bluuebunny/crossref_metadata_2025 huggingface dataset:
Continued Impact of Pneumococcal Conjugate Vaccine on Carriage in Young Children
Authors: Huang Susan S. , Hinrichsen Virginia L. , Stevenson Abbie E. , Rifas-Shiman Sheryl L. , Kleinman Ken , Pelton Stephen I. , Lipsitch Marc , Hanage William P. , Lee Grace M. , Finkelstein Jonathan A.
Published: June 2009

OBJECTIVES: The goals were to assess serial changes in Streptococcus pneumoniae serotypes and antibiotic resistance in young children and to evaluate whether risk factors for carriage have been altered by heptavalent pneumococcal conjugate vaccine (PCV7).

METHODS: Nasopharyngeal specimens and questionnaire/medical record data were obtained from children 3 months to <7 years of age in primary care practices in 16 Massachusetts communities during the winter seasons of 2000–2001 and 2003–2004 and in 8 communities in 2006–2007. Antimicrobial susceptibility testing and serotyping were performed with S pneumoniae isolates.

RESULTS: We collected 678, 988, and 972 specimens during the sampling periods in 2000–2001, 2003–2004, and 2006–2007, respectively. Carriage of non-PCV7 serotypes increased from 15% to 19% and 29% (P < .001), with vaccine serotypes decreasing to 3% of carried serotypes in 2006–2007. The relative contribution of several non-PCV7 serotypes, including 19A, 35B, and 23A, increased across sampling periods. By 2007, commonly carried serotypes included 19A (16%), 6A (12%), 15B/C (11%), 35B (9%), and 11A (8%), and high-prevalence serotypes seemed to have greater proportions of penicillin nonsusceptibility. In multivariate models, common predictors of pneumococcal carriage, such as child care attendance, upper respiratory tract infection, and the presence of young siblings, persisted.

CONCLUSIONS: The virtual disappearance of vaccine serotypes in S pneumoniae carriage has occurred in young children, with rapid replacement with penicillin-nonsusceptible nonvaccine serotypes, particularly 19A and 35B. Except for the age group at highest risk, previous predictors of carriage, such as child care attendance and the presence of young siblings, have not been changed by the vaccine.
Paternal Depressive Symptoms During Pregnancy Are Related to Excessive Infant Crying
Authors: van den Berg Mijke P. , van der Ende Jan , Crijnen Alfons A. M. , Jaddoe Vincent W. V. , Moll Henriette A. , Mackenbach Johan P. , Hofman Albert , Hengeveld Michiel W. , Tiemeier Henning , Verhulst Frank C.
Published: June 2009

OBJECTIVE: Excessive infant crying, or infantile colic, is a common and often stress-inducing problem for parents that can ultimately result in child abuse. From previous research it is known that maternal depression is related to excessive crying, but so far little is known about the influence of paternal depression.

METHODS: In a prospective, population-based study, we obtained information on both maternal and paternal depressive symptoms at 20 weeks of pregnancy by using the Brief Symptom Inventory. Parental depressive symptoms were related to excessive crying in 4426 two-month-old infants. The definition of excessive crying was based on the widely used Wessel's criteria (ie, crying >3 hours for >3 days in the past week).

RESULTS: After adjustment for depressive symptoms of the mother and relevant confounders, we found a 1.29 (95% confidence interval: 1.09–1.52) higher risk of excessive infant crying per SD of paternal depressive symptoms.

CONCLUSIONS: Our findings indicate that paternal depressive symptoms during pregnancy might be a risk factor for excessive infant crying. This finding could be related to genetic transmission, interaction of a father with lasting depressive symptoms with the infant, or related indirectly through contextual stressors such as marital, familial, or economic distress.
Cardiac Safety of Methylphenidate Versus Amphetamine Salts in the Treatment of ADHD
Authors: Winterstein Almut Gertrud , Gerhard Tobias , Shuster Jonathan , Saidi Arwa
Published: June 2009

OBJECTIVES: Safety concerns about central nervous system stimulants for the treatment of attention-deficit/hyperactivity disorder (ADHD) include adverse cardiac effects. This study aimed to compare the risk for cardiac events in users of methylphenidate and amphetamine salts.

METHODS: A retrospective cohort design using claims data from the Florida Medicaid fee-for-service program representing a total of 2131953 children and adolescents was used. The analysis included all beneficiaries who were between 3 and 20 years of age, enrolled between July 1994 and June 2004, had at least 1 physician diagnosis of ADHD and were newly started on methylphenidate or amphetamine salts. Each month of follow-up was classified according to stimulant use into current use or former use. We defined cardiac events as first emergency department (ED) visit for cardiac disease or symptoms. Risk between current users of methylphenidate versus amphetamine salts and former users of drugs in these categories was compared by using a time-dependent Cox proportional hazard model that adjusted for differences in gender; race; age; year of the index date; disability; congenital anomalies; history of circulatory disease; history of hospital admission; and use of antidepressants, antipsychotics, and bronchodilators.

RESULTS: A total of 456 youth visited the ED for cardiac reasons during 52783 years of follow-up. After adjustment for differences in covariates, the risk for cardiac ED visits was similar among current users of methylphenidate or amphetamines. Periods of former use had a similar risk between youth with an exposure history to methylphenidate or amphetamine.

CONCLUSION: Exposure to methylphenidate and amphetamines salts showed similar risk for cardiac ED visits. Additional population-based studies that address manifestation of serious heart disease, especially after long-term use, dosage comparisons, and interactions with preexisting cardiac risk factors are needed to inform psychiatric treatment decisions.
Headache in Young Children in the Emergency Department: Use of Computed Tomography
Authors: Lateef Tarannum M. , Grewal Mandeep , McClintock William , Chamberlain James , Kaulas Himanshu , Nelson Karin B.
Published: June 2009

OBJECTIVE: The goal was to determine whether computed tomographic (CT) scans led to better acute care of young children with headache presenting the emergency department (ED).

METHODS: We examined the records of 364 children 2 to 5 years of age who presented with headache to a large urban ED between July 1, 2003, and June 30, 2006. By reviewing initial history and examination findings, we first identified patients with secondary headaches (ie, with readily identifiable explanations such as ventriculoperitoneal shunts, known brain tumors, or acute illnesses, such as viral syndromes, fever, probable meningitis, or trauma). Charts for the remaining patients were reviewed for headache history, neurologic examination findings, laboratory and neuroimaging results, final diagnosis, and disposition.

RESULTS: On the basis of initial history and physical examination results, 306 children (84%) had secondary headaches. For 72% of those children, acute febrile illnesses and viral respiratory syndromes accounted for the headaches. Among the 58 children (16%) who had no recognized central nervous system disease or systemic illness at presentation, 28% had CT scans performed. Of those, 1 scan yielded abnormal results, showing a brainstem glioma; the patient demonstrated abnormal neurologic examination findings on the day of presentation. For 15 (94%) of 16 patients, the CT scans did not contribute to diagnosis or management. For 59% of children with apparently primary headaches, no family history was recorded.

CONCLUSION: For young children presenting to the ED with headache but normal neurologic examination findings and nonworrying history, CT scans seldom lead to diagnosis or contribute to immediate management.
Do Stimulants Protect Against Psychiatric Disorders in Youth With ADHD? A 10-Year Follow-up Study
Authors: Biederman Joseph , Monuteaux Michael C. , Spencer Thomas , Wilens Timothy E. , Faraone Stephen V.
Published: June 2009

OBJECTIVE: Little is known about the effect of stimulant treatment in youth with attention-deficit/hyperactivity disorder (ADHD) on the subsequent development of comorbid psychiatric disorders. We tested the association between stimulant treatment and the subsequent development of psychiatric comorbidity in a longitudinal sample of patients with ADHD.

METHODS: We conducted a case-control, 10-year prospective follow-up study into young-adult years of youth with ADHD. At baseline, we assessed consecutively referred white male children with (n = 140) and without (n = 120) ADHD, aged 6 to 18 years. At the 10-year follow-up, 112 (80%) and 105 (88%) of the children in the ADHD and control groups, respectively, were reassessed (mean age: 22 years). We examined the association between stimulant treatment in childhood and adolescence and subsequent comorbid disorders and grade retention by using proportional hazards survival models.

RESULTS: Of the 112 participants with ADHD, 82 (73%) were previously treated with stimulants. Participants with ADHD who were treated with stimulants were significantly less likely to subsequently develop depressive and anxiety disorders and disruptive behavior and less likely to repeat a grade compared with participants with ADHD who were not treated.

CONCLUSIONS: We found evidence that stimulant treatment decreases the risk for subsequent comorbid psychiatric disorders and academic failure in youth with ADHD.
Health Status and Behavioral Outcomes for Youth Who Anticipate a High Likelihood of Early Death
Authors: Borowsky Iris Wagman , Ireland Marjorie , Resnick Michael D.
Published: June 2009

OBJECTIVE: The relationship between adolescents' perceived risk for dying and their involvement in risk behaviors is unknown. We sought to determine the proportion of US youth who anticipate a high likelihood of early mortality and relationships with health status and risk behaviors over time.

METHODS: We analyzed data from times 1 (1995), 2 (1996), and 3 (2001–2002) of the National Longitudinal Study of Adolescent Health, a nationally representative sample of youth in grades 7 through 12. The relationship between perceived risk for premature mortality and health behaviors/outcomes was assessed by using bivariate and multivariate analyses.

RESULTS: At time 1, 14.7% of the 20594 respondents reported at least a 50/50 chance that they would not live to age 35. In adjusted models, illicit drug use, suicide attempt, fight-related injury, police arrest, unsafe sexual activity, and a diagnosis of HIV/AIDS predicted early death perception at time 2, time 3, or both (adjusted odds ratios: 1.26–5.12). Conversely, perceived early mortality at time 1 predicted each of these behaviors and outcomes, except illicit drug use, at time 2 or time 3, most strongly a diagnosis of HIV/AIDS (adjusted odds ratios: 7.13 [95% confidence interval: 2.50–20.36]).

CONCLUSIONS: Adolescent involvement in risk behaviors predicted a belief in premature mortality 1 and 7 years later. Reciprocally, adolescents' perceived risk for early death predicted serious health outcomes, notably a diagnosis of HIV/AIDS in young adulthood. Given its frequency and influence on behavior and health, adolescents' perceived risk for early death should be incorporated into psychosocial assessments and interviews.
State and Regional Variation in Regulations Related to Feeding Infants in Child Care
Authors: Benjamin Sara E. , Taveras Elsie M. , Cradock Angie L. , Walker Elizabeth M. , Slining Meghan M. , Gillman Matthew W.
Published: June 2009

OBJECTIVE: The purpose of this study was to compare state and regional variation in infant feeding regulations for child care facilities and to compare these regulations to national standards.

METHODS: We reviewed regulations for child care for all US states and Washington, DC, and examined patterns according to type of facility and geographic region. We compared state regulations with national standards for feeding infants in child care. The standards included were: (1) infants are fed according to a feeding plan from a parent or physician; (2) breastfeeding is supported by the child care facility; (3) no solid food is given before 6 months of age; (4) infants are fed on demand; (5) infants are fed by a consistent caregiver; (6) infants are held while feeding; (7) infants cannot carry or sleep with a bottle; (8) caregivers cannot feed >1 infant at a time; (9) no cow's milk is given to children <12 months of age; (10) whole cow's milk is required for children 12 to 24 months of age; and (11) no solid food is fed in a bottle.

RESULTS: The mean number of regulations for states was 2.8 (SD: 1.6) for centers and 2.0 (SD: 1.3) for family child care homes. No state had regulations for all 11 standards for centers; only Delaware had regulations for 10 of the 11 standards. For family child care homes, Ohio had regulations for 5 of the 11 standards, the most of any state. States in the South had the greatest mean number of regulations for centers (3.3) and family child care homes (2.2), and the West had the fewest (2.3 and 1.9, respectively).

CONCLUSIONS: Many states lacked infant feeding regulations. Encouraging states to meet best-practice national standards helps ensure that all child care facilities engage in appropriate and healthful infant feeding practices.
Estimation of Optimal CPR Chest Compression Depth in Children by Using Computer Tomography
Authors: Braga Matthew S. , Dominguez Troy E. , Pollock Avrum N. , Niles Dana , Meyer Andrew , Myklebust Helge , Nysaether Jon , Nadkarni Vinay
Published: June 2009

OBJECTIVE: Pediatric consensus-driven cardiopulmonary resuscitation guidelines target chest compression (CC) depths of one third to one half anterior-posterior (AP) chest depth. Estimates for this target as assessed by computed tomography (CT) measurements of internal and external AP chest dimensions could direct future pediatric cardiopulmonary resuscitation guidelines.

METHODS: A total of 280 consecutive chest CT scans in permuted blocks of 20 for each of 14 age divisions between 0 and 8 years were reconstructed and analyzed. External and internal AP depths were measured at midsternum, and residual chest depth was calculated at simulated one-third and one-half AP compressions.

RESULTS: After a simulated compression calculation, one-half external AP depth CC would result in residual internal depth of <10 mm for 94% (263 of 280) of children 3 months to 8 years. For a one-third external AP CC, only 0.4% (1 of 280) of children 3 months to 8 years had a calculated residual internal chest depth <10 mm.

CONCLUSIONS: By using CT reconstruction estimates of chest dimensions across the developmental spectrum from 0 to 8 years of age, we demonstrated that a simulated CC targeting approximately one-third external AP chest depth seems radiographically appropriate for children aged 3 months to 8 years, whereas simulated CC targeting approximately one-half external AP chest depth seems radiographically to be too deep, resulting in residual internal chest depth of <10 mm for most patients of this age.
Using Personal Health Records to Improve the Quality of Health Care for Children
Authors:   Council on Clinical Information Technology
Published: June 2009

This Policy Statement was retired August 2014.

A personal health record (PHR) is a repository of information from multiple contributors (eg, patient, family, guardians, physicians, and other health care professionals) regarding the health of an individual. The development of electronic PHRs presents new opportunities and challenges to the practice of pediatrics. This policy statement provides recommendations for actions that pediatricians can take to support the development and use of PHRs for children.

Pediatric health care professionals must become actively involved in developing and adopting PHRs and PHR systems. The American Academy of Pediatrics supports development of: educational programs for families and clinicians on effective and efficient use of PHRs;incentives to facilitate PHR use and maintenance; andchild- and adolescent-friendly standards for PHR content, portability, security, and privacy.

Properly designed PHR systems for pediatric care can empower patients. PHRs can improve access to health information, improve coordination of preventive health and health maintenance activities, and support emergency and disaster management activities. PHRs provide support for the medical home for all children, including those with special health care needs and those in foster care. PHRs can also provide information to serve as the basis for pediatric quality improvement efforts.

For PHRs to be adopted sufficiently to realize these benefits, we must determine how best to support their development and adoption. Privacy and security issues, especially with regard to children and adolescents, must be addressed.
Antenatal Counseling Regarding Resuscitation at an Extremely Low Gestational Age
Authors: Batton Daniel G. ,   Committee on Fetus and Newborn
Published: June 2009

The anticipated delivery of an extremely low gestational age infant raises difficult questions for all involved, including whether to initiate resuscitation after delivery. Each institution caring for women at risk of delivering extremely preterm infants should provide comprehensive and consistent guidelines for antenatal counseling. Parents should be provided the most accurate prognosis possible on the basis of all the factors known to affect outcome for a particular case. Although it is not feasible to have specific criteria for when the initiation of resuscitation should or should not be offered, the following general guidelines are suggested. If the physicians involved believe there is no chance for survival, resuscitation is not indicated and should not be initiated. When a good outcome is considered very unlikely, the parents should be given the choice of whether resuscitation should be initiated, and clinicians should respect their preference. Finally, if a good outcome is considered reasonably likely, clinicians should initiate resuscitation and, together with the parents, continually reevaluate whether intensive care should be continued. Whenever resuscitation is considered an option, a qualified individual, preferably a neonatologist, should be involved and should be present in the delivery room to manage this complex situation. Comfort care should be provided for all infants for whom resuscitation is not initiated or is not successful.
Expert Witness Participation in Civil and Criminal Proceedings
Authors:   Committee on Medical Liability and Risk Management
Published: June 2009

The interests of the public and both the medical and legal professions are best served when scientifically sound and unbiased expert witness testimony is readily available in civil and criminal proceedings. As members of the medical community, patient advocates, and private citizens, pediatricians have ethical and professional obligations to assist in the administration of justice. The American Academy of Pediatrics believes that the adoption of the recommendations outlined in this statement will improve the quality of medical expert witness testimony in legal proceedings and, thereby, increase the probability of achieving outcomes that are fair, honest, and equitable. Strategies for enforcing guidance and promoting oversight of expert witnesses are proposed.
Design of the Dubai Metro light rail viaducts—superstructure
Authors: Smith D. A. , Hewson N. R. , Hendy C. R.
Published: June 2009

The Dubai Metro light rail scheme is a flagship project in the United Arab Emirates. It is currently one of the largest civil engineering projects under construction and, when completed, it will be the longest fully automated rail system in the world. The first phase of the rail system is due to be opened in September 2009 and will include over 42 km of precast concrete viaduct. The majority of the viaduct utilises a slender precast segmental post-tensioned concrete U-shaped trough form for its construction, with a width of 10 m, a total depth of 2·04 m and span lengths up to 44 m. The slender deck slab and profiled edge beams result in both an economic and aesthetically pleasing structure which has been rapidly constructed while being suitable for the harsh environment of the Middle East. The wide U-shape of the deck is unusual for concrete bridges and presented a number of challenges, including complex three-dimensional and dynamic behaviour. This paper discusses the design and construction of the viaduct superstructure. It presents the structural arrangement and design of the precast segmental U-shaped trough deck, describing the challenges encountered in the detailed design phase of the project.
Maximum dynamic stress on bridges traversed by moving loads
Authors: Cantero D. , González A. , OBrien E. J.
Published: June 2009

Most current research on dynamic effects due to traffic load on simply supported bridges is focused on the mid-span section of the bridge because this location corresponds to the worst static bending moment. However, the maximum total moment allowing for dynamics may differ considerably from the maximum moment at mid-span. This paper shows how the maximum can occur in a section relatively far from mid-span with a significant difference in magnitude.
Maillart bridges: from structural concept to strengthening
Authors: Micelli F. , La Tegola A.
Published: June 2009

This paper presents an innovative strengthening concept for open-spandrel reinforced concrete deck-stiffened arch bridges, known as ‘Maillart bridges’ all over the world. The strengthening concept and design equations are presented for a real bridge of span length 60 m built in southern Italy in 1965. Theoretical concepts related to the mechanical behaviour of the bridge are presented using traditional structural analysis based on the influence line theory. This paper shows how such a method can easily highlight the parameters necessary to define a strengthening strategy that should preserve architectural aspects of a bridge. To meet the new load-bearing capacity derived from new traffic needs, the arch strength should be increased by 17% while the shear and flexural strength of the deck should be increased by 35%. The strengthening concept involves increasing the arch thickness by 5% by using fibre-reinforced concrete (which will also improve the durability of the structure), increasing the flexural strength of the deck with the use of unidirectional fibre reinforced polymer epoxy-bonded laminates and increasing the local shear strength of the deck with bidirectional epoxy-bonded sheets.
Quantification of Phytoestrogens in Industrial Waste Streams
Authors: Lundgren Mark S. , Novak Paige J.
Published: June 2009

Chemical compounds, including plant-based phytoestrogens, can function as hormone mimics and alter endocrine signaling in wildlife. In the present study, the waste streams from 19 plant-processing industries, including biofuel manufacturers, were sampled and analyzed for the phytoestrogens genistein, daidzein, coumestrol, formononetin, biochanin A, and zearalenone, via liquid chromatography/mass spectrometry. Eight of these industries contained phytoestrogens at environmentally relevant levels (≥1,000 ng/L), with the highest at approximately 250,000 ng/L. The influent and effluent streams of three municipal wastewater treatment plants receiving flow from some of these industries also were sampled and analyzed for the same phytoestrogens. It appeared that aerobic biological treatment, such as activated sludge, was able to remove these compounds from the liquid stream. Nevertheless, the effluent stream from one of the wastewater treatment plants had a phytoestrogen concentration above 1,000 ng/L. Results of the present study indicate the need for caution when designing facilities to treat the effluents from biofuel and other plant-processing industries.
Development of a Type 2 Diabetes Risk Model From a Panel of Serum Biomarkers From the Inter99 Cohort
Authors: Kolberg Janice A. , Jørgensen Torben , Gerwien Robert W. , Hamren Sarah , McKenna Michael P. , Moler Edward , Rowe Michael W. , Urdea Mickey S. , Xu Xiaomei M. , Hansen Torben , Pedersen Oluf , Borch-Johnsen Knut
Published: June 2009

OBJECTIVE

The purpose of this study was to develop a model for assessing the 5-year risk of developing type 2 diabetes from a panel of 64 circulating candidate biomarkers.

RESEARCH DESIGN AND METHODS

Subjects were selected from the Inter99 cohort, a longitudinal population-based study of ∼6,600 Danes in a nested case-control design with the primary outcome of 5-year conversion to type 2 diabetes. Nondiabetic subjects, aged ≥39 years, with BMI ≥25 kg/m2 at baseline were selected. Baseline fasting serum samples from 160 individuals who developed type 2 diabetes and from 472 who did not were tested. An ultrasensitive immunoassay was used to measure of 58 candidate biomarkers in multiple diabetes-associated pathways, along with six routine clinical variables. Statistical learning methods and permutation testing were used to select the most informative biomarkers. Risk model performance was estimated using a validated bootstrap bias-correction procedure.

RESULTS

A model using six biomarkers (adiponectin, C-reactive protein, ferritin, interleukin-2 receptor A, glucose, and insulin) was developed for assessing an individual's 5-year risk of developing type 2 diabetes. This model has a bootstrap-estimated area under the curve of 0.76, which is greater than that for A1C, fasting plasma glucose, fasting serum insulin, BMI, sex-adjusted waist circumference, a model using fasting glucose and insulin, and a noninvasive clinical model.

CONCLUSIONS

A model incorporating six circulating biomarkers provides an objective and quantitative estimate of the 5-year risk of developing type 2 diabetes, performs better than single risk indicators and a noninvasive clinical model, and provides better stratification than fasting plasma glucose alone.
Effect of Ingested Interferon-α on β-Cell Function in Children With New-Onset Type 1 Diabetes
Authors: Rother Kristina I. , Brown Rebecca J. , Morales Miriam M. , Wright Elizabeth , Duan Zhigang , Campbell Carol , Hardin Dana S. , Popovic Jadranka , McEvoy Robert C. , Harlan David M. , Orlander Philip R. , Brod Staley A.
Published: June 2009

OBJECTIVE

To evaluate the safety and efficacy of ingested human recombinant interferon-α (hrIFN-α) for preservation of β-cell function in young patients with recent-onset type 1 diabetes.

RESEARCH DESIGN AND METHODS

Subjects aged 3–25 years in whom type 1 diabetes was diagnosed within 6 weeks of enrollment were randomly assigned to receive ingested hrIFN-α at 5,000 or 30,000 units or placebo once daily for 1 year. The primary outcome was change in C-peptide secretion after a mixed meal.

RESULTS

Individuals in the placebo group (n = 30) lost 56 ± 29% of their C-peptide secretion from 0 to 12 months, expressed as area under the curve (AUC) in response to a mixed meal. In contrast, children treated with hrIFN-α lost 29 ± 54 and 48 ± 35% (for 5,000 [n = 27] and 30,000 units [n = 31], respectively, P = 0.028, ANOVA adjusted for age, baseline C-peptide AUC, and study site). Bonferroni post hoc analyses for placebo versus 5,000 units and placebo versus 30,000 units demonstrated that the overall trend was determined by the 5,000-unit treatment group. Adverse events occurred at similar rates in all treatment groups.

CONCLUSIONS

Ingested hrIFN-α was safe at the doses used. Patients in the 5,000-unit hrIFN-α treatment group maintained more β-cell function 1 year after study enrollment than individuals in the placebo group, whereas this effect was not observed in patients who received 30,000 units hrIFN-α. Further studies of low-dose ingested hrIFN-α in new-onset type 1 diabetes are needed to confirm this effect.
Hypoglycemia and Clinical Outcomes in Patients With Diabetes Hospitalized in the General Ward
Authors: Turchin Alexander , Matheny Michael E. , Shubina Maria , Scanlon James V. , Greenwood Bonnie , Pendergrass Merri L.
Published: June 2009

OBJECTIVE

Hypoglycemia is associated with adverse outcomes in mixed populations of patients in intensive care units. It is not known whether the same risks exist for diabetic patients who are less severely ill. In this study, we aimed to determine whether hypoglycemic episodes are associated with higher mortality in diabetic patients hospitalized in the general ward.

RESEARCH DESIGN AND METHODS

This retrospective cohort study analyzed 4,368 admissions of 2,582 patients with diabetes hospitalized in the general ward of a teaching hospital between January 2003 and August 2004. The associations between the number and severity of hypoglycemic (≤50 mg/dl) episodes and inpatient mortality, length of stay (LOS), and mortality within 1 year after discharge were evaluated.

RESULTS

Hypoglycemia was observed in 7.7% of admissions. In multivariable analysis, each additional day with hypoglycemia was associated with an increase of 85.3% in the odds of inpatient death (P = 0.009) and 65.8% (P = 0.0003) in the odds of death within 1 year from discharge. The odds of inpatient death also rose threefold for every 10 mg/dl decrease in the lowest blood glucose during hospitalization (P = 0.0058). LOS increased by 2.5 days for each day with hypoglycemia (P < 0.0001).

CONCLUSIONS

Hypoglycemia is common in diabetic patients hospitalized in the general ward. Patients with hypoglycemia have increased LOS and higher mortality both during and after admission. Measures should be undertaken to decrease the frequency of hypoglycemia in this high-risk patient population.
ATLANTIC DIP: Pregnancy Outcome for Women With Pregestational Diabetes Along the Irish Atlantic Seaboard
Authors: Dunne Fidelma P. , Avalos Gloria , Durkan Meave , Mitchell Yvonne , Gallacher Therese , Keenan Marita , Hogan Marie , Carmody Louise A. , Gaffney Geraldine ,   for the ATLANTIC DIP collaborators
Published: June 2009

OBJECTIVE

Prospective evaluation of pregnancy outcomes in pregestational diabetes along the Atlantic seaboard 2006–2007.

RESEARCH DESIGN AND METHODS

The Atlantic Diabetes in Pregnancy group, representing five antenatal centers in a wide geographical location, was established in 2005. All women with diabetes for >6 months before the index pregnancy were included. Results were collected electronically via the DIAMOND Diabetes Information System. Pregnancy outcome was compared with background rates.

RESULTS

There were 104 singleton pregnancies. The stillbirth rate (25/1,000) was 5 times, perinatal mortality rate (25/1,000) 3.5 times, and congenital malformation rate (24/1,000) 2 times that of the background population. A total of 28% of women received prepregnancy care, 43% received prepregnancy folic acid, and 51% achieved an A1C ≤7% at first antenatal visit.

CONCLUSIONS

Women are not well prepared for pregnancy, and outcomes are suboptimal. A regional prepregnancy care program and centralized glucose management are urgently needed.
Chemometrics as an option to assess clinical data from diabetes mellitus type 2 patients
Authors: Nikolov Marian , Simeonova Pavlina , Simeonov Vasil
Published: June 2009

The present study deals with the application of two major multivariate statistical approaches - Cluster Analysis (CA) and Principal Components Analysis (PCA) as an option for assessment of clinical data from diabetes mellitus type 2 patients. One hundred clinical cases of patients are considered as object of the statistical classification and modeling, each one of them characterized by 34 various clinical parameters. The goal of the study was to find patterns of similarity, both between the patients and the clinical tests. Each group of similarity is interpreted revealing at least five clusters of correlated parameters or five latent factors, which determine the data structure. Relevant explanation of the clustering is found based on the pattern of similarity like glucose level, anthropometric data, enzyme level, liver function, kidney function etc. It is assumed that this classification could be of help in optimizing the performance of clinical test for this type of patients and for designing a pattern for the role of the different groups of test in determining the metabolic syndrome of the patients.
No Escape from the Long-term Crisis? The Social Democrats' Failure to Devise a Promising Political Strategy
Authors: Egle Christoph
Published: June 2009

The result of the 2005 Bundestag election provoked difficult questions concerning the political positioning of the SPD. Should the Social Democrats negate the Schröder government's Agenda 2010 reforms in order to regain voters from the Left and envisage a government coalition with the Left Party, even though this party has been portrayed as "unfit to govern"? Or should the SPD stick to the center, at the risk of losing even more voters to its leftist competitor? Based on a theoretical concept of different party goals (vote, office, policy, and democracy-seeking) and strategic party behavior, this article explains why the SPD did not succeed in establishing a promising strategy with regard to these questions. This failure is caused mainly by the party's internal divisions and its severe leadership problems. In addition, the structure of German party competition and the institutions of federalism make it even more difficult to handle these problems with success.
Wald in der Freizeit- und Tourismusnutzung: Sehnsucht Natur oder Nachhaltigkeit? (Essay) | The forest for leisure activities and tourism: a yearning for nature or sustainable development? (essay)
Authors: Forster Stefan
Published: June 2009

As a background for recreation, the forest is gaining in importance – in particular in tourist resorts and in built-up areas. In our leisure time and during our holidays we increasingly flee from our hectic and nondescript everyday life to seek peace and relaxation in distinctive landscapes. Many people perceive the forest as synonymous with nature. The forest is a secret place full of ancient mysteries, which today still accompany and fascinate visitors. This transmuted view of the forest is an excellent example of people's estrangement from the natural world. The truth is that the forest is an «artificial» place, formed by man. The spirit of the epoch, ecological opinions, economical and political constraints put their stamp on the shape of the forest landscape and correspondingly on its management. This discrepancy leads to conflict between visitors and forest managers and leaves the concept of sustainable development wrecked on the grounds of mutual misunderstandings. A closer discussion between forestry specialists on the one hand, and those seeking relaxation or offering leisure and tourist activities on the other, is absolutely necessary. In particular the tourist industry, which uses and commercializes the forest landscape as idyllic scenery, should take on more responsibility for the implementation of a sustainable development.
Graubündens Wald im Fokus | Focus on the Grisons forest
Authors: Hefti Reto
Published: June 2009

In the mountainous canton Grisons, much visited by tourists, the forest has always had an important role to play. New challenges are now presenting themselves. The article goes more closely into two themes on the Grisons forestry agenda dominating in the next few years: the increased use of timber and climate change. With the increased demand for logs and the new sawmill in Domat/Ems new opportunities are offered to the canton for more intensive use of the raw material, wood. This depends on a reduction in production costs and a positive attitude of the population towards the greater use of wood. A series of measures from the Grisons Forestry Department should be of help here.

The risk of damage to infrastructure is particularly high in a mountainous canton. The cantonal government of the Grisons has commissioned the Forestry Department to define the situation concerning the possible consequences of global warming on natural hazards and to propose measures which may be taken. The setting up of extensive measurement and information systems, the elaboration of intervention maps, the estimation of the danger potential in exposed areas outside the building zone and the maintenance of existing protective constructions through the creation of a protective constructions register, all form part of the government programme for 2009 to 2012.

In the Grisons, forest owners and visitors will have to become accustomed to the fact that their forests must again produce more wood and that, on account of global warming, protective forests will become even more important than they already are today.
Klimaänderung und Naturgefahren in Graubünden | Climate change and natural hazards in the Grisons
Authors: Marty Christoph , Phillips Marcia , Lehning Michael , Wilhelm Christian , Bauder Andreas
Published: June 2009

On account of the current global warming, climate researchers warn of a possible increase in the frequency and magnitude of extreme weather conditions in the future. As an alpine canton, the Grisons are particularly exposed to such events. In the article, the effects of climatic change on large avalanches, floods, mud avalanches, landslides and rock falls are discussed, together with the thawing of permafrost and the melting of glaciers. In the case of large avalanches, thanks to present scientific knowledge and existing protective structures, a greater danger is not necessarily to be feared. However, where floods and mud avalanches are concerned, the situation is somewhat different: there is a greater likelihood of an increased frequency of more severe events in the future. In addition, the potentially endangered zones are larger and more difficult to protect. For such events, therefore, the potential for prevention and damage reduction is significantly higher. The future risk of rock falls and landslides is more difficult to predict. These are highly dependent on the local geology and the necessary understanding of the processes involved is still far from complete. Permafrost degradation and the disappearance of many small glaciers will create new sources of danger and hence increase yet again the risk of floods, mud avalanches and rock falls. The responsible authorities in Canton Grisons are aware of these hazards and lay emphasis on the documentation of events, the establishment of systems of measurement and of information, on warning systems and the application of damage reducing measures on site.
Thermodynamics of Surfactants, Block Copolymers and Their Mixtures in Water: The Role of the Isothermal Calorimetry
Authors: De Lisi Rosario , Milioto Stefania , Muratore Nicola
Published: June 2009

The thermodynamics of conventional surfactants, block copolymers and their mixtures in water was described to the light of the enthalpy function. The two methodologies, i.e. the van’t Hoff approach and the isothermal calorimetry, used to determine the enthalpy of micellization of pure surfactants and block copolymers were described. The van’t Hoff method was critically discussed. The aqueous copolymer+surfactant mixtures were analyzed by means of the isothermal titration calorimetry and the enthalpy of transfer of the copolymer from the water to the aqueous surfactant solutions. Thermodynamic models were presented to show the procedure to extract straightforward molecular insights from the bulk properties.
Co-localization of Carbonic Anhydrase and Phosphoenol-pyruvate Carboxylase and Localization of Pyruvate Kinase in Roots and Hypocotyls of Etiolated Glycine max Seedlings
Authors: Dimou Maria , Paunescu Anca , Aivalakis Georgios , Flemetakis Emmanouil , Katinakis Panagiotis
Published: June 2009

We investigated the presence of carbonic anhydrase in root and hypocotyl of etiolated soybean using enzymatic, histochemical, immunohistochemical and in situ hybridization approaches. In parallel, we used in situ hybridization and immunolocaliza-tion to determine the expression pattern and localization of phosphoenolpyruvate carboxylase. Their co-localization in the root tip as well as in the central cylinder, suggests that a large fraction of the CO2 may be re-introduced into C4 compounds. GmPK3 expression, coding for a cytoplasmic isoform of pyruvate kinase, was detected in all different root cell types, suggesting that both phosphoenolpyruvate-utilizing enzymes are involved in phosphoenolpyruvate metabolism in etiolated soybean roots; a case indicative of the necessary flexibility plant metabolism has to adopt in order to compensate various physiological conditions.
Heats of Mixing Using an Isothermal Titration Calorimeter: Associated Thermal Effects
Authors: Rodríguez de Rivera Manuel , Socorro Fabiola , Matos José  S.
Published: June 2009

The correct determination of the energy generated or absorbed in the sample cell of an Isothermal Titration Calorimeter (ITC) requires a thorough analysis of the calorimetric signal. This means the identification and quantification of any thermal effect inherent to the working method. In this work, it is carried out a review on several thermal effects, studied by us in previous work, and which appear when an ITC is used for measuring the heats of mixing of liquids in a continuous mode. These effects are due to: (i) the difference between the temperature of the injected liquid and the temperature of the mixture during the mixing process, (ii) the increase of the liquid volume located in the mixing cell and (iii) the stirring velocity. Besides, methods for the identification and quantification of the mentioned effects are suggested.
Preparation of 5-Bromo-2-naphthol: The Use of a Sulfonic Acid as a Protecting and Activating Group
Authors: Everett Renata , Hamilton Jillian , Abelt Christopher
Published: June 2009

The preparation of 5-bromo-2-naphthol (4) in three steps from 5-amino-2-naphthol (1) is described. A sulfonic acid group is introduced at the 1-position as an activating and protecting group for the Sandmeyer reaction. The sulfonate group allows for the use of only water and sulfuric acid as solvents. The sulfonic acid is introduced with three equivalents of sulfuric acid, and it is removed in 20% aq. sulfuric acid.
Charge Transport in Carbon Nanotubes-Polymer Composite Photovoltaic Cells
Authors: Ltaief Adnen , Bouazizi Abdelaziz , Davenas Joel
Published: June 2009

We investigate the dark and illuminated current density-voltage (J/V) characteristics of poly(2-methoxy-5-(2’-ethylhexyloxy)1-4-phenylenevinylene) (MEH-PPV)/single-walled carbon nanotubes (SWNTs) composite photovoltaic cells. Using an exponential band tail model, the conduction mechanism has been analysed for polymer only devices and composite devices, in terms of space charge limited current (SCLC) conduction mechanism, where we determine the power parameters and the threshold voltages. Elaborated devices for MEH-PPV:SWNTs (1:1) composites showed a photoresponse with an open-circuit voltage Voc of 0.4 V, a short-circuit current density JSC of 1 µA/cm² and a fill factor FF of 43%. We have modelised the organic photovoltaic devices with an equivalent circuit, where we calculated the series and shunt resistances.
Ethanolic Extract of Propolis (EEP) Enhances the Apoptosis- Inducing Potential of TRAIL in Cancer Cells
Authors: Szliszka Ewelina , Czuba Zenon P. , Domino Maciej , Mazur Bogdan , Zydowicz Grzegorz , Krol Wojciech
Published: June 2009

Ethanolic extract of propolis (EEP) is one of the richest sources of phenolic acids and flavonoids. EEP and its phenolic compounds have been known for various biological activities including immunopotentiation, chemopreventive and antitumor effects. Tumor necrosis factor related apoptosis inducing ligand (TRAIL) is a naturally occurring anticancer agent that preferentially induces apoptosis in cancer cells and is not toxic toward normal cells. We examined the cytotoxic and apoptotic effect of EEP and phenolic compounds identified in propolis in combination with TRAIL on HeLa cancer cells. HeLa cells were resistant to TRAIL-induced apoptosis. Our study demonstrated that EEP and its components significantly sensitize to TRAIL induced death in cancer cells. The percentage of the apoptotic cell after exposure to 50 μg/mL EEP and 100 ng/mL TRAIL increased to 71.10±1.16%. The strongest cytotoxic effect in combination with TRAIL on HeLa cells exhibited apigenin and CAPE at the concentration of 50 μM (58.87±0.75% and 49.59±0.39%, respectively). In this report, we show for the first time that EEP markedly augmented TRAIL mediated apoptosis in cancer cells and confirmed the importance of propolis in chemoprevention of malignant tumors.
Synthesis and Antitumor Evaluation of Novel Bis-Triaziquone Derivatives
Authors: Huang Cheng Hua , Kuo Hsien-Shou , Liu Jia-Wen , Lin Yuh-Ling
Published: June 2009

Aziridine-containing compounds have been of interest as anticancer agents since late 1970s. The design, synthesis and study of triaziquone (TZQ) analogues with the aim of obtaining compounds with enhanced efficacy and reduced toxicity are an ongoing research effort in our group. A series of bis-type TZQ derivatives has been prepared and their cytotoxic activities were investigated. The cytotoxicity of these bis-type TZQ derivatives were tested on three cancer lines, including breast cancer (BC-M1), oral cancer (OEC-M1), larynx epidermal cancer (Hep2) and one normal skin fibroblast (SF). Most of these synthetic derivatives displayed significant cytotoxic activities against human carcinoma cell lines, but weak activities against SF. Among tested analogues the bis-type TZQ derivative 1a showed lethal effects on larynx epidermal carcinoma cells (Hep2), with an LC50 value of 2.02 mM, and also weak cytotoxic activity against SF cells with an LC50 value over 10 mM for 24 hr treatment. Comparing the viability of normal fibroblast cells treated with compound 1a and TZQ, the LC50 value of the latter was 2.52 mM, indicating more toxicity than compound 1a. This significantly decreased cytotoxicity of compound 1a towards normal SF cells, while still maintaining the anticancer activity towards Hep2 cells is an interesting feature. Among the seven compounds synthesized, compound 1c has similar toxicity effects on the three cancer cell lines and SF normal cells as the TZQ monomer.
Effects of Maté Tea Intake on ex Vivo LDL Peroxidation Induced by Three Different Pathways
Authors: Matsumoto Ruth Lobato  T. , Mendonça Simone , Moura de Oliveira Daniela , Souza Marina F. , Markowicz Bastos Deborah H.
Published: June 2009

Yerba maté (Ilex paraguariensis) is a native South America plant widely consumed as different beverages. Yerba maté leaves contains high concentrations of polyphenols that are responsible for its high in vitro and in vivo antioxidant activity. The in vivo antioxidant properties vis a vis LDL particles has not yet been studied for maté tea, the roasted yerba maté product. The aim of this study was to evaluate the antioxidant activity of maté tea ingestion ex vivo on human LDL. Fasting peripheral venous blood samples of healthy women were taken in three different times: before drinking the tea, one hour later and after one week (7 days) of daily consumption of maté tea. The isolated LDL was oxidized by three different pathways [copper (CuSO4), lipoxygenase and peroxynitrite (SIN-1)]. Conjugated dienes and structural modifications on LDL were evaluated. Ingestion of maté tea increased LDL resistance towards ex vivo copper oxidation, but did not alter the peroxidation pattern when SIN-1 or lipoxygenase were used as oxidants