bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of acute heat stress on rat adrenal glands: a morphological and stereological study
Authors: Koko Vesna , Djordjeviæ Jelena , Cvijiæ Gordana , Davidoviæ Vukosava
Published: November 2004

The morphological and stereological structure of rat adrenal gland was analysed by light microscopy after an acute (60 min) exposure to high ambient temperature (38°C). A significant increase in plasma corticotrophin (ACTH)and serum corticosterone (CORT) concentrations was observed, confirming that acute heat exposure has a strong stressful effect. Under these conditions the adrenal gland mass and volume were decreased, probably as the consequence of adrenal cortex reduction, especially that of the zona fasciculata (ZF). Histological examination revealed that many ZF cells were deprived of lipid droplets. Fibrosis was observed in all parts of the adrenal gland, both cortex and medulla, of heat stressed animals. Mitotic figures were absent in cortical cells after heat exposure, but there were no differences in ZF and zona reticularis (ZR) small blood vessels compared to nonstressed controls.
Metabolic power of European starlingsSturnus vulgarisduring flight in a wind tunnel, estimated from heat transfer modelling, doubly labelled water and mask respirometry
Authors: Ward S. , Möller U. , Rayner J. M. V. , Jackson D. M. , Nachtigall W. , Speakman J. R.
Published: November 2004

It is technically demanding to measure the energetic cost of animal flight. Each of the previously available techniques has some disadvantage as well advantages. We compared measurements of the energetic cost of flight in a wind tunnel by four European starlings Sturnus vulgaris made using three independent techniques: heat transfer modelling, doubly labelled water (DLW)and mask respirometry. We based our heat transfer model on thermal images of the surface temperature of the birds and air flow past the body and wings calculated from wing beat kinematics. Metabolic power was not sensitive to uncertainty in the value of efficiency when estimated from heat transfer modelling. A change in the assumed value of whole animal efficiency from 0.19 to 0.07 (the range of estimates in previous studies) only altered metabolic power predicted from heat transfer modelling by 13%. The same change in the assumed value of efficiency would cause a 2.7-fold change in metabolic power if it were predicted from mechanical power. Metabolic power did not differ significantly between measurements made using the three techniques when we assumed an efficiency in the range 0.11–0.19, although the DLW results appeared to form a U-shaped power-speed curve while the heat transfer model and respirometry results increased linearly with speed. This is the first time that techniques for determining metabolic power have been compared using data from the same birds flying under the same conditions. Our data provide reassurance that all the techniques produce similar results and suggest that heat transfer modelling may be a useful method for estimating metabolic rate.
The relationship between wingbeat kinematics and vortex wake of a thrush nightingale
Authors: Rosén M. , Spedding G. R. , Hedenström A.
Published: November 2004

The wingbeat kinematics of a thrush nightingale Luscinia lusciniawere measured for steady flight in a wind tunnel over a range of flight speeds(5–10 m s–1), and the results are interpreted and discussed in the context of a detailed, previously published, wake analysis of the same bird. Neither the wingbeat frequency nor wingbeat amplitude change significantly over the investigated speed range and consequently dimensionless measures that compare timescales of flapping vs. timescales due to the mean flow vary in direct proportion to the mean flow itself, with no constant or slowly varying intervals. The only significant kinematic variations come from changes in the upstroke timing (downstroke fraction) and the upstroke wing folding (span ratio), consistent with the gradual variations, primarily in the upstroke wake, previously reported.

The relationship between measured wake geometry and wingbeat kinematics can be qualitatively explained by presumed self-induced convection and deformation of the wake between its initial formation and later measurement, and varies in a predictable way with flight speed. Although coarse details of the wake geometry accord well with the kinematic measurements, there is no simple explanation based on these observed kinematics alone that accounts for the measured asymmetries of circulation magnitude in starting and stopping vortex structures. More complex interactions between the wake and wings and/or body are implied.
A New Photocatalyst of RuO2-loaded PbWO4 for Overall Splitting of Water
Authors: Saito Nobuo , Kadowaki Haruhiko , Kobayashi Hisayoshi , Ikarashi Kouki , Nishiyama Hiroshi , Inoue Yasunobu
Published: November 2004

Lead tungstate, PbWO4, with a tetragonal structure was found to make a stable photocatalyst for the decomposition of water to produce H2 and O2 when combined with RuO2. This is the first example of tungsten oxide that is photocatalytically active for the reaction. The structural feature of PbWO4 is the presence of tetrahedral WO4. The DFT calculation showed that Pb2+ with d10s2 electronic configuration had significant influences on both valence and conduction band structures.
Electrospray Mass Spectrometry and Tandem Mass Spectrometry of the Natural Mixture of Cyclic Peptides from Linseed
Authors: Stefanowicz Piotr
Published: November 2004

The cyclic peptides from linseed are composed exclusively of the hydrophobic amino acids: Phe, Leu, Ile, Val, Met, Pro and Trp. Because these compounds do not contain functional groups which undergo protonation or deprotonation easily, their ionization in solvents usually used for peptide analysis is not efficient. A rapid and sensitive procedure for the detection and structure elucidation of the cyclic peptides based on ionization with Na+ and NH4+ ions is described. A cationization of methionine-containing peptides with methyl iodide has been described also. The extract of Linum utitatissimum seeds was analyzed directly using electrospray ionization mass spectrometry and neutral loss electrospray ionization tandem mass spectrometry techniques. The analysis confirms the presence of cyclolinopeptides reported previously: CLA [c(Pro–Pro–Phe–Phe–Leu–Ile–Ile–Leu–Val], and CLB [c(Pro–Pro–Phe–Phe–Val–Ile–Met–Ile–Leu)]. Cyclolinopeptides CLC, CLD, CLE and CLG, which contain methionine oxide, were detected in relatively small quantities. These peptides probably result from the oxidation of their precursors which were not reported: CLD′ [c(Pro–Phe–Phe–Trp–Ile–Met–Leu–Leu)], CLE′ [c(Pro–Leu–Phe–Ile–Met–Leu–Val–Phe)], CLF [c(Pro– Phe–Phe–Trp–Val–Met–Leu–Met)] and CLG [c(Pro–Phe–Phe–Trp–Ile–Met–Leu–Met)], present at higher concentrations in the extract protected from atmospheric oxygen. The sequences of the unreported cyclic peptides were proposed on the basis of collision-induced dissociation experiments and homology with peptides described by Morita1,2 and supported by the fragmentation of synthetic analogs of CLA of a known structure.
Electrospray Tandem Mass Spectrometry for Structural Characterization of Aporphine-Benzylisoquinoline Alkaloids
Authors: Wu Wu-Nan , Moyer Michael D.
Published: November 2004

Electrospray mass spectrometry and tandem mass spectrometry techniques were utilized to elucidate the structures of ten aporphine-benzylisoquinoline alkaloids, consisting of a monoether link between aporphine and benzyltetrahydroisoquinoline units, which were isolated and identified previously from a variety of Thalictrum sp. (Ranunculaceae family) based mainly on the ultraviolet, infrared, circular dichroism, nuclear magnetic resonance, electron ionization mass spectrometry (EI-MS), chemical ionization mass spectrometry (CI-MS), derivatization and chemical degradation techniques. In this investigation, protonated molecules, [M + H]+ ions, for nine tertiary alkaloids, a molecular ion, [M+•] ion, for a quaternary alkaloid and very intense doubly-protonated molecules, [M + 2H]2+ ions (100% of relative abundance) in Q1 Scan MS spectra, and prominent, as well as diagnostic, product ions for structural information in the tandem mass spectra were observed for all investigated alkaloids each in nanogram quantities. More than 10 μg quantities of each investigated alkaloid or other isoquinoline and aporphine analogs were needed for the CI-MS, EI-MS and fast atom bombardment mass spectrometric analysis from the previous studies.
Models of Fragmentations Induced by Electron Attachment to Protonated Peptides
Authors: Bakken Vebjørn , Helgaker Trygve , Uggerud Einar
Published: November 2004

Invoking a number of theoretical levels ranging from HF/STO-3G to CCSD(T)/aug-cc-pVQZ, we have made a detailed survey of six potential energy surfaces (NH4+, NH4•, [CH3CONHCH3]H+, [CH3CONHCH3]H•, [HCONHCH2CONH2]H+ and [HCONHCH2CONH2]H•). In conjunction with this, ab inito direct dynamics calculations have been conducted, tracing out several hundred reaction trajectories to reveal details of the electron-capture dissociation mechanism. The model calculations suggest the possibility of a bimodal pattern where some of the radicals, formed upon recombination, dissociate almost directly within one picosecond, the remaining radicals being subject to complete energy redistribution with a subsequent dissociation occurring at the microsecond timescale. Both processes give rise to c and z backbone fragments, resulting from cleavage of N?Cα bonds of the peptide chain.
Determination of Rare Earth Impurities in High Purity Europium Oxide by Inductively Coupled Plasma-Mass Spectrometry and Evaluation of Concentration Values for Europium Oxide Standard Material
Authors: Zhang Anding , Liu Xiangsheng , Zhang Wen
Published: November 2004

Direct determinations of 13 rare earth elements (La, Ce, Pr, Nd, Sm, Gd, Tb, Dy, Ho, Er, Yb, Lu and Y) in high purity europium oxide by inductively coupled plasma mass spectrometry (ICP-MS) have been reported. The operating parameters of the instrument were optimized and the spectral interferences and the matrix effects were investigated. Using Ga or Rh as the internal standard can eliminate most of the matrix effects. The detection limits (3 σ, n = 10, integral time = 1s) are 0.013–0.085 ng mL−1 and the reproducibility ( n = 11) is 0.9–3%. The recoveries of spiking samples are 80–108%. Europium oxide standard material was made and its concentration values were evaluated by various techniques from 10 collaborating laboratories. By comparison of the results of ICP-MS with the results of other techniques, we have validated that ICP-MS is an accurate and reliable technique for analysis of ultratrace impurities in high purity rare earth matrix.
Determination of Phenylalanine Isotope Ratio Enrichment by Liquid Chromatography/Time-of-Flight Mass Spectrometry
Authors: Wu Zhanpin , Zhang Xiao-Jun , Cody Robert B. , Wolfe Robert R.
Published: November 2004

The application of time-of-flight mass spectrometry to isotope ratio measurements has been limited by the relatively low dynamic range of the time-to-digital converter detectors available on commercial liquid chromatography/time-of-flight mass spectrometry (LC/ToF-MS) systems. Here, we report the measurement of phenylalanine isotope ratio enrichment by using a new LC/ToF-MS system with wide dynamic range. Underivatized phenylalanine was injected onto a C18 column directly with 0.1% formic acid/acetonitrile as the mobile phase. The optimal instrument parameters for the time-of-flight mass spectrometer were determined by tuning the instrument with a phenylalanine standard. The accuracy of the isotope enrichment measurement was determined by the injection of standard solutions with known isotope ratios ranging from 0.02% to 9.2%. A plot of the results against the theoretical values gave a linear curve with R2 of 0.9999. The coefficient of variation for the isotope ratio measurement was below 2%. The method is simple, rapid and accurate and presents an attractive alternative to traditional gas chromatography/mass spectrometry applications.
Changes in Phospholipid Composition within the Dystrophic Muscle by Matrix-Assisted Laser Desorption/Ionization Mass Spectrometry and Mass Spectrometry Imaging
Authors: Touboul David , Piednoël Hélène , Voisin Vincent , De La Porte Sabine , Brunelle Alain , Halgand Frédéric , Laprévote Olivier
Published: November 2004

Duchenne muscular dystrophy (DMD) is a neuromuscular disease linked to the lack of dystrophin, a submembrane protein, leading to muscle weakness and associated with a defect of the lipid metabolism. A study of the fatty acid composition of glycerophos-phatidylcholines by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-ToF-MS) and tandem mass spectrometry (MS/MS) enabled us to characterize a change in the lipid composition of dystrophic cells at the time of the differentiation. This modification has been used as a marker to identify with profiling and imaging MALDI-ToF MS regenerating areas in sections of an mdx mouse leg muscle. It is the first time that such a slight change in fatty acid composition has been observed directly on tissue slices using mass spectrometry. This approach will be useful in monitoring the treatment of muscular regeneration.
Characterization of the O-4 Phosphorylated and O-5 Substituted Kdo Reducing End Group and Sequencing of the Core Oligosaccharide of Aeromonas Salmonicida ssp Salmonicida Lipopolysaccharide Using Tandem Mass Spectrometry
Authors: Banoub Joseph , Aneed Anas El , Cohen Alejandro , Martin Patrick
Published: November 2004

The molecular structure of the wild strain of the lipopolysaccharide (LPS) core of Aeromonas salmonicida, ssp salmonicida has been sequenced using tandem mass spectrometry. The core oligosaccharide was determined to contain an O-4 phosphorylated and O-5 substituted Kdo reducing group and its structure is proposed as follows:

[Formula: see text]

After the core oligosaccharide of LPS was released from the lipid A portion by conventional treatment with 1 % acetic acid, we demonstrated the existence of a homogeneous mixture composed mainly of the native core oligosaccharide containing the Kdo with its O-4 phosphate group intact and a degraded core oligosaccharide mixture which eliminated the O-4 phosphate group with extreme ease. The precise molecular structure and glycone sequence of the homogeneous mixture of phosphorylated and dephosphorylated core oligosaccharides was determined by electrospray ionization mass spectrometry and tandem mass spectrometric (MS/MS) analysis. Collision-induced dissociation MS/MS of the homogeneous mixture of permethylated core oligosaccharides afforded a series of diagnostic product ions which confirmed the established sequence of the glycones to be determined. Matrix-assisted laser desorption/ionization MS/MS reconfirmed the molecular structure of the dephosphorylated homogeneous permethylated mixture of the core oligosaccharides containing the diastereomeric 4,8- and 4,7-anhydro-α-keto acids.
Chiral Discrimination on the Host–Guest Complexation of Resorc[4]arenes with Quarternary Amines
Authors: Mehdizadeh Ahmad , Letzel Matthias C. , Klaes Michael , Agena Ceno , Mattay Jochen
Published: November 2004

The interaction of inherently chiral resorc[4]arenes with different chiral ammonium ions was measured by electrospray ionization mass spectrometry. For this purpose, one enantiomer of the ammonium guests was labeled with deuterium to distinguish the enantiomers by their mass. We synthesized the ammonium salts by the reaction of chiral primary amines with either CH3I or CD3I and analyzed the resulting ammonium iodides by nuclear magnetic resonance and optical rotation. The complexation experiments were performed by mixing the chiral host with various ratios of the unlabeled guest and its labeled enantiomer. By analyzing the integrals of the host–guest complexes, we observed a chiral discrimination effect and a secondary isotope effect as well.
Electrospray Mass Spectrometry of a Series of Mixed Nitrido 99gTc-Heterocomplexes Conjugated with Bio-Active Molecules
Authors: Tubaro Michela , Marotta Ester , Tisato Francesco , Bolzati Cristina , Porchia Marina , Refosco Fiorenzo , Tomasin Patrizia , Cavazza-Ceccatoc Mario , Traldia Pietro
Published: November 2004

Electrospray ionization mass spectrometry (ESI-MS) was successfully employed for the identification of six nitrido technetium mixed ligand complexes with a general formula of [99gTc(N)(O,S-BID)(PNP)], where PNP represents a heterodiphosphine and O,S-BID represents a simple dianionic bidentate ligand (compounds 1–3) or a more sophisticated N-substituted O,S-cysteine framework conjugated with a bio-active molecule (BAM) (compounds 4–6). In spite of similar coordination spheres exhibited by all the complexes investigated, simple co-ordination compounds 1–3 displayed collisionally-induced fragmentation processes (MSn) different from those observed in biomolecule-containing compounds 4–6. In the latter, more decomposition channels were observed. This behavior is likely to be associated with some additional intramolecular contacts of the biomolecule (or part of the biomolecule) with pendant group(s) incorporated in the PNP-co-ligand. This view is further supported by the observations arising from both in vitro binding affinity experiments and nuclear magnetic resonance investigations. The presence of cationized forms for all compounds 1–6 and the practical lack of the [2M + Na]+ species for biomolecule-containing compounds 4–6 provided further evidence of a subtly different structural conformation.
Response of Homocysteine, Cystathionine, and Methylmalonic Acid to Vitamin Treatment in Dialysis Patients
Authors: Obeid Rima , Kuhlmann Martin K , Köhler Hans , Herrmann Wolfgang
Published: November 2004

Background: Hyperhomocysteinemia is observed in >80% of hemodialysis patients and is considered a risk factor for cardiovascular disease. Vitamin treatment lowers total homocysteine (tHcy) concentrations in plasma and may therefore reduce the associated risk. Current treatment strategies have not achieved normalization of tHcy in the majority of dialysis patients.

Methods: We administered folic acid (5 mg) plus vitamin B6 (50 mg) and B12 (0.7 mg) intravenously to 38 hyperhomocysteinemic patients (tHcy >18 μmol/L) after each dialysis treatment. The treatment phase lasted 1 month, and serum concentrations of tHcy, methylmalonic acid (MMA), and cystathionine were measured at weeks 0, 2, 4, 6, 8, and 24.

Results: The median serum tHcy concentration decreased significantly, from 26.1 μmol/L at baseline to 13.2 μmol/L at week 4. The median change in tHcy after 4 weeks was 13.4 μmol/L (−51%) compared with baseline. Serum MMA and cystathionine concentrations were reduced by 28% and 26%, respectively, but neither was normalized at 4 weeks. Backward-elimination stepwise regression analysis revealed that higher concentrations of tHcy, MMA, and cystathionine and lower folate at baseline predict changes of tHcy after treatment. Twenty weeks after vitamin withdrawal, tHcy concentrations returned to values comparable to baseline (median, 24.8 μmol/L).

Conclusions: The combination of folic acid, vitamin B12, and vitamin B6 used in this study normalized serum concentrations of tHcy in almost all of our hyperhomocysteinemic dialysis patients. This regimen may be used to investigate the effects of homocysteine normalization on cardiovascular outcomes in hemodialysis patients.
Nonadherence With Pediatric Human Immunodeficiency Virus Therapy as Medical Neglect
Authors: Roberts Gretchen M. , Wheeler J. Gary , Tucker Nancy C. , Hackler Chris , Young Karen , Maples Holly D. , Darville Toni
Published: November 2004

Objective. To examine the results of an interventionist approach applied to human immunodeficiency virus (HIV)-infected children for whom caregiver nonadherence was suspected as the cause of treatment failure.

Methods. The medical records of a cohort of 16 perinatally HIV-infected children whose care was managed at the Arkansas Children’s Hospital Pediatric HIV Clinic for an uninterrupted period of ≥3 years were reviewed through July 2003. Data collected included date of birth, dates of and explanations for clinic visits and hospitalizations, dates of laboratory evaluations, CD4+ T cell percentages, plasma HIV-1 RNA levels, antiretroviral medications, viral resistance tests (eg, phenotype and genotype), and physician-initiated interventions to enhance adherence to the medication regimen. A stepwise interventionist approach was undertaken when patients continued to demonstrate high viral loads, despite documented viral sensitivity to the medication regimen and caregivers’ insistence that medications were being administered regularly. Step 1 was prescribing a home health nurse referral, step 2 was administering directly observed therapy (DOT) while the patient was hospitalized for 4 days, and step 3 was submitting a physician-initiated medical neglect report to the Arkansas Department of Human Services.

Results. The results for 6 patients for whom this stepwise approach was initiated are reported. Home health nurse referrals failed to result in sustained improvements in adherence in all 6 cases. Viral load assays performed before and after DOT provided an objective measure of the effect of adherence, with 12 hospitalizations resulting in a mean ± SD decrease in HIV RNA levels of 1.09 ± 0.5 log10 copies per mL, with a range of 0.6 to 2.1 log10 copies per mL. Four families responded to DOT hospitalization, and sustained decreases in the respective patients’ viral loads were noted. In 2 cases, medical neglect reports were submitted when DOT did not result in improved adherence. These patients were eventually placed in foster care, with subsequent improvements in their viral loads and CD4+ T cell percentages.

Conclusions. Nonadherence with antiretroviral therapy can be established on the basis of persistently elevated HIV RNA levels that decrease with DOT. Nonadherence poses a danger to the child that is grave and potentially irreversible. Caregivers should be offered all available resources to help them adhere to a sound treatment plan. In cases of demonstrated inability to provide needed care, it is necessary to consider seeking child protection, even for apparently healthy children.
Low-Normal Gestational Age as a Predictor of Asthma at 6 Years of Age
Authors: Raby Benjamin A. , Celedón Juan C. , Litonjua Augusto A. , Phipatanakul Wanda , Sredl Diane , Oken Emily , Ryan Louise , Weiss Scott T. , Gold Diane R.
Published: November 2004

Background. Perinatal factors, including gestational age and birth weight, influence the development of atopy in early life. However, the role of these factors in the development of asthma in later life among children who do not develop perinatal respiratory disease remains unclear.

Methods. Four hundred fifty-four infants who had a history of allergy or asthma in at least 1 parent, were born in the 36th week of gestation or later, and did not develop perinatal respiratory distress were monitored for at least 6 years. Associations between predictor variables and asthma and wheeze were assessed with multivariate logistic regression and repeated-event analyses.

Results. Although we previously observed a relationship between low birth weight and persistent wheeze in the first 1 year of life, we did not observe similar associations between low birth weight and asthma at 6 years of age (odds ratio [OR]: 1.05; 95% confidence interval [CI]: 0.40–2.73). However, a strong relationship was found between low-normal gestational age and asthma at 6 years of age (OR: 4.7; 95% CI: 2.1–10.5). The effects of low-normal gestational age were significantly greater among boys than among girls (boys: OR: 8.15; 95% CI: 2.98–22.3; girls: OR: 1.90; 95% CI: 0.38–13.83). Longitudinal analysis of the relationship between gestational age and wheeze during the 6 years of observation confirmed these gender differences.

Conclusions. Among children at high risk of developing atopic disease, late prematurity might be an important additional determinant of asthma later in life, and these effects are gender specific.
Healthy Steps: A Case Study of Innovation in Pediatric Practice
Authors: Zuckerman Barry , Parker Steven , Kaplan-Sanoff Margot , Augustyn Marilyn , Barth Michael C.
Published: November 2004

Healthy Steps (HS) represents a significant innovation in the way pediatric primary care can be delivered. Based on the standards and principles of Bright Futures and the American Academy of Pediatrics Health Supervision Guidelines, HS enhances and expands traditional pediatric care by including a child development specialist (Healthy Steps specialist) as part of the pediatric practice team. Services offered by this person, typically a nurse, early childhood educator, or social worker, include more time to spend discussing preventive issues during well-child visits, home visits, a telephone information line exclusively addressing developmental and behavioral concerns, new written materials, and more seamless linkages to community resources and parent support groups.

The original HS cohort consisted of 15 pediatric practices in a variety of settings (private practices, health centers, pediatric training programs). Evaluated for the effects of HS on their family were 3737 intervention and comparison families. HS families received significantly more preventive and developmental services, compared to families in the control group. HS families were also less likely to be dissatisfied with their pediatric primary care. Additionally, HS had a positive impact on parenting in many areas including adherence to health visits, nutritional practices, developmental stimulation, appropriate disciplinary techniques, and correct sleeping position. Other outcome measures (such as initiation or duration of breastfeeding, child development knowledge, sense of competence, and reports of child language development at 2 years of age) did not differ between intervention and comparison group.

Compared to other early childhood intervention efforts, HS offers a comparable positive impact on parenting at a relatively inexpensive cost: an estimated $400 per family per year (compared to $4500 from Early Head Start). Approximately 3 years after the evaluation of HS ended, 10 of the original 24 sites are still in operation, and an additional 24 sites have started up. Although funding and reimbursement remain an important barrier, continued growth of HS suggests an abiding interest in this approach to expand and enhance preventive and developmental care in pediatric primary care.
A Population-Based Comparison of Clinical and Outcome Characteristics of Young Children With Serious Inflicted and Noninflicted Traumatic Brain Injury
Authors: Keenan Heather T. , Runyan Desmond K. , Marshall Stephen W. , Nocera Mary Alice , Merten David F.
Published: November 2004

Objective. Diagnosing inflicted traumatic brain injury (TBI) in young children is difficult in practice. Comparisons of children with inflicted and noninflicted TBI may help to identify markers of inflicted TBI. The objective of this study was to compare inflicted and noninflicted TBI in terms of presenting complaints, clinical features, and hospital outcomes.

Methods. The presenting complaint, clinical finding, hospital course, and outcome of all children who were aged 2 years or younger in North Carolina and were admitted to a pediatric intensive care unit or died with a TBI in 2000 and 2001 were reviewed. Clinical presentation and injury types were compared between children with inflicted and noninflicted TBI. Risk ratios were used to compare clinical and outcome characteristics between the 2 groups. Among survivors, multivariate binomial regression was used to examine the adjusted risk of a poor outcome dependent on injury type.

Results. A total of 80 (52.6%) children had inflicted and 72 (47.3%) children had noninflicted TBI. Children with noninflicted TBI (not in a motor vehicle crash) were more likely to present to the emergency department asymptomatic (44.8% vs 8.3%) and to have a specific history of trauma than children with inflicted TBI. Retinal hemorrhage, metaphyseal fracture, rib fracture, and subdural hemorrhage were more commonly found in children with inflicted compared with noninflicted TBI. Skeletal survey and ophthalmologic examination combined would have missed 8 (10.0%) inflicted TBI cases.

Conclusions. Manner of presentation and injury types are helpful in distinguishing inflicted TBI. Clinicians should not rule out inflicted TBI on the basis of skeletal survey and ophthalmoscopy alone but should proceed to computed tomography and/or magnetic resonance imaging.
Maternal and Infant Factors Associated With Excess Kindergarten Costs
Authors: Roth Jeffrey , Figlio David N. , Chen Yuwen , Ariet Mario , Carter Randolph L. , Resnick Michael B. , Morse Steven B.
Published: November 2004

Objective. To estimate the excess educational costs at kindergarten from infant and maternal factors that are reported routinely at birth.

Methods. Birth and school records were analyzed for all children who were born in Florida between September 1, 1990, and August 31, 1991, and entered kindergarten from 1996 through 1999 (N = 120 554). Outcome measure was cost to state, derived from base allocation for students in regular classrooms plus multiplier weights for those who were assigned to 8 mutually exclusive special education categories or who repeated kindergarten.

Results. More than one quarter of the study cohort was found to be assigned to special education classes at kindergarten. Regression model estimates indicated that children who were born at <1000 g (n = 380) generated 71% higher costs in kindergarten than children who were born at ≥2500 g. Children who were born at 1000 to 1499 g (n = 839) generated 49% higher costs. Other birth conditions, independent of birth weight, were associated with higher kindergarten costs: family poverty (31%), congenital anomalies (29%), maternal education less than high school (20%), and no prenatal care (14%). Because of their prevalence, family poverty and low maternal education accounted for >75% of excess kindergarten costs. If 9% of infants who weighed between 1500 and 2499 g (n = 1027) could be delivered at 2500 g, then the state of Florida potentially could save $1 million in kindergarten costs. Savings of a similar magnitude might be achieved if 3% of mothers who left school without a diploma (n = 1528) were to graduate.

Conclusions. Any policy recommendation aimed at reducing education costs in kindergarten must take into consideration 3 factors: the prevalence of risk conditions whose amelioration is desired, the potential cost savings associated with reducing those conditions, and the costs of amelioration. Projecting these costs from information that is available at birth can assist school districts and state agencies in allocating resources.
Long-Term Pulmonary Sequelae in Children Who Were Treated With Extracorporeal Membrane Oxygenation for Neonatal Respiratory Failure
Authors: Hamutcu Refika , Nield Toni A. , Garg Meena , Keens Thomas G. , Platzker Arnold C.G.
Published: November 2004

Objective. Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy for neonates with intractable respiratory failure, but the long-term pulmonary outcome is unknown. Our aim was to investigate the long-term pulmonary sequelae of these children.

Study Design. We studied 50 children at 11.1 ± 1.1 years (mean ± SD) who had been treated with neonatal ECMO for meconium aspiration syndrome (38%), sepsis (18%), sepsis with pneumonia (12%), congenital diaphragmatic hernia (12%), congenital heart disease (8%), persistent pulmonary hypertension of the newborn (6%), and respiratory distress syndrome (4%) and 27 healthy controls (10.8 ± 1.6 years). All subjects completed a respiratory questionnaire and performed pulmonary function and graded cardiopulmonary exercise testing.

Results. Neonatal ECMO survivors had hyperinflation (median residual volume: 131%), airway obstruction (median forced expired volume in 1 second: 79%), lower oxygen saturation with exercise, and lower peak oxygen consumption than controls. The ECMO group achieved similar exercise minute ventilation to controls, with more rapid and shallow breathing. ECMO survivors had an increased frequency of exercise-induced bronchospasm. Those who required higher inspired oxygen tension and ventilator pressures after weaning from ECMO had lower forced expired volume in 1 second and oxygen saturation values.

Conclusion. Neonatal ECMO survivors experience lung injury lasting into later childhood. Lung dysfunction correlates with the extent and duration of barotrauma and oxygen exposure as neonates.
Physical Activity Among Children Attending Preschools
Authors: Pate Russell R. , Pfeiffer Karin A. , Trost Stewart G. , Ziegler Paula , Dowda Marsha
Published: November 2004

Objectives. Obesity rates are increasing among children of all ages, and reduced physical activity is a likely contributor to this trend. Little is known about the physical activity behavior of preschool-aged children or about the influence of preschool attendance on physical activity. The purpose of this study was to describe the physical activity levels of children while they attend preschools, to identify the demographic factors that might be associated with physical activity among those children, and to determine the extent to which children's physical activity varies among preschools.

Methods. A total of 281 children from 9 preschools wore an Actigraph (Fort Walton Beach, FL) accelerometer for an average of 4.4 hours per day for an average of 6.6 days. Each child's height and weight were measured, and parents of participating children provided demographic and education data.

Results. The preschool that a child attended was a significant predictor of vigorous physical activity (VPA) and moderate-to-vigorous physical activity (MVPA). Boys participated in significantly more MVPA and VPA than did girls, and black children participated in more VPA than did white children. Age was not a significant predictor of MVPA or VPA.

Conclusions. Children's physical activity levels were highly variable among preschools, which suggests that preschool policies and practices have an important influence on the overall activity levels of the children the preschools serve.
Use of Incident Reports by Physicians and Nurses to Document Medical Errors in Pediatric Patients
Authors: Taylor James A. , Brownstein Dena , Christakis Dimitri A. , Blackburn Susan , Strandjord Thomas P. , Klein Eileen J. , Shafii Jaleh
Published: November 2004

Objectives. To describe the proportion and types of medical errors that are stated to be reported via incident report systems by physicians and nurses who care for pediatric patients and to determine attitudes about potential interventions for increasing error reports.

Methods. A survey on use of incident reports to document medical errors was sent to a random sample of 200 physicians and nurses at a large children's hospital. Items on the survey included proportion of medical errors that were reported, reasons for underreporting medical errors, and attitudes about potential interventions for increasing error reports. In addition, the survey contained scenarios about hypothetical medical errors; the physicians and nurses were asked how likely they were to report each of the events described. Differences in use of incident reports for documenting medical errors between nurses and physicians were assessed with χ2 tests. Logistic regression was used to determine the association between health care profession type and likelihood of reporting medical errors.

Results. A total of 140 surveys were returned, including 74 from physicians and 66 by nurses. Overall, 34.8% of respondents indicated that they had reported <20% of their perceived medical errors in the previous 12 months, and 32.6% had reported <40% of perceived errors committed by colleagues. After controlling for potentially confounding variables, nurses were significantly more likely to report ≥80% of their own medical errors than physicians (odds ratio: 2.8; 95% confidence interval: 1.3–6.0). Commonly listed reasons for underreporting included lack of certainty about what is considered an error (indicated by 40.7% of respondents) and concerns about implicating others (37%). Potential interventions that would lead to increased reporting included education about which errors should be reported (listed by 65.4% of respondents), feedback on a regular basis about the errors reported (63.8%) and about individual events (51.2%), evidence of system changes because of reports of errors (55.4%), and an electronic format for reports (44.9%). Although virtually all respondents would likely report a 10-fold overdose of morphine leading to respiratory depression in a child, only 31.7% would report an event in which a supply of breast milk is inadvertently connected to a venous catheter but is discovered before any breast milk goes into the catheter.

Conclusions. Medical errors in pediatric patients are significantly underreported in incident report systems, particularly by physicians. Some types of errors are less likely to be reported than others. Information in incident reports is not a representative sample of errors committed in a children's hospital. Specific changes in the incident report system could lead to more reporting by physicians and nurses who care for pediatric patients.
Height and Social Adjustment: Are Extremes a Cause for Concern and Action?
Authors: Sandberg David E. , Bukowski William M. , Fung Caroline M. , Noll Robert B.
Published: November 2004

Objective. Growth hormone treatment of hormone-sufficient short youths is predicated on the belief that short stature is associated with social problems with peers. This study assessed peer relations and social adjustment as a function of height in a community sample.

Methods. A cross-sectional study was conducted at 1 public school district in Western New York of students of both genders who attended grades 6 to 12 (N = 956). Target groups included participants of short stature (height ≤−1.6 standard deviation, ie, ≤5th percentile for age- and gender-adjusted population norms; n = 68) and tall stature (≥1.6 standard deviation; ≥95th percentile; n = 58) and classmates of average height (between the 25th and 75th percentiles; n = 123) used for within-class comparisons. All remaining unclassified classmates (n = 704) also provided data. Self- and peer-rated assessment of social reputation and social acceptance was measured.

Results. Minimal effects of height on measures of social functioning were detected despite substantial statistical power. We detected no significant relationships between height and measures of friendship, popularity, or reputation with peers. Findings did not vary by gender of participant, by peer- or self-report, or by whether data from the entire sample were used or target groups were contrasted with comparison participants. Shorter students were perceived by peers to be younger than their age. This influence was restricted to lower grades and did not have an impact on measures of social acceptance or reputation with peers.

Conclusions. Extremes of stature in the general population—either short or tall—have minimal detectable impact on peer perceptions of social behavior, friendship, or acceptance. Findings are not supportive of the need to intervene a priori because of the potential risk of negative stature-related social sequelae. Furthermore, if problems with peer relationships are identified among short or tall youths, then factors other than stature should be considered as etiologically important.
Essential Tremor Among Children
Authors: Jankovic Joseph , Madisetty Jaswanth , Dat Vuong Kevin
Published: November 2004

Objective. To characterize the clinical and therapeutic aspects of essential tremor (ET) among children.

Background. ET, an autosomal dominant disorder, has been studied extensively among adults, but little is known regarding its occurrence, clinical characteristics, treatment, and prognosis in pediatric populations. Often stigmatized as a disorder of the elderly, ET may be misdiagnosed among children. Previous studies of childhood-onset ET were limited by small sample sizes.

Methods. Clinical data, including gender, age at onset, family history, associated disorders, and response to treatment, were collected for consecutive patients diagnosed with childhood-onset ET at the Movement Disorders Clinic at Baylor College of Medicine.

Results. Of the 39 patients with ET, 29 (74.4%) were male. The mean age at onset was 8.8 ± 5.0 years, and the mean age at evaluation was 20.3 ± 14.4 years. A family history of tremor was noted for 79.5% of the patients. Eighteen (46.2%) had some neurologic comorbidity, such as dystonia, which was noted for 11 patients (28.2%). Only 24 of the patients (61.5%) were treated with a specific antitremor medication; 5 of the 12 patients treated with propranolol experienced improvement.

Conclusions. Concomitant movement disorders, such as dystonia, are common among patients with childhood-onset ET, which supports the concept that ET is a heterogeneous disorder. Treatment strategies used for adult patients with ET seem to be effective also for children with ET, although controlled therapeutic trials in this population of patients with ET are lacking.
Computer-Aided Anthropometry in the Evaluation of Dysmorphic Children
Authors: Zankl Andreas
Published: November 2004

Objective. Although anthropometry is widely regarded as the technique of choice for the evaluation of dysmorphic features among children, it is only rarely used in clinical practice. Possible reasons for this are the limited access of pediatricians to appropriate reference values and the time-consuming way measurements must be plotted onto growth charts. This article describes a computer program that overcomes these problems and greatly facilitates the use of anthropometric measurements in pediatric medicine.

Design. A computer program for PalmOS-based, handheld computers that compares entered anthropometric measurements with age- and gender-matched reference values was developed. The software is distributed free of charge and can be downloaded (www.medgen.unizh.ch/abase/).

Results. The ABase software contains age- and gender-matched reference values for 18 anthropometric measures frequently used for the evaluation of dysmorphic children. The proband's age is automatically calculated from the entered birth date and can be corrected for prematurity. Entered measurements are compared with the internal reference values; the results are displayed as percentile ranks or z scores and are plotted on digital growth charts.

Conclusions. The presented software makes anthropometric reference values easily accessible on the ward or in the clinic and greatly reduces the time needed to plot the measurements onto growth charts. This should promote more widespread use of anthropometry in pediatric medicine.
Temporary Removal of Navel Piercing Jewelry for Surgery and Imaging Studies
Authors: Muensterer Oliver J.
Published: November 2004

Background. Navel piercings are becoming increasingly popular among adolescents. Body piercing jewelry must be removed before surgery, because electrical burns can occur with electrocauterization. Also, piercing jewelry creates artifacts during magnetic resonance imaging. Even temporary piercing jewelry removal may lead to closure of the subcutaneous tract; therefore, temporary replacement with a nonmetallic spacer is indicated.

Objective. This report describes a simple, safe, effective method for perioperative temporary replacement of navel piercing jewelry with a universally available, nonmetallic, sterile, intravenous catheter.

Methods. The umbilical piercing jewelry of 5 adolescent female patients was removed before surgical or radiologic interventions by using the following technique: 1) disinfecting the piercing and umbilical area with 70% isopropyl alcohol, 2) opening the piercing jewelry by removing the bead from the bar, 3) placing the tip of a tight-fitting intravenous catheter (14 or 16 gauge, without the needle) over the threaded tip of the bar, 4) advancing the intravenous catheter caudally, pushing the piercing out of the skin tract, and 5) removing the jewelry and leaving the intravenous catheter in the subcutaneous skin tract as a spacer. After the intervention, the piercing jewelry was reinserted by following the described steps in reverse order. The patients were evaluated after 1 week, for assessment of any adverse effects, including infection.

Results. With this method, piercing jewelry removal and reinsertion required <2 minutes for all patients. No procedural complications were noted. All jewelry was reinserted successfully after the procedure. The intravenous catheter left in situ did not interfere with surgery, and it did not produce any artifacts or adverse effects during magnetic resonance imaging. Follow-up evaluations at 1 week demonstrated no signs of irritation, infection, or other side effects of the procedure for any of the patients.

Conclusions. Periprocedural removal of navel piercing jewelry with this new technique proved to be quick, feasible, and safe. Piercings in other locations on the body may be replaced for surgery or imaging studies in the same way, with minor modifications.
Neurologic Complications Associated With Influenza A in Children During the 2003–2004 Influenza Season in Houston, Texas
Authors: Maricich Stephen M. , Neul Jeffrey L. , Lotze Timothy E. , Cazacu Andreea C. , Uyeki Timothy M. , Demmler Gail J. , Clark Gary D.
Published: November 2004

Objectives. Our objectives were to (1) describe the clinical characteristics of and viruses isolated from patients who presented with neurologic symptoms associated with influenza A infection and were hospitalized at Texas Children’s Hospital during October and November 2003 and (2) to raise awareness of the neurologic complications of influenza among US children.

Methods. We reviewed the medical and laboratory records of all children who were hospitalized with neurologic symptoms and who also had evidence of influenza virus infection by rapid antigen testing or viral isolation.

Results. Eight children aged 5 months to 9 years with neurologic complications associated with influenza A were identified. None of the children had received the influenza vaccine. Four presented with seizures, 3 with mental status changes, and 1 with mutism. All but 1 of the patients had influenza A viral antigen detected in nasal wash samples. Influenza A virus was isolated in culture from nasal wash specimens obtained from 6 of the patients; influenza A virus was also isolated from the cerebrospinal fluid of 1 of these patients. None of the patients had serum metabolic abnormalities or other cerebrospinal fluid abnormalities. Three of the patients had brain imaging abnormalities. Five of the patients were treated with antivirals. All 8 of the patients survived, 6 with complete recovery and 2 with sequelae (1 mild and 1 severe).

Conclusions. Neurologic symptoms and sequelae were associated with influenza A virus infection in children during the 2003–2004 influenza season in Houston, Texas. Influenza should be considered in the differential diagnosis in patients with seizures and mental status changes, especially if they present with respiratory symptoms or during an influenza outbreak.