bluuebunny/crossref_metadata_2025 huggingface dataset:
From the Ouchless Place to Comfort Central: The Evolution of a Concept
Authors: Schechter Neil L.
Published: October 2008

Although the past 20 years have yielded an outpouring of research on pain management in children, this information is often not applied uniformly to children in the hospital. To address this deficiency, we developed a systematic institution-wide program to reduce pain in all children in the hospital. Our goal was to create a setting in which attention to pain control and comfort measures would be inherent in all inpatient encounters. We labeled the inpatient unit in which this concept evolved as the “Ouchless Place” and described the program and its development in a 1997 Pediatrics article. In this article we describe the further evolution of that concept in light of the broader changes that have occurred in the field of pain management and in our community. The development of a new children's hospital allowed us to examine what we had learned from our previous experience and modify our program on the basis of that review. This new initiative was renamed “Comfort Central,” recognizing that although no inpatient experience could be entirely “ouchless,” we could still pledge to families that we were attentive to pain and would provide the most comfort that we could. Specific changes that were put in place in our model included the acquisition of administrative authority to mandate change; the extension of our program to the laboratory, outpatient clinics, and physician offices; the incorporation of newer, more active educational models; increased emphasis on collaboration with other services; increased visibility of pain-relief efforts; and development of an ongoing quality improvement program that monitors the efficacy of pain-relief initiatives in the institution. The elements of this program may be applicable to other health care systems that desire to develop a more cohesive system-wide approach to pain reduction in those for whom they provide care.
On the Front Lines: Lessons Learned in Implementing Multidisciplinary Peripheral Venous Access Pain-Management Programs in Pediatric Hospitals
Authors: Leahy Sarah , Kennedy Robert M. , Hesselgrave Joy , Gurwitch Karen , Barkey Mary , Millar Toni F.
Published: October 2008

Venipuncture and intravenous cannulation are among the most common and widespread medical procedures performed on children today. Therefore, effective treatment of venous access pain can benefit from an integrated systems approach that enlists multiple players in the health care system. By using case studies that analyze this issue from the perspective of the nurse, the physician, the pharmacist, and the child life specialist, this article illustrates how multidisciplinary programs designed to manage needle pain have been developed successfully in several institutions. Common themes that arise from these case studies include the importance of a multidisciplinary evidence-based approach to advocate change; a system-wide protocol for the administration of local anesthetics; convenient access to topical local anesthetics; department and hospital-wide support for educational efforts, including training in nonpharmacologic techniques used by child life specialists; and ongoing quantification of the overall success of any program. Implementation of these strategies can result in significant improvements in the pediatric venous access experience.
Coadministration of RIX4414 Oral Human Rotavirus Vaccine Does Not Impact the Immune Response to Antigens Contained in Routine Infant Vaccines in the United States
Authors: Dennehy Penelope H. , Bertrand Helen R. , Silas Peter E. , Damaso Silvia , Friedland Leonard R. , Abu-Elyazeed Remon
Published: October 2008

OBJECTIVE. This study was conducted to confirm the absence of immune interference of 2 doses of RIX4414 (Rotarix) on routine infant vaccinations in the United States.

STUDY DESIGN. A total of 484 healthy infants aged 6 to 12 weeks were randomly assigned to 1 of 2 groups to receive 3 doses of Pediarix (combined diphtheria-tetanus-acellular pertussis-hepatitis B-poliovirus vaccine [DTaP-HBV-IPV]), Prevnar (7-valent pneumococcal conjugate vaccine [PCV7]), and ActHIB (Haemophilus influenzae type b conjugate vaccine [Hib]) at 2, 4, and 6 months of age with RIX4414 either coadministered at 2 and 4 months (Co-ad) or administered separately at 3 and 5 months (Sep-ad). Serum antibodies were measured 1 month after dose 3 of the DTaP-HBV-IPV, PCV7, and Hib vaccines.

RESULTS. Antibody responses to all antigens were similar in infants in both the Co-ad and Sep-ad groups. Seroprotective antibody concentrations against diphtheria, tetanus, hepatitis B, and poliovirus types 1, 2, and 3 were achieved by ≥97.9% of the infants in both groups. Antipolyribosyl ribitol phosphate antibody levels of ≥1.0 μg/mL were achieved by 88.3% to 89.4% of infants in both groups. In both groups, ≥97.8% of the infants were seropositive for antipertussis antibodies and the 7 pneumococcal serotypes. Predefined criteria for noninferiority between groups were reached for all antigens.

CONCLUSIONS. Two doses of RIX4414 coadministered with routine infant vaccines as recommended in the United States (DTaP-HBV-IPV, PCV7, and Hib) did not impair the immune response to any of the coadministered antigens.
Longitudinal Effects of Violent Video Games on Aggression in Japan and the United States
Authors: Anderson Craig A. , Sakamoto Akira , Gentile Douglas A. , Ihori Nobuko , Shibuya Akiko , Yukawa Shintaro , Naito Mayumi , Kobayashi Kumiko
Published: October 2008

CONTEXT. Youth worldwide play violent video games many hours per week. Previous research suggests that such exposure can increase physical aggression.

OBJECTIVE. We tested whether high exposure to violent video games increases physical aggression over time in both high- (United States) and low- (Japan) violence cultures. We hypothesized that the amount of exposure to violent video games early in a school year would predict changes in physical aggressiveness assessed later in the school year, even after statistically controlling for gender and previous physical aggressiveness.

DESIGN. In 3 independent samples, participants’ video game habits and physically aggressive behavior tendencies were assessed at 2 points in time, separated by 3 to 6 months.

PARTICIPANTS. One sample consisted of 181 Japanese junior high students ranging in age from 12 to 15 years. A second Japanese sample consisted of 1050 students ranging in age from 13 to 18 years. The third sample consisted of 364 United States 3rd-, 4th-, and 5th-graders ranging in age from 9 to 12 years.

RESULTS. Habitual violent video game play early in the school year predicted later aggression, even after controlling for gender and previous aggressiveness in each sample. Those who played a lot of violent video games became relatively more physically aggressive. Multisample structure equation modeling revealed that this longitudinal effect was of a similar magnitude in the United States and Japan for similar-aged youth and was smaller (but still significant) in the sample that included older youth.

CONCLUSIONS. These longitudinal results confirm earlier experimental and cross-sectional studies that had suggested that playing violent video games is a significant risk factor for later physically aggressive behavior and that this violent video game effect on youth generalizes across very different cultures. As a whole, the research strongly suggests reducing the exposure of youth to this risk factor.
Procalcitonin Levels in Febrile Infants After Recent Immunization
Authors: Dauber Andrew , Weiss Scott , Maniaci Vincenzo , Nylen Eric , Becker Kenneth L. , Bachur Richard
Published: October 2008

BACKGROUND. Procalcitonin has been identified as a useful blood marker of serious bacterial infection in febrile infants. Many infants present with a febrile reaction after receiving immunizations. The effects of immunization on procalcitonin have not been investigated.

METHODS. We performed a prospective observational cohort study at a large, urban pediatric emergency department. Infants ≤90 days of age with fever of ≥38°C were enrolled. Subjects were divided into 3 groups: infants with serious bacterial infection; subjects without serious bacterial infection who received recent (<48 hours) immunizations; and subjects without serious bacterial infection who did not recently receive immunizations. Procalcitonin was measured by using a quantitative immunometric assay.

RESULTS. Over 13 months, procalcitonin was measured for 271 infants. There were 44 (16%) patients with serious bacterial infection, 35 in the recent-immunization group, and 192 in the no-recent-immunization group. The median procalcitonin level for serious bacterial infection was 0.53 ng/mL, for recent immunization was 0.29 ng/mL, and for no recent immunizations was 0.17 ng/mL. Procalcitonin values were elevated for patients with serious bacterial infection compared with patients both with and without recent immunizations. Compared with patients who had no recent immunizations, procalcitonin levels were elevated in patients with recent immunization. Using a cut point of 0.12 ng/mL, the sensitivity of procalcitonin for serious bacterial infection was 96%, specificity was 23%, and negative predictive value was 96%. Two patients with recent immunization who had serious bacterial infection were identified with this cut point.

CONCLUSIONS. Among febrile infants with recent immunization, procalcitonin levels are increased compared with patients with fever and no identified bacterial infection. Despite this increase, procalcitonin can still reliably discriminate infants with serious bacterial infection.
Growth of Infants With IgE-Mediated Cow's Milk Allergy Fed Different Formulas in the Complementary Feeding Period
Authors: Wang Julie
Published: October 2008

Agostoni C, Fiocchi A, Riva E, et al. Pediatr Allergy Immunol. 2007;18(7):599–606

PURPOSE OF THE STUDY. Observational studies have shown that allergic infants, irrespective of their type of diet, show various degrees of growth depression in the first year of life. The authors investigated whether the type of milk in the complementary feeding period (6–12 months of age) is associated with differences in the increase of standardized growth indices (weight-for-age [WA], length-for-age [LA], and weight-for-length [WL] z scores) in infants with cow's milk allergy (CMA).

STUDY POPULATION. One hundred sixty infants with immunoglobulin E–mediated CMA entered the study in a 5-year period; 108 were formula fed and 52 were still breastfed at 6 months.

METHODS. Infants were randomly assigned to 3 special formulas: a soy formula (n = 32); a casein hydrolysate (n = 31); or a rice hydrolysate (n = 30). A fourth, nonrandomized group was made up of allergic infants who were still breastfed at up to 12 months (n = 32). Groups were compared for WA, LA, and WL z scores at 6, 9, and 12 months of age.

RESULTS. All groups showed low WA and LA z scores at 6 months of age. Infants fed hydrolyzed products showed a trend toward higher WA z-score increments in the 6- to 12-month period. The use of casein- and rice-based hydrolyzed formulas resulted in higher changes in WA compared with soy formula.

CONCLUSIONS. Further research should be aimed at optimizing the dietary needs and feeding regimens for infants with CMA.

REVIEWER COMMENTS. Use of infant formulas for children with CMA, if not exclusively breastfeeding, is necessary to provide adequate nutrition at a critical time for a child's growth. Few studies have compared growth parameters in children with CMA using different formulas. This study demonstrates that different formulas can contribute to different growth rates in allergic children. This area requires additional investigation to optimize nutrition for these infants.
Childhood Asthma After Bacterial Colonization of the Airway in Neonates
Authors: Smart Brian A.
Published: October 2008

Bisgaard H, Hermansen MN, Buchvald F, et al. N Engl J Med. 2007;357(15):1487–1495

PURPOSE OF THE STUDY. To investigate a possible association between bacterial colonization of the hypopharynx in asymptomatic neonates and later development of recurrent wheeze, asthma, and allergy during the first 5 years of life.

STUDY POPULATION. The subjects were children from the Copenhagen Prospective Study on Asthma in Childhood who were born to mothers with asthma. Samples were obtained from 321 subjects at the age of 1 month when the infants were asymptomatic.

METHODS. Aspirates from the hypopharyngeal region were cultured for Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus. Wheeze was monitored prospectively on diary cards during the first 5 years of life. Peripheral eosinophil count, total immunoglobulin E (IgE) levels, and specific IgE levels were measured at 4 years of age. Lung function was measured and asthma was diagnosed at the age of 5.

RESULTS. Overall, 21% of the infants were colonized with S pneumoniae, M catarrhalis, H influenzae, or a combination of these organisms. Colonization with ≥1 of these organisms, but not S aureus, was significantly associated with persistent wheeze, acute severe exacerbation of wheeze, and hospitalization for wheeze. Eosinophil counts and total IgE levels at age 4 were significantly increased in children colonized at age 1 month with S pneumoniae, M catarrhalis, or H influenzae, but the specific IgE level was not significantly affected. Children who had been colonized neonatally with S pneumoniae, M catarrhalis, or H influenzae also had, at age 5, increased prevalence of asthma, increased risk for hospitalization for wheeze, and increased reversibility of airway resistance after the administration of a bronchodilator.

CONCLUSIONS. Neonates colonized in the hypopharyngeal region with S pneumoniae, M catarrhalis, H influenzae, or a combination of these organisms are at increased risk for recurrent wheeze and asthma early in life.

REVIEWER COMMENTS. This is a fascinating study. Although it must be pointed out that this was a high-risk population (the mothers had asthma) and the “photograph” of these patients at ages 4 and 5 may not represent their final end point, this study gives new insight into the interaction between infectious disease, atopy, and asthma. I hope the investigators will extend this trial to older ages and that other groups will try to replicate these findings in both low- and high-risk populations of children.
Adherence to Follow-up Recommendations in Asthma
Authors: Lasley Mary V.
Published: October 2008

van Gent R, de Meer G, Rovers MM, Kimpen JL, van der Ent CK, van Essen LE. Arch Dis Child. 2008;93(3):236–238

PURPOSE OF THE STUDY. To assess the willingness of parents of children with possible asthma to visit their general practitioner (GP).

STUDY POPULATION. A cross-sectional group of 130 Dutch children aged 7 to 10 years with possible asthma were studied.

METHODS. Participating parents completed the International Study of Asthma and Allergies in Childhood questionnaire. A child was considered to have “diagnosed asthma” if a doctor had diagnosed him or her with asthma in the preceding 12 months. A child was considered to have “possible asthma” if the child had (1) no physician-diagnosed asthma in the preceding 12 months, (2) asthma symptoms in the preceding 12 months, and (3) either reversible airway obstruction or bronchial hyperreactivity. Parents of children with possible asthma were sent a letter recommending further medical evaluation by their GP. The GP received a letter with the results of the questionnaire and lung-function tests. A research nurse contacted parents to conduct a telephone interview regarding adherence to recommendations.

RESULTS. A total of 2745 children were invited to participate in the study, and 1758 children participated. Eighty-one (5%) children were diagnosed with asthma and 130 (8%) had a possible diagnosis of asthma, which represented the study population. A follow-up interview was completed for 114 children (88%). Sixty-two percent of the children visited a doctor, and 38% of the parents refused to visit the GP. The main reason for parents not visiting a GP was absence or mildness of symptoms. Most of the parents stated that they would visit a GP if symptoms worsened.

CONCLUSIONS. Two thirds of the children with undiagnosed asthma visited their GP. Willingness to follow-up the recommendations was greater for children with more severe airway reversibility and if the mother was less well educated.

REVIEWER COMMENTS. Asthma screening in children relies on parental recognition of asthma symptoms. The authors pointed out that parents often underrecognize symptoms of asthma in their child. However, when confronted with information of a possible asthma diagnosis, the majority of parents sought advice from their GP. Asthma screening programs can be a useful tool for helping children with undiagnosed asthma to seek professional care.
Duration of Humoral Immunity to Common Viral and Vaccine Antigens
Authors: Smart Brian A.
Published: October 2008

Amanna IJ, Carlson NE, Slifka MK. N Engl J Med. 2007;357(19):1903–1915

PURPOSE OF THE STUDY. To better define the duration of humoral immunity and the role played by memory B cells.

STUDY POPULATION. There were 45 human subjects followed for up to 26 years. These participants were recruited from the Oregon National Primate Research Center. The only inclusion criteria was that subjects had at least 3 serum samples banked for at least 3 years before the study began. The average age at the start and end of the study was 37 and 52 years, respectively.

METHODS. Blood samples were drawn at least annually, and serum was banked. Antibody titers were measured to vaccinia, measles, mumps, rubella, varicella-zoster, Epstein-Barr, tetanus, and diphtheria. Each subject gave an average of 14 serum samples over an average of 15.2 years. Also, the investigators measured antigen-specific memory B cells by means of limiting-dilution analysis and compared memory B-cell frequencies to their corresponding serum antibody levels. The majority of subjects had vaccination to smallpox in childhood and had recovered from the other viral diseases such as measles and rubella.

RESULTS. The antibody responses to viral antigens were very stable, with estimated half-lives ranging from 50 years for varicella-zoster to >200 years for measles and mumps. Against tetanus and diphtheria, the antibody responses waned more rapidly with half-lives of 11 and 19 years, respectively. The investigators also found that B-cell memory was long-lived, but there was no significant correlation between peripheral memory B-cell numbers and antibody levels for 5 of the 8 antigens.

CONCLUSIONS. Serologic memory for multiple antigens is maintained for remarkably sustained periods of time. Also, memory B-cell numbers did not correlate with antibody titers, which suggests that peripheral memory B-cells and antibody-secreting plasma cells may represent independently regulated cell populations and may play different roles in the maintenance of immunity.

REVIEWER COMMENTS. At the end of the study, the average age of the participants was 52 years. Most had received vaccination to smallpox, but most had also contracted natural measles, mumps, or rubella during childhood. This study population, therefore, does not represent our current population of children with complex schedules of vaccinations. Furthermore, we cannot conclude from this study that vaccination-induced immunity is necessarily as long-lived as natural infection-induced immunity. Nonetheless, this report does give fascinating insight into the “adult” side of immunity to many of the childhood diseases against which we vaccinate. This study also sheds light on possible mechanisms for sustained humoral immunity, which it seems may not entirely depend on regulation by memory B cells.
Infections in Child Day Care Centers and Later Development of Asthma, Allergic Rhinitis, and Atopic Dermatitis Infections in Child Day Care Centers: Prospective Follow-up Survey 12 Years After Controlled Randomized Hygiene Intervention
Authors: Kim Jennifer S.
Published: October 2008

Dunder T, Tapiainen T, Pokka T, Uhari M. Arch Pediatr Adolesc Med. 2007;161(10):972–977

PURPOSE OF THE STUDY. To evaluate the effect of prevention of common infections in child day care centers (CDCCs) on the later development of allergic disease.

STUDY POPULATION. Children <2 years of age were recruited from 20 CDCCs in Finland for a 15-month randomized, controlled hygiene intervention trial conducted in 1991–1992. Among the children in the intervention CDCCs, there were 27% fewer episodes of acute otitis media and 24% fewer days of antimicrobial agents.

METHODS. Questionnaires were sent in 2003 (12 years later) to 1376 participants of the previous intervention trial; 928 participated (response rate: 68%). The main outcome measures were the number of respondents with a physician diagnosis of asthma, allergic rhinitis, and/or atopic dermatitis (AD) and those who reported symptoms of atopic disease.

RESULTS. No differences were found between the intervention and control groups with regard to rates of asthma, allergic rhinitis, or AD or with frequency of atopic symptoms.

CONCLUSIONS. The prevention of common respiratory tract and enteric infections during early childhood does not change later allergic morbidity.

REVIEWER COMMENTS. This particular hygiene intervention, aimed at decreasing the frequency of common childhood upper respiratory and gastrointestinal illnesses, was not successful in decreasing the development of asthma, allergic rhinitis, or AD among this cohort. The authors argued that the magnitude of the reduction in infections and duration of the intervention should have led to an increase in asthma rates as proposed by the hygiene hypothesis. However, the infection history was based on clinical symptoms and use of antibiotics rather than more definitive laboratory diagnostic measures for specific bacteria and/or viruses. In addition, the follow-up data were based solely on questionnaire findings, which have an inherent reporting bias. Regardless, additional studies are necessary to characterize the role of the hygiene hypothesis in the development of atopic disease.
Home Exposures to Environmental Tobacco Smoke and Allergic Symptoms Among Young Children in Singapore
Authors: Maloney Jennifer M.
Published: October 2008

Zuraimi MS, Tham KW, Chew FT, Ooi PL, David K. Int Arch Allergy Immunol. 2008;146(1):57–65

PURPOSE OF THE STUDY. To investigate the association of environmental tobacco smoke (ETS) exposure among preschool-aged children with allergic symptoms in homes in Singapore.

STUDY POPULATION. The authors studied children between the ages of 1.5 and 6 years who were attending 687 child care centers in Singapore.

METHODS. This study used a cross-sectional design, adopting an expanded and modified International Study on Asthma and Allergies in Childhood (ISAAC) questionnaire for the evaluation of asthma and allergies in 6794 children attending 120 randomly selected child care centers. Specific information on demographics and ETS exposures was obtained. Adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) were determined by using Poisson multivariate regression with a log-link function and robust variance estimates as recommended for cross-sectional studies.

RESULTS. The response rate was 70.0%, and 4759 children from 97 centers participated. After adjusting for covariates, it was found that home ETS exposure was associated with increased risks of current symptoms of rhinitis (PR: 1.23 [95% CI: 1.01–1.50]) and rhinoconjunctivitis (PR: 1.79 [95% CI: 1.26–2.54]). These associations followed dose-response trends with respect to the number of cigarettes smoked or smokers in the home. Home ETS exposures were also associated with higher PRs of wheeze, nocturnal cough, and doctor-diagnosed asthma. Compared with paternal smoking, higher risks of the above-listed outcomes were found for maternal smoking.

CONCLUSIONS. Home ETS exposure is a risk factor associated with rhinitis and asthma among preschool-aged children.

REVIEWER COMMENTS. This article provides additional evidence that exposure to ETS is associated with asthma and rhinitis. These findings support the continued need to discuss the risks of ETS exposure when reviewing anticipatory guidance items with families.
Randomized, Placebo-Controlled Trial of Lactobacillus rhamnosus GG as Treatment of Atopic Dermatitis in Infancy
Authors: Keet Corinne A. , Wood Robert A.
Published: October 2008

Grüber C, Wendt M, Sulser C, et al. Allergy. 2007;62(11):1270–1276

PURPOSE OF THE STUDY. To investigate the efficacy of Lactobacillus rhamnous GG (LGG) as a food supplement for children with mild-to-moderate atopic dermatitis (AD).

STUDY POPULATION. One hundred two children aged 3 to 12 months with mild-to-moderately severe AD who were not taking antiinflammatory medications were included in this German study.

METHODS. Subjects were randomly assigned to receive LGG (5 × 109 colony-forming units twice per day) or placebo for 12 weeks. Severity Scoring Atopic Dermatitis (SCORAD) index and use of hydrocortisone 1% ointment as a rescue medication were recorded at 4, 8, and 12 weeks of treatment.

RESULTS. One hundred two subjects were randomly assigned and completed the treatment period (54 in the treatment group, 48 in the placebo group). Initial symptom load was similar in both groups (SCORAD index: 24.6 ± 8.8 in the LGG group and 23.6 ± 7.8 in the placebo group) and improved over time. There were no statistically significant differences between the groups at any of the analysis times (SCORAD index for LGG versus placebo: 23.8 ± 12.4 vs 20.6 ± 9.9 at 4 weeks, 22.5 ± 14.6 vs 17.9 ± 13.1 at 8 weeks, and 19.6 ± 15.4 vs 15.1 ± 12.1 at 12 weeks, respectively). No statistically significant differences were found when the data were stratified according to age, eczema severity, or use of rescue medications, and no differences were found in the use of rescue medications, total immunoglobulin E level, or newly developed allergic sensitization to hen's egg or cow's milk.

CONCLUSIONS. This study showed no therapeutic effect of LGG for the treatment of mild-to-moderate AD in infancy.

REVIEWER COMMENTS. In our practice, parents of children with AD frequently inquire about whether they should supplement their children's diets with lactobacilli. Previous studies had shown some possible benefit of supplementation with lactobacilli for prevention of AD in infants at risk but even less-promising results regarding its use in the treatment of AD. This study adds to the literature, finding no utility of lactobacilli supplementation for the treatment of established AD.
A Multicenter, Randomized, Controlled Trial of Dexamethasone for Bronchiolitis
Authors: Chipps Bradley E.
Published: October 2008

Corneli HM, Zorc JJ, Majahan P, et al. N Engl J Med. 2007;357(4):331–339

PURPOSE OF THE STUDY. To evaluate the efficacy of a single dose of oral dexamethasone (1 mg/kg) compared with placebo in the treatment of acute bronchiolitis.

STUDY POPULATION. A total of 600 children (aged 2–12 months) with a first episode of wheezing diagnosed in the emergency department as moderate-to-severe bronchiolitis were included.

METHODS. Patients were enrolled at 20 emergency departments during the months of November through April over a 3-year period. The primary outcome was respiratory assessment and score change during the first 4 hours. Later outcomes evaluated included length of hospital stay, medical visits, and adverse events.

RESULTS. Baseline characteristics were similar for both groups. The admission rate was 39.7% for children assigned to dexamethasone compared with 41% for those assigned to placebo. Both groups had improvement during the observation period with similar mean changes in respiratory assessment score. For the patients admitted to the hospital, there was no difference in mean hospital stay (2.55 vs 2.27 days), subsequent hospital admissions, or adverse events.

CONCLUSIONS. Single-dose dexamethasone did not prevent hospital admission for bronchiolitis.

REVIEWER COMMENTS. This study finally allows for a definitive statement that no significant benefit can be seen with the use of corticosteroid for first episodes of wheezing. It should be noted that bronchodilator treatment was not regulated but seemed not to affect outcomes because treatment was equally distributed between the groups. This continues to strengthen the notion that supportive therapy with good hydration and preventing hypoxia are the most important interventions for a first episode of bronchiolitis.
Attenuation of Allergic Contact Dermatitis Through the Endocannabinoid System
Authors: Gern James E.
Published: October 2008

Karsak M, Gaffal E, Date R, et al. Science. 2007;316(5830):1494–1497

PURPOSE OF THE STUDY. To assess the role of cannabinoid receptors in allergic contact dermatitis.

STUDY POPULATION AND METHODS. The study was conducted in an animal model for cutaneous contact hypersensitivity using wild-type mice and also those lacking cannabinoid receptors (CB1 and CB2).

RESULTS. Mice lacking both known cannabinoid receptors display exacerbated allergic inflammation. In contrast, fatty acid amide hydrolase–deficient mice, which have increased levels of the endocannabinoid anandamide, displayed reduced allergic responses in the skin. Cannabinoid receptor antagonists exacerbated allergic inflammation, whereas receptor agonists attenuated inflammation.

CONCLUSIONS. These results demonstrate a protective role of the endocannabinoid system for contact allergy in the skin and suggest a target for therapeutic intervention.

REVIEWER COMMENTS. This very clever study was based on an observation that mice lacking cannabinoid receptors tended to develop an itchy dermatitis at the site of nickel-containing ear tags. From this simple observation, the authors conducted a series of well-designed experiments that demonstrated that the cannabinoid receptors help to regulate cell recruitment to sites of inflammation in the context of contact dermatitis. These results have led to new insights to the pathogenesis of this disorder and may lead to a new treatment for contact dermatitis. I wonder if cannabinoid receptors are involved in other forms of skin allergy.
Hospital Discharge of the High-Risk Neonate
Authors:   Committee on Fetus and Newborn
Published: October 2008

This Policy Statement was reafirmed May 2011 and November 2018.

This policy statement updates the guidelines on discharge of the high-risk neonate first published by the American Academy of Pediatrics in 1998. As with the earlier document, this statement is based, insofar as possible, on published, scientifically derived information. This updated statement incorporates new knowledge about risks and medical care of the high-risk neonate, the timing of discharge, and planning for care after discharge. It also refers to other American Academy of Pediatrics publications that are relevant to these issues. This statement draws on the previous classification of high-risk infants into 4 categories: (1) the preterm infant; (2) the infant with special health care needs or dependence on technology; (3) the infant at risk because of family issues; and (4) the infant with anticipated early death. The issues of deciding when discharge is appropriate, defining the specific needs for follow-up care, and the process of detailed discharge planning are addressed as they apply in general to all 4 categories; in addition, special attention is directed to the particular issues presented by the 4 individual categories. Recommendations are given to aid in deciding when discharge is appropriate and to ensure that all necessary care will be available and well coordinated after discharge. The need for individualized planning and physician judgment is emphasized.
HIV Testing and Prophylaxis to Prevent Mother-to-Child Transmission in the United States
Authors:   Committee on Pediatric AIDS
Published: October 2008

This Policy Statement was reaffirmed June 2011, November 2014, and October 2020.

Universal HIV testing of pregnant women in the United States is the key to prevention of mother-to-child transmission of HIV. Repeat testing in the third trimester and rapid HIV testing at labor and delivery are additional strategies to further reduce the rate of perinatal HIV transmission. Prevention of mother-to-child transmission of HIV is most effective when antiretroviral drugs are received by the mother during her pregnancy and continued through delivery and then administered to the infant after birth. Antiretroviral drugs are effective in reducing the risk of mother-to-child transmission of HIV even when prophylaxis is started for the infant soon after birth. New rapid testing methods allow identification of HIV-infected women or HIV-exposed infants in 20 to 60 minutes. The American Academy of Pediatrics recommends documented, routine HIV testing for all pregnant women in the United States after notifying the patient that testing will be performed, unless the patient declines HIV testing (“opt-out” consent or “right of refusal”). For women in labor with undocumented HIV-infection status during the current pregnancy, immediate maternal HIV testing with opt-out consent, using a rapid HIV antibody test, is recommended. Positive HIV antibody screening test results should be confirmed with immunofluorescent antibody or Western blot assay. For women with a positive rapid HIV antibody test result, antiretroviral prophylaxis should be administered promptly to the mother and newborn infant on the basis of the positive result of the rapid antibody test without waiting for results of confirmatory HIV testing. If the confirmatory test result is negative, then prophylaxis should be discontinued. For a newborn infant whose mother's HIV serostatus is unknown, the health care professional should perform rapid HIV antibody testing on the mother or on the newborn infant, with results reported to the health care professional no later than 12 hours after the infant's birth. If the rapid HIV antibody test result is positive, antiretroviral prophylaxis should be instituted as soon as possible after birth but certainly by 12 hours after delivery, pending completion of confirmatory HIV testing. The mother should be counseled not to breastfeed the infant. Assistance with immediate initiation of hand and pump expression to stimulate milk production should be offered to the mother, given the possibility that the confirmatory test result may be negative. If the confirmatory test result is negative, then prophylaxis should be stopped and breastfeeding may be initiated. If the confirmatory test result is positive, infants should receive antiretroviral prophylaxis for 6 weeks after birth, and the mother should not breastfeed the infant.
First description of swine torque teno virus (TTV) and detection of a new genogroup in Hungary: Short communication
Authors: Takács Mária , Dencs Ágnes , Csiszár Csenge , Hettmann Andrea , Rusvai Erzsébet , Szomor Katalin , Pálfi Vilmos , Nagy Béla
Published: October 2008

Torque teno virus (TTV) belongs to the floating genus of
Anellovirus
. It was discovered in a human patient, and later it was also found in animals including pigs. The aim of this study was to investigate the presence and estimate the prevalence of swine TTV in Hungarian pig herds for the first time, and to characterise the viruses found. Serum samples of 82 adult swine from 13 piggeries and 44 weaned pigs from one large herd were tested by PCR for the presence of TTV DNA. Viral DNA was found in 30% of the adult swine and 73% of the weaned pigs tested. Liver and intestine of weaned pigs were also tested and found to be infected at a lower rate. The TTV sequences found in sera and intestines were similar and could be clustered as swine genogroup 1. However, the sequences derived from one liver were remarkably different from all other known genogroups and seemed to represent a new genogroup.
Retrospective clinical comparison of idiopathic versus symptomatic epilepsy in 240 dogs with seizures
Authors: Pákozdy Ákos , Leschnik Michael , Tichy Alexander , Thalhammer Johann
Published: October 2008

In the present study, 240 cases of dogs with seizures were analysed retrospectively. The aim was to examine the underlying aetiology and to compare primary or idiopathic epilepsy (IE) with symptomatic epilepsy (SE) concerning signalment, history, ictal pattern, clinical and neurological findings. The diagnosis of symptomatic epilepsy was based on confirmed pathological changes in haematology, serum biochemistry, cerebrospinal fluid (CSF) analysis and morphological changes of the brain by CT/MRI or histopathological examination. Seizure aetiologies were classified as idiopathic epilepsy (IE, n = 115) and symptomatic epilepsy (SE, n = 125). Symptomatic epilepsy was mainly caused by intracranial neoplasia (39) and encephalitis (23). The following variables showed significant difference between the IE and SE group: age, body weight, presence of partial seizures, cluster seizures, status epilepticus, ictal vocalisation and neurological deficits. In 48% of the cases, seizures were found to be due to IE, while 16% were due to intracranial neoplasia and 10% to encephalitis. Status epilepticus, cluster seizures, partial seizures, vocalisation during seizure and impaired neurological status were more readily seen with symptomatic epilepsy. If the first seizure occurred between one and five years of age or the seizures occurred during resting condition, the diagnosis was more likely IE than SE.
Evaluation of microvessel density (MVD) in canine mammary tumours by quantitative immunohistochemistry of the claudin-5 molecule
Authors: Jakab Csaba , Halász Judit , Kiss András , Schaff Zsuzsa , Szász Attila , Rusvai Miklós , Abonyi Tóth Zsolt , Kulka Janina
Published: October 2008

In our recent investigation, angiogenesis was evaluated and quantified by immunohistochemical evaluation of microvessel density (MVD) using claudin-5 (CLDN-5) as a marker for vascular endothelium in 67 canine mammary gland tumours. Computer image analysis was used to measure the intratumoural MVD. Higher intratumoural MVD was detected in malignant simple neoplasms compared with benign tumours. Furthermore, the results of MVD were correlated with histological grade, higher grades being accompanied by higher MVD. In simple adenomas and grade I tubular-tubulopapillary simple carcinomas the intratumoural microvessels were wide and regular in shape with evident erythrocytes in their lumen. In grade III solid carcinomas the microvessels were smaller, less regular and had irregular shape, often without a distinct lumen, and isolated endothelial cells were frequently present. In the complex carcinomas MVD was low and the intratumoural microvessels were mostly irregular in shape without a distinct lumen. The evaluation of MVD by CLDN-5 immunohistochemistry may give useful additional information on the angiogenic potential of breast cancers in dogs.
Impact of housing technology on blood plasma corticosterone levels in laying hens
Authors: Pavlik Ales , Jezova Daniela , Zapletal David , Bakos Jan , Jelinek Pavel
Published: October 2008

The aim of the present study was to test the hypothesis that keeping laying hens in an enriched environment supposed to represent a better welfare for the birds is accompanied by decreased corticosterone levels, compared to hens kept under traditional conditions. Plasma corticosterone levels in hens reared in standard and enriched cages and those kept on deep litter from 15 to 75 weeks of age were evaluated. The highest corticosterone levels were observed in hens kept on deep litter, which was associated with a lower intensity of egg production, longest time of movement and a high percentage of time spent dustbathing and scratching. Hens housed in the enriched environment exhibited low levels of aggression, low body weight at the end of the experiment and similar or higher corticosterone levels compared to those of hens kept under standard conditions. Thus, the results of the present study show that housing technologies which are more similar to the animal’s natural environment need not be associated with decreased levels of plasma corticosterone. Keeping hens in traditional cage technology was not found to be particularly stressful, which may be an important finding with respect to the current restrictions on outside housing in regions with an increased risk of viral infection.
Friction reduction and wear resistance of electro-co-deposited inorganic fullerene-like WS2 coating for improved stainless steel orthodontic wires
Authors: Redlich Meir , Gorodnev Alex , Feldman Yishay , Kaplan-Ashiri Ifat , Tenne Reshef , Fleischer Niles , Genut Menachem , Feuerstein Noam
Published: October 2008

A new type of composite metal–nanoparticle coating that significantly reduces the friction force of various surfaces, particularly archwires in orthodontic applications, is demonstrated. The coating is based on electrodeposited Ni film impregnated with inorganic fullerene-like nanospheres of tungsten disulphide. The first encouraging tests have shown reduction of up to 60% of the friction force between coated rectangular archwires and self-ligating brackets in comparison with uncoated archwires. The coating not only significantly reduces friction of commercial archwires but also maintains this low value of friction for the duration of the tests in comparison to archwires coated with nickel film without the nanoparticles. The coated surfaces of the wires were examined by scanning electron microscopy equipped with energy dispersive analyzer and by x-ray powder diffraction methods before and after the friction tests. Using these analyses, it was possible to qualitatively estimate the state of the Ni+IF-WS2 coating before and after the friction test compared to Ni coated wires without IF-WS2.
Plastic deformation processes in Cu/Sn bimetallic films
Authors: Kumar K.S. , Reinbold L. , Bower A.F. , Chason E.
Published: October 2008

Although the driving force for the growth of Sn whiskers from the surface of Sn coatings on copper is thought to be internally generated stress due to the formation of Cu6Sn5at the Cu/Sn interface, little is known about the nature of this internal stress and how it cracks the surface Sn oxide (an important precursor to whisker formation). Arguments based on elasticity alone do not appear to be sufficient and suggest an important role for plastic deformation. Direct observations, made by transmission electron microscopy of cross-sectioned bimetallic Cu/Sn thin-film specimens, confirm plastic deformation of the Sn grains due to the formation of Cu6Sn5. Dislocation motion and pile-up at the surface Sn oxide, rotation associated with subgrain boundary formation, interaction of the subgrain boundaries with the Sn surface, and diffusional processes are various mechanisms that can produce stress at the Sn surface and crack the Sn oxide.
Spherical indentation of an elastic bilayer: A modification of the perturbation approach
Authors: Kim Jae Hun , Korach Chad S. , Gouldstone Andrew
Published: October 2008

Accurate mechanical property measurement of films on substrates by instrumented indentation requires a solution describing the effective modulus of the film/substrate system. Here, a first-order elastic perturbation solution for spherical punch indentation on a film/substrate system is presented. Finite element method (FEM) simulations were conducted for comparison with the analytic solution. FEM results indicate that the new solution is valid for a practical range of modulus mismatch, especially for a stiff film on a compliant substrate. It also shows that effective modulus curves for the spherical punch deviates from those of the flat punch when the thickness is comparable to contact size.
Hardness evolution of Al–Cr–N coatings under thermal load
Authors: Willmann Herbert , Mayrhofer Paul H. , Hultman Lars , Mitterer Christian
Published: October 2008

Microstructure and hardness evolution of arc-evaporated single-phase cubic Al0.56Cr0.44N and Al0.68Cr0.32N coatings have been investigated after thermal treatment in Ar atmosphere. Based on a combination of differential scanning calorimetry and x-ray diffraction studies, we can conclude that Al0.56Cr0.44N undergoes only small structural changes without any decomposition for annealing temperatures Ta ⩽ 900 °C. Consequently, the hardness decreases only marginally from the as-deposited value of 30.0 ± 1.1 GPa to 29.4 ± 0.9 GPa with Ta increasing to 900 °C, respectively. The film with higher Al content (Al0.68Cr0.32N) exhibits formation of hexagonal (h) AlN at Ta ⩾ 700 °C, which occurs preferably at grain boundaries as identified by analytical transmission electron microscopy. Hence, the hardness increases from the as-deposited value of 30.1 ± 1.3 GPa to 31.6 ± 1.4 GPa with Ta = 725 °C. At higher temperatures, where the size and volume fraction of the h-AlN phase increases, the hardness decreases to 27.5 ± 1.0 GPa with Ta = 900 °C.
Molecular dynamic studies on MgO–Al2O3–SiO2glass-ceramics
Authors: Zhang Peixin , Zhu Caizhen , Zhang Dongyun , Qiu Qi , Ren Xiangzhong , Liu Jianhong
Published: October 2008

Three sets of original dynamics model parameters for MgO–Al2O3–SiO2(MAS) system were reported for the first time in this paper; moreover, a new parameter optimization standard was put forward to study three different molecular dynamic models of MAS glass-ceramics. The limitations of the conventional parameter optimization methods were also studied. The results indicate: (i) Born-Mayer-Huggins (BMH) model can be only used to simulate amorphous MAS systems. Furthermore, both static optimization and a dynamics test are necessary; (ii) for structure optimization or macroproperties calculation, high accuracy has been achieved relative to the experimental results by using the core-shell (CS) model; (iii) partialQ model computes at a high speed, about twelve times that of the CS model; (iv) for a bulk system, the partialQ model can be first used to obtain an initial structure rapidly, followed by the CS model for high accuracy calculation. In this way, both accuracy and efficiency are achieved. When the model was used to simulate the cordierite crystal and the amorphous in the cordierite glass-ceramic, the results were consistent with the experiments and the structure data from the ab initio calculation. Simulations on amorphous structures in the cordierite glass-ceramic with various compositions displayed that the bond length or coordination numbers (CN) of Si–O and Al–O remained the same with increasing content of MgO, suggesting no change in the tetrahedral configuration of short-range structure. Although the bond length of Mg–O stays almost the same with the increasing content of MgO, the coordination number increases to a certain extent, and the content of O-bridge in SiO2glass drops from 100%–60% in pyrope glass.
Effects of manganese addition on microstructure and press formability of hot-rolled Mg–Al–Zn alloy sheets
Authors: Huang Xinsheng , Suzuki Kazutaka , Watazu Akira , Shigematsu Ichinori , Saito Naobumi
Published: October 2008

Differential speed rolling (DSR) has been carried out on AZ31 alloys with Mn additions of 0 to 0.6 wt% for investigating the effects of Mn on microstructure, texture, mechanical properties, and formability. The Al–Mn compounds were formed in the sample with a Mn addition of only 0.2 wt% because of its low solid-solubility limit. There were tiny differences among the DSR-processed AZ31 alloys with different Mn contents, while the AZ31 alloy without Mn addition exhibited a more homogeneous microstructure, a weaker basal texture intensity, and a much superior formability together with a larger likelihood of grain growth during annealing. The Mn dissolving in αMg matrix exerted a far stronger influence on the resulting properties compared with those existing in form of the Al–Mn compounds. The Mn solute atoms induced an increase in c/a ratio, which may suppress activity of nonbasal slips and in turn degrade the deformation capability.