inferior cerebellar artery loops were found in the internal auditory canals of 7 (12.5%) of the 56 ears in this group, which is not significantly different from the 12.3% incidence recorded for the entire collection. In 23 cases of unilateral Meniere's disease, there were anterior inferior cerebellar artery loops in the hydropic ears in 3, the opposite ear in 1, and both ears in 1. We can find no correlation between unexplained hearing loss, tinnitus, vertigo, or Meniere's disease and the presence of the anterior inferior cerebellar artery in the internal auditory canal.
Effects of arytenoid adduction on laryngeal function following ansa cervicalis nerve transfer for vocal fold paralysis in an in vivo canine model
Authors: Nasri Sina , Sercarz Joel A. , Ye Ming , Kreiman Jody , Gerratt Bruce R. , Berke Gerald S.
Published: November 2006

Laryngeal reinnervation with the ansa cervicalis has been proposed as a treatment for human unilateral vocal fold paralysis (UVFP). This study tested the assumption that results from reinnervation could be improved if combined with medialization surgery. Six canine subjects underwent recurrent laryngeal nerve section and reinnervation with a branch of the ansa cervicalis. After reinnervation, vocal function was assessed before and after arytenoid adduction. Although laryngeal function improved significantly following reinnervation, results were significantly enhanced by the addition of medialization surgery. The implications for the treatment of human unilateral vocal fold paralysis are discussed.
Modified liberatory maneuver: Effective treatment for benign paroxysmal positional vertigo
Authors: Harvey Steven A. , Hain Timothy C. , Adamiec Lois C.
Published: November 2006

A modification of the liberatory maneuver was used to treat 25 patients with benign paroxysmal positional vertigo (BPPV). The modified liberatory maneuver relieved symptoms without recurrence in 11 (44%) patients. A partial response was noted in 6 (24%) patients, and there was no improvement in 8 (32%) patients. Follow‐up ranged from 1 to 20 months (median 4.0 months). Patient age was not predictive of response to treatment. Duration of symptoms before treatment, however, was greater in nonresponders (median 15.5 months) than in complete (median 5.0 months) or partial (median 3.5 months) responders. The modified liberatory maneuver takes approximately 5 minutes to perform and provides effective treatment in two thirds of patients who suffer from BPPV.
Prediction of occult neck disease in laryngeal cancer by means of a logistic regression statistical model
Authors: Ghouri Ahmed F. , Zamora Rene L. , Sessions Donald G. , Spitznagel Edward L. , Harvey Joseph E.
Published: November 2006

The ability to accurately predict the presence of subclinical metastatic neck disease in clinically N0 patients with primary epidermoid cancer of the larynx would be of great value in determining whether to perform an elective neck dissection. We describe a statistical approach to estimating the probability of occult neck disease given pretreatment clinical parameters. A retrospective study was performed involving 736 clinically N0 patients with primary laryngeal cancer who were treated surgically with primary resection and ipsilateral neck dissection. Nodal involvement was determined histologically after surgical lymphadenectomy. A logistic regression model was used to derive an equation that calculated the probability of occult neck metastasis based on pretreatment T stage, tumor location, and histologic grade. The model has a sensitivity of 74%, a specificity of 87%, and can be entered into a programmable calculator.
Variations of the ‘grand-piano sign’ during total knee replacement
Authors: Cui W.-Q. , Won Y.-Y. , Baek M.-H. , Kim K.-K. , Cho J.-H.
Published: October 2006

The appearance of the ‘grand-piano sign’ on the anterior resected surface of the femur has been considered to be a marker for correct femoral rotational alignment during total knee replacement. Our study was undertaken to assess quantitatively the morphological patterns on the resected surface after anterior femoral resection with various angles of external rotation, using a computer-simulation technique. A total of 50 right distal femora with varus osteoarthritis in 50 Korean patients were scanned using computerised tomography. Computer image software was used to simulate the anterior femoral cut, which was applied at an external rotation of 0°, 3° and 6° relative to the posterior condylar axis, and parallel to the surgical and clinical epicondylar axes in each case. The morphological patterns on the resected surface were quantified and classified as the ‘grand-piano sign’, ‘the boot sign’ and the ‘butterfly sign’. The surgeon can use the analogy of these quantified sign patterns to ensure that a correct rotational alignment has been obtained intra-operatively.
An Acute Effect of Neuregulin 1β to Suppress α7-Containing Nicotinic Acetylcholine Receptors in Hippocampal Interneurons
Authors: Chang Qing , Fischbach Gerald D.
Published: November 2006

We examined rapid effects of neuregulin (NRG) on nicotinic acetylcholine (ACh) receptors in interneurons located in the stratum radiatum of the hippocampus. Two types of response were detected by whole-cell recordings after brief pulses of ACh. One type was a rapidly rising and falling (monophasic) current that was blocked by methyllycaconitine. The other type was a similar fast response followed by a more slowly rising and falling current. The slow component of the biphasic response was resistant to methyllycaconitine. Perfusion or local application with NRG 1β rapidly decreased fast inward ACh currents. NRG 1β had no effect on slow responses. NRG 1β suppression was abolished by the ErbB tyrosine kinase inhibitor PD 158780 (4-[(3-bromophenyl) amino]-6-(methylamino)-pyrido[3,4-d]pyridimine). The NRG 1β effect was also inhibited by phalloidin and cytochalasin D. Furthermore, NRG 1β decreased the number of surface Alexa Fluor 488 α-bungarotoxin binding sites. We believe that the NRG 1β-induced inhibition of ACh currents is because of receptor internalization trigged by protein tyrosine phosphorylation. Significantly, fast nicotinic EPSCs evoked in the presence of muscarinic, ionotropic glutamate, and GABA receptors antagonists were also reduced by NRG 1β. Thus, short-term as well as long-term effects of NRG must be taken into consideration in studies of ACh receptor-mediated synaptic efficacy in the CNS.
Adenosine A2AReceptors in Bone Marrow-Derived Cells But Not in Forebrain Neurons Are Important Contributors to 3-Nitropropionic Acid-Induced Striatal Damage as Revealed by Cell-Type-Selective Inactivation
Authors: Huang Qing-Yuan , Wei Catherine , Yu Liqun , Coelho Joana E. , Shen Hai-Ying , Kalda Anti , Linden Joel , Chen Jiang-Fan
Published: November 2006

Endogenous adenosine acting at the adenosine A2Areceptor (A2AR) can modify brain injury in a variety of neurological disorder models. However, both A2AR activation and inactivation have been shown to be neuroprotective in different situations, raising the intriguing possibility that A2ARs in distinct cellular elements may have different and even opposing effects. In this study, we developed three novel transgenic models to dissect out cell-type-specific actions of A2ARs on striatal damage by the mitochondrial toxin 3-nitropropionic acid (3-NP). Whereas global inactivation of A2ARs exacerbated 3-NP-induced neurological deficit behaviors and striatal damage, selective inactivation of A2ARs in forebrain neurons (using the Cre/loxP strategy) did not affect neurological deficit or striatal damage after the acute systemic treatment of 3-NP and intrastriatal injection of malonate. However, selective inactivation of A2ARs in bone marrow-derived cells (BMDCs) by transplanting bone marrow cells from global A2AR knock-out (KO) mice into wild-type C57BL/6 mice produced a similar phenotype of global A2AR KO mice, i.e., exacerbation of 3-NP-induced striatal damage. Thus, cell-type-selective inactivation of A2ARs reveals that A2ARs in BMDCs but not in forebrain neurons are an important contributor to striatal damage induced by mitochondrial dysfunction.
Ataxin-3 Represses Transcription via Chromatin Binding, Interaction with Histone Deacetylase 3, and Histone Deacetylation
Authors: Evert Bernd O. , Araujo Julieta , Vieira-Saecker Ana M. , de Vos Rob A. I. , Harendza Sigrid , Klockgether Thomas , Wüllner Ullrich
Published: November 2006

Ataxin-3 (AT3), the disease protein in spinocerebellar ataxia type 3 (SCA3), has been associated with the ubiquitin–proteasome system and transcriptional regulation. Here we report that normal AT3 binds to target DNA sequences in specific chromatin regions of the matrix metalloproteinase-2 (MMP-2) gene promoter and represses transcription by recruitment of the histone deacetylase 3 (HDAC3), the nuclear receptor corepressor (NCoR), and deacetylation of histones bound to the promoter. Both normal and expanded AT3 physiologically interacted with HDAC3 and NCoR in a SCA3 cell model and human pons tissue; however, normal AT3-containing protein complexes showed increased histone deacetylase activity, whereas expanded AT3-containing complexes had reduced deacetylase activity. Consistently, histone analyses revealed an increased acetylation of total histone H3 in expanded AT3-expressing cells and human SCA3 pons. Expanded AT3 lost the repressor function and displayed altered DNA/chromatin binding that was not associated with recruitment of HDAC3, NCoR, and deacetylation of the promoter, allowing aberrant MMP-2 transcription via the transcription factor GATA-2. For transcriptional repression normal AT3 cooperates with HDAC3 and requires its intact ubiquitin-interacting motifs (UIMs), whereas aberrant transcriptional activation by expanded AT3 is independent of the UIMs but requires the catalytic cysteine of the ubiquitin protease domain. These findings demonstrate that normal AT3 binds target promoter regions and represses transcription of a GATA-2-dependent target gene via formation of histone-deacetylating repressor complexes requiring its UIM-associated function. Expanded AT3 aberrantly activates transcription via its catalytic site and loses the ability to form deacetylating repressor complexes on target chromatin regions.
Abnormal Function of C-Fibers in Patients with Diabetic Neuropathy
Authors: Ørstavik Kristin , Namer Barbara , Schmidt Roland , Schmelz Martin , Hilliges Marita , Weidner Christian , Carr Richard W. , Handwerker Hermann , Jørum Ellen , Torebjörk H. Erik
Published: November 2006

The mechanisms underlying the development of painful and nonpainful neuropathy associated with diabetes mellitus are unclear. We have obtained microneurographic recordings from unmyelinated fibers in eight patients with diabetes mellitus, five with painful neuropathy, and three with neuropathy without pain. All eight patients had large-fiber neuropathy, and seven patients had pathological thermal thresholds in their feet, indicating the involvement of small-caliber nerve fibers. A total of 163 C-fibers were recorded at knee level from the common peroneal nerve in the patients (36–67 years old), and these were compared with 77 C-fibers from healthy controls (41–64 years old). The ratio of mechano-responsive to mechano-insensitive nociceptors was ∼2:1 in the healthy controls, whereas in the patients, it was 1:2. In patients, a fairly large percentage of characterized fibers (12.5% in nonpainful and 18.9% in painful neuropathy) resembled mechano-responsive nociceptors that had lost their mechanical and heat responsiveness. Such fibers were rarely encountered in age-matched controls (3.2%). Afferent fibers with spontaneous activity or mechanical sensitization were found in both patient groups. We conclude that small-fiber neuropathy in diabetes affects receptive properties of nociceptors that leads to an impairment of mechano-responsive nociceptors.
Activity-Dependent Plasticity in the Olfactory Intrabulbar Map
Authors: Marks Carolyn A. , Cheng Kai , Cummings Diana M. , Belluscio Leonardo
Published: November 2006

In mammals, each olfactory bulb contains two mirror-symmetric glomerular maps. Isofunctional glomeruli within each bulb are specifically linked through a set of reciprocal intrabulbar projections (IBPs) to form an intrabulbar map. We injected neural tracers into the glomerular layer on one side of the bulb and examined the resulting projection on the opposite side. In adult mice, the size of the projection tuft is directly proportional to the size of the injected region. Using this ratio as a measure of IBP maturity, we find an immature 5:1 projection to injection ratio at 1 week of age that gradually refines to a mature 1:1 by 7 weeks. Moreover, whereas the glomerular map is able to form despite the elimination of odorant-induced activity, the intrabulbar map shows clear activity dependence for its precise formation. Here we show through experiments with both naris-occluded and anosmic mice that odorant-induced activity is not required to establish IBPs but is crucial for projection refinement. In contrast, increased glomerular activation through exposure to distinct odorants during map development can accelerate the refinement of projections associated with the activated glomeruli. These findings illustrate a clear role for odorant-induced activity in shaping the internal circuitry of the bulb. Interestingly, activity deprivation can alter the organization of both the developing and the mature map to the same degree, demonstrating that intrabulbar map plasticity is maintained into adulthood with no discernible critical period.
Die „zweite Bauernrätebewegung“ im Deutschen Reich 1919–1920
Authors: Balestracci Fiammetta
Published: October 2006

Vorspann

Nach der Revolution von 1918 waren überall im Reich Arbeiter- und Soldatenräte entstanden, die mit den alten agrarischen Interessenverbänden um die Kontrolle der Räte wetteiferten, die sich in den landwirtschaftlich geprägten Regionen gebildet hatten. Im Frühjahr 1919 trat mit August Davier ein Großagrarier aus Sachsen-Anhalt auf den Plan, der das Projekt eines nationalen Zusammenschlusses aller agrarischen Interessen verfolgte – schließlich aber scheiterte. Worauf wollte der Großagrarier hinaus? Und weshalb erlitt er mit seinen Ambitionen, die sich offenkundig auch gegen den neuen demokratischen Staat richteten, Schiffbruch?
Bonn und das strategische Embargo gegen die Sowjetunion und ihre Verbündeten 1949–1958
Authors: Fäßler Peter E.
Published: October 2006

Vorspann

Das Embargo, das die USA nach 1945 gegenüber der Sowjetunion und deren Verbündeten errichteten, wurde zu einem der zentralen Faktoren in der internationalen Wirtschaftspolitik der Nachkriegszeit. Dem standen die massiven wirtschaftlichen Interessen gegenüber, welche die westeuropäischen Volkswirtschaften, und insbesondere die der Bundesrepublik, im „Ostblock“ verfolgten. Schon sehr bald befand sich die Bonner Regierung in einem fundamentalen Dilemma: Sollte sie ihre wirtschaftlichen Interessen den außenpolitischen unterordnen?
An Effective Nonchemical Treatment for Head Lice: A Lot of Hot Air
Authors: Goates Brad M. , Atkin Joseph S. , Wilding Kevin G. , Birch Kurtis G. , Cottam Michael R. , Bush Sarah E. , Clayton Dale H.
Published: November 2006

OBJECTIVES. Head lice (Pediculus humanus capitis) are a major irritant to children and their parents around the world. Each year millions of children are infested with head lice, a condition known as pediculosis, which is responsible for tens of millions of lost school days. Head lice have evolved resistance to many of the currently used pediculicides; therefore, an effective new treatment for head lice is needed. In this study we examined the effectiveness of several methods that use hot air to kill head lice and their eggs.

METHODS. We tested 6 different treatment methods on a total of 169 infested individuals. Each method delivers hot air to the scalp in a different way. We evaluated how well these methods kill lice and their eggs in situ. We also performed follow-up inspections to evaluate whether the sixth, most successful, method can cure head louse infestations.

RESULTS. All 6 methods resulted in high egg mortality (≥88%), but they showed more-variable success in killing hatched lice. The most successful method, which used a custom-built machine called the LouseBuster, resulted in nearly 100% mortality of eggs and 80% mortality of hatched lice. The LouseBuster was effective in killing lice and their eggs when operated at a comfortable temperature, slightly cooler than a standard blow-dryer. Virtually all subjects were cured of head lice when examined 1 week after treatment with the LouseBuster. There were no adverse effects of treatment.

CONCLUSIONS. Our findings demonstrate that one 30-minute application of hot air has the potential to eradicate head lice infestations. In summary, hot air is an effective, safe treatment and one to which lice are unlikely to evolve resistance.
School Performance and Social-Emotional Behavior of Primary School Children Before and After a Disaster
Authors: Smilde-van den Doel Dini A. , Smit Cees , Wolleswinkel-van den Bosch Judith H.
Published: November 2006

OBJECTIVES. The purpose of this work was to evaluate the cognitive and social-emotional consequences in a general population of primary school children affected by the firework disaster in Enschede, the Netherlands, on May 13, 2000. The explosions caused tremendous damage in the surrounding neighborhood. Twenty-two people immediately died and >1000 were injured.

METHODS. This retrospective study assessed school performance and social-emotional behavior before and up to 3 years after the disaster. Objectively measured school test results in spelling and arithmetic/mathematics and multi-informant social-emotional behavioral assessments were compared between exposed and nonexposed primary school children. Multivariate logistic-regression was used to assess the relationship between exposure and cognitive and social emotional functioning.

RESULTS. On school performances, the children exposed to the disaster performed over a period of 3 years after the disaster as good as or better than classmates, controls, and a national reference population. Shortly after the disaster, exposed children even seemed to have better school test results than nonexposed children. Two to 3 years after the disaster, a significant effect of disaster exposure was found on social-emotional behavior. Problematic behavior was reported by teachers, parents, and the school doctor.

CONCLUSIONS. This study demonstrates a limited influence of disaster exposure on school performance in primary school children. This study also shows that teachers and youth health care practitioners especially should be aware of children starting school several years after a disaster. Although very young at the time of a disaster (1–4 years of age), they may experience disaster-related problems.
The National Children's Study: A 21-Year Prospective Study of 100 000 American Children
Authors: Landrigan Philip J. , Trasande Leonardo , Thorpe Lorna E. , Gwynn Charon , Lioy Paul J. , D'Alton Mary E. , Lipkind Heather S. , Swanson James , Wadhwa Pathik D. , Clark Edward B. , Rauh Virginia A. , Perera Frederica P. , Susser Ezra
Published: November 2006

Prospective, multiyear epidemiologic studies have proven to be highly effective in discovering preventable risk factors for chronic disease. Investigations such as the Framingham Heart Study have produced blueprints for disease prevention and saved millions of lives and billions of dollars. To discover preventable environmental risk factors for disease in children, the US Congress directed the National Institute of Child Health and Human Development, through the Children's Health Act of 2000, to conduct the National Children's Study. The National Children's Study is hypothesis-driven and will seek information on environmental risks and individual susceptibility factors for asthma, birth defects, dyslexia, attention-deficit/hyperactivity disorder, autism, schizophrenia, and obesity, as well as for adverse birth outcomes. It will be conducted in a nationally representative, prospective cohort of 100000 US-born children. Children will be followed from conception to 21 years of age. Environmental exposures (chemical, physical, biological, and psychosocial) will be assessed repeatedly during pregnancy and throughout childhood in children's homes, schools, and communities. Chemical assays will be performed by the Centers for Disease Control and Prevention, and banks of biological and environmental samples will be established for future analyses. Genetic material will be collected on each mother and child and banked to permit study of gene-environment interactions. Recruitment is scheduled to begin in 2007 at 7 Vanguard Sites and will extend to 105 sites across the United States. The National Children's Study will generate multiple satellite studies that explore methodologic issues, etiologic questions, and potential interventions. It will provide training for the next generation of researchers and practitioners in environmental pediatrics and will link to planned and ongoing prospective birth cohort studies in other nations. Data from the National Children's Study will guide development of a comprehensive blueprint for disease prevention in children.
Hyperglycemia Is a Risk Factor for Early Death and Morbidity in Extremely Low Birth-Weight Infants
Authors: Hays Stephane P. , Smith E. O'Brian , Sunehag Agneta L.
Published: November 2006

OBJECTIVES. The objectives of this study were to determine the prevalence of hyperglycemia in extremely low birth-weight infants and to determine whether hyperglycemia increases the risk of early adverse outcomes (death or intraventricular hemorrhage of grade 3 or 4) and/or affects the length of hospital stay among survivors without intraventricular hemorrhage.

METHODS. The charts of all extremely low birth-weight infants (n = 93) admitted to Texas Children's Hospital (Houston, TX) during 2001 were reviewed. The highest daily blood glucose concentrations, highest dopamine infusion rates, highest daily percentage of inspired oxygen, and mean blood sodium concentrations were averaged over the first week of life or before death or occurrence of grade 3 or 4 intraventricular hemorrhage. Among survivors without severe intraventricular hemorrhage, the time ratio for blood glucose concentrations of >150 mg/dL was calculated.

RESULTS. More than 50% of the infants had persistent blood glucose concentrations of >150 mg/dL during their first week of life. Early adverse outcomes were associated with the average highest daily blood glucose concentration through interaction with the Clinical Risk Index for Babies score and with the average highest daily percentage of inspired oxygen. The length of hospital stay was associated with the time ratio for blood glucose concentrations of >150 mg/dL through interaction with birth weight and the average highest daily percentage of inspired oxygen.

CONCLUSION. These data confirm the high prevalence of hyperglycemia among parenterally fed, extremely low birth-weight infants and show that high blood glucose concentrations increase the risk of early death and grade 3 or 4 intraventricular hemorrhage and the length of hospital stay among survivors without intraventricular hemorrhage, which suggests that prevention and treatment of hyperglycemia may improve the outcomes of extremely low birth-weight infants.
Evaluation and Development of Potentially Better Practices to Improve Pain Management of Neonates
Authors: Sharek Paul J. , Powers Richard , Koehn Amy , Anand Kanwaljeet J. S.
Published: November 2006

OBJECTIVE

Despite increased knowledge, improved options, and regulatory man-dates, pain management of neonates remains inadequate, promoted by the ineffective translation of research data into clinical practice. The Neonatal Intensive Care Quality Improvement Collaborative 2002 was created to provide participating NICUs the tools necessary to translate research, related to prevention and treat-ment of neonatal pain, into practice. The objective for this study was to use proven quality improvement methods to develop a process to improve neonatal pain management collaboratively.

METHODS

Twelve members of the Neonatal Intensive Care Quality Improvement Collaborative 2002 formed an exploratory group to improve neonatal pain management. The exploratory group established group and site-specific goals and outcome measures for this project. Group members crafted a list of potentially better practices on the basis of the available literature, encouraged implementation of the potentially better practices at individual sites, developed a database for sharing information, and measured baseline outcomes.

RESULTS

The goal “improve the assessment and management of infants experiencing pain in the NICU” was established. In addition, each site within the group identified local goals for improvement in neonatal pain management. Data from 7 categories of neonates (N = 277) were collected within 48 hours of NICU admission to establish baseline data for clinical practices. Ten potentially better practices were developed for prioritized pain conditions, and 61 potentially better practices were newly implemented at the 12 participating sites. Various methods were used for pain assessment at the participating centers. At baseline, heel sticks were used more frequently than peripheral intravenous insertions or venipunctures, with substantial variability in the number of avoidable procedures between centers. Pain was assessed in only 17% of procedures, and analgesic interventions were performed in 19% of the procedures at baseline.

CONCLUSIONS

Collaborative use of quality improvement methods resulted in the creation of self-directed, efficient, and effective processes to improve neonatal pain management. Group establishment of potentially better practices, collective and site-specific goals, and extensive baseline data resulted in accelerated implementation of clinical practices that would not likely occur outside a collaborative setting.
Primary Hemorrhagic Stroke in Children With Sickle Cell Disease Is Associated With Recent Transfusion and Use of Corticosteroids
Authors: Strouse John J. , Hulbert Monica L. , DeBaun Michael R. , Jordan Lori C. , Casella James F.
Published: November 2006

OBJECTIVES. Primary hemorrhagic stroke is an uncommon complication of sickle cell disease, with reported mortality rates of 24% to 65%. Most reported cases are in adults; little is known about its occurrence in children. Proposed risk factors include previous ischemic stroke, aneurysms, low steady-state hemoglobin, high steady-state leukocyte count, acute chest syndrome, and hypertransfusion. We performed a retrospective case-control study to evaluate risk and prognostic factors for primary hemorrhagic stroke among children with sickle cell disease.

PATIENTS AND METHODS. Case subjects (sickle cell disease and primary hemorrhagic stroke) and control subjects (sickle cell disease and ischemic stroke) were identified at 2 children’s hospitals from January 1979 to December 2004 by reviewing divisional records and the discharge databases.

RESULTS. We identified 15 case subjects (mean age: 10.4 ± 1.3 years) and 29 control subjects (mean age: 5.2 ± 0.4 years). An increased risk of hemorrhagic stroke was associated with a history of hypertension and recent (in the last 14 days) transfusion, treatment with corticosteroids, and possibly nonsteroidal antiinflammatory drugs. Average blood pressures at well visits (adjusted for age and gender) were similar between the 2 groups, suggesting that hypertension was intermittent

CONCLUSIONS. In this group of children with sickle cell disease, hemorrhagic stroke was associated with a history of hypertension or antecedent events including transfusion or treatment with corticosteroids. Improved understanding of risk and prognostic factors, especially those that are modifiable, may help prevent this devastating complication in children with sickle cell disease.
A Systematic Review for the Effects of Television Viewing by Infants and Preschoolers
Authors: Thakkar Rupin R. , Garrison Michelle M. , Christakis Dimitri A.
Published: November 2006

OBJECTIVE. The purpose of this work was to conduct a systematic review of experimental trials for the effects of television viewing by infants and preschoolers.

METHODS. Searches were conducted as of January 2005 on several online bibliographic databases for the disciplines of medicine, psychology, education, and communications. Relevant bibliographies were also reviewed. The article contents were critically evaluated to determine whether they met inclusion criteria. Data were extracted from each included article regarding study methods and results.

RESULTS. Twelve controlled trials met all of the criteria for inclusion in this review. All of the studies focused on the effect of television content rather than viewing time. The findings suggest that educational television programs are successful in broadening young children's knowledge, affecting their racial attitudes, and increasing their imaginativeness. There is insufficient experimental evidence for effects of viewing these programs on either children's prosocial behavior or their aggressive behavior. Finally, there is some evidence that viewing cartoons has a negative effect on children's attentional abilities.

CONCLUSIONS. A number of gaps remain in the literature. Although the amount of time children spend viewing television raises concern, the studies presented here focus only on content. Despite the fact that infants are the fastest growing television market segment, the controlled trials only include children aged ≥3 years. Finally, the clinical utility of the findings are questionable given that most studies included small group sizes, all took place in nonnaturalistic settings, and all but 1 study only evaluated short-term effects of television viewing.
Primary Care Physicians' Attitudes Regarding Follow-up Care for Children With Positive Newborn Screening Results
Authors: Kemper Alex R. , Uren Rebecca L. , Moseley Kathryn L. , Clark Sarah J.
Published: November 2006

BACKGROUND. Although primary care physicians are responsible for providing follow-up care after a positive newborn screen, little is known about their willingness or ability to do so.

METHODS. A national mail survey of a random sample of 350 general pediatricians and 350 family physicians was conducted from April to June 2006.

RESULTS. The response rate was 63% among pediatricians and 50% among family physicians. Most pediatricians (89.7%) and nearly one half of family physicians (44.1%) had had a patient with a positive newborn screen within the past 5 years. Most respondents thought that primary care physicians should be responsible for informing families about a positive newborn screen (73.2%), arranging confirmatory testing (66.0%), and coordinating subspecialty referral (85.3%). However, more than one half (56.2%) would prefer newborn screening programs to provide the initial evaluation of positive newborn screening results. Some respondents (but fewer pediatricians than family physicians) reported that they were not competent to discuss conditions included in newborn screening panels (eg, 22.6% of pediatricians and 53.2% of family physicians for phenylketonuria and 8.8% of pediatricians and 40.4% of family physicians for congenital hypothyroidism). More than one half (58.3%) thought that families with a child diagnosed as having congenital hypothyroidism should receive formal genetic counseling. Respondents were less likely to think that families with a child with sickle cell trait, compared with families with a child who is a cystic fibrosis carrier, should receive formal genetic counseling (69.3% vs 84.1%).

CONCLUSIONS. Many primary care physicians are not prepared to manage the follow-up care of children with a positive newborn screen, including initial counseling, diagnosis, and subspecialty referral. New strategies are needed to ensure appropriate and equitable health care delivery.
The Persistence of American Indian Health Disparities
Authors: Jones David S.
Published: November 2006

Disparities in health status between American Indians and other groups in the United States have persisted throughout the 500 years since Europeans arrived in the Americas. Colonists, traders, missionaries, soldiers, physicians, and government officials have struggled to explain these disparities, invoking a wide range of possible causes. American Indians joined these debates, often suggesting different explanations. Europeans and Americans also struggled to respond to the disparities, sometimes working to relieve them, sometimes taking advantage of the ill health of American Indians.

Economic and political interests have always affected both explanations of health disparities and responses to them, influencing which explanations were emphasized and which interventions were pursued. Tensions also appear in ongoing debates about the contributions of genetic and socioeconomic forces to the pervasive health disparities. Understanding how these economic and political forces have operated historically can explain both the persistence of the health disparities and the controversies that surround them.
Medicaid Status and Stage at Diagnosis of Cervical Cancer
Authors: O’Malley Cynthia D. , Shema Sarah J. , Clarke Lisa S. , Clarke Christina A. , Perkins Carin I.
Published: November 2006

Objectives. We examined whether Medicaid beneficiaries are more likely to be diagnosed with late-stage cervical cancer than women not enrolled in Medicaid.

Methods. Using the California Cancer Registry–Medicaid linked file, we identified 4682 women diagnosed during 1996–1999 with invasive cervical cancer. Multivariate logistic regression was used to evaluate the association between late-stage diagnosis and prediagnosis Medicaid status.

Results. Late-stage disease was diagnosed in 51% of Medicaid and 42% of non-Medicaid women. Relative to women without Medicaid coverage, adjusted odds ratios for late-stage diagnosis were 2.8 times higher among women enrolled in Medicaid at the time of their diagnosis and 1.3 times higher among those intermittently enrolled before being diagnosed. Vietnamese women were less likely than White women to have advanced disease; the adjusted odds for women in other racial/ethnic groups did not differ from those among Whites. Women of low socioeconomic status and older women were at increased risk.

Conclusions. Women intermittently enrolled in Medicaid or not enrolled until their diagnosis were at greatest risk of a late-stage diagnosis, suggesting that more outreach to at-risk women is needed to ensure access to screening services.
Ascertainment of Hispanic Ethnicity on California Death Certificates: Implications for the Explanation of the Hispanic Mortality Advantage
Authors: Eschbach Karl , Kuo Yong-Fang , Goodwin James S.
Published: November 2006

Objectives. We determined the size and correlates of underascertainment of Hispanic ethnicity on California death certificates.

Methods. We used 1999 to 2000 vital registration data. We compared Hispanic ethnicity reported on the death certificate to Hispanic ethnicity derived from birthplace for the foreign-born and an algorithm that used first and last name and percentage of Hispanics in the county of residence for the US-born. We validated death certificate nativity by comparing data with that in linked Social Security Administration records.

Results. Ethnicity and birthplace information was concordant for foreign-born Hispanics, who have mortality rates that are 25% to 30% lower than those of non-Hispanic Whites. Death certificates likely underascertain deaths of US-born Hispanics, particularly at older ages, for persons with more education, and in census tracts with lower percentages of Hispanics. Conservative correction for under-ascertainment eliminates the Hispanic mortality advantage for US-born men.

Conclusions. Hispanic ethnicity is accurately ascertained on the California death certificate for immigrants. Immigrant Hispanics have lower age-adjusted mortality rates than do non-Hispanic Whites. For US-born Hispanics, the mortality advantage compared with non-Hispanic Whites is smaller and may be explained by underreporting of Hispanic ethnicity on the death certificate.
Under the Feminist Post-Structuralist Lens: Women in Computing Education
Authors: Markwick Katrina
Published: November 2006

Despite various reform efforts, a persistent concern remains within education regarding the under-representation of women in non-traditional subject areas, such as science and engineering. As society is becoming increasingly technocratic, this article examines this issue in relation to Information Technology (IT), as a relatively new educational area. In doing so, I review some of the literature surrounding the gendering of this site and draw upon empirical findings from a study exploring the experiences of women in university computing courses. The aim of this article is to consider and critique the dominant paradigms that have been adopted, drawing upon constructions and understandings of subjectivity of educational theorists who offer alternative ways of approaching this issue. In this article I argue that to move forward we must disrupt and dismantle the gender binary that is so insidiously embedded in the discursive repertoire of the dominant paradigm of educational research and reform. A feminist post-structuralist approach, as employed by several educational theorists, offers opportunities for transcending such duality, while engaging more effectively with the lived experiences of individual women.
Computer Gaming and Interactive Simulations for Learning: A Meta-Analysis
Authors: Vogel Jennifer J. , Vogel David S. , Cannon-Bowers Jan , Bowers Clint A. , Muse Kathryn , Wright Michelle
Published: November 2006

Substantial disagreement exists in the literature regarding which educational technology results in the highest cognitive gain for learners. In an attempt to resolve this dispute, we conducted a meta-analysis to decipher which teaching method, games and interactive simulations or traditional, truly dominates and under what circumstances. It was found that across people and situations, games and interactive simulations are more dominant for cognitive gain outcomes. However, consideration of specific moderator variables yielded a more complex picture. For example, males showed no preference while females showed a preference for the game and interactive simulation programs. Also, when students navigated through the programs themselves, there was a significant preference for games and interactive simulations. However, when teachers controlled the programs, no significant advantage was found. Further, when the computer dictated the sequence of the program, results favored those in the traditional teaching method over the games and interactive simulations. These findings are discussed in terms of their implications for exiting theoretical positions as well as future empirical research.
Quality Assurance in the German School System
Authors: Huber Stephan Gerhard , Gördel Bettina
Published: November 2006

Whereas internationally the shift towards quality control of school systems started in the early 1980s, mainly promoted by transnational agencies, this development only began in Germany in the mid 1990s. However, a clear-cut change from an input-controlled and centralised to a more output-controlled, decentralised and deregulated supervision system was initiated in most of the German Länder (the states of the German Federal Republic) no more than at the beginning of the new century. Main triggers were the sobering results of German pupils in international assessment tests like the Trends in International Mathematics and Science Study (TIMSS), the Programme for International Student Assessment (PISA), and the Progress in International Reading Literacy Study (PIRLS) compared to other countries which regularly assessed the school system's performance by various means. Now, all 16 German Länder have started model projects with certain groups of schools in each state to try out how self-managing of schools or local management of schools works. They are on their way to an output-controlled steering system of school quality. Due to the federal constitutional system, the progression in this regard is differently advanced and the characteristics of the local management of schools are manifold. Nevertheless, in all Länder several concurrent aspects can be identified. The five structural components on which the new system of quality control is based are: the traditional tasks of the school supervisory authorities, external school inspections, internal self-evaluations, assessment tests for system monitoring combined with regular educational reports, and last but not least, teacher professionalisation. The fundament of this control system is an understanding of school as a self-managing organisation, which is responsible for educational, financial, and personnel matters. In this area of school self-management, Germany is just beginning to reform its highly centralised and regulated school system towards more self-managing structures at its base.
De-Democratisation in Denmark?
Authors: Hjort Katrin
Published: November 2006

In Denmark, as in many other countries, international agendas represented by the Organisation for Economic Cooperation and Development's Programme for International Student Assessment studies, the European Bologna process and the school effectiveness movement are important factors for educational policy. However, in national contexts, international policies become interwoven with local agendas and power relations. In Denmark, neo-liberal educational policies are linked with the present reform processes in the Danish welfare system, new public management. At the moment a political majority in Denmark has decided — without much of a prior democratic debate — to tone down the democratic statements in the objects clause of the Danish Primary Education Act. This seems odd, since traditionally, democracy has been a pillar in the self-perception and self-projection of the Danish educational system. The question dealt with in this article is whether we are dealing with de-democratisation in the Danish educational system and the Danish society, or with the development of new interpretations of democracy and a new need for a democratic debate.
Angle between the patellar ligament and tibial plateau in dogs with partial rupture of the cranial cruciate ligament
Authors: Schwandt Christian S. , Bohorquez-Vanelli Alejandra , Tepic Slobodan , Hassig Michael , Dennler Renate , Vezzoni Aldo , Montavon Pierre M.
Published: November 2006

Objective—To measure the angles between the patellar ligament and the tibial plateau and between the patellar ligament and the common tangent at the tibiofemoral contact point (TFCP) in stifle joints of dogs with partial rupture of the cranial cruciate ligament (CrCL) for comparison with data obtained for stifle joints in dogs with intact CrCLs.

Sample Population—60 stifle joints of 54 dogs with surgically confirmed partial CrCL rupture.

Procedures—Mediolateral radiographic views of the stifle joints were obtained, and the angles between the patellar ligament and the conventionally defined tibial plateau (angle γ) and between the patellar ligament and the common tangent to the TFCP (angle α) were measured at incidental stifle joint flexion (angle β) by 2 independent observers. Data underwent linear regression analysis and were compared with findings in joints of dogs without degenerative joint disease.

Results—In stifle joints of dogs with a partial rupture of the CrCL, angles γ and α were 5° and 2° larger than each corresponding angle in healthy canine joints. At 100° of flexion, the patellar ligament was perpendicular to the conventionally defined tibial plateau. At 110° of flexion, the patellar ligament was perpendicular to the common tangent at the TFCP.

Conclusions and Clinical Relevance—In dogs, stifle joints with partially ruptured CrCLs have marginally larger angles between the patellar ligament and the tibial plateau, compared with joints with intact CrCLs; at equivalent angles of flexion, comparatively greater shear force affects the CrCLs in stifle joints with partial CrCL ruptures.