bluuebunny/crossref_metadata_2025 huggingface dataset:
It's time to talk: rekindling the relationship with primary care
Authors: Banks Roger , Gask Linda
Published: February 2008

Healthcare provision in the UK is in a process of continual change. The structures and processes by which people with mental health problems and people with learning disabilities receive support from statutory services have been, and continue to be, subject to many and varied strategic, policy and professional influences. Integrated and collaborative ways of working between generalist (‘primary’) and specialist (‘secondary’) care have become eroded over time and yet they may be needed more than ever. In this editorial we encourage a collaborative approach between practitioners in generalist and specialist care in studying and developing three strands of work: policy and strategy; training; and professional behaviour. Above all, we advocate strongly for a renewed and dynamic dialogue between psychiatrists and general practitioners in working together to provide high-quality mental healthcare.
The MAPK Kinase Kinase-1 Is Essential for Stress-Induced Pancreatic Islet Cell Death
Authors: Mokhtari Dariush , Myers Jason W. , Welsh Nils
Published: February 2008

The aim of the present investigation was to characterize the role of the MAPK kinase kinase-1 (MEKK-1) in stress-induced cell death of insulin producing cells. We observed that transient overexpression of the wild type MEKK-1 protein in the insulin-producing cell lines RIN-5AH and βTC-6 increased c-Jun N-terminal kinase (JNK) phosphorylation and augmented cell death induced by diethylenetriamine/nitroso-1-propylhydrazino)-1-propanamine (DETA/NO), streptozotocin (STZ), and hydrogen peroxide (H2O2). Furthermore, DETA/NO or STZ induced a rapid threonine phosphorylation of MEKK-1. Silencing of MEKK-1 gene expression in βTC-6 and human dispersed islet cells, using in vitro-generated diced small interfering RNA, resulted in protection from DETA/NO, STZ, H2O2, and tunicamycin induced cell death. Moreover, in DETA/NO-treated cells diced small interfering RNA-mediated down-regulation of MEKK-1 resulted in decreased activation of JNK but not p38 and ERK. Inhibition of JNK by treatment with SP600125 partially protected against DETA/NO- or STZ-induced cell death. In summary, our results support an essential role for MEKK-1 in JNK activation and stress-induced β-cell death. Increased understanding of the signaling pathways that augment or diminish β-cell MEKK-1 activity may aid in the generation of novel therapeutic strategies in the treatment of type 1 diabetes.
Response Gene to Complement 32 Expression Is Induced by the Luteinizing Hormone (LH) Surge and Regulated by LH-Induced Mediators in the Rodent Ovary
Authors: Park Eun-Sil , Choi Seungho , Muse Kenneth N. , Curry Thomas E. , Jo Misung
Published: February 2008

Response gene to complement 32 (Rgc32) has recently been suggested to be expressed in the ovary and regulated by RUNX1, a transcription factor in periovulatory follicles. In the present study, we determined the expression profile of the Rgc32 gene in the rodent ovary throughout the reproductive cycle and the regulatory mechanism(s) involved in Rgc32 expression during the periovulatory period. Northern blot and in situ hybridization analyses revealed the up-regulation of Rgc32 expression in periovulatory follicles. Rgc32 mRNA was also localized to newly forming corpora lutea (CL) and CL from previous estrous cycles. Further studies using hormonally induced luteal and luteolysis models revealed a transient increase in levels of Rgc32 mRNA at the time of functional regression of the CL. Next, the regulation of Rgc32 expression was investigated in vitro using rat preovulatory granulosa cells. The effect of human chorionic gonadotropin on Rgc32 expression was mimicked by forskolin, but not phorbol 12-myristate 13-acetate, and was mediated by the activation of progesterone receptors and the epidermal growth factor-signaling pathway. The mechanism by which RUNX1 regulates Rgc32 expression was investigated using chromatin immunoprecipitation and Rgc32 promoter-luciferase reporter assays. Data from these assays revealed direct binding of RUNX1 in the Rgc32 promoter region in vivo as well as the involvement of RUNX binding sites in the transactivation of the Rgc32 promoter in vitro. In summary, the present study demonstrated the spatial/temporal-specific expression of Rgc32 in the ovary, and provided evidence of LH-initiated and RUNX1-mediated expression of Rgc32 gene in luteinizing granulosa cells.
Thyroid-Stimulating Hormone Induces Interleukin-6 Release from Human Adipocytes through Activation of the Nuclear Factor-κB Pathway
Authors: Antunes Tayze T. , Gagnon AnneMarie , Langille Melanie L. , Sorisky Alexander
Published: February 2008

Our objective was to identify the signaling pathway activated by TSH that induces IL-6 secretion from human abdominal sc differentiated adipocytes. Human abdominal sc preadipocytes in culture were differentiated into adipocytes. IL-6 release stimulated by TSH was inhibited by 35% (P < 0.05) with SN50, an inhibitor of nuclear factor-κB (NF-κB) nuclear translocation, and 60% (P < 0.01) with sc-514, an inhibitor of inhibitory-κB (IκB) kinase (IKK)-β. Phosphorylation of IKKβ increased upon TSH treatment (10.3-fold, P < 0.01), and IκBα levels were reduced by 78% (P < 0.01). TSH activated NF-κB (23-fold, P < 0.001), a process that was inhibited (60%, P < 0.01) by SN50. Inhibition of protein kinase A by H89 did not affect TSH-stimulated IKKβ phosphorylation or IκBα degradation. TSH-mediated NF-κB activation and IL-6 induction also specifically occurred in Chinese hamster ovarian cells expressing the human TSH receptor, resulting in a 5.9-fold (P < 0.001) increase in IKKβ phosphorylation and a 9.5-fold increase in IL-6 mRNA expression. Our data demonstrate that the IKKβ/NF-κB pathway is a novel TSH target that is required for TSH-induced IL-6 release from human adipocytes.
Progesterone Receptors and Neural Development: A Gap between Bench and Bedside?
Authors: Wagner Christine K.
Published: February 2008

Despite a recent increase in the clinical use of progesterone in pregnant women and premature neonates, very little is understood about the potential role of this hormone and its receptors in neural development. Findings from rodent models indicate that the brain is indeed sensitive to progesterone during critical periods of development and maturation. Dramatic sex differences in progesterone receptor (PR) expression, in which males express higher levels of PR than females in specific regions, suggest that PR may play an important role in the sexual differentiation of brain and behavior and that the expression of PR may be one mechanism by which testicular hormones masculinize the brain. PR is also transiently expressed during fetal and neonatal development in areas of the brain associated with cognitive behaviors. PR protein and mRNA are expressed in pyramidal cell layers of perinatal cortex in an anatomically and developmentally specific manner, generating the intriguing hypothesis that progesterone is essential for normal cortical development. Basic research elucidating a potential role for progesterone and PR in developing brain is reviewed in light of the clinical use of this hormone. The necessity for future research integrating findings from the bench and the bedside is evident.
High-speed gallop locomotion in the Thoroughbred racehorse. II. The effect of incline on centre of mass movement and mechanical energy fluctuation
Authors: Parsons K. J. , Pfau T. , Ferrari M. , Wilson A. M.
Published: February 2008

During locomotion on an incline, mechanical work is performed to move an animal up the slope and increase the potential energy (PE) of the trunk and hence the centre of mass (CoM). Thus, at a given speed the total net mechanical work increases with the PE of the animal. In this study we investigate the mechanical energy (ME) fluctuations and the mechanical cost of transport (MCT) in six horses galloping up a range of gradients. We captured trunk movement with a six degrees-of-freedom inertial sensor mounted over the dorsal spinous process of the fourth to sixth thoracic vertebrae of the horse. Footfall timings were measured using a previously validated system of limb-mounted accelerometers. Speed was measured using a Global Positioning System (GPS) data logger. A track survey provided detailed incline information for the track. Linear (craniocaudal, mediolateral and dorsoventral) and rotational (roll, pitch and heading) kinematic parameters(displacement, velocity and acceleration) were calculated at speeds ranging from 9.0 to 12.0 m s–1 during routine training over a range of inclines. Estimates of ME fluctuations and the MCT were made. Results showed the effect of incline on trunk motion during galloping was small. Increases in linear mechanical work and MCT were primarily explained by an increase in the work required to move the animal up the slope (and increase the PE of the CoM). Within the stride the majority of the work was performed during hindlimb stance. Our results have provided new insights into how horses power uphill locomotion.
Is a convergently derived muscle-activity pattern driving novel raking behaviours in teleost fishes?
Authors: Konow Nicolai , Sanford Christopher P. J.
Published: February 2008

Behavioural differences across prey-capture and processing mechanisms may be governed by coupled or uncoupled feeding systems. Osteoglossomorph and salmonid fishes process prey in a convergently evolved tongue-bite apparatus(TBA), which is musculoskeletally coupled with the primary oral jaws. Altered muscle-activity patterns (MAPs) in these coupled jaw systems could be associated with the independent origin of a novel raking behaviour in these unrelated lineages. Substantial MAP changes in the evolution of novel behaviours have rarely been quantified so we examined MAP differences across strikes, chewing and rakes in a derived raking salmonid, the rainbow trout, Oncorhynchus mykiss. Electromyography, including activity onset timing, duration, mean amplitude and integrated area from five feeding muscles revealed significant differences between behaviour-specific MAPs. Specifically, early activity onset in the protractor hyoideus and adductor mandibularis muscles characterised raking, congruent with a recent biomechanical model of the component-mechanisms driving the raking preparatory and power-stroke phases. Oncorhynchus raking MAPs were then compared with a phylogenetically derived osteoglossomorph representative, the Australian arowana, Scleropages jardinii. In both taxa, early onset of protractor hyoideus and adductor mandibularis activity characterised the raking preparatory phase, indicating a convergently derived MAP, while more subtle inter-lineage divergence in raking MAPs resulted from onset-timing and duration differences in sternohyoideus and hypaxialis activity. Convergent TBA morphologies are thus powered by convergently derived MAPs, a phenomenon not previously demonstrated in feeding mechanisms. Between lineages, differences in TBA morphology and associated differences in the functional coupling of jaw systems appear to be important factors in shaping the diversification of raking behaviours.
Prey detection by great cormorant (Phalacrocorax carbo sinensis)in clear and in turbid water
Authors: Strod Tamir , Izhaki Ido , Arad Zeev , Katzir Gadi
Published: February 2008

The scattering and absorption of light by water molecules and by suspended and dissolved matter (turbidity) degrade image transmission and, thus,underwater perception. We tested the effects on visual detection of prey size and distance (affecting apparent prey size) and of low-level water turbidity in hand-reared great cormorants (Phalacrocorax carbo sinensis) diving for natural prey (fish) in a forced-choice situation. The cormorants'detection of underwater prey relied on vision. The minimal tested subtending visual angle of the prey at detection ranged between ∼34.2′ (prey size constant; distance varied) and 9.5′ (distance constant; prey size varied). For all tested distances (0.8–3.1 m) the mean detection success was significantly higher than the chance level. The probability of a correct choice declined significantly with increased distance, with Detection success=–0.034D+1.021 (where D is distance, r2=0.5, N=70, P<0.001). The combined effect of turbidity and distance on the probability of detection success was significant, with both variables having a negative effect: Detection success=–0.286D–0.224Tu+1.691 (where Tu is turbidity, r2=0.68, N=144, P<0.001). At prey detection threshold, the relationship between distance and turbidity was: D=3.79e–4.55Tu. It is concluded that (i) the subtending angle of natural prey at detection was lower than that of resolution of square-wave, high-contrast grating and (ii) turbidity, at levels significantly lower than commonly used in behavioural experiments, had a pronounced effect on visually mediated behaviour patterns.
Physiological and biochemical traits correlate with differences in growth rate and temperature adaptation among groups of the eastern oysterCrassostrea virginica
Authors: Pernet Fabrice , Tremblay Réjean , Redjah Iften , Sévigny Jean-Marie , Gionet Chantal
Published: February 2008

We tested two hypotheses in this study: first, that intraspecific growth variations in a marine bivalve are correlated with physiological (basal metabolic rate and scope for growth) and biochemical (membrane lipids)characteristics, and, second, that this bivalve shows intraspecific variations in physiological and biochemical adaptations to temperature. To test these hypotheses, five genetically distinct groups of juvenile oysters Crassostrea virginica that showed differences in their growth rates were maintained in the laboratory (1) for further measurements of growth and standard metabolic rates and (2) subjected to acclimation at 4°C, 12°C and 20°C and further examined for scope for growth and determination of membrane lipid composition. Our results show that a lower basal metabolic rate and lower unsaturation index of membrane lipids coincides with higher growth rates and a higher scope for growth in oysters. We provide evidence that intraspecific differences in basal metabolic rate in oysters are related to membrane unsaturation as predicted by Hulbert's theory of membranes as metabolic pacemakers. Furthermore, our results suggest that the theory of membranes as metabolic pacemakers is related to intraspecific differences in growth. A perfect negative relationship was observed between the acclimation temperature and the unsaturation index of membrane lipids in oysters, as predicted by the homeoviscous adaptation theory. However, changes in the unsaturation index in response to temperature were mainly due to variations in the eicosapentaenoic (20:5n-3) fatty acid in fast-growing oysters, whereas slow-growing animals changed both docosahexaenoic acid (22:6n-3) and 20:5n-3. Thus, the pattern of biochemical compensation in response to temperature in this species shows intraspecific variation.
Recent Changes in the Management of Blunt Splenic Injury: Effect on Splenic Trauma Patients and Hospital Implications
Authors: Sinha S , Raja SVV , Lewis MH
Published: February 2008

INTRODUCTION

Management of blunt splenic injury has been controversial with an increasing trend towards splenic conservation. A retrospective study was performed to identify the effect of this changed policy on splenic trauma patients and its implications.

PATIENTS AND METHODS

Data regarding patient demography, mode of splenic injury, CT grading, blood transfusion requirement, operative findings hospital stay and follow-up were collected. Statistical analysis of the data was performed using non-parametric Mann–Whitney tests

RESULTS

Over an 8-year period, only 21 patients were admitted with blunt splenic injury. Ten patients were managed operatively and 11 non-operatively. Non-operative management failed in one patient due to continued bleeding. Using Buntain's CT grading, the majority of grades I and II splenic injuries were managed non-operatively and grades III and IV were managed operatively (P = 0.008). Blood transfusion requirement was significantly higher among the operative group (P = 0.004) but the non-operative group had a significantly longer hospital stay (P = 0.029). Among those managed non-operatively (median age, 24.5 years), a number of patients were followed up with CT scans with significant radiation exposure and unknown long-term consequences.

CONCLUSIONS

Non-operative management of blunt splenic trauma in adults can be performed with an acceptable outcome. Although CT is classed as the ‘gold standard’, initial imaging for detection and evaluation of blunt splenic injury, ultrasound can play a major role in follow-up imaging and potentially avoids major radiation exposure.
Audit of Referral Patterns for Hernia Repair – Are General Practitioners Aware of the Changing Face of Herniorrhaphy?
Authors: Coulston JE , Williams GL , Stephenson BM
Published: February 2008

INTRODUCTION

The objective of this study was to examine referral patterns from general practitioners for groin hernia surgery and to assess their knowledge of services available to their patients.

PATIENTS AND METHODS

An anonymous postal questionnaire was sent to 120 general practitioners (GPs) in the South East Wales region who routinely refer patients for inguinal hernia surgery to the Royal Gwent Healthcare NHS Trust.

RESULTS

A total of 86 questionnaire replies were returned. There was variation in referral patterns between the GPs with the majority (84%) referring their patients for groin hernia repair to either a general surgeon or as an open referral. Only 14% referred directly to a hernia specialist and none regularly referred to a laparoscopic surgeon.

CONCLUSIONS

Referral patterns for inguinal hernia surgery do not reflect services provided in secondary care. Further education is required so that a patient's care can be optimised.
Should Vascular Surgeons be Trained in Endovascular Techniques? – An Observational Study
Authors: Krysa J , Downes M , Taylor P
Published: February 2008

INTRODUCTION

The aim of this study was to determine if there is a satisfactory cover for interventional radiology and whether vascular surgeons have received sufficient training in endovascular techniques.

MATERIALS AND METHODS

This was an observational study based on questionnaires sent to radiology and vascular trainers and vascular trainees in England. A total of 50 NHS trusts were chosen randomly to take part in the study and 320 questionnaires were sent out with an overall consultant response rate of 57%.

RESULTS

Of vascular consultants in the study group, 53% have had experience in endovascular procedures. Overall, 87% felt that there were not enough radiologists to fulfil the demand and 64% would like further training in endovascular procedures. In addition, 69% would like to be involved in a vascular rota without the general component. Similarly, 81% of radiologists felt that the demand was not being met, as emergency interventional radiology cover was not available on most nights in 65% of the trusts. Of responders, 72% would not object to training of vascular trainees in interventional work and 43% would be happy to be involved in training. Some 33% would accept a vascular trainee for 1 year.

CONCLUSIONS

Integrated fellowship in vascular surgery and interventional radiology has been implemented and tested in a number of centres in the US. This approach could be implemented in some of the larger vascular units in the UK.
A New ELISA for Use in a 3-ELISA System to Assess Concentrations of VEGF Splice Variants and VEGF110 in Ovarian Cancer Tumors
Authors: Gutierrez Johnny , Konecny Gottfried E , Hong Kyu , Burges Alexander , Henry Timothy D , Lambiase Pier D , Lee Wong Wai , Meng Y Gloria
Published: February 2008

Background: Vascular endothelial growth factor (VEGF), which affects tumor angiogenesis, is expressed as different splice variants, including the major isoforms VEGF165 and VEGF121, and can be cleaved by plasmin to generate VEGF110. The amount of VEGF121 and VEGF110 in biological samples has not been well studied.

Methods: We developed an ELISA that detects VEGF165 and VEGF121 equally, but does not detect VEGF110. We used this ELISA together with 2 other ELISAs, one detecting VEGF165 and the other detecting VEGF165, VEGF121, and VEGF110 equally, to assess the concentrations of VEGF121 and VEGF110 in ovarian cancer tumors.

Results: The median concentrations in ovarian cancer tumor lysates were 0.61 (range <0.055–74) fmol/mg protein for VEGF165, 1.4 (range <0.20–500) fmol/mg protein for VEGF165 plus VEGF121, and 2.3 (range <0.079–520) fmol/mg protein for total VEGF including VEGF110 (n = 248). VEGF concentrations measured by the 3 ELISAs were highly correlated (r = 0.91–0.94). Median estimated VEGF121 and VEGF110 concentrations were 0.77 and 0.58 fmol/mg protein, respectively. In lysates with measurable VEGF165 and total VEGF concentrations, mean VEGF165 was approximately 31% (SD 23%) of the total VEGF (n = 217). In contrast, VEGF165 constituted approximately half of the total circulating VEGF.

Conclusion: VEGF165, VEGF121, and VEGF110 may be present at significant amounts in ovarian cancer tumors.
Mitigating Accident Risk in Farm Tractors
Authors: Etzler Linnea , Marzani Stefano , Montanari Roberto , Tesauri Francesco
Published: February 2008

FEATURE AT A GLANCE: The complexity of on-board equipment for farm tractors has grown dramatically in recent years, leading to significant changes in the operator's work situation. Today, most tractor functions are performed from inside the cabin, but little progress has been made toward reducing the risks associated with higher workloads. This article describes a methodology for designing a risk mitigation system for reducing rollover accidents. The methodology represents a combination of hierarchical task analysis and function allocation. Its implementation led to a final solution composed of visual and auditory displays and a joystick that gives force feedback in risky situations
A Forensic Investigation of a Portable Crib Collapse
Authors: Fairbrother Jeffrey T. , Readdick Christine A. , Shea John B.
Published: February 2008

FEATURE AT A GLANCE: This article describes a forensic analysis of a portable crib that was involved in the death of a 17-month-old boy. The investigation included an event analysis, torque measurements, and observation of users. A three-factor approach that considered the interactions among users, the crib, and the contexts in which the crib is used yielded a broad understanding of the situation surrounding the use of the crib and helped identify a plausible series of events that could lead to a child fatality. The results illustrated the benefits of the three-factor approach in recognizing aspects of use that might be overlooked during the design of products.
Avoiding Friendly Fire Incidents Through Performance Assessment
Authors: Hawley John K.
Published: February 2008

FEATURE AT A GLANCE: During the combat operations phase of the Iraq War, Patriot air defense missile units were involved in two fratricide incidents. Patriot's unacceptable fratricide rate (18% of engagements) prompted the commanding general of the air defense center to request a human-performance-oriented assessment of the fratricide incidents to complement the official board of inquiry investigation. This article summarizes the results and recommendations from that assessment. Recommendations for solutions to the fratricide problem involved both command and control and training modifications. The article's primary focus is the 3-year follow-on effort to implement and evaluate selected aspects of the recommended fixes.
Anwendungspotenzial integrierter Dünnschichtresonatoren in flüssigen und gasförmigen Medien (Application Potential of Integrated Thin Film Resonators in Liquid and Gaseous Media)
Authors: Schreiter Matthias , Link Mathias , Weber Jan
Published: February 2008

Integrierte bulk-akustische Dünnschichtresonatoren, sogenannte Film Bulk Acoustic Resonators (FBARs), eignen sich hervorragend für eine Vielzahl von Sensoranwendungen in gasförmigen und unter bestimmten Voraussetzungen auch flüssigen Medien. Analog zur klassischen Quarz-Mikrowaage wird eine Verschiebung der akustischen Resonanz, beispielsweise durch eine Massenanbindung, detektiert. Der entscheidende Vorteil des FBAR liegt in der Realisierbarkeit integrierter Arrays mit einer Vielzahl von Resonatoren, was den Einsatz für komplexe Messaufgaben, beispielsweise in medizinischen Anwendungen, ermöglicht. Neben der gravimetrischen Detektion besteht die Möglichkeit zur Detektion von mechanischen Spannungen und auch zur Messung von Viskositäten des Umgebungsmediums. In diesem Artikel werden Ergebnisse zu Untersuchungen des FBAR für eine Reihe potenzieller Anwendungen vorgestellt und bewertet.
Belastungsanalyse elektronischer Systeme (Load Analysis of Electronic Systems)
Authors: Pustan David , Wilde Jürgen
Published: February 2008

Elektronische Systeme und deren Bauelemente sind besonders im Automobilbereich vielfältigen und harten Umweltbelastungen ausgesetzt. Solche Feldbelastungen wurden mittels mikrosystemtechnischer Sensoren in einem elektronischen Motorsteuergerät umfassend aufgezeichnet und für eine Lebensdauerbetrachtung klassifiziert. In dieser Arbeit wird die Feuchteentwicklung im Steuergerät unter Feldbedingungen untersucht sowie der Einfluss der Temperatur auf die thermo-mechanische Verformung eines LFBGA-Bauelementes (Low Profile Fine Pitch Ball Grid Array Package) auf der Steuergeräteplatine mit modernen Testverfahren wie der ESPI-Methode (Electronic Speckle Pattern Interferometry) und einem Testchip analysiert.
Effects of Prolonged and Exclusive Breastfeeding on Child Behavior and Maternal Adjustment: Evidence From a Large, Randomized Trial
Authors: Kramer Michael S. , Fombonne Eric , Igumnov Sergei , Vanilovich Irina , Matush Lidia , Mironova Elena , Bogdanovich Natalia , Tremblay Richard E. , Chalmers Beverley , Zhang Xun , Platt Robert W. ,   for the Promotion of Breastfeeding Intervention Trial (PROBIT) Study Group
Published: February 2008

OBJECTIVE. The objective of this study was to assess the long-term effects of breastfeeding on child behavior and maternal adjustment.

METHODS. We followed up children who were in the Promotion of Breastfeeding Intervention Trial, a cluster-randomized trial of a breastfeeding promotion intervention based on the World Health Organization/United Nations Children's Fund Baby-Friendly Hospital Initiative. A total of 17046 healthy, breastfeeding mother–infant pairs were enrolled from 31 Belarussian maternity hospitals and affiliated polyclinics; 13889 (81.5%) were followed up at 6.5 years. Mothers and teachers completed the Strengths and Difficulties Questionnaire and supplemental questions bearing on internalizing and externalizing behavioral problems. Mothers also responded to questions concerning their relationships to their partner and child and their breastfeeding of subsequently born children.

RESULTS. The experimental intervention led to a large increase in exclusive breastfeeding at 3 months (43.3% vs 6.4%) and a significantly higher prevalence of any breastfeeding at all ages up to and including 12 months. No significant treatment effects were observed on either the mother or the teacher Strengths and Difficulties Questionnaire ratings of total difficulties, emotional symptoms, conduct problems, hyperactivity, peer problems, or prosocial behavior or on the supplemental behavioral questions. We found no evidence of treatment effects on the parent's marriage or on the mother's satisfaction with her relationships with her partner or child, but the experimental intervention significantly increased the duration of any breastfeeding, and mothers in the experimental group were nearly twice as likely to breastfeed exclusively the next-born child for at least 3 months.

CONCLUSIONS. On the basis of the largest randomized trial ever conducted in the area of human lactation, we found no evidence of risks or benefits of prolonged and exclusive breastfeeding for child and maternal behavior. Breastfeeding promotion does, however, favorably affect breastfeeding of the subsequent child.
Luteinizing Hormone and Follicle-Stimulating Hormone Levels in Extreme Prematurity: Development of Reference Intervals
Authors: Greaves Ronda F. , Hunt Rodney W. , Chiriano Angela S. , Zacharin Margaret R.
Published: February 2008

OBJECTIVES. Establishing pediatric reference intervals has always been challenging, with most ranges used in pediatric laboratories developed over many years. The clinical interpretation of gonadotropins is important in the context of ambiguous genitalia. The aim of this study was to develop reference intervals for luteinizing hormone and follicle-stimulating hormone in infants born between 24 and 29 weeks’ gestation.

METHODS. Samples were collected at 0 to 43 days after birth from 82 premature infants born <30 weeks’ gestation for analysis of luteinizing hormone and follicle-stimulating hormone by automated immunochemiluminometric immunoassays.

RESULTS. The 43 male infants demonstrated a range of luteinizing hormone levels from 0.1 to 13.4 IU/L and of follicle-stimulating hormone levels from 0.3 to 4.6 IU/L. The 39 female infants demonstrated a range of luteinizing hormone levels from 0.2 to 54.4 IU/L and of follicle-stimulating hormone levels from 1.2 to 167.0 IU/L. The ratio of luteinizing hormone/follicle-stimulating hormone levels differed with males, ranging from 0.3 to 9.4, and females, at <0.5.

CONCLUSION. These data provide guidance for the interpretation of luteinizing hormone and follicle-stimulating hormone levels for the first 6 weeks of life in extremely premature infants born between 24 and 29 weeks’ gestation. The availability of age-appropriate reference intervals is essential for correct and timely interpretation of biochemical results to the clinician.
Age Differences in Inflammatory and Hypermetabolic Postburn Responses
Authors: Jeschke Marc G. , Norbury William B. , Finnerty Celeste C. , Mlcak Ronald P. , Kulp Gabriela A. , Branski Ludwik K. , Gauglitz Gerd G. , Herndon Blair , Swick Aron , Herndon David N.
Published: February 2008

OBJECTIVE. The aim of this study was to identify contributors to morbidity and death in severely burned patients <4 years of age.

METHODS. A total of 188 severely burned pediatric patients were divided into 3 age groups (0–3.9 years, 4–9.9 years, and 10–18 years of age). Resting energy expenditure was measured through oxygen consumption, body composition through dual-energy x-ray absorptiometry, liver size and cardiac function through ultrasonography, and levels of inflammatory markers, hormones, and acute-phase proteins through laboratory chemistry assays.

RESULTS. Resting energy expenditure was highest in the 10- to 18-year-old group, followed by the 4- to 9.9-year-old group, and was lowest in the 0- to 3.9-year-old group. Children 0 to 3.9 years of age maintained lean body mass and body weight during acute hospitalization, whereas children >4 years of age lost body weight and lean body mass. The inflammatory cytokine profile showed no differences between the 3 age groups, whereas liver size increased significantly in the 10- to 18-year-old group and was lowest in the 0- to 3.9-year-old group. Acute-phase protein and cortisol levels were significantly decreased in the toddler group, compared with the older children. Cardiac data indicated increased cardiac work and impaired function in the toddler group, compared with the other 2 age groups.

CONCLUSIONS. Increased mortality rates for young children are associated with increased cardiac work and impaired cardiac function but not with the inflammatory and hypermetabolic responses.
Vaccination Coverage in 14-Year-Old Adolescents: Documentation, Timeliness, and Sociodemographic Determinants
Authors: Vandermeulen Corinne , Roelants Mathieu , Theeten Heidi , Depoorter Anne-Marie , Van Damme Pierre , Hoppenbrouwers Karel
Published: February 2008

OBJECTIVE. The objective of this study was to measure the coverage and influencing determinants of hepatitis B virus, measles-mumps-rubella, and Meningococcus serogroup C vaccination in 14-year-old adolescents in Flanders, Belgium, in 2005.

METHODS. A total of 1500 adolescents who were born in 1991 and were living in Flanders were selected with a 2-stage cluster sampling technique. Home visits to copy vaccination documents and complete a questionnaire on sociodemographic and other related factors were conducted by trained interviewers. Only documented vaccination dates were accepted. Missing data were, when possible, retrieved through medical charts of the School Health System.

RESULTS. For 1344 (89.6%) adolescents, a home visit was performed. Vaccination coverage was 75.7% for the third dose of hepatitis B virus, 80.6% for the first dose and 83.6% for the second dose of measles-mumps-rubella, and 79.8% for Meningococcus serogroup C. Only 74.6% of the adolescents had proof of 2 measles-mumps-rubella vaccines. Although 1006 (74.8%) adolescents had vaccination data available at home at the time of the interview, only 427 (31.8%) were able to show written proof of all studied vaccines. The probably underestimated coverage rates are well below World Health Organization recommendations, but timeliness of vaccinations was respected. Univariate logistic regression showed that unemployment of the father as proxy measure of socioeconomic status was detrimental for vaccination status, in contrast to partial employment of the mother, which was a favorable factor. Previously unreported determinants of lower coverage rates inferred from this study are single divorced parents, larger families (≥4 children), lower adolescent educational level, enrollment in special education, and repeating a grade.

CONCLUSIONS. Insufficient documentation is a major barrier in this vaccination coverage study. More attention should go to those with the lowest coverage rates, such as adolescents from large families, with separated parents, and with a lower socioeconomic background.
Incremental Diagnostic Yield of Pediatric Cardiac Assessment After Fetal Echocardiography in the Offspring of Women With Congenital Heart Disease: A Prospective Study
Authors: Thangaroopan Molly , Wald Rachel M. , Silversides Candice K. , Mason Jennifer , Smallhorn Jeffrey F. , Sermer Mathew , Colman Jack M. , Siu Samuel C.
Published: February 2008

OBJECTIVE. We sought to determine the incremental diagnostic utility of pediatric cardiac assessment in the offspring of women with congenital heart disease who have had previous fetal echocardiography.

PATIENTS AND METHODS. We prospectively followed pregnant women with congenital heart disease who were receiving care at 2 obstetric and cardiac centers and identified 276 infants who underwent both fetal echocardiography and pediatric cardiac assessment. All of the infants with abnormal fetal echocardiography findings or abnormal pediatric cardiac assessments underwent subsequent confirmatory pediatric echocardiography.

RESULTS. In this cohort, congenital heart disease was detected in 22 (8%) of 276 offspring born to women with congenital heart disease. There was concordance between the results of fetal echocardiography and pediatric cardiac assessment in 235 (85%) of 276 offspring (231, both normal; 4, both abnormal) and discordance between the results of fetal echocardiography and pediatric cardiac assessment in 41 (15%) of 276 infants. In the 41 subjects with discordant results, there were normal fetal echocardiography findings but abnormal pediatric cardiac assessments in 35 of 41 (pediatric echocardiography revealed congenital heart disease in 18 of 35 and normal anatomy in 17 of 35) and abnormal fetal echocardiography findings but normal pediatric cardiac assessments in 6 of 41 (pediatric echocardiography findings normal in all 6 of the infants). Fetal echocardiography detected all of the major forms of congenital heart disease. Lesions missed by fetal echocardiography but detected on pediatric cardiac assessment included shunt lesions and minor valvular abnormalities.

CONCLUSIONS. Although fetal echocardiography can reliably exclude major forms of congenital heart disease, minor congenital heart disease lesions can be missed on fetal echocardiography; however, these can be diagnosed with careful pediatric cardiac assessment. Postnatal pediatric cardiac assessment has incremental diagnostic utility for the detection of congenital heart disease in the offspring of women with congenital heart disease and previous fetal echocardiography.
Effects of Continuity of Care in Infancy on Receipt of Lead, Anemia, and Tuberculosis Screening
Authors: Flores Ana I. , Bilker Warren B. , Alessandrini Evaline A.
Published: February 2008

OBJECTIVES. The goals were (1) to examine the influence of continuity of care on delivery of lead, anemia, and tuberculosis screening in a cohort of Medicaid-enrolled children, (2) to determine whether well-child care continuity had a greater effect than continuity for all ambulatory visits, and (3) to investigate which aspects of continuity were most associated with receipt of these screening services.

METHODS. A prospective birth cohort of 1564 Medicaid-enrolled infants was studied. Continuity of care scores for the first 6 months of life were calculated for total ambulatory visits and well-child care visits. Outcomes of interest were performance of ≥1 screening for lead toxicity, anemia, and tuberculosis during the first 24 months of life.

RESULTS. For total ambulatory visits, children with complete continuity of care (the same practitioner seen for every visit) were more than twice as likely to receive lead screening, compared with children who saw a different practitioner for every visit, irrespective of the measurement technique used. Similarly, children with complete continuity were 1.5 to 2 times more likely to have been screened for tuberculosis. Continuity showed a lesser, but still significant, effect on anemia screening. Well-child care visit continuity of care had less impact on screening performance than did total visit continuity of care.

CONCLUSIONS. In this study, greater continuity of care in infancy was associated with increased likelihood of receiving screening for lead toxicity, anemia, and tuberculosis in the first 24 months of life. The dimension of continuity of care that was most influential in this population was dispersion of visits among different practitioners.
Risk of Immune Thrombocytopenic Purpura After Measles-Mumps-Rubella Immunization in Children
Authors: France Eric K. , Glanz Jason , Xu Stanley , Hambidge Simon , Yamasaki Kristi , Black Steve B. , Marcy Michael , Mullooly John P. , Jackson Lisa A. , Nordin James , Belongia Edward A. , Hohman K. , Chen Robert T. , Davis Robert ,   for the Vaccine Safety Datalink Team
Published: February 2008

BACKGROUND. The measles-mumps-rubella vaccine has been associated with immune thrombocytopenia purpura in 2 small studies.

METHODS. By using the Vaccine Safety Datalink, we identified measles-mumps-rubella–vaccinated children aged 1 to 18. A case of immune thrombocytopenia purpura was defined as a patient with a platelet count of ≤50000/μL with clinical bleeding and normal red and white blood cell indices. The immune thrombocytopenia purpura incidence rates during exposed (42 days after vaccination) and unexposed time periods were determined. A retrospective cohort of vaccinated children was used to determine incident rate ratios for children aged 1 to 18 years, 12 to 23 months, and 12 to 15 months.

RESULTS. A total of 1036689 children received 1107814 measles-mumps-rubella vaccinations; there were 259 confirmed patients with immune thrombocytopenia purpura. Because only 5 exposed cases occurred after age 2, analyses were limited to children aged 12 to 23 months. Exposed patients aged 12 to 23 months had lower median platelet counts than those who were unexposed and had similar median duration of illness (11 vs 10 days). The incident rate ratio was highest for children aged 12 to 15 months at 7.10. The incident rate ratio for boys aged 12 to 15 months was 14.59, and the incident rate ratio for girls in the same age group was 3.22. Seventy-six percent of immune thrombocytopenia purpura cases in children aged 12 to 23 months were attributable to measles-mumps-rubella vaccination. This vaccine causes 1 case of immune thrombocytopenia purpura per every 40000 doses.

CONCLUSION. Measles-mumps-rubella vaccine that is given in the second year of life is associated with an increased risk of immune thrombocytopenia purpura.
Routine Measurement of Head Circumference as a Tool for Detecting Intracranial Expansion in Infants: What Is the Gain? A Nationwide Survey
Authors: Zahl Sverre Morten , Wester Knut
Published: February 2008

OBJECTIVE. The aim of the present study was to investigate the importance of routine head circumference measurements in the detection of intracranial expansive conditions, because only fragmented evidence exists in favor of this routine.

METHODS. The study was a nationwide study based on the medical records of all Norwegian departments of pediatrics and neurosurgery. The study included all Norwegian children <5 years of age who were hospitalized because of intracranial expansion during a 4-year period (1999–2002). Information about diagnostic codes, symptoms, and ages at symptom onset and at admission was collected from the medical records.

RESULTS. The study included 298 patients. For 173 (58%), hydrocephalus was the primary diagnosis; 57 (19%) had intracranial tumors and 68 (23%) had other primary diagnoses. For 46% of the children, increased head circumference was the first and main symptom leading to diagnosis. Increased head circumference was much more common as the symptom that led to diagnosis for patients with hydrocephalus (72%), compared with patients with cysts (31%) or tumors (5%). Increasing head circumference seems important mainly in detecting hydrocephalus and cysts, especially during the first 10 months of life.

CONCLUSIONS. Routine measurements of head circumference during the first year of life mainly detect infants with hydrocephalus or cysts; other expansive conditions yield other symptoms. Most children with increased head circumference as a symptom of intracranial expansion are identified during the first 10 months of life.
Impact of Intimate Partner Violence on Children's Well-Child Care and Medical Home
Authors: Bair-Merritt Megan H. , Crowne Sarah Shea , Burrell Lori , Caldera Debra , Cheng Tina L. , Duggan Anne K.
Published: February 2008

OBJECTIVES. Intimate partner violence has been linked to poor child health. A continuous relationship with a primary care pediatric provider can help to detect intimate partner violence and connect families with needed services. The objectives of this study were to determine the relationship between intimate partner violence and (1) maternal report of a regular site for well-child care, (2) maternal report of a primary pediatric provider, (3) well-child visits in the first year of life, (4) up-to-date immunizations at 2 years of age, (5) maternal report of medical neglect, and (6) maternal report of the pediatric provider–caregiver relationship.

METHODS. This retrospective cohort study evaluated data from 209 at-risk families participating in the evaluation of the Healthy Families Alaska program. Research staff interviewed mothers near the time of an index child's birth and again at the child's second birthday. Medical charts were abstracted for information on well-child visits and immunizations.

RESULTS. Mothers who disclosed intimate partner violence at the initial interview (n = 62) were significantly less likely to report a regular site for well-child care or a primary pediatric provider. In multivariable models, children of mothers who disclosed intimate partner violence tended to be less likely to have the recommended 5 well-child visits within the first year of life and were significantly less likely to be fully immunized at 2 years of age. Differences in medical neglect were not statistically significant. Of mothers who reported a specific primary pediatric provider, those with intimate partner violence histories trusted this provider less and tended to rate less favorably pediatric provider–caregiver communication and the overall quality of the pediatric provider–caregiver relationship.

CONCLUSIONS. Future research should explore effective ways to link intimate partner violence–exposed children with a medical home and a primary pediatric provider and to improve relationships between pediatric providers and caregivers who face violence at home.
Randomized, Controlled Trial of a Best-Practice Individualized Behavioral Program for Treatment of Childhood Overweight: Scottish Childhood Overweight Treatment Trial (SCOTT)
Authors: Hughes Adrienne R. , Stewart Laura , Chapple Jan , McColl John H. , Donaldson Malcolm D. C. , Kelnar Christopher J. H. , Zabihollah Mehran , Ahmed Faisal , Reilly John J.
Published: February 2008

OBJECTIVE. The objective of this study was to determine whether a generalizable best-practice individualized behavioral intervention reduced BMI z score relative to standard dietetic care among overweight children.

METHODS. The design consisted of an assessor-blinded, randomized, controlled trial involving 134 overweight children (59 boys, 75 girls; BMI ≥ 98th centile relative to United Kingdom 1990 reference data for children aged 5–11 years) who were randomly assigned to a best-practice behavioral program (intervention) or standard care (control). The intervention used family-centered counseling and behavioral strategies to modify diet, physical activity, and sedentary behavior. BMI z score, weight, objectively measured physical activity and sedentary behavior, fat distribution, quality of life, and height z score were recorded at baseline and at 6 and 12 months.

RESULTS. The intervention had no significant effect relative to standard care on BMI z score from baseline to 6 months and 12 months. BMI z score decreased significantly in both groups from baseline to 6 and 12 months. For those who complied with treatment, there was a significantly smaller weight increase in those in the intervention group compared with control subjects from baseline to 6 months. There were significant between-group differences in favor of the intervention for changes in total physical activity, percentage of time spent in sedentary behavior, and light-intensity physical activity.

CONCLUSIONS. A generalizable, best-practice individualized behavioral intervention had modest benefits on objectively measured physical activity and sedentary behavior but no significant effect on BMI z score compared with standard care among overweight children. The modest magnitude of the benefits observed perhaps argues for a longer-term and more intense intervention, although such treatments may not be realistic for many health care systems.