bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimental evaluation of the power balance model of speed skating
Authors: de Koning Jos. J. , Foster Carl , Lampen Joanne , Hettinga Floor , Bobbert Maarten F.
Published: December 2004

Prediction of speed skating performance with a power balance model requires assumptions about the kinetics of energy production, skating efficiency, and skating technique. The purpose of this study was to evaluate these parameters during competitive imitations for the purpose of improving model predictions. Elite speed skaters ( n = 8) performed races and submaximal efficiency tests. External power output (Po) was calculated from movement analysis and aerodynamic models and ice friction measurements. Aerobic kinetics was calculated from breath-by-breath oxygen uptake (V̇o2). Aerobic power (Paer) was calculated from measured skating efficiency. Anaerobic power (Pan) kinetics was determined by subtracting Paer from Po. We found gross skating efficiency to be 15.8% (1.8%). In the 1,500-m event, the kinetics of Pan was characterized by a first-order system as Pan = 88 + 556 e−0.0494 t (in W, where t is time). The rate constant for the increase in Paer was −0.153 s−1, the time delay was 8.7 s, and the peak Paer was 234 W; Paer was equal to 234[1 − e−0.153(t−8.7)] (in W). Skating position changed with preextension knee angle increasing and trunk angle decreasing throughout the event. We concluded the pattern of Paer to be quite similar to that reported during other competitive imitations, with the exception that the increase in Paer was more rapid. The pattern of Pan does not appear to fit an “all-out” pattern, with near zero values during the last portion of the event, as assumed in our previous model (De Koning JJ, de Groot G, and van Ingen Schenau GJ. J Biomech 25: 573–580, 1992). Skating position changed in ways different from those assumed in our previous model. In addition to allowing improved predictions, the results demonstrate the importance of observations in unique subjects to the process of model construction.
Cytokine-Induced Modulation of Cardiac Function
Authors: Prabhu Sumanth D.
Published: December 2004

Cytokines act in an autocrine and/or paracrine fashion to induce a diverse variety of biological responses. Several cardiac diseases are associated with cytokine activation, and such activation significantly influences several physiologic parameters, including cardiac mechanical function. This review summarizes the current concepts regarding the modulation of myocardial function by cytokines and provides rationale for the sometimes-conflicting results in the literature regarding underlying mechanisms and patterns of dysfunction. Although traditionally considered cardiodepressant mediators, contractile responses are complex and bimodal, with an early response (within minutes) of variable direction, stimulatory or depressant, depending on the ambient physiologic milieu and relative contributions of the underlying signaling pathways that are activated. These pathways include sphingomyelinase-, nitric oxide (NO)-, and phospholipase A2-dependent signaling with resultant combined effects on contraction and the Ca
2+
transient. This is subsequently followed by a profoundly cardiodepressant late response lasting hours to days, depending on the production of secondary mediators and the combined influence of NO generated from inducible NO synthase, reactive oxygen species, and alterations in β-adrenergic receptor signaling. The interrelationships between these pathways and the time-dependence of their activation are important considerations in the evaluation of cytokine-dependent dysfunction during both acute cardiac injury and chronic cardiac pathologies.
Comparing Social Groups: Wald Statistics for Testing Equality Among Multiple Logit Models
Authors: Liao Tim Futing
Published: December 2004

Social scientists often study the differential effects of explanatory variables among multiple social groups such as race, ethnic group, and nation.This paper examines the Wald test for testing equality of logit coefficients from models of multiple social groups. I propose a Wald statistic that can perform some joint tests of group comparisons that the usual likelihood ratio test cannot. Two examples apply the Wald statistic for testing various hypotheses, and show that the Wald test is flexible and straightforward for making comparisons across social groups, and that the proposed Wald test may find wide applications in the social sciences.
French Canadian Family Relationships in Penetanguishene: A Study of 1990 and a Comparative Update for 2003
Authors: McCauley Timothy
Published: December 2004

This study seeks to compare the changing nature of family and its importance for human society. Research completed in 1992 and updated for 2003 explores the ways in which French Canadian families in Penetanguishene have adapted to the changing material conditions in the larger North American culture and to their community. The study examines: husband/wife relationships, parents and children, and extended relatives, and finds that although the French Canadian families in Penetanguishene remain fairly intact and functional until 1990, the dramatic changes over the last decade have impacted significantly upon life in this community leading to the emergence of a new family form which scholars of the family would classify as “situational.”
Transfers Matter Most: How Changes in Transfer Systems of Canada and the United States Explain the Divergence in Household Poverty Levels from 1974-1994
Authors: Zuberi Daniyal
Published: December 2004

From 1974 to 1994, Canada and the United States experienced quite substantial divergences in relative household poverty rates and inequality levels from similar starting points.Although several scholars have attempted to explain Canadian and U.S. differences in poverty and inequality levels at one point in time, none have satisfactorily explained the causes of these divergent trends. Utilizing high quality, comparable data from the Luxembourg Income Survey, my analysis of the household poverty rates demonstrates that differences in the policies and reforms of the two country’s transfer systems explains the divergence relative household poverty rates. The data also seriously cast doubt on other potential market, cultural, or tax system explanations. Further, by selectively removing the income from each specific category and then specific type of transfer income and recalculating the household poverty rate, my “sensitivity-type” analysis clearly demonstrates the predominant explanatory power for differences in the structure and reforms of social insurance transfers income and, more specifically, social retirement benefits.

In Canada, the expansion of the Guaranteed Income Supplement (GIS) for low-income elderly families over this period provides the only plausible explanation for the dramatic reduction in the poverty rate of the elderly households relative to the United States and, perhaps somewhat surprisingly, explains most of the divergence in household poverty rates between the two countries from 1974 to 1994. As a large part of the divergence in inequality rates is also driven by reduction in household poverty rates in Canada relative to the United States, the expansion of the GIS benefits also provides a major explanation for the divergence in levels of household inequality over this period.
Medicalization in Nepal: A Study of the Influence of Westernization on Defining Deviant and Illness Behavior in a Developing Country
Authors: Furr L. Allen
Published: December 2004

One point of debate in discussions of the modernization of developing societies concerns the effects of Westernization on how people in these societies see the world and develop a sense of meaning in light of rapid and often broad-sweeping social and cultural changes. Where Western culture has little influence, traditional and religious based ideologies that define “why people misbehave” dominate modes of thinking, and medicalized definitions of deviant behavior are absent (Conrad 1992).This study of 276 Nepali teachers investigates if definitions of deviant behavior may be influenced by encroaching Westernization. Subjects were presented with a scenario of a 12-year-old girl engaging in deviant behavior. Results indicate that those who were in agreement with certain Western values and cultural tastes were more likely to label the girl’s behavior as a mental illness and to refer her to a Western-style social agent for treatment rather than to a traditional Nepali helper. These findings lend tentative support to the notion that medicalization is a function of Western culture.
“Parity of Esteem”: A Conceptual Framework for Assessing Peace Processes, with a South African Case Study
Authors: du Toit Pierre
Published: December 2004

In the first part of this article a conceptual framework for assessing the durability of negotiated peace settlements is developed. The framework elaborates on approaches that hold that dealing with issues of relative group status is central to the effectiveness of negotiated settlements. The dynamics of post-settlement competition, the negotiated rules that shape such competition, and the impact of competitive outcomes on inter-group status, whether adverse or positive, is explored. It is argued that peace settlements with rules that shape competition in such a way that both parity of outcomes and parity of esteem can be achieved will be more durable. Parity of esteem is achieved to the extent that competitive rules inhibit stakeholders from drawing invidious comparisons from competitive outcomes. The second part of the article comprises a case study of South Africa. A descriptive analysis is made of a particular set of rules that emanate from the 1993/96 negotiated settlement. The competitive arena is the employment market and the rules of affirmative action. The case study centers on a ruling in a case brought to the South African Labor Court by the Solidarity Trade Union. The case illustrates the emergence of invidious comparisons, the dynamics of in-group and out-group interaction, the construction and reconstruction of identities, and the shifting equilibrium of relative group status. In conclusion, it is found that the current rules shaping this competitive situation inhibit the emergence of parity of esteem.
The Impact of National Identity on Conflict Behavior: Comparative Analysis of Two Ethnic Minorities in Crimea
Authors: Korostelina Karina
Published: December 2004

This paper examines the process of national identity formation among ethnic minorities in the Crimea—specifically, the moderation effects of national identity building on interrelations between conflict indicators and readiness for conflict or compromise for two ethnic minorities in Crimea. Based on a survey in the Crimea, results show that national identity moderates the effects of ethnic identity, ethnocentrism, economic deprivation, and majority/minority position on individual and group conflict behavior and such effects differ between two ethnic groups, namely Russians and Crimean Tatars. For both groups the strongest moderation effect was found for ethnocentrism and ethnic identity.
Why Independence? The Instrumental and Ideological Dimensions of Nationalism
Authors: Brown David
Published: December 2004

This article explores the distinction between an instrumentalist nationalism employed as a resource to combat relative deprivation and an ideological nationalism that resolves the anomic impact of social disruption by constructing politics as a simplistic moral confrontation between the virtuous “Us” and the demonized “Other.” This distinction is related to the examination of how radicalized ethnic majority nationalisms and radicalized ethnic minority nationalisms might be buffered by civic nationalisms, or by the resilience of patrimonial networks. These conceptualizations of nationalism illuminate, and are at the same time illuminated by, one contemporary dispute, that of Achenese secessionism in Indonesia.
Africa and Globalization: Marginalization and Resistance
Authors: Gibson Nigel C.
Published: December 2004

This chapter is a contribution to the ongoing debate about Africa and globalization and the interrelated issues of capitalism, marginalization, representation, and political leadership. Problematizing the discourse of Africa as “diseased” and “hapless,” the World Bank's structural adjustment “cure-all” is presented as being much worse than the “disease” that preceded it. Proposing a critical ethics of globalization—which highlights the gap between globalizations's miraculous, self-reflective images and the miserable conditions it creates—there is an attempt to uncover agents of change on the African continent. Social movements such as those fighting for water and electricity in Soweto, for land in Kenya, or against environmental destruction by oil companies in the Niger delta raise questions about the viability of globalization. Often led by women, these movements not only challenge the “male deal” that defines national governments and multinational corporations, but also call for a revaluation of subsistence economies and local democratic polities as alternatives to globalization. In short, this chapter offers important conceptual, as well as practical, challenges to globalization, indeed to the very nature of politics itself.
Women, Land-Struggles and Globalization: An International Perspective
Authors: Federici Silvia
Published: December 2004

Despite a systematic attempt by colonial powers to destroy female systems of farming, across the planet women today constitute the bulk of agricultural workers and are in the forefront of the struggle for a non-capitalist use of natural resources (land, forests, waters). The article examines these struggles, arguing that by defending subsistence agriculture, communal access to land, and opposing land expropriation, women internationally are building the way to a new non-exploitative society, and one in which the threat of famines and ecological devastation will be dispelled.

How can we ever get out of poverty if we can't get a piece of land to work? If we had land to plant, we wouldn't need to get food sent to us all the way from the United States. No. We'd have our own. But as long as the government refuses to give us the land and other resources we need, we'll continue to have foreigners running our country.

—Elvia Alvarado (Benjamin 1987: 104)
Feminism in the Mau Mau Resurgence
Authors: Brownhill Leigh S. , Turner Terisa E.
Published: December 2004

We argue that there is a resurgence of Mau Mau in Kenya and that at its forefront are the demands and actions of landless women. The Mau Mau war against colonialism inspired millions in their struggles during the 1950s, 1960s, and 1970s. The continuation of the anti-imperial struggle on the African continent in the 1980s and 1990s expanded into the anti-corporate globalization movement of the 2000s. The gendered demands for communal land and autonomous production during the 1952–60 Mau Mau war were suppressed by compromises or “male deals.” The subsistence voices of land-poor women and dispossessed men were silenced in the 1950s and again in the 1980s by the elite clamor for commodified land and crops. Widespread landlessness has produced a new Mau Mau, which asserts a feminist life economy.
Militarism and Islamism in Algeria
Authors: Turshen Meredeth
Published: December 2004

This article focuses on the combined consequences for women of militarization and pan-Islamism—a particular manifestation of Islam that has spread using some of the mechanisms of globalization, especially global trade and global communications. The empirical data are drawn from the civil conflict of the 1990s in Algeria, where an Islamist movement led by the Islamic Salvation Front (FIS) and several armed Islamist groups (notably the GIA, the Armed Islamic Group) terrorized the population and killed tens of thousands of people in an attempt to seize control of the state. External support from pan-Islamists accounts, in part, for the ability of the FIS and the GIA to gain a foothold in Algeria. The pan-Islamist movement has cells in Europe and the Middle East, some of which were in contact with Algerian Islamists. Armed Islamist groups from Algeria received training from Al Qaeda, combat experience in Afghanistan and Bosnia, and financial support from Saudi Arabia, Sudan, and Iran.
Visiting Africa: Constructions of Nation and Identity on Travel Websites
Authors: Fürsich Elfriede , Robins Melinda B.
Published: December 2004

In this textual analysis, we investigate the official travel websites of African countries. Our study examines where travel and tourism fit into agendas of nationalist constructions. Whose vision of nation is being served by these constructions? How does this “image-work” by developing nations reconcile the paradoxes between modernization, authenticity, and change? Do host nations sustain earlier or develop new authenticities as they become “tourist-nations”? We find that this official travel publicity often denotes a struggle to create a cohesive national identity to be sold to Western tourists while constructing a problematic discourse of cultural distinction and self-exotication.
An Economic Analysis of Agricultural Production in Senegal: A Case Study of the Thiès and Diourbel Regions
Authors: Cisse Aly , Bravo-Ureta Boris E. , Fuentes Paul , Thiam Abdourahmane
Published: December 2004

Enterprise budgets and linear programming techniques are used to determine the profitability of individual crops and optimal cropping patterns for typical farms located in Diourbel and Thiès, two regions in the center of the Senegalese Peanut Basin. An intensification analysis through the introduction of La Fleur 11, which is a relatively new ground-nut seed variety, and operating capital constraints are also included in this study. Finally, farm income is compared with two poverty line measures.

The profitability results show that groundnut exhibits the highest gross returns and net profits per hectare and millet the lowest net profits per hectare. Moreover, La Fleur 11 exhibits a higher yield when compared to traditional groundnut varieties such as 55-437. The results of the linear programming model suggest that groundnut production is the most profitable use of agricultural land in Diourbel, while in Thiès sorghum shows the highest profitability. Excess labor is found in all the cases examined while the opportunity cost of land ranges from FCFA 25,551 to FCFA 318,612 (US $39.31 to US $490.17, at an exchange rate of FCFA 650/US $1 for 1997). The farm income analysis indicates that the level of poverty is severe in the area of the study. In addition, large farms are not as poor as small farms, and non-farm income could contribute to poverty alleviation.
Unblocking the Blockages: Challanges for Nigerian Education
Authors: Ogunsanya Mobolaji , Thomas Harold
Published: December 2004

This article reports on the findings from a EU funded programming study of the education sector in Nigeria. Following a brief overview of the education sector, the article comments on the management of the sector and outlines some of the challenges for educational development. Blockages in the system are identified and areas for reform are explored. It is argued that if current blockages are to be unblocked, an holistic approach to reform will need to be adopted with a focus on legislative, structural, funding, managerial, academic and staff development issues. It is argued, however, that reforms within the education sector will be insufficient to convert vision into reality unless they are supported by a willingness to address wider economic and societal issues.
Civil Society and Japan’s Dysfunctional Democracy
Authors: Hirata Keiko
Published: December 2004

Japan has long been described as a dysfunctional democracy due to the limited role of grassroots movements compared to other industrialized countries. This paper critiques the notion of an Asian path to democracy in Japan and outlines how industrial maturation and globalization have given rise to new forms of Japanese social activism. The historical growth and development of Japan’s grassroots movements is analyzed, with a focus on nongovernmental organizations (NGOs) involved in international development. The paper examines in detail the push and pull factors behind the growth and influence of these NGOs, and analyzes the new forms of state-society relations that have emerged as the Ministry of Foreign Affairs and NGOs begin to collaborate. Finally, the paper assesses the significance of grassroots activism for democratic invigoration in Japan and beyond.
Insulin Sensitivity Among Obese Children and Adolescents, According to Degree of Weight Loss
Authors: Reinehr Thomas , Kiess Wieland , Kapellen Thomas , Andler Werner
Published: December 2004

Objective. Insulin sensitivity is impaired among some obese children, reflecting an atherogenic risk factor profile for the affected subjects. This study was performed to examine the amount of weight reduction required to improve insulin sensitivity.

Methods. We studied changes in insulin sensitivity indices (ISIs) for glucose metabolism (homeostasis model assessment and quantitative insulin sensitivity check index) and fat metabolism (free fatty acids) during a 1-year period among obese children who attended an obesity intervention program. The children were divided into 4 groups according to their changes in body mass index (BMI) SD score (SDS), as follows: group I, decrease in SDS-BMI of ≥0.5; group II, decrease in SDS-BMI of ≥0.25 to <0.5; group III, decrease in SDS-BMI of <0.25; group IV, increase in SDS-BMI.

Results. Fifty-seven obese children (age range: 6–14 years; median age: 10 years; 46% boys) were included in the study. The 4 groups did not differ with respect to age, gender, degree of overweight (SDS-BMI), or ISI values at baseline. An increase in SDS-BMI (group IV, n = 12) was followed by a significant decrease in ISI values. The ISIs improved for group I (n = 9), whereas there were no significant changes in these parameters for group II (n = 21) and group III (n = 15).

Conclusions. During a 1-year period, an increase in weight among obese children was associated with a decrease in insulin sensitivity. Weight loss was followed by significant improvement in insulin sensitivity for glucose and fat metabolism but only if the SDS-BMI decreased by ≥0.5 during the 1-year period.
Evaluation of a Staff-Only Hospitalist System in a Tertiary Care, Academic Children's Hospital
Authors: Dwight Prabo , MacArthur Colin , Friedman Jeremy N. , Parkin Patricia C.
Published: December 2004

Objective.

The staff/housestaff hospitalist system has been evaluated in 2 pediatric centers in the United States. In Canada, fewer residents and duty hour restrictions led to the development of a staff-only hospitalist system. The objective of this study was to compare the staff-only pediatric hospitalist system and the staff/housestaff hospitalist system with respect to traditional outcome measures.

Design.

This cohort study (staff-only hospitalist system versus staff/housestaff system) used electronic health records data (July 1, 1996, to June 30, 1997) for all admissions (n = 3807) to the general pediatric inpatient unit of an urban, tertiary care, pediatric, teaching hospital in Toronto, Canada. Outcome measures included length of hospital stay, subspecialty consultations, readmission to the hospital, and death during the hospital stay.

Results.

The median length of hospital stay was reduced by 14% for patients admitted to the staff-only hospitalist system, compared with the staff/housestaff hospitalist system (2.5 and 2.9 days, respectively). This difference remained statistically significant after adjustment for age, gender, and comorbidity. There were no significant differences between the 2 models of care with respect to subspecialty consultation, hospital readmission, or mortality rates. A stratified analysis showed similar findings for the 10 most frequent diagnostic groups.

Conclusions.

The staff-only hospitalist system was associated with a significant reduction in the hospital length of stay, without evidence of adverse effects on mortality or readmission rates, compared with the staff/hospitalist system. In the context of recent restrictions on resident duty hours in the United States, these findings may be of interest to pediatric teaching hospitals considering the development of a similar staff-only hospitalist model.
Persistence of Benefits of Continuous Subcutaneous Insulin Infusion in Very Young Children With Type 1 Diabetes: A Follow-up Report
Authors: Weinzimer Stuart A. , Ahern JoAnn H. , Doyle Elizabeth A. , Vincent Miranda R. , Dziura James , Steffen Amy T. , Tamborlane William V.
Published: December 2004

Objective. Use of continuous subcutaneous insulin infusion (CSII) has increased dramatically in recent years, and pump therapy has been shown to be a safe and effective alternative to multiple daily injections in adults and older pediatric patients with type 1 diabetes. Its use in very young children, however, has been limited, although this group might be expected to benefit the most from CSII. The objective of this study was to analyze the CSII efficacy and safety data in very young children with type 1 diabetes from our Diabetes Clinic database.

Methods. Glycosylated hemoglobin (HbA1c), severe hypoglycemia (SH), and ketoacidosis (DKA) in the year before CSII were compared with corresponding values during pump treatment in all children who started CSII before age 7.

Results. Sixty-five children (mean age: 4.5 y at CSII initiation; range: 1.4–6.9 years; 28 girls; 3 black, 1 Hispanic) were analyzed for >162 patient-years of follow-up. Mean HbA1c (7.4 ± 1.0 prepump) decreased to 7.0 ± 0.9 after 12 months of CSII and continued to improve even after 4 years on CSII. The rate of SH was reduced by 53% (from 78 to 37/100 patient-years). Children who received daytime care from paid caregivers (n = 26) experienced significant reductions in HbA1c and hypoglycemia frequency. There were no episodes of DKA requiring emergency treatment in the year before CSII and 4 episodes (4 per 100 patient-years) after transition to pump.

Conclusions. CSII is a durable and effective means of optimizing glycemic control in very young patients with type 1 diabetes and may be superior to multiple daily injections in minimizing the risk of severe hypoglycemia in this age group. Employment of paid caregivers does not preclude safe and effective use of CSII.
Increased Behavioral Morbidity in School-Aged Children With Sleep-Disordered Breathing
Authors: Rosen Carol L. , Storfer-Isser Amy , Taylor H. Gerry , Kirchner H. Lester , Emancipator Judith L. , Redline Susan
Published: December 2004

Objective. To assess whether sleep-disordered breathing (SDB), ranging from primary snoring to obstructive sleep apnea (OSA), is associated with increased behavioral morbidity.

Methods. A cross-sectional study was conducted of school-aged children in an urban, community-based cohort, stratified for term or preterm (<37 weeks' gestation) birth status. A total of 829 children, 8 to 11 years old (50% female, 46% black, 46% former preterm birth) were recruited from a cohort study. All children had unattended in-home overnight cardiorespiratory recordings of airflow, respiratory effort, oximetry, and heart rate for measurement of the apnea hypopnea index (number of obstructive apneas and hypopneas per hour). SDB was defined by either parent-reported habitual snoring or objectively measured OSA. Functional outcomes were assessed with 2 well-validated parent ratings of behavior problems: the Child Behavioral Checklist and the Conners Parent Rating Scale–Revised:Long.

Results. Forty (5%) children were classified as having OSA (median apnea hypopnea index: 7.1 per hour; interquartile range: 3.1–10.5), 122 (15%) had primary snoring without OSA, and the remaining 667 (80%) had neither snoring nor OSA. Children with SDB had significantly higher odds of elevated problem scores in the following domains: externalizing, hyperactive, emotional lability, oppositional, aggressive, internalizing, somatic complaints, and social problems.

Conclusions. Children with relatively mild SDB, ranging from primary snoring to OSA, have a higher prevalence of problem behaviors, with the strongest, most consistent associations for externalizing, hyperactive-type behaviors.
Recognition and Management of Pediatric Fractures by Pediatric Residents
Authors: Ryan Leticia Manning , DePiero Andrew D. , Sadow Karin B. , Warmink Corwin A. , Chamberlain James M. , Teach Stephen J. , Johns Christina M. S.
Published: December 2004

Background. Competence in basic orthopedic assessment and interpretation of radiographs is important for pediatricians because appropriate initial management of fractures can expedite therapy and minimize morbidity. However, requirements for training in orthopedics and radiology are poorly defined in pediatric residency programs.

Objective. To assess the ability of pediatric residents to recognize and to manage appropriately pediatric fractures.

Methods. This study involved administration of a case-based questionnaire with radiographs to volunteer categorical pediatric residents in 3 geographically diverse training programs. The diagnosis and management of 8 orthopedic complaints were evaluated. Responses were scored according to the number of features identified accurately, including the presence or absence of a fracture. Residents who were able to identify a fracture were assessed with respect to their ability to classify the fracture and to provide initial management. The study was pretested with a group of pediatric emergency medicine attending physicians, to establish the suitability of the cases.

Results. Among the 3 residency sites, 102 of 190 eligible pediatric residents (53.7%) participated, yielding 95 completed questionnaires. The mean number of cases in which a resident correctly answered the question, “Is a fracture present?” and correctly identified the fractured bone (if a fracture was present) was 6.5 ± 1.2 of 8 cases (81.6%; 95% confidence interval: 78.5–84.7%). The diagnostic accuracy of Salter-Harris classification in cases in which such fractures were present was 40.9%. The mean score of correctly identified features for the resident group was 38.5 ± 9.4, of a possible 64 points (proportion correct: 60.1%; 95% confidence interval: 57.2-63%). There was a small but significant difference in mean correct responses between first-year residents (proportion correct: 55.4%; 95% confidence interval: 50.8- 60.3%) and third-year residents (proportion correct: 65.1%; 95% confidence interval: 60.7-69.5%). There was no association between the proportion of correct responses and whether or not residents had taken radiology or orthopedics elective courses in medical school. Overall, 43% of cases were both identified and managed correctly by the pediatric residents.

Conclusions. For residents from the participating training programs, skills in recognizing and managing pediatric fractures were suboptimal. Additional review of training requirements is necessary to identify more clearly areas of improvement for current curricula.
Clostridium septicum Myonecrosis in Congenital Neutropenia
Authors: Barnes Chris , Gerstle J. Ted , Freedman Melvin H. , Carcao Manuel D.
Published: December 2004

Severe congenital neutropenia (SCN) and Clostridium septicum myonecrosis is an uncommon and life-threatening association requiring urgent combined aggressive medical and surgical management. We report 2 cases of SCN (1 with known Kostmann's syndrome and 1 not known at presentation to have a congenital neutropenic disorder but subsequently received a diagnosis of cyclic neutropenia) who presented with spontaneous C septicum myonecrosis. The cases highlight the importance of response to recombinant human granulocyte colony-stimulating factor in obtaining a satisfactory outcome for these patients. Early, empirical use of recombinant human granulocyte colony-stimulating factor in patients who are suspected of having a congenital neutropenia and who present with life-threatening sepsis is recommended.
Spectrum of Clinical Manifestations of West Nile Virus Infection in Children
Authors: Yim Robert , Posfay-Barbe Klara M. , Nolt Dawn , Fatula George , Wald Ellen R.
Published: December 2004

Reports of clinical manifestations of West Nile virus (WNV) infections in children have been relatively rare. Four cases of WNV infection in children are described: the first report of prolonged encephalitis and fulminant hepatitis caused by WNV, and 3 other presentations of WNV, including the first report of ocular involvement in a child.
Trends in Risk Factors for Cardiovascular Disease Among Children and Adolescents in the United States
Authors: Ford Earl S. , Mokdad Ali H. , Ajani Umed A.
Published: December 2004

Background. The increasing prevalence of obesity among children and adolescents in recent decades might have affected trends in obesity-associated risk factors for cardiovascular disease.

Participants and Methods. We used data for 12 665 children and adolescents, 2 to 17 years of age, from the Third National Health and Nutrition Examination Survey (1988–1994) and for 3611 children and adolescents from National Health and Nutrition Examination Survey 1999–2000.

Results. For participants 2 to 17 years of age, waist circumference increased 1.6 cm among male subjects and 2.4 cm among female subjects. Mean systolic blood pressure increased by 2.2 mm Hg among children and adolescents 8 to 17 years of age. There were significant decreases in concentrations of triglycerides (8.8 mg/dL) and glucose (2.5 mg/dL) among children and adolescents 12 to 17 years of age. Mean concentrations of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and glycosylated hemoglobin were relatively unchanged. Some changes in means of risk factors varied according to age.

Conclusions. The temporal trends for risk factors among children and adolescents during the 1990s exhibited different patterns. The effects of the increasing prevalence of obesity on the cardiovascular health of children and adolescents remain unclear.
Declining Diagnosis of Birth Asphyxia in California: 1991–2000
Authors: Wu Yvonne W. , Backstrand Kendall H. , Zhao Shoujun , Fullerton Heather J. , Johnston S. Claiborne
Published: December 2004

Objective. Birth asphyxia is recognized as an important cause of neonatal morbidity and mortality. Whether advances in perinatal care have altered the incidence of birth asphyxia is unknown. We determined the incidence of birth asphyxia diagnoses made over a 10-year period in California.

Methods. In a population-based retrospective cohort study of 5 364 663 live births, we determined the incidence and case fatality of birth asphyxia between 1991 and 2000. Using a statewide administrative hospital discharge database, we identified all newborn admissions that generated a diagnosis of birth asphyxia (International Classification of Diseases, Ninth Revision, Clinical Modification codes 768.5, 768.6, or 768.9) or a diagnosis that overlaps with birth asphyxia, such as congenital encephalopathy or fetal distress. We determined incidence and in-hospital case fatality rates adjusted for birth weight and demographic characteristics and stratified by associated perinatal complications.

Results. The 24 330 newborns who received a diagnosis of birth asphyxia yielded a population incidence of 4.5 per 1000 live births. Black ethnicity (relative risk [RR]: 1.3; 95% confidence interval [CI]: 1.2–1.3), male gender (RR: 1.2; 95% CI: 1.1–1.2), and low socioeconomic status (RR: 1.2; 95% CI: 1.1–1.2) all were associated with increased risk. The diagnosis of birth asphyxia decreased by 91% from 14.8 to 1.3 per 1000 live births during the study years. This decrease could not be explained by an increased diagnosis of overlapping conditions. Overall case fatality was 4%, and the majority of deaths in infants >2000 g occurred in the presence of congenital anomalies, cord abnormalities, or maternal hemorrhage. In newborns <2000 g, case fatality was highest in the presence of chorioamnionitis (48%).

Conclusion. The diagnosis of birth asphyxia has decreased dramatically in recent years. The factors that are responsible for this decline are unclear and deserve additional investigation.
Topical 4% Amethocaine Gel Reduces the Pain of Subcutaneous Measles-Mumps-Rubella Vaccination
Authors: O'Brien Lisa , Taddio Anna , Ipp Moshe , Goldbach Morton , Koren Gideon
Published: December 2004

Objectives. Ametop gel (4% amethocaine) is a relatively new topical anesthetic that produces anesthesia within 30 to 45 minutes and therefore may be appropriate for use in busy outpatient settings. The objective of this study was to assess the efficacy and safety of 4% amethocaine in reducing the pain of subcutaneous measles-mumps-rubella vaccination in 1-year-old infants.

Methods.A double-blind, randomized, placebo-controlled trial was conducted in pediatric outpatient clinics.

Results.A total of 120 infants participated in the study; 60 were followed up for assessment of antibody titers after 1 month. Either 1 g of amethocaine or placebo was applied for 30 minutes before vaccination. The Modified Behavioral Pain Scale was used to assess pain; the mean (standard deviation) pain scores for the amethocaine group (n = 61) was 1.5 (1.6) versus 2.3 (2.2) for the placebo group (n = 59). The rate of vaccination success (88% and 87%) was not different between treatment groups.

Conclusions.4% Amethocaine significantly reduces the pain of measles-mumps-rubella vaccination in infants when compared with placebo and does not seem to interfere with subsequent development of protective antibody levels. Because of its relatively short application time (30 minutes), 4% amethocaine may be suitable for busy clinics and emergency departments.
Epidemiologic Features of Kawasaki Disease in Taiwan, 1996–2002
Authors: Chang Luan-Yin , Chang I-Shou , Lu Chun-Yi , Chiang Bor-Luen , Lee Chin-Yun , Chen Pei-Jer , Wang Jin-Town , Ho Hong-Nerng , Chen Ding-Shinn , Huang Li-Min ,   and the Kawasaki Disease Research Group
Published: December 2004

Objective. Kawasaki disease (KD) is the most common acquired heart disease in children worldwide. The incidence of KD varies among different countries, with Asian countries supposedly having higher incidences than Western countries. However, the incidence of KD in Taiwan has not been well investigated.

Methods. Since the implementation of Taiwan's National Health Insurance (NHI) in 1995, NHI has covered health care for >96% its population. Using the NHI database from 1996 to 2002, we investigated epidemiologic features of KD (International Classification of Diseases, Ninth Revision, code 446.1), the rate of coronary artery aneurysm formation (International Classification of Diseases, Ninth Revision, code 414.11), and the change in incidence during the recent 7 years. We also compared the annual incidences in Taiwan with those reported by other countries.

Results. During the 7-year study period, KD occurred most frequently in the summer and least frequently in winter. It is interesting that the highest peak occurred in the summer of 1998 at the same time that Taiwan's enterovirus 71 epidemic was occurring. Ninety-one percent of KD cases occurred in children who were <5 years old, and the male-to-female ratio was 1.70:1. Recurrence of KD was found in 1.3% (94 of 7305) of these children, and coronary artery aneurysm was found in 7.3% (536 of 7305). The annual incidence per 100 000 children was 146 in children <1 year old, 98 in 1-year-old children, 51 in 2-year-old children, 28 in 3-year-old children, 19 in 4-year-old children, and 5.3 in 5- to 9-year-old children; the incidence of KD decreased with increased age. The overall incidence was 66 cases per 100 000 children <5 years old from 1996 to 2002 with the annual incidence not differing significantly during the 7-year study period.

Conclusions. KD in Taiwan occurs more frequently in boys and in the summer months. During the 7-year study period, the annual KD incidence in Taiwan of 66/100000 in children <5 years old was the second highest in the world after Japan.
Psychosocial and Academic Characteristics of Extremely Low Birth Weight (≤800 g) Adolescents Who Are Free of Major Impairment Compared With Term-Born Control Subjects
Authors: Grunau Ruth E. , Whitfield Michael F. , Fay Taryn B.
Published: December 2004

Objective. To compare academic and cognitive ability, attention, attitudes, and behavior of extremely low birth weight (ELBW) adolescents who are free of major impairments at 17 years of age with term-born control subjects.

Methods. Between January 31, 1981, and February 9, 1986, 250 infants of ≤800 g were admitted for intensive care in British Columbia, 98 (39%) of whom survived to late adolescence. Teens with major sensorimotor handicaps and/or IQ <70 were excluded (n = 19). Of the 79 eligible ELBW teens, 53 (67%) were assessed at 17.3 (16.3–19.7) years (birth weight: 720 [520–800g]; gestation: 26 [23–29] weeks). The test battery screened the following areas: cognitive (Wechsler Intelligence Scale for Adults Third Edition, 3 subtests), academic (Wide Range Achievement Test-3), attention (Connors' Continuous Performance Task), self-report (Harter Self-Perception Profile for Adolescents; Job Search Attitude Inventory), and parent report (Child Behavior Check List). A comparison group of term born control subjects (n = 31) were also assessed (birth weight: 3506 [3068–4196] g; gestation: 40 [39–42] weeks) at age 17.8 (16.5–19.0) years. Multivariate analysis of variance (group × gender) was conducted for each domain (cognitive, academic, self-report, and parent report).

Results. The ELBW group showed lower cognitive scores (vocabulary, block design, and digit symbol) and academic skills (reading and arithmetic) compared with control subjects, with no gender differences. There were no differences in attention between the 2 groups using a repetitive computer task. ELBW teens reported lower scholastic, athletic, job competence, and romantic confidence and viewed themselves as more likely to need help from others in finding a job. In the behavioral domain, parents reported their ELBW teens to display more internalizing, more externalizing, and more total problems than the control teens, with ELBW boys showing more problems. ELBW teens showed a higher percentage of clinically significant behavior problems than control subjects.

Conclusions. In a provincial cohort of unimpaired survivors of birth weight ≤800 g, psychosocial and educational vulnerabilities persist into late adolescence and may complicate the transition to adult life compared with their peers.
Prophylaxis of Early Adrenal Insufficiency to Prevent Bronchopulmonary Dysplasia: A Multicenter Trial
Authors: Watterberg Kristi L. , Gerdes Jeffrey S. , Cole Cynthia H. , Aucott Susan W. , Thilo Elizabeth H. , Mammel Mark C. , Couser Robert J. , Garland Jeffery S. , Rozycki Henry J. , Leach Corinne L. , Backstrom Conra , Shaffer Michele L.
Published: December 2004

Background. Infants developing bronchopulmonary dysplasia (BPD) show decreased cortisol response to adrenocorticotropic hormone. A pilot study of low-dose hydrocortisone therapy for prophylaxis of early adrenal insufficiency showed improved survival without BPD at 36 weeks’ postmenstrual age, particularly in infants exposed to histologic chorioamnionitis.

Methods. Mechanically ventilated infants with birth weights of 500 to 999 g were enrolled into this multicenter, randomized, masked trial between 12 and 48 hours of life. Patients received placebo or hydrocortisone, 1 mg/kg per day for 12 days, then 0.5 mg/kg per day for 3 days. BPD at 36 weeks’ postmenstrual age was defined clinically (receiving supplemental oxygen) and physiologically (supplemental oxygen required for O2 saturation ≥90%).

Results. Patient enrollment was stopped at 360 patients because of an increase in spontaneous gastrointestinal perforation in the hydrocortisone-treated group. Survival without BPD was similar, defined clinically or physiologically, as were mortality, head circumference, and weight at 36 weeks. For patients exposed to histologic chorioamnionitis (n = 149), hydrocortisone treatment significantly decreased mortality and increased survival without BPD, defined clinically or physiologically. After treatment, cortisol values and response to adrenocorticotropic hormone were similar between groups. Hydrocortisone-treated infants receiving indomethacin had more gastrointestinal perforations than placebo-treated infants receiving indomethacin, suggesting an interactive effect.

Conclusions. Prophylaxis of early adrenal insufficiency did not improve survival without BPD in the overall study population; however, treatment of chorioamnionitis-exposed infants significantly decreased mortality and improved survival without BPD. Low-dose hydrocortisone therapy did not suppress adrenal function or compromise short-term growth. The combination of indomethacin and hydrocortisone should be avoided.
Role of Pediatricians in Advocating Life Support Training Courses for Parents and the Public
Authors:   Committee on Pediatric Emergency Medicine
Published: December 2004

Available literature suggests a need for both initial cardiopulmonary resuscitation basic life support training and refresher courses for parents and the public as well as health care professionals. The promotion of basic life support training courses that establish a pediatric chain of survival spanning from prevention of cardiac arrest and trauma to rehabilitative and follow-up care for victims of cardiopulmonary arrest is advocated in this policy statement and is the focus of an accompanying technical report. Immediate bystander cardiopulmonary resuscitation for victims of cardiac arrest improves survival for out-of-hospital cardiac arrest. Pediatricians will improve the chance of survival of children and adults who experience cardiac arrest by advocating for cardiopulmonary resuscitation training and participating in basic life support training courses as participants and instructors.
Managed Care and Children With Special Health Care Needs
Authors: Kastner Theodore A. ,   and Committee on Children with Disabilities
Published: December 2004

This Clinical Report was retired May 2011.

The implementation of managed care for children with special health care needs is often associated with apprehension regarding new barriers to health care services. At times, these barriers may overshadow opportunities for improvement. This statement discusses such opportunities, identifies challenges, and proposes active roles for pediatricians and families to improve managed care for children with special health care needs.