bluuebunny/crossref_metadata_2025 huggingface dataset:
Modafinil and armodafinil treatment for fatigue for HIV-positive patients with and without chronic hepatitis C
Authors: Rabkin J G , McElhiney M C , Rabkin R
Published: March 2011

Fatigue is prevalent among patients with hepatitis C virus (HCV) and with HIV/AIDS but there are no established fatigue treatments for either condition or their combination. We analysed data from three trials of modafinil or armodafinil for HIV-positive patients with fatigue, including 36 co-infected with HCV, to compare treatment response and safety parameters related to HCV status. One hundred and twenty patients received active drug and 70 were randomized to placebo. Fatigue response rate to modafinil/armodafinil was 100% for patients with HCV (18/18) and 73% (74/102) for patients without HCV. Placebo response rate was 28% (5/18) and 29% (15/52), respectively. Depressive symptoms improved only when energy improved. Viral load declined from baseline after 12 and 26 weeks of active medication. CD4 cell count did not change, nor did alanine transaminase and aspartate aminotransferase for patients with HCV. Patients with haematocrit below the reference range responded, as well as patients whose values were within the reference range. Modafinil and armodafinil appear effective and well tolerated for treating fatigue among both HCV-positive and HCV-negative patients with HIV/AIDS, suggesting that they may hold promise for HIV-positive patients considering alpha interferon/ribavirin treatment for HCV. Further investigation in a focused trial is warranted.
Hoarseness of voice in an AIDS patient: a rare presenting feature of disseminated histoplasmosis
Authors: Sanmani L , Randall C J , Palfrey J , Rowen D
Published: March 2011

Laryngeal histoplasmosis is very rare among patients with HIV and very few cases have so far been documented. We report a case of laryngeal histoplasmosis in a patient with no prior AIDS defining diagnosis, which mimicked epithelial neoplasia, and was treated successfully with oral fluconazole.
Women's perceptions of the effects of menopause and hormone replacement therapy on skin
Authors: Leitch Claire , Doherty Valerie , Gebbie Ailsa
Published: March 2011

Although women frequently associate skin issues with menopause and hormone replacement therapy (HRT), little work has been done to investigate a possible relationship. A questionnaire was given to women attending a specialist menopause clinic; 87 women responded. Skin problems generally were common, with over 64% of respondents reporting past problems. Around half felt that the menopause had resulted in skin changes; dry skin was the predominant complaint at this stage. However, use of HRT in the short term did not result in any conclusive trends in skin condition in the majority of users.
The effects of urinary incontinence and availability of publically accessible toilets: an online survey
Authors: Cumming Grant P , Currie Heather D , Moncur Rik
Published: March 2011

Previous surveys on www.menopausematters.co.uk and published in this journal show that women are reluctant to seek help for reduced libido, vaginal atrophy and dyspareunia despite adverse effects on health and wellbeing. Additionally, health professionals frequently fail to explore these areas during consultations despite proven treatments being available. Women suffering urinary incontinence (UI) show similar trends in their reticence to seek help and in their health professionals addressing their issues. These issues must be addressed through patient empowerment and direct questioning from health professionals. Well maintained, publically accessible toilets are also an important provision to achieving a holistic approach to UI.
Compounded or confused? Bioidentical hormones and menopausal health
Authors: Huntley Alyson L
Published: March 2011

The aim of this article is to focus on compounded bioidentical hormone (BH) formulations for menopausal symptoms and to discuss the impact of these on women's choice of treatment. The practice of compounding BHs for individualized treatment of women with menopausal symptoms has developed in the USA. In spite of claims of superiority, there is no evidence to suggest that these formulations are any more efficacious or safe than conventional hormone replacement therapy (HRT). In fact, there are some concerns about dosing inconsistencies and usefulness of saliva testing that is carried out as part of this type of treatment. While there should be no serious safety issues for women, there is a mismatch between the reality of compounded BH formulations and women's perception of them.
The management of cryptogenic stroke in pregnancy
Authors: Orchard E A , Wilson N , Ormerod O J M
Published: March 2011

Cerebrovascular accidents (CVAs) during pregnancy are uncommon but can have devastating consequences. The causes of CVA in both the pregnant and the non-pregnant state are diverse and require thorough investigation. Recent studies have indicated that embolic stroke in young adults may be caused by paradoxical emboli through a patent foramen ovale (PFO), suggesting that the presence of a PFO should be specifically sought in pregnant or postpartum women presenting with CVA. This review will outline the causes of CVAs in pregnancy and the role of paradoxical emboli, with a focus on PFO.
Postpartum thyroiditis: an autoimmune thyroid disorder which predicts future thyroid health
Authors: Keely Erin Joanne
Published: March 2011

Postpartum thyroiditis is a potentially destructive lymphocytic thyroiditis occurring in approximately 8% of the pregnant population, making it the most common endocrine disorder associated with pregnancy. This autoimmune thyroid disorder is precipitated by the postpartum immunological rebound that follows the partial immunosuppression of pregnancy, in individuals already at risk of autoimmune thyroid disease. The manifestations of postpartum thyroiditis are usually not present at the six-week postpartum visit and thus it is important that all physicians be aware of the risks, presentation and intervention required for this common disorder. Postpartum thyroiditis is a strong predictor of future thyroid health and it is essential that women with a history of postpartum thyroiditis be screened regularly, especially prior to a future pregnancy. Selenium supplementation has recently been identified as a potential means to prevent postpartum thyroiditis in women at risk but further studies are required before recommendations for its use can be made.
Thrombosis and embolism in pregnancy and the puerperium, reducing the risk: what proportion of patients reach the threshold for thromboprophylaxis?
Authors: Revell Bethany J , Smith Richard P
Published: March 2011

In November 2009 the Royal College of Obstetricians and Gynaecologists published an updated guideline, ‘Reducing the risk of thrombosis and embolism during pregnancy and the puerperium’. This includes a clear and simple score-based risk assessment tool, designed for antenatal and postnatal patients. Thresholds are given at which thromboprophylaxis should be offered. However the proportion of patients who reach the threshold is not estimated in the guideline, and we are not aware of any published data regarding this. In this cross-sectional study, we studied the case-notes of all 109 deliveries conducted over a one-week period, including elective caesarean sections. Of those, 7% met the threshold for antenatal thromboprophylaxis and 41% met the threshold for postnatal thromboprophylaxis.
Gastroparesis in pregnancy: case report and literature review
Authors: Achong N , Fagermo N , Scott K , D'emden M
Published: March 2011

Gastroparesis is a syndrome characterized by delayed gastric emptying in the absence of mechanical obstruction. The most common underlying aetiology is diabetes mellitus; however, many cases are idiopathic. Pregnancy per se is associated with gastrointestinal neuromuscular dysfunction; however, reports of gastroparesis arising during pregnancy are rare. We report a case of severe gastroparesis and proximal small bowel paresis presenting during pregnancy.
Headaches and papilloedema in a pregnant woman with polycystic ovarian syndrome
Authors: Morton Adam
Published: March 2011

Idiopathic intracranial hypertension (IIH) is a rare condition, its highest incidence being in obese women of reproductive age. A woman with polycystic ovarian syndrome and IIH is presented, a new diagnosis during pregnancy resulting in a change in her management.
Venous malformations of the anterior abdominal wall in blue rubber bleb naevus syndrome: implications for antenatal and intrapartum management
Authors: Cauldwell Matthew , Kyle Pippa , Treharne Ian , Wong Terry , Holden Simon T , Nelson-Piercy Catherine
Published: March 2011

Blue rubber bleb naevus syndrome (BRBNS) is a rare vascular disorder characterized by rubbery blue–purple cutaneous nodules that are histologically thin-walled dilated vascular spaces. The exact inheritance of the disease in unknown but in cases of familial recurrence, there appears to be a pattern of autosomal dominant inheritance. The vascular lesions may manifest in any organ system but tend to predominate in the gastrointestinal tract (GI). There are only a handful of cases reported in the literature, but reported complications arising from the naevi include sponatenous GI bleeding requiring laparotomy and blood transfusion and the development of large naevi in the cervix thus preventing vaginal delivery. In this case we describe a patient with known BRBNS who developed symptomatic anaemia during her pregnancy which required antenatal admission and blood transfusion. She was managed expectantly in a multidisciplinary setting by obstetricians, gastroenterologists and an obstetric physician with the aim of a vaginal delivery. Nevertheless, she had an elective caesarean section at term for breech presentation. Surgery was complicated by the unexpected finding of venous malformations within the abdominal wall musculature and subcutaneous fat that resulted in a primary haemorrhage and required urgent blood transfusion. The patient made a good postoperative recovery and had a healthy male infant who at birth displayed no external features of BRBNS. This report demonstrates for the first time the appearance of naevi in the abdominal wall and the important considerations that need to be made regarding mode of delivery and future pregnancies.
Compression versus sclerotherapy for patients with isolated refluxing reticular veins and telangiectasia: a randomized trial comparing quality-of-life outcomes
Authors: Schul M W , Eaton T , Erdman B
Published: March 2011

Objective

To prospectively study quality-of-life (QoL) benefits comparing compression stockings to sclerotherapy in subjects with symptomatic reticular veins and telangiectasia.

Methods

Fifty-eight consecutive female patients with normal saphenous and deep venous systems and venous dysfunction score (VDS) ≥4 were randomized to either sclerotherapy ( N = 29) or thigh high 20–30 mmHg compression stockings ( N = 29). Following a trial of compression, subjects in the compression arm were eligible to crossover to the sclerotherapy arm. Patient-reported QoL data were acquired using a modified Aberdeen Varicose Vein Questionnaire in five stages, initial severity (T0), following compression trial (T1), after reticular vein sclerotherapy (T2), approximately three months after sclerotherapy for telangiectasia (T3) and the 12-month mark (T4).

Result

For patients in the compression arm, four key symptoms including aching, pain, leg cramps and restlessness were significantly reduced, while patients in the sclerotherapy arm of treatment reported broad symptom relief in all key symptoms assessed.

Conclusion

Isolated refluxing reticular and telangiectatic vein disease may cause QoL impairment in select patients and represent far more than a cosmetic concern. Compression therapy offers relief of aching, pain, leg cramping and restlessness in patients with isolated refluxing reticular veins and telangiectasia. Sclerotherapy of reticular veins offers a statistically superior broad spectrum relief of symptoms, while additional sclerotherapy of residual telangiectasia in this cohort demonstrated additive relief of aching and pain. Symptom assessments at 12 months suggest ongoing symptom relief following sclerotherapy.
Subcutaneous fasciotomy and eradication of superficial venous reflux for chronic and recurrent venous ulcers: mid-term results
Authors: Christenson J T , Prins C , Gemayel G
Published: March 2011

Objective

Increased intramuscular and subcutaneous tissue pressures are often found in patients with severe chronic venous insufficiency venous ulcer disease. Additional subcutaneous para-tibial fasciotomy promotes early ulcer healing. This study evaluates the mid-term effect of eradication of superficial reflux with additional fasciotomy in patients with increased tissue pressures.

Method

Between January 2006 and June 2009, 58 patients underwent fasciotomy. Tissue pressures (intramuscular and subcutaneous) were measured. Sixty-nine limbs with 91 venous ulcers were treated. Mean duration of the venous ulcer was 3.4 years. Underlying disease was post-thrombotic syndrome (PT) in 19 patients (33%, 24 limbs, 27 ulcers) and non-post-thrombotic (non-PT) severe chronic venous insufficiency in 39 (67%, 45 limbs, 64 ulcers). All patients were C6 at the time of surgery. Preoperative tissue pressures were 23.5 ± 6.1 mmHg (intramuscularly) and 9.8 ± 3.2 mmHg (subcutaneously).

Results

Ninety ulcers (99%) healed postoperatively (42 with and 48 without skin grafting). Tissue pressures significantly decreased following surgery and remained low at three months postoperatively. Ten ulcers in six patients recurred six to 20 months postoperatively (11%), resulting in 86.4 actuarial freedom from venous ulcer recurrence at three years following surgery. Four patients (1 non-PT and 3 PT) had re-fasciotomy; all healed initially but two ulcers (2 patients, PT) recurred at 11 and 12 months. Those patients underwent re-fasciotomy, one healed and one recurred six months later.

Conclusion

Eradication of superficial reflux with additional subcutaneous fasciotomy for chronic and recurrent venous ulcer improves ulcer healing or success of skin grafting. Mid-term results are excellent particularly in patients with non-PT disease. Recurrence is more frequently seen in patients with PT syndrome. In patients with ulcer recurrence and high tissue pressures, re-fasciotomy can be helpful to promote healing, particularly in patients with primary venous disease.
Three cases of stroke following peripheral venous interventions
Authors: Ma R W L , Pilotelle A , Paraskevas P , Parsi K
Published: March 2011

We report three cases of stroke in association with peripheral venous interventions that each included foam ultrasound-guided sclerotherapy (UGS). All three female patients experienced a right middle cerebral artery (MCA) stroke causing dysphasia and left hemiparesis. A patent foramen ovale was found in each patient. The first incident occurred two days after foam UGS to treat small tributaries of a great saphenous vein (GSV). Paradoxical clot embolism was presumed in this case where concurrent deep vein thrombosis with non-occlusive thrombus in a medial gastrocnemius vein extending to the popliteal vein was detected on ultrasound. The second case occurred immediately at the completion of foam UGS and ambulatory phlebectomy to treat GSV tributaries. Paradoxical gas embolism was demonstrated in this patient confirmed by visualization of bubbles in the right MCA on CT angiography. The third case occurred one day after endovenous laser ablation (1470 nm) and foam UGS to treat both great and small saphenous veins. No specific cause could be confirmed in this patient. Sodium tetradecyl sulphate foam was used in all three cases (3%, 16 mL; 1.5%, 4 mL and 3%, 25 mL, respectively). All three patients recovered completely within a few days.
Necessary Optimality Conditions for Multiobjective Bilevel Programs
Authors: Ye Jane J.
Published: March 2011

The multiobjective bilevel program is a sequence of two optimization problems, with the upper-level problem being multiobjective and the constraint region of the upper level problem being determined implicitly by the solution set to the lower-level problem. In the case where the Karush-Kuhn-Tucker (KKT) condition is necessary and sufficient for global optimality of all lower-level problems near the optimal solution, we present various optimality conditions by replacing the lower-level problem with its KKT conditions. For the general multiobjective bilevel problem, we derive necessary optimality conditions by considering a combined problem, with both the value function and the KKT condition of the lower-level problem involved in the constraints. Most results of this paper are new, even for the case of a single-objective bilevel program, the case of a mathematical program with complementarity constraints, and the case of a multiobjective optimization problem.
A Geometric Characterization of the Power of Finite Adaptability in Multistage Stochastic and Adaptive Optimization
Authors: Bertsimas Dimitris , Goyal Vineet , Sun Xu Andy
Published: March 2011

In this paper, we show a significant role that geometric properties of uncertainty sets, such as symmetry, play in determining the power of robust and finitely adaptable solutions in multistage stochastic and adaptive optimization problems. We consider a fairly general class of multistage mixed integer stochastic and adaptive optimization problems and propose a good approximate solution policy with performance guarantees that depend on the geometric properties of the uncertainty sets. In particular, we show that a class of finitely adaptable solutions is a good approximation for both the multistage stochastic and the adaptive optimization problem. A finitely adaptable solution generalizes the notion of a static robust solution and specifies a small set of solutions for each stage; the solution policy implements the best solution from the given set, depending on the realization of the uncertain parameters in past stages. Therefore, it is a tractable approximation to a fully adaptable solution for the multistage problems. To the best of our knowledge, these are the first approximation results for the multistage problem in such generality. Moreover, the results and the proof techniques are quite general and also extend to include important constraints such as integrality and linear conic constraints.
Buy-at-Bulk Network Design with Protection
Authors: Antonakopoulos Spyridon , Chekuri Chandra , Shepherd Bruce , Zhang Lisa
Published: March 2011

We consider approximation algorithms for buy-at-bulk network design, with the additional constraint that demand pairs be protected against a single edge or node failure in the network. In practice, the most popular model used in high-speed telecommunication networks for protection against failures is the so-called 1 + 1 model. In this model, two-edge or node-disjoint paths are provisioned for each demand pair. We obtain the first nontrivial approximation algorithms for buy-at-bulk network design in the 1 + 1 model for both edge and node-disjoint protection requirements. Our results are for the single-cable cost model, which is prevalent in optical networks. More specifically, we present a constant-factor approximation for the single-sink case and a polylogarithmic factor approximation for the multicommodity case. These results are of interest for practical applications and also suggest several new challenging theoretical problems.
The positive impact of physical activity on cognition during adulthood: a review of underlying mechanisms, evidence and recommendations
Authors: Ratey John J. , Loehr James E.
Published: March 2011

A growing body of literature suggests that physical activity beneficially influences brain function during adulthood, particularly frontal lobe-mediated cognitive processes, such as planning, scheduling, inhibition, and working memory. For our hunter-gatherer ancestors, times of famine interspersed with times of feast necessitated bouts of intense physical activity balanced by periods of rest. However, the sedentary lifestyle that pervades modern society has overridden the necessity for a physically active lifestyle. The impact of inactivity on disease processes has been the focus of much attention; the growing understanding that physical activity also has the benefit of enhancing cognitive performance strengthens the imperative for interventions that are successful in increasing physical activity, with the outcomes of promoting health and productivity. Population health and performance programs that promote physical activity provide benefits for employees and employers through improvements in worker health and performance and financial returns for the company. In this review, we examine the mechanisms by which physical activity improves cognition. We also review studies that evaluate the effects of physical activity on cognitive executive performance in adulthood, including longitudinal studies that address the impact of physical activity during early adulthood and midlife on preservation of cognition later in life. This is of particular importance given that adulthood represents prime working years and that physical activity promotion is a key component of population health and performance programs. Finally, we provide recommendations for maximizing the lasting benefits of movement and physical activity on cognition in adulthood.
Circulating vaspin and visfatin are not affected by acute or chronic energy deficiency or leptin administration in humans
Authors: Kang Eun Seok , Magkos Faidon , Sienkiewicz Elizabeth , Mantzoros Christos S
Published: March 2011

Objective

Animal and in vitro studies indicate that leptin alleviates starvation-induced reduction in circulating vaspin and stimulates the production of visfatin. We thus examined whether vaspin and visfatin are affected by short- and long-term energy deprivation and leptin administration in human subjects in vivo.

Design and methods

We measured circulating levels of vaspin and visfatin i) before and after 72 h of starvation (leading to severe hypoleptinemia) with or without leptin administration in replacement doses in 13 normal-weight subjects, ii) before and after 72 h of starvation with leptin administration in pharmacological doses in 13 lean and obese subjects, iii) during chronic energy deficiency in eight women with hypothalamic amenorrhea on leptin replacement for 3 months, and iv) during chronic energy deficiency in 18 women with hypothalamic amenorrhea on leptin replacement or placebo for 3 months.

Results

Acute starvation decreased serum leptin to 21% of baseline values, (P=0.002) but had no significant effect on vaspin and visfatin concentrations (P>0.05). Nor did normalization of leptin levels affect the concentrations of these two adipokines (P>0.9). Leptin replacement in women with hypothalamic amenorrhea did not significantly alter vaspin and visfatin concentrations, whether relative to baseline or placebo administration (P>0.25). Pharmacological doses of leptin did not affect circulating vaspin and visfatin concentrations (P>0.9).

Conclusions

Circulating vaspin and visfatin are not affected by acute or chronic energy deficiency leading to hypoleptinemia and are not regulated by leptin in human subjects, indicating that these adipocyte-secreted hormonal regulators of metabolism are independently regulated in humans.
A Double-Blind, Placebo-Controlled Study of Atomoxetine in Young Children With ADHD
Authors: Kratochvil Christopher J. , Vaughan Brigette S. , Stoner Julie A. , Daughton Joan M. , Lubberstedt Brian D. , Murray Desiree W. , Chrisman Allan K. , Faircloth Melissa A. , Itchon-Ramos Nilda B. , Kollins Scott H. , Maayan Lawrence A. , Greenhill Laurence L. , Kotler Lisa A. , Fried Jane , March John S.
Published: March 2011

OBJECTIVE:

To evaluate the efficacy and tolerability of atomoxetine for the treatment of attention-deficit/hyperactivity disorder (ADHD) in 5- and 6-year-old children.

METHODS:

This was an 8-week, double-blind, placebo-controlled randomized clinical trial of atomoxetine in 101 children with ADHD. Atomoxetine or placebo was flexibly titrated to a maximum dose of 1.8 mg/kg per day. The pharmacotherapist reviewed psychoeducational material on ADHD and behavioral-management strategies with parents during each study visit.

RESULTS:

Significant mean decreases in parent (P = .009) and teacher (P = .02) ADHD–IV Rating Scale scores were demonstrated with atomoxetine compared with placebo. A total of 40% of children treated with atomoxetine met response criteria (Clinical Global Impression–Improvement Scale indicating much or very much improved) compared with 22% of children on placebo, which was not significant (P = .1). Decreased appetite, gastrointestinal upset, and sedation were significantly more common with atomoxetine than placebo. Although some children demonstrated a robust response to atomoxetine, for others the response was more attenuated. Sixty-two percent of subjects who received atomoxetine were moderately, markedly, or severely ill according to the Clinical Global Impression–Severity Scale at study completion.

CONCLUSIONS:

To our knowledge, this is the first randomized controlled trial of atomoxetine in children as young as 5 years. Atomoxetine generally was well tolerated and reduced core ADHD symptoms in the children on the basis of parent and teacher reports. Reductions in the ADHD-IV Rating Scale scores, however, did not necessarily translate to overall clinical and functional improvement, as demonstrated on the Clinical Global Impression–Severity Scale and the Clinical Global Impression–Improvement Scale. Despite benefits, the children in the atomoxetine group remained, on average, significantly impaired at the end of the study.
Postnatal-Onset Microcephaly: Pathogenesis, Patterns of Growth, and Prediction of Outcome
Authors: Rosman N. Paul , Tarquinio Daniel C. , Datseris Marianna , Hou Wei , Mannheim Glenn B. , Emigh Christie E. , Rivkin Michael J.
Published: March 2011

OBJECTIVE:

Although children with postnatal-onset microcephaly (POM) generally have poor development, we speculated that better somatic growth would predict better development in these children.

PATIENTS AND METHODS:

We followed 57 children with POM for an average of 4.2 years (13 encephaloclastic, 14 dysgenetic, 6 with Rett syndrome, 24 idiopathic) and calculated the developmental quotient (DQ) at each visit (DQ > 0.70 was considered normal). SD scores (SDS) for measurements were analyzed using a repeated measures mixed-effects model to assess effect of weight, height, head circumference (HC), and age on DQ. Pearson's correlation was used to examine the independent influence of each variable on final DQ.

RESULTS:

Forty-four children (77%) had a low DQ (mean: 0.33), but 13 (23%) had a normal DQ (mean: 0.93), including 10 idiopathic and 3 encephaloclastic. Mean HC fell below −2 SDS in all before 1 year (destructive at 3.3 months, idiopathic low-DQ at 7.5 months, dysgenetic at 8.5 months, Rett syndrome at 11 months, and idiopathic normal-DQ at 11.5 months). Mean weights and heights both fell below −2 SDS for all low-DQ groups but remained normal in both normal-DQ groups. Weight, height, and HC were independent predictors of DQ (P < .0001). Final DQ correlated with weight (r = 0.27), height (r = 0.41), and HC (r = 0.13).

CONCLUSIONS:

Most children with POM have poor later development. Whatever the cause of POM, persons in whom postnatal body growth (weight, height, HC) is better sustained have more favorable development, and in one-quarter of such persons (mostly idiopathic POM), final DQ is normal.
Cost Comparison of Baby Friendly and Non–Baby Friendly Hospitals in the United States
Authors: DelliFraine Jami , Langabeer Jim , Williams Janet F. , Gong Alice K. , Delgado Rigoberto I. , Gill Sara L.
Published: March 2011

OBJECTIVES:

The objectives of this study were to provide an economic assessment of the incremental costs associated with obtaining the World Health Organization and United Nations International Children's Emergency Fund designation as a Infant-Friendly hospital. We hypothesized that baby-friendly hospitals will have higher costs than similar non–baby-friendly hospitals.

METHODS:

Data from the 2007 American Hospital Association and the 2007 Centers for Medicare and Medicaid Cost Reports were used to compare labor and delivery costs in baby-friendly and non–baby-friendly hospitals. Operational costs per delivery were calculated using a matched-pairs analysis of a sample of baby-friendly and non–baby-friendly hospitals in the United States. Costs associated with labor-and-delivery diagnosis–related codes were analyzed for each baby-friendly hospital and compared with the mean and median costs incurred by non–baby-friendly hospitals.

RESULTS:

Nursery plus labor-and-delivery costs for the baby-friendly sites were $2205 per delivery, compared with $2170 for the non–baby-friendly matched pair. Baby-friendly facilities have slightly higher costs than non–baby-friendly facilities, ranging from 1.6% to 5%, but these costs were not statistically significant (P > .05).

CONCLUSIONS:

These results suggest that becoming baby-friendly is relatively cost-neutral for a typical acute care hospital. Although the overall expense of providing baby-friendly hospital nursery services is greater than nursery service costs of non–baby-friendly hospitals, the cost difference was not statistically significant. Additional research is needed to compare the economic impact of maternal and infant health benefits from breastfeeding versus the incremental expenses of becoming a baby-friendly hospital.
Pediatric Trauma BIG Score: Predicting Mortality in Children After Military and Civilian Trauma
Authors: Borgman Matthew A. , Maegele Marc , Wade Charles E. , Blackbourne Lorne H. , Spinella Philip C.
Published: March 2011

OBJECTIVE:

To develop a validated mortality prediction score for children with traumatic injuries.

PATIENTS AND METHODS:

We identified all children (<18 years of age) in the US military established Joint Theater Trauma Registry from 2002 to 2009 who were admitted to combat-support hospitals with traumatic injuries in Iraq and Afghanistan. We identified factors associated with mortality using univariate and then multivariate regression modeling. The developed mortality prediction score was then validated on a data set of pediatric patients (≤18 years of age) from the German Trauma Registry, 2002–2007.

RESULTS:

Admission base deficit, international normalized ratio, and Glasgow Coma Scale were independently associated with mortality in 707 patients from the derivation set and 1101 patients in the validation set. These variables were combined into the pediatric “BIG” score (base deficit + [2.5 × international normalized ratio] + [15 − Glasgow Coma Scale), which were each calculated to have an area under the curve of 0.89 (95% confidence interval: 0.83–0.95) and 0.89 (95% confidence interval: 0.87–0.92) on the derivation and validation sets, respectively.

CONCLUSIONS:

The pediatric trauma BIG score is a simple method that can be performed rapidly on admission to evaluate severity of illness and predict mortality in children with traumatic injuries. The score has been shown to be accurate in both penetrating-injury and blunt-injury populations and may have significant utility in comparing severity of injury in future pediatric trauma research and quality-assurance studies. In addition, this score may be used to determine inclusion criteria on admission for prospective studies when accurately estimating the mortality for sample size calculation is required.
Risk of Asthma in Young Adults Who Were Born Preterm: A Swedish National Cohort Study
Authors: Crump Casey , Winkleby Marilyn A. , Sundquist Jan , Sundquist Kristina
Published: March 2011

OBJECTIVE:

Preterm birth is associated with asthma-like symptoms in childhood and possibly in adolescence, but the longer-term risk of asthma is unknown and increasingly relevant as larger numbers of these individuals enter adulthood. Our objective was to evaluate whether those who were born preterm are more likely to be prescribed asthma medications in young adulthood than those who were born term.

PATIENTS AND METHODS:

We conducted a national cohort study of all singleton infants born in Sweden from 1973 through 1979 (n = 622 616), followed to ages 25.5 to 35.0 years to determine whether asthma medications were prescribed in 2005–2007. Asthma medication data were obtained from all outpatient and inpatient pharmacies throughout Sweden. To improve the positive predictive value for asthma, the outcome was defined as prescription of (1) both a β-2 agonist inhalant and a glucocorticoid inhalant or (2) a combination inhalant containing a β-2 agonist and other drugs for obstructive airway diseases.

RESULTS:

Young adults who were born extremely preterm (23–27 weeks' gestation) were 2.4 times more likely (adjusted 95% CI: 1.41–4.06) to be prescribed asthma medications than those who were born term. No association was found between later preterm birth (28–32 or 33–36 weeks' gestation) and asthma medications in young adulthood.

CONCLUSIONS:

This is the first study with sufficient statistical power to evaluate the risk of asthma beyond adolescence in individuals who were born extremely preterm. The results suggest that extreme preterm birth (23–27 weeks' gestation), but not later preterm birth, is associated with an increased risk of asthma at least into young adulthood.
A Strong Synergism of Low Birth Weight and Prenatal Smoking on Asthma in Schoolchildren
Authors: Bjerg Anders , Hedman Linnea , Perzanowski Matthew , Lundbäck Bo , Rönmark Eva
Published: March 2011

BACKGROUND:

Prenatal smoke exposure is associated with airway inflammation and asthma in children. It also increases the risk of low birth weight (LBW). LBW is associated with decreased lung function independently of smoking.

OBJECTIVE:

To study the independent and joint effects of prenatal smoking and LBW on childhood asthma.

METHODS:

In 1996, all children aged 7 to 8 years in 3 cities in northern Sweden were invited to an International Study of Asthma and Allergy in Childhood questionnaire survey. This study focused on the follow-up of children aged 11 to 12 years, in which 3389 children (96%) participated. A subset of 2121 children underwent skin-prick testing. Self-reported physician-diagnosed asthma has been clinically validated.

RESULTS:

Mean birth weight was 3360 g in children exposed to prenatal smoking and 3571 g in nonexposed children (P < .001). The association of prenatal smoking with physician-diagnosed asthma was stronger in LBW children (risk ratio: 8.8 [95% confidence interval: 2.1–38]) than in normal birth weight children (risk ratio: 1.3 [95% confidence interval: 1.0–1.8]). LBW alone was not an independent predictor of asthma. These associations were similar in multivariate analysis, and the interaction term LBW × smoking was highly statistically significant.

CONCLUSIONS:

There was a strong interaction of LBW and prenatalsmoking on the risk of physician-diagnosed asthma, which has not been demonstrated previously. This was consistently seen with adjustment for known risk factors, including allergic sensitization. Plausibly, airway inflammation from prenatal smoke exposure induces obstructive symptoms more easily in the underdeveloped airways of LBW children.
Algal biofuels from wastewater treatment high rate algal ponds
Authors: Craggs R. J. , Heubeck S. , Lundquist T. J. , Benemann J. R.
Published: March 2011

This paper examines the potential of algae biofuel production in conjunction with wastewater treatment. Current technology for algal wastewater treatment uses facultative ponds, however, these ponds have low productivity (∼10 tonnes/ha.y), are not amenable to cultivating single algal species, require chemical flocculation or other expensive processes for algal harvest, and do not provide consistent nutrient removal. Shallow, paddlewheel-mixed high rate algal ponds (HRAPs) have much higher productivities (∼30 tonnes/ha.y) and promote bioflocculation settling which may provide low-cost algal harvest. Moreover, HRAP algae are carbon-limited and daytime addition of CO2 has, under suitable climatic conditions, the potential to double production (to ∼60 tonnes/ha.y), improve bioflocculation algal harvest, and enhance wastewater nutrient removal. Algae biofuels (e.g. biogas, ethanol, biodiesel and crude bio-oil), could be produced from the algae harvested from wastewater HRAPs, The wastewater treatment function would cover the capital and operation costs of algal production, with biofuel and recovered nutrient fertilizer being by-products. Greenhouse gas abatement results from both the production of the biofuels and the savings in energy consumption compared to electromechanical treatment processes. However, to achieve these benefits, further research is required, particularly the large-scale demonstration of wastewater treatment HRAP algal production and harvest.
The effect of aerated rock filter geometry on the rate of nitrogen removal from facultative pond effluents
Authors: Hamdan R. , Mara D. D.
Published: March 2011

Rock filters are an established technology for polishing waste stabilization pond effluents. However, they rapidly become anoxic and consequently do not remove ammonium-nitrogen. Horizontal-flow aerated rock filters (HFARF), developed to permit nitrification and hence ammonium-N removal, were compared with a novel vertical-flow aerated rock filter (VFARF). There were no differences in the removals of BOD5, TSS and TKN, but the VFARF consistently produced effluents with lower ammonium-N concentrations (<0.3 mg N/L) than the HFARF (0.8−1.5 mg N/L) and higher nitrate-N concentrations (24–29 mg N/L vs. 17–24 mg N/L).
The removal of ammonia from sanitary landfill leachate using a series of shallow waste stabilization ponds
Authors: Leite V. D. , Pearson H. W. , de Sousa J. T. , Lopes W. S. , de Luna M. L. D.
Published: March 2011

This study evaluated the efficiency of a shallow (0.5 m deep) waste stabilization pond series to remove high concentrations of ammonia from sanitary landfill leachate. The pond system was located at EXTRABES, Campina Grande, Paraiba, Northeast Brazil. The pond series was fed with sanitary landfill leachate transported by road tanker to the experimental site from the sanitary landfill of the City of Joao Pessoa, Paraiba. The ammoniacal-N surface loading on the first pond of the series was equivalent to 364 kg ha−1 d−1 and the COD surface loading equivalent to 3,690 kg ha−1 d−1. The maximum mean ammonia removal efficiency was 99.5% achieved by the third pond in the series which had an effluent concentration of 5.3 mg L−1 ammoniacal-N for an accumulative HRT of 39.5 days. The removal process was mainly attributed to ammonia volatilization (stripping) from the pond surfaces as a result of high surface pH values and water temperatures of 22–26°C. Shallow pond systems would appear to be a promising technology for stripping ammonia from landfill leachate under tropical conditions.
Evaluation of extracellular biopolymer and its impact on bioflocculation in activated sludge bioreactors
Authors: Ehlers G. A. C. , Turner S. J.
Published: March 2011

The influence and dynamics of bacterial extracellular polysaccharide (EPS) polymer production and its impact on bioflocculation in activated sludge (AS) bench-scale reactors were investigated. The impact of food to microorganism ratio (F/M), reactor configuration and easily biodegradable carbohydrates in influent streams on biological processes that support or weaken good floc formation and the link with EPS quantity was studied. Bioreactors were run as either sequencing batch or continuous systems using wastewater media with glucose or acetate as C source in different F/M ratios. EPS levels were quantified using mid-infrared spectroscopy which provided a rapid technique for monitoring biological processes within AS WWTP. The analysis revealed an interdependent link between EPS production, sludge settling characteristics and mode of reactor operation. An inverse relationship between F/M ratios and EPS quantities was seen but a positive link between EPS levels and aggregation indices, a measure of the efficiency of inter cell attachment and which indicates good settling properties, was also seen. This indicates that during high F/M conditions in lab-scale AS reactors, low levels of EPS may be produced which could have a negative impact on settling of the biomass. Floc architecture was examined under the microscope. Transient growth of filamentous bacteria was seen in the reactors.
Explaining differential sources of zoonotic pathogens in intensively-farmed catchments using kinematic waves
Authors: McBride Graham B.
Published: March 2011

Surveys in streams draining intensively farmed catchments can, during flood events, indicate differential time-concentration patterns between a bacterial health-risk indicator (E. coli) and a major zoonotic pathogen that it seeks to indicate—Campylobacter. The indicator‘s peak concentration at a monitoring station can arrive ahead of the flood peak (the pollutograph leads the hydrograph), whereas the peak pathogen concentration arrives with the flood peak (the pollutograph and hydrograph peaks coincide). In other cases the E. coli pollutograph can lag the hydrograph. These observations have generated the hypothesis that such behaviour reflects three different possible (predominant) sources of pathogens in the floodwater: (i) by sediment entrainment, (ii) via local land runoff, or (iii) from upstream releases (e.g., from dams, inflows, or upstream floods). A general theory for contaminants in idealized stream floods has been developed, considering all three sources, based on kinematic wave theory. It can explain the observed differential time-concentration patterns. The calculation procedures and associated results are intended to inform public policy, by identifying predominant pathogen sources and therefore helping to focus attention on the important delivery mechanisms. This will better inform quantitative health risk assessments for downstream water users (recreational uses, water supplies, food production and processing industries).
Adsorption of hexavalent chromium on dunite
Authors: Demetriou Antri , Pashalidis Ioannis
Published: March 2011

The paper presents and discusses the effect of various physicochemical parameters (e.g. pH, ionic strength, Cr(VI) initial concentration, amount of the adsorbent, temperature and contact time between metal ion and adsorbent) on the adsorption efficiency of Cr(VI) on dunite in aqueous solutions under atmospheric conditions. Evaluation of the experimental data shows that dunite presents increased affinity for Cr(VI) over a wide pH range and Cr(VI) concentration, and the experimental data are well fitted by the Kd adsorption model. The relative adsorption is pH dependent and decreases slightly (about 10%) with increasing pH, because of changes in the surface charge of the solid. The effect of the ionic strength is significant (particularly at low pH), indicating the predominance of outer-sphere complexes. Moreover, adsorption experiments at various temperatures, two different pH values (pH 3 and pH 8) and three different ionic strengths (0.0, 0.1 and 1.0 M NaClO4), indicate an endothermic but spontaneous entropy-driven processes.
Alkylphenols in atmospheric depositions and urban runoff
Authors: Bressy A. , Gromaire M. -C. , Lorgeoux C. , Chebbo G.
Published: March 2011

A sampling campaign was conducted in order to determine alkylphenol (AP) concentrations in stormwater as well as potential AP sources in suburban environments. An analytical procedure was developed to quantify APs in bulk atmospheric deposition, building runoff, road runoff and stormwater. Both nonylphenols and octylphenols could be quantified in each sample. Median stormwater concentrations amounted to: 470 ng/l for nonylphenols, and 36 ng/l for octylphenols. These concentrations are 3 times higher than those found in atmospheric deposition, thus proving that local human activity constitutes a significant source of contamination. The contributions of the various sources to stormwater have been assessed from mass balances at the catchment scale. 70% of AP mass in stormwater originates from building and road emissions. Annual AP fluxes have been extrapolated from the total AP mass measured over our sampling periods for atmospheric depositions (44 to 84 µgNP/m2/yr) and stormwater (100 to 190 µgNP/m2/yr). Moreover, since APs were mainly found in the dissolved fraction, runoff treatment devices based on settling are unlikely to be very efficient.
Triclosan: its occurrence, fate and effects in the Australian environment
Authors: Kookana R. S. , Ying G-G. , Waller N. J.
Published: March 2011

Triclosan (TCS) is an antimicrobial agent used widely in household products such as soaps, household cleaners, cosmetics, sportswear, mouthwash and toothpaste. It is a bioaccumulative compound known for its high toxicity to algae, daphnids, fish and other aquatic organisms. We investigated its occurrence in effluents, biosolids and surface waters in Australia, as well as its fate in Australian soils and wastewater treatment plants (WWTPs), including the effects on microbial processes in soils. The concentrations of TCS in 19 effluents ranged from 23 to 434 ng/L (median 108 ng/L) and in 17 biosolids from 0.09 to 16.79 mg/kg on dry weight basis (median 2.32 mg/kg). TCS at concentrations of up to 75 ng/L were detected in receiving waters from five creeks affected by effluent discharge from WWTPs. The removal rate of TCS in five selected WWTPs ranged from 72 and 93%, ascribed mainly to sorption onto sludge and biological degradation. Biodegradation in a clay loam soil was noted with a half life of 18 days. However the half-lives under field conditions are expected to be very different. The studies on the effect of TCS on soil microbiological processes showed that triclosan can disrupt the nitrogen cyclein sensitive soils at concentrations ≥5 mg/kg. In view of the recent risk assessment by the Australian regulatory agency NICNAS, there is an urgent need to assess exposure to TCS and its effect on ecosystem health.
The relationship between BOD:N ratio and wastewater treatability in a nitrogen-fixing wastewater treatment system
Authors: Slade A. H. , Thorn G. J. S. , Dennis M. A.
Published: March 2011

A BOD:N:P ratio of 100:5:1 is often used as a benchmark for nutrient addition in nutrient limited wastewaters. The impact of varying nitrogen levels, whilst maintaining phosphorus constant, was studied in a simulated aerated lagoon (BOD:N of 100:0; 100:1.3; 100:1.8; 100:2.7 and 100:4.9). A synthetic wastewater was prepared using methanol, glucose and acetate as the combined carbon source, ammonium chloride as the nitrogen source and dipotassium hydrogen phosphate as the phosphorus source. Nitrogen levels did not impact organic carbon removal, but did strongly influence floc structure. With no supplemental nitrogen, growth was dispersed. Increasing the nitrogen level increased filamentous growth, with a marked change in filamentous species occurring between a BOD:N ratio of 100:1.8 and 100:2.7. Nitrogen fixation occurred at a BOD:N ratio of 100:0; 100:1.3 and 100:1.8, with nitrogen loss at BOD:N ratios of 100:2.7 and 100:4.9. At a BOD:N ratio of 100:4.9, ammonium discharge was significantly greater (1.8 mg/L) than at the lower nitrogen levels (0.04 – 0.18 mg/L). Phosphorus behaviour was more variable, however significantly more phosphorus was discharged at the lowest nitrogen level than at the highest (p<0.05). Based on readily available nitrogen, the BOD:N ratio at which nitrogen fixation no longer occurred was around 100:1.9.