bluuebunny/crossref_metadata_2025 huggingface dataset:
Bringing Robustness to Patient Flow Management Through Optimized Patient Transports in Hospitals
Authors: Hanne Thomas , Melo Teresa , Nickel Stefan
Published: March 2009

Intrahospital transports are often required for diagnostic or therapeutic reasons. Depending on the hospital layout, transportation between nursing wards and service units is either provided by ambulances or by trained personnel who accompany patients on foot. In many large German hospitals, the patient transport service is poorly managed and lacks work-flow coordination. This contributes to higher hospital costs (e.g., because a patient is not delivered to the operating room on time) and to patient inconvenience (e.g., because of long waiting times). We designed a computer-based planning system, Opti-TRANS©, that supports all phases of the transportation flow, including travel booking, dispatching transport requests, and monitoring and reporting trips in real time. The methodology, which we developed to solve the underlying optimization problem—a dynamic dial-a-ride problem with hospital-specific constraints, draws on fast heuristic methods to ensure the efficient and timely provision of transports. We illustrate the strong impact of Opti-TRANS on the daily performance of the patient transportation service of a large German hospital. The major benefits of Opti-TRANS include streamlined transportation processes and work flow, significant savings, and improved patient satisfaction. Moreover, it has contributed to increased awareness among hospital staff of the importance of implementing efficient logistics practices.
Parent‐delivered compensatory education for children at risk of educational failure: Improving the academic and self‐regulatory skills of a Sure Start preschool sample
Authors: Ford Ruth M. , McDougall Sine J. P. , Evans Daphne
Published: March 2009

Thirty preschoolers from low‐income families participated in a 12‐month intervention programme, funded by Sure Start, which engaged them in scaffolded educational activities delivered at home by their mothers. Immediately following the programme, the intervention group outperformed matched controls in tests of academic knowledge, receptive vocabulary, and inhibitory control, but not short‐term memory or theory of mind. Teachers' ratings of children's capabilities upon school entry favoured the intervention group, especially in terms of listening, responding, writing, mathematics, and personal/social skills. Superior inhibitory control, short‐term memory, and numerical skills were associated with higher ratings whereas theory of mind made a unique, negative contribution to responding. We discuss the implications of these findings for efforts to nurture the development of cognitive self‐regulation and school readiness during early childhood.
Afterimages of savages: Implicit associations between primitives, animals and children
Authors: Saminaden Annick , Loughnan Stephen , Haslam Nick
Published: March 2009

Historically, traditional people have often been likened to animals and children. A study employing implicit social cognition methods examined whether these associations endure in a more subtle, implicit form. Consistent with colonial era portrayals of indigenous and other traditional people as ‘primitives’ or ‘savages’, participants continued to associate them with animal‐ and child‐related stimuli more readily than people from modern, industrialized societies. In addition, traditional people were ascribed fewer uniquely human attributes than their modern counterparts. These findings, replicated with verbal and pictorial representations of the traditional/modern distinction, were independent of any positive or negative evaluation of traditional people. They imply that colonial ‘images of savages’ persist in contemporary western society as a cultural residue.
Radical bricolage: building coherence in the liberal arts using art modelling and language
Authors: Clayson James Edward
Published: March 2009

Because of the very broad and fragmented nature of undergraduate general education requirements there is a need to help students find unity in diversity. The search for coherence has led my institution, the American University in Paris, to introduce a series of freshmen courses called
First Bridge that deliberately pair professors from different disciplines to develop and teach a common course that explores the linkages between their areas of special interest. This article describes my own experience of teaching a First Bridge course called Visual Thinking and Artful Seeing,
in which I represented the mathematics and computer science department while my coteacher, a painter, came from the art department. It was our intention to explore how different ways of seeing, the very act of seeing and the art of talking about seeing could help each of us begin to discover
the commonalities that lie behind seemingly different disciplines and their methodologies. My part of the bargain requires using Imagine Logo to gain access to different levels of seeing by building computer models to examine a range of visual artefacts and their inherent structures.
Escribir el Lugar: collaborative projects in public spaces
Authors: Molina Javier Abad , Garrido Alfredo Palacios
Published: March 2009

Este artculo presenta dos proyectos artsticos llevados a cabo en dos espacios pblicos diferentes: las calles de una ciudad y las paredes exteriores de una escuela infantil. En ambos proyectos se ha intervenido en esos espacios usando la potencialidad visual y comunicativa del lenguaje
escrito. La idea central en ambos casos ha sido la de dotar de significacin a un espacio pblico, haciendo visible en el mismo aspectos de la experiencia de los usuarios de ese espacio. Para ello hemos desarrollado un trabajo colaborativo que en el caso de la ciudad ha implicado a nios, ancianos
e inmigrantes y en el caso de la escuela infantil a los nios de 34 aos. Los dos proyectos han contribuido a facilitar la identificacin con el lugar y a transformar un paisaje para integrar aspectos de la identidad de sus habitantes.
Business associations and their contribution to knowledge networks in Mexico
Authors: Luna Matilde , Tirado Ricardo
Published: March 2009

Mexican businesses are organized in a highly complex system, comprising an enormous variety of associations that group individual firms according to sectors and geographical lines of division. These associations may constitute an efficient means of support for the construction of knowledge networks benefiting their members. We analyze academicindustry relationship in which business associations (BAs) of different types participate in order to explore the connection between different institutional settings and knowledge network development. We argue that the structure of BAs is a key factor in their ability to sustain networking. It is, therefore, possible to speak of structural advantages or disadvantages as regards the building of triple helix relations.
Sweetening Jane: Equivalence through Genre, and the Problem of Class in Austen Adaptations
Authors: Strong Jeremy
Published: March 2009

This article argues that an approach to understanding adaptations in terms of genre offers a perspective at least as productive as considerations of the verbal and visual languages of prose and cinema. Examining three recent Austen adaptations Sense and Sensibility (Lee 1995), Emma
(McGrath 1996), and Pride and Prejudice (Wright 2005), but also addressing other film and television versions it demonstrates that efforts to make the new texts conform to prevailing expectations for romantic comedy, explain key changes. In tandem with these alterations, and also a component
of the adaptive sweetening process, various interventions allow the derived texts to present an altered ideological temperament to their originals. This encompasses the films' handling of class and issues of sexual politics, and is manifested in the systematic excision and reduction of original
elements, as well as in schemes of addition and amplification.
Recent insights into the role of dipeptidyl aminopeptidase IV (DPIV) and aminopeptidase N (APN) families in immune functions
Authors: Ansorge Siegfried , Bank Ute , Heimburg Anke , Helmuth Martin , Koch Gudrun , Tadje Janine , Lendeckel Uwe , Wolke Carmen , Neubert Klaus , Faust Jürgen , Fuchs Petra , Reinhold Dirk , Thielitz Anja , Täger Michael
Published: March 2009

: In the past, different research groups could show that treatment of immune cells with inhibitors of post-proline splitting dipeptidyl aminopeptidases leads to functional changes in the immune system consistent with immunosuppression. This is due to the inhibition of proliferation of lymphocytes and the production of inflammatory cytokines of the TH

: Summarizing data obtained from the usage of different non-selective and selective inhibitors of DPIV, DP8/9, FAP, and DPII, this review provides evidence that in addition to DPIV, DP8/9 also regulate the immune response via modulation of cell cycle progression and cytokine production. The strongest and most consistent effects in vitro were, however, observed with non-selective inhibitors for the suppression of DNA synthesis and cytokine production. Similar effects were provoked by APN inhibitors, which were also found to suppress DNA synthesis and the production of inflammatory cytokines in vitro. However, different mechanisms and signaling pathways appear to mediate the cellular effects resulting from the inhibition of either APN or DPIV family members. In particular, members of the APN family uniquely influence the function of CD4

Clin Chem Lab Med 2009;47:253–61.
Environmental Toxicology and Risk Assessment: Third Volume
Authors: Hughes JS , Biddinger GR , Mones E
Published: March 2009

Description

Features the latest advances in determining the impact of chemicals on the environment.

A comprehensive overview of the current status of ecological risk assessment and suggested advances for the discipline is the cornerstone of this publication. Twenty-two additional papers are presented in five categories, including, for the first time ever, the subject of Models in Ecological Risk Assessment.

Other categories include:

Ecotoxicology: Prediction and Assessment -- The estimation and measurement of ecological effects at various sites.

Sediment Toxicology -- Varied procedures to identify and assess contaminated sediments.

Fate and Effects of Chemicals -- How specific chemicals impact laboratory microcosm systems, fresh and saltwater flora and fauna, and general molecular structural parameters.

Methods Development -- The development and refinement of new methods to evaluate exposure and toxicity in the field of risk assessment.
Bioremediation of Pollutants in Soil and Water
Authors: Schepart BS
Published: March 2009

Description

A detailed overview of innovative ways to combat the pollution of the environment.

17 peer-reviewed papers have been divided into five primary categories:

Bioremediation Feasibility and Applicability--Four papers address a number of issues including how bioremediation technology compares favorably with other technologies from a cost standpoint, and the role of screening strategies in the decision making process to use bioremediation.

Bioremediation of Polynuclear Aromatic Hydrocarbons--Three papers tackle the problems associated with chemical pollutants that contain carcinogens and are particularly difficult to degrade.

In Situ Bioremediation--Case studies are presented, including a demonstration of how plants and microbes act symbiotically in the treatment of agrochemicals.

Bioremediation of Hazardous Chemicals--Three papers address the biological treatment of contaminated soils and the mechanisms in a mixed microbial ecosystem.

Enhancement of Bioremediation--Among the four papers presented is the application of bioremediation in the 1989 Alaskan Exxon-Valdez oil spill beach cleanup.
Fracture Mechanics: 26th Volume
Authors: Reuter W , Underwood JH , Newman JC
Published: March 2009

Description

Compiles the latest information in fracture mechanics research from the world's leading scientists and engineers in the field. In addition to an extensive overview of applied fracture mechanics as it pertains to pressure vessels safety, STP 1256 features 42 peer-reviewed papers that cover: Constraint Crack Initiation; • Constraint Crack Growth; • Weldments; • Engineered Materials; • Subcritical Crack Growth; • Dynamic Loading; • and Applications.
Engineering Properties of Asphalt Mixtures and the Relationship to their Performance
Authors: Huber GA , Decker DS
Published: March 2009

Description

13 peer-reviewed papers feature the most current information onmeasuring fundamental asphalt mixture engineering properties and relating these properties to pavement performance. This publication explores innovative asphalt pavement performance methods, and includes five papers that deal specifically with the latest results from the Strategic Highway Research Program (SHRP). Other topics explore:

• Engineering properties with a long history in performance prediction

• Techniques for Predicting Pavement Performance using Existing Pavements

• and Tensile Strength in Relation to Low Temperature Cracking.
Mode I and Mode II Fracture Toughness Measured Between Differently Oriented Plies in Graphite/Epoxy Composites
Authors: Chou I , Kimpara I , Kageyama K , Ohsawa I
Published: March 2009

The Mode I and Mode II fracture toughness between differently oriented plies in graphite/epoxy composites was characterized using DCB and ENF tests. GIc was almost the same for the 0/0, 30/−30, and 60/−60 interfaces. GIc for the 0/0 interface was approximately 30% higher than for the 30/−30 and 60/−60 interfaces when the crack initiation was characterized at the onset of nonlinear response. A remarkable increase of fracture toughness also appeared as the crack propagated. In addition, the rising rate of fracture toughness, dGR/da, increased as the fiber orientation at the crack front inclined away from the delamination direction. This was because angled plies at delaminated surfaces were apt to cause transverse cracking as the fiber orientation of the angled plies inclined away from the delamination direction. Consequently, the increase of fracture surface increased the fracture toughness.
Measured Airflows in a Multifamily Building
Authors: Palmiter L , Heller J , Sherman M
Published: March 2009

A method has been developed to measure real-time airflow in multifamily buildings. This method uses a multi-tracer measurement system (MTMS) and simultaneous measurements of pressure, temperature, and environmental conditions. These measurements are evaluated along with the results of blower door and flowhood fan tests to develop a complete picture of the airflow patterns in multifamily buildings due to temperature differences, wind, and mechanical ventilation.

Six units in an unoccupied three-story multifamily building in Portland, Oregon were tested for a period of eight days during February and March 1992 using this method. The apartments were equipped with timer-controlled ventilation fans that were set to come on at regular two-hour intervals throughout the test period, enabling a thorough evaluation of the effect of various fan conditions on the flow of air from the outside as well as between units.

The average ventilation rate from natural driving forces alone (wind and stack effects) was about 40 m3/h per unit, or 0.22 air changes per hour (ACH). The average ventilation rate during the periods with all ventilation fans running was 75 m3/h (0.41 ACH). There was also a significant amount of inter-apartment airflow, which was dominated by flow from lower units to the unit directly above from temperature-driven stack effects. Operating all exhaust fans together had little effect on the interzone flows; however, operation of a single exhaust fan significantly increased the interzone flow to that apartment from all adjacent units. The percentage of total airflow that was outdoor air was found to be lower for higher units than for lower units.
An Analysis of Moisture Accumulation in the Roof Cavities of Manufactured Housing
Authors: Burch D
Published: March 2009

A detailed computer analysis is conducted to investigate whether moisture problems occur in the roof cavity of manufactured homes constructed in compliance with the current Department of Housing and Urban Development (HUD) Standards for manufactured housing. The current HUD Standards require a ceiling vapor retarder, but do not require outdoor ventilation of the roof cavity. In cold climates, the analysis revealed that moisture accumulates at lower roof surface and poses a risk of material degradation.

The analysis found the following combination of passive measures to be effective in preventing detrimental winter moisture accumulation at lower surface of the roof: 1) providing a ceiling vapor retarder, 2) sealing penetrations and openings in the ceiling construction, and 3) providing natural ventilation openings in the roof cavity.

In addition, the performance of a roof cavity exposed to a hot and humid climate is investigated. The analysis revealed that outdoor ventilation of the roof cavity causes the monthly mean relative humidity at the upper surface of the vapor retarder to exceed 80%. This condition is conducive to mold and mildew growth.
Reaction Sequences in Atmospheric Corrosion of Zinc
Authors: Odnevall I , Leygraf C
Published: March 2009

Frequent phase identifications of a large number of zinc panels exposed to different atmospheric conditions, both in national an international exposure programs, have revealed a variety of corrosion products. In order to extract basic information about the atmospheric corrosion processes involved, emphasis has been placed on more precise characterization of corrosion products, from the initial stages to full developed end products. Extensive field exposures under rain sheltered conditions have been performed in rural, urban, industrial and marine atmospheres. These programs have included different methods for surface and bulk analysis of corrosion products, as well as measurements of deposition rates for gases and aerosols, and measurements of climatic parameters. Depending on atmospheric conditions, the complex growth of corrosion products seems to result in end products containing at least one of the structurally related phases: Zn5(CO3) 2(OH)6, Zn5(OH)8Cl2 ∙H2O, Zn4SO4(OH)6 ∙ 4H2O, Zn4Cl2(OH)4SO4 ∙ 5H2O and NaZn4Cl(OH)6SO4∙6H2O.

This presentation discusses actual reaction sequences in the formation of the above-mentioned corrosion products in terms of structural chemistry and deposition rates for atmospheric constituents. Several of the reaction sequences seem to depend on actual deposition rates for sulfur dioxide (SO2) and chloride (Cl-) in the atmosphere.
The Relationship Between Constraint and Ductile Fracture Initiation as Defined by Micromechanical Analyses
Authors: Panontin TL , Sheppard SD
Published: March 2009

The overall objective of this study is to provide a proven methodology to allow the transfer of ductile fracture initiation properties measured in standard labora tory specimens to large, complex, flawed structures. A significant part of this work involved specifically addressing effects of constraint on transferability under large scale yielding conditions. The approach taken was to quantify constraint effects through micro-mechanical fracture models coupled with finite element generated crack tip stress-strain fields to identify the local condition corresponding to fracture initiation. Detailed finite element models predicted the influence of specimen geometry, loading mode, and material flow properties on the crack tip fields.

The ability of two local, ductile fracture models (the Rice and Tracey void growth model [1] (VGM) and the stress-modified, critical strain (SMCS) criterion of Mackenzie et al. and Hancock and Cowling [2,3]) to predict fracture initiation were investigated. Predictions were made using experimentally verified, two- and three-dimensional, finite strain, large deformation, finite element analyses. Two, high toughness pressure vessel steels were investigated: A516 Gr70, a ferritic, carbon-manganese mild steel demonstrating high hardening behavior, and HY-80, a martensitic, high strength low alloy (HSLA) steel possessing medium hardening ability. Experimental verification of the ductile frac ture initiation predictions was performed in a variety of crack geometries possessing a range of a/w ratios from 0.15 to 0.70 and experiencing a range of load conditions from three point bending to nearly pure tension. The predicted constraint dependence of global ductile fracture parameters in the two materials is shown.
Three-Dimensional CTOA and Constraint Effects During Stable Tearing in a Thin-Sheet Material
Authors: Dawicke DS , Newman JC , Bigelow CA
Published: March 2009

A small strain theory, three-dimensional elastic-plastic finite element analysis was used to simulate fracture in thin sheet 2024-T3 aluminum alloy in the T-L orientation. Both straight and tunneled cracks were modeled. The tunneled crack front shapes as a function of applied stress were obtained from the fracture surface of tested specimens. The stable crack growth behavior was measured at the specimen surface as a function of applied stress. The fracture simulation modeled the crack tunneling and extension as a function of applied stress. The results indicated that the global constraint factor, αg, initially dropped during stable crack growth. After peak applied stress was achieved, αg began to increase slightly. The effect of crack front shape on αg was small, but the crack front shape did greatly influence the local constraint and through-thickness crack-tip opening angle (CTOA) behavior. The surface values of CTOA for the tunneled crack front model agreed well with experimental measurements, showing the same initial decrease from high values during the initial 3mm of crack growth at the specimen's surface. At the same time, the interior CTOA values increased from low angles. After the initial stable tearing region, the CTOA was constant through the thickness. The three-dimensional analysis appears to confirm the potential of CTOA as a two-dimensional fracture criterion.
Introduction, Overview, Issues
Authors: Wells PG , Butler JN , Hughes JS
Published: March 2009

The Exxon Valdez oil spill in Prince William Sound, Alaska, in March 1989, was the largest crude spill to date in US waters. It prompted many studies on the fate, transport and effects of the oil on biota in Alaskan waters, as well as on archaeological sites. This book consists of 25 research papers presented at an ASTM Symposium in April 1993. This introductory chapter summarizes topics and highlights of those papers, covering chemistry and fate, shoreline impacts, effects on fish, fisheries and wildlife, and impacts on archaeological sites, and discusses some of the issues arisiing from the study of this spill. Some lessons learned from this research included: • The need for accurate identification of the spilled oil-derived hydrocarbons in all samples, • The extensive movement of the oil down the Alaskan coast, with its unique fate characteristics, • The strong chemical basis required for interpreting the biological significance of sedimented hydrocarbons, • The difficulty of separating oil effects on biological populations from changes due to other variables (biotic and abiotic), • The need for sensitive hydrocarbon biomarkers, and • The need to have established definitions and criteria to determine whether biological recovery had occurred.

To provide a context for the papers in this volume, other published literature and symposia on this spill are discussed. Some of the more important remaining issues include: • The duration of effects of the residual oil, • The extent of intertidal impact and recovery, • The extent and duration of impacts of the spill on fisheries and wildlife populations, including seabirds and sea otters.

Additional issues, of considerable importance, but not concerned primarily with the fate and effects of the spilled oil, include: • The need for the oil spill community as a whole to agree ahead of time on how to study such accidental spills, and select appropriate monitoring tools. • The effect of impending litigation on the type and extent of the research conducted,

This volume provides the reader with detailed insights into the ecological impacts of such accidents in cold sub-arctic waters, and some of the outstanding scientific issues on the effects and recovery patterns after such spill events.
Shoreline Ecology Program for Prince William Sound, Alaska, Following the Exxon Valdez Oil Spill: Part 3—Biology
Authors: Gilfillan ES , Page DS , Harner EJ , Boehm PD
Published: March 2009

This study describes the biological results of a comprehensive shoreline ecology program designed to assess ecological recovery in Prince William Sound following the Exxon Valdez oil spill on March 24, 1989. The program is an application of the “Sediment Quality Triad” approach, combining chemical, toxicological, and biological measurements. The study was designed so that results could be extrapolated to the entire spill zone in Prince William Sound.

The spill affected four major shoreline habitat types in Prince William Sound: pebble/gravel, boulder/cobble, sheltered bedrock, and exposed bedrock. The study design had two components: (1) one-time stratified random sampling at 64 sites representing four habitats and four oiling levels (including unoiled reference sites) and (2) periodic sampling at 12 nonrandomly chosen sites that included some of the most heavily oiled locations in the sound. Biological communities on rock surfaces and in intertidal and shallow subtidal sediments were analyzed for differences resulting from to oiling in each of 16 habitat/tide zone combinations. Statistical methods included univariate analyses of individual species abundances and community parameter variables (total abundance, species richness, and Shannon diversity), and multivariate correspondence analysis of community structure.

The communities of animals and plants inhabiting the bedrock and coarse sediments on Prince William Sound's shorelines responded much differently to oiling than communities in soft-sediment environments that were the subject of a majority of shoreline studies conducted after other oil spills.

Sedimentary environments in Prince William Sound did not become anaerobic but showed evidence of increased biological activity as the oil residue became a source of organic carbon—without the usual succession of opportunistic invaders. Similarly, some bedrock sites showed increases in abundance, species richness, and diversity, as the spaces created by oiling were recolonized. This was to be expected in a high-energy environment dominated by “patch dynamics”; the rock surfaces and sediments support a mosaic of species that are adapted to rapidly colonize new spaces created by wave action and other physical factors.

Two measures of ecological shoreline recovery are reported: an upper-limit estimate based on univariate analysis of community parameters and a lower-limit estimate based on multivariate correspondence analysis of community structure. Overall, the results indicate that between 73% and 91% of the oiled shoreline in Prince William Sound was ecologically recovered (i.e., it was indistinguishable from reference) in the summer of 1990. These results reflect rapid recovery of the biological communities and are consistent with chemical and toxicological studies (this volume), which found that hydrocarbon-related toxicity was virtually absent in the shoreline sediments by 1990–1991.
Shoreline Impacts in the Gulf of Alaska Region Following the Exxon Valdez Oil Spill
Authors: Gilfillan ES , Suchanek TH , Boehm PD , Harner EJ , Page DS , Sloan NA
Published: March 2009

Forty-eight sites in the Gulf of Alaska region (GOA-Kodiak Island, Kenai Peninsula, and Alaska Peninsula) were sampled in July/August 1989 to assess the impact of the March 24, 1989, Exxon Valdez oil spill on shoreline chemistry and biological communities hundreds of miles from the spill origin. In a 1990 companion study, 5 of the Kenai sites and 13 of the Kodiak and Alaska Peninsula sites were sampled 16 months after the spill.

Oiling levels at each site were estimated visually and/or quantified by chemical analysis. The chemical analyses were performed on sediment and/or rock wipe samples collected with the biological samples. Additional sediment samples were collected for laboratory amphipod toxicity tests. Mussels were also collected and analyzed for hydrocarbon content to assess hydrocarbon bioavailability.

Biological investigations at these GOA sites focused on intertidal infauna, epifauna, and macroalgae by means of a variety of common ecological techniques. For rocky sites the percentage of hard substratum covered by biota was quantified. At each site, up to 5 biological samples (scrapes of rock surfaces or sediment cores) were collected intertidally along each of 3 transects, spanning tide levels from the high intertidal to mean-lowest-low-water (zero tidal datum). Organisms (down to 1.0 mm in size) from these samples were sorted and identified. Community parameters including organism abundance, species richness, and Shannon diversity were calculated for each sample.

As expected for shores so far from the spill origin, oiling levels were substantially lower, and beached oil was more highly weathered than in Prince William Sound (PWS). Samples of oiled GOA shoreline sediment were not statistically more toxic in bioassay tests than sediment from unoiled reference sites.

As a consequence of the lower oil impact, the biological communities were not as affected as those in the sound. Biological impacts, although present in 1989 in the GOA, were localized, which is consistent with the patchy and discontinuous nature of much of the oiling in GOA. Some organisms were locally reduced or eliminated in oiled patches but survived in unoiled patches nearby. In areas where oiling occurred, impacts were generally limited to middle and upper intertidal zones.

Analyses of mussel samples indicate that by 1990 little of the shoreline oil remained bioavailable to epifauna. Quantifiable measures of the overall health and vitality of shoreline biological communities, such as organism abundance, species richness, and Shannon diversity for sediment infauna, show few significant differences between oiled and reference sites in 1990.
A Field and Laboratory Assessment of Oil-Spill Effects on Survival and Reproduction of Pacific Herring Following the Exxon Valdez Spill
Authors: Pearson WH , Moksness E , Skalski JR
Published: March 2009

Pacific herring, Clupea pallasi, spawn along hundreds of kilometres of shoreline in Prince William Sound. Herring eggs incubate in intertidal and shallow subtidal areas attached to kelp and eelgrass. In April 1989, following the Exxon Valdez oil spill, there was potential in Prince William Sound for localized effects on spawning herring, their eggs, and the hatching larvae. Field and laboratory investigations in 1989 and 1990 were designed to assess potential injury to Prince William Sound herring by testing for differences between oiled regions and unoiled reference areas and by relating biological response variables to the concentrations of polycyclic aromatic hydrocarbons (PAH) in eggs-on-kelp samples. Hydrocarbon analyses and laboratory incubation were conducted on eggs-on-kelp samples from Prince William Sound and Sitka Sound. The eggs and hatching larvae were examined to evaluate several response variables: egg development, hatch, larval survival, abnormal development of larvae, larval length, and larval yolk-sac volume.

Analysis of 1989 shoreline surveys indicate that about 96% of the total spawn length (158 km) in Prince William Sound occurred along shorelines with no oiling, and less than 1% of the 1989 total spawn length occurred along shorelines with moderate to heavy oiling. Analysis of shoreline oiling in both 1989 and 1990 from all surveys indicates that about 90 to 91% of the total 1989 spawn length occurred along unoiled shorelines. Effects on herring eggs were minor in 1989 even in oiled areas. No significant relationship was found between 1989 PAH burdens in eggs-on-kelp samples and 9 out of 10 biological response variables. In 1989, significantly lower proportions of developed eggs were observed for Cabin Bay samples visibly contaminated with tarry deposits. The location where these effects were seen represented less than 2% of total 1989 spawn length. No effects of the spill on herring were evident in 1990. No significant relationship was found between 1990 PAH burdens and the seven biological response variables studied. Biological response variables from Sitka Sound were either not significantly different from or significantly lower (more adverse) than those from Prince William Sound.

Our 1989 and 1990 results are consistent with the low exposure of herring to oil and do not indicate an extent of injury that would be significant to the Prince William Sound herring population. The biomass and harvests of Prince William Sound herring had reached record high levels in the three years immediately following the spill so that the minor effects observed in 1989 did not translate into decreases in the population level.
Developmental Interventions in the NICU
Authors: Hussey-Gardner Brenda , Famuyide Mobolaji
Published: March 2009

Both the rates of prematurity and survival of preterm infants have increased in the United States over the past 10 years. Preterm infants are at great risk for medical complications and future developmental disabilities. This article reviews the developmental outcomes of studies implementing developmental interventions in the NICU. Interventions include the newborn individualized care and assessment program, massage, oral-motor stimulation, positioning, skin-to-skin care, music, visual stimuli, light, and multimodal stimulation. Results of eight blinded, randomized, controlled trials included in this review demonstrate an effect that consistently favors the intervention group.
Routine Vaccination Against Pertussis and the Risk of Childhood Asthma: A Population-Based Cohort Study
Authors: Spycher Ben D. , Silverman Michael , Egger Matthias , Zwahlen Marcel , Kuehni Claudia E.
Published: March 2009

BACKGROUND. In industrialized countries vaccination coverage remains suboptimal, partly because of perception of an increased risk of asthma. Epidemiologic studies of the association between childhood vaccinations and asthma have provided conflicting results, possibly for methodologic reasons such as unreliable vaccination data, biased reporting, and reverse causation. A recent review stressed the need for additional, adequately controlled large-scale studies.

OBJECTIVE. Our goal was to determine if routine childhood vaccination against pertussis was associated with subsequent development of childhood wheezing disorders and asthma in a large population-based cohort study.

METHODS. In 6811 children from the general population born between 1993 and 1997 in Leicestershire, United Kingdom, respiratory symptom data from repeated questionnaire surveys up to 2003 were linked to independently collected vaccination data from the National Health Service database. We compared incident wheeze and asthma between children of different vaccination status (complete, partial, and no vaccination against pertussis) by computing hazard ratios. Analyses were based on 6048 children, 23 201 person-years of follow-up, and 2426 cases of new-onset wheeze.

RESULTS. There was no evidence for an increased risk of wheeze or asthma in children vaccinated against pertussis compared with nonvaccinated children. Adjusted hazard ratios comparing fully and partially vaccinated with nonvaccinated children were close to one for both incident wheeze and asthma.

CONCLUSION. This study provides no evidence of an association between vaccination against pertussis in infancy and an increased risk of later wheeze or asthma and does not support claims that vaccination against pertussis might significantly increase the risk of childhood asthma.
Exploring Emergency Contraception Knowledge, Prescription Practices, and Barriers to Prescription for Adolescents in the Emergency Department
Authors: Goyal Monika , Zhao Huaqing , Mollen Cynthia
Published: March 2009

OBJECTIVE. The objective of this study was to assess the proportion of emergency medicine physicians who had prescribed emergency contraception pills to adolescents, to identify potential barriers to emergency contraception pill prescription for adolescents, and to assess physician knowledge of emergency contraception pills.

PARTICIPANTS AND METHODS. A cross-sectional, anonymous, Internet-based survey of members of the American Academy of Pediatrics Section of Emergency Medicine was conducted. Providers were included in analysis if they were attending physicians caring for children (<22 years of age) in the emergency department setting >30% of the time. Survey questions included demographics, emergency contraception pill prescription rates for adolescents, attitudes toward emergency contraception pills for adolescents, and emergency contraception pill knowledge questions.

RESULTS. A total of 1005 Section of Emergency Medicine members were contacted; 424 (42%) responded, and 133 did not meet inclusion criteria. Of the 291 eligible respondents, 282 had complete surveys. Eighty-five percent of the respondents stated that they had prescribed emergency contraception pills to adolescents, 71% within the previous year. Of those, 81% prescribed emergency contraception pills <5 times. The 5 most frequently cited barriers were concern for lack of follow-up (72%), time constraints (40%), lack of clinical resources (33%), discouraging regular contraceptive use (29%), and concern about birth defects (27%). Thirty-nine percent of respondents identified ≥5 barriers to emergency contraception pill prescriptions for adolescents. Forty-three percent incorrectly answered >50% of the questions. Physicians were more likely to report prescribing emergency contraception pills if they had answered >3 of the knowledge-based questions correctly and were less likely to report prescribing if they identified >5 barriers.

CONCLUSIONS. Although a large proportion of emergency department physicians reported prescribing emergency contraception pills to adolescents, the pills were prescribed infrequently. Factors associated with nonprescription were decreased knowledge of emergency contraception pills and identifying >5 barriers. Identification of these potential barriers and education regarding emergency contraception pills may ultimately improve adolescent access to emergency contraception pills in the emergency department.
Airway Obstruction During Mask Ventilation of Very Low Birth Weight Infants During Neonatal Resuscitation
Authors: Finer Neil N. , Rich Wade , Wang Casey , Leone Tina
Published: March 2009

OBJECTIVES. The delivery of adequate but not excessive ventilation remains one of the most common problems encountered during neonatal resuscitation, especially in the very low birth weight infant. Our observations suggest that airway obstruction is a common occurrence after delivery of such infants, and we use colorimetric carbon dioxide detectors during bag-and-mask resuscitation to assist in determining whether the airway was patent. We reviewed our experience to determine the frequency of the occurrence of recognizable airway obstruction during resuscitation of very low birth weight infants.

METHODS AND PATIENTS. The previous prospective trial randomly assigned preterm infants <32 weeks' gestation to resuscitation with either room air or 100% oxygen using pulse oximetry. Colorimetric carbon dioxide detectors were used to assist with bag-and-mask ventilation and to confirm intubation. From the video recordings, the number of positive pressure breaths without a color change in the detector until the breaths were associated with an unequivocal color change was counted as obstructed breaths. From the analog tracings, the number of breaths that had a peak pressure plateau of ≥0.2 second and were not associated with a color change was recorded as the number of obstructed breaths.

RESULTS. None of the studied infants required cardiopulmonary resuscitation or received epinephrine, and all were judged to have an effective circulation during resuscitation. Six of the 24 infants enrolled in the trial received only continuous positive airway pressure. The remaining 18 infants received a median of 14 obstructed breaths (range: 4–37 breaths) delivered over a mean and median interval of 56.7 and 45.0 seconds, respectively (range: 10.0–220.0 seconds). A subgroup of 11 infants was analyzed using airway-pressure data. The target peak inspiratory pressure was 30 cm H2O. Ten of these 11 infants had obstructed breaths as defined by no change in the PediCap despite reaching the target pressure for ≥0.2 second.

CONCLUSION. Airway obstruction occurs in the majority of the very low birth weight infants who receive ventilation with a face mask during resuscitation and the use of a colorimetric detector can facilitate its recognition and management.
Pediatric Primary Care to Help Prevent Child Maltreatment: The Safe Environment for Every Kid (SEEK) Model
Authors: Dubowitz Howard , Feigelman Susan , Lane Wendy , Kim Jeongeun
Published: March 2009

CONTEXT. Effective strategies for preventing child maltreatment are needed. Few primary care–based programs have been developed, and most have not been well evaluated.

OBJECTIVE. Our goal was to evaluate the efficacy of the Safe Environment for Every Kid model of pediatric primary care in reducing the occurrence of child maltreatment.

METHODS. A randomized trial was conducted from June 2002 to November 2005 in a university-based resident continuity clinic in Baltimore, Maryland. The study population consisted of English-speaking parents of children (0–5 years) brought in for child health supervision. Of the 1118 participants approached, 729 agreed to participate, and 558 of them completed the study protocol. Resident continuity clinics were cluster randomized by day of the week to the model (intervention) or standard care (control) groups. Model care consisted of (1) residents who received special training, (2) the Parent Screening Questionnaire, and (3) a social worker. Risk factors for child maltreatment were identified and addressed by the resident physician and/or social worker. Standard care involved routine pediatric primary care. A subset of the clinic population was sampled for the evaluation. Child maltreatment was measured in 3 ways: (1) child protective services reports using state agency data; (2) medical chart documentation of possible abuse or neglect; and (3) parental report of harsh punishment via the Parent-Child Conflict Tactics scale.

RESULTS. Model care resulted in significantly lower rates of child maltreatment in all the outcome measures: fewer child protective services reports, fewer instances of possible medical neglect documented as treatment nonadherence, fewer children with delayed immunizations, and less harsh punishment reported by parents. One-tailed testing was conducted in accordance with the study hypothesis.

CONCLUSIONS. The Safe Environment for Every Kid (SEEK) model of pediatric primary care seems promising as a practical strategy for helping prevent child maltreatment. Replication and additional evaluation of the model are recommended.
Trends in High-Turnover Stays Among Children Hospitalized in the United States, 1993–2003
Authors: Macy Michelle L. , Stanley Rachel M. , Lozon Marie M. , Sasson Comilla , Gebremariam Achamyeleh , Davis Matthew M.
Published: March 2009

OBJECTIVE. Brief hospitalizations for children may constitute an opportunity to provide care in an alternative setting such as an observation unit. The goal of this study was to characterize recent national trends in brief inpatient stays for children in the United States.

METHODS. Using the Nationwide Inpatient Sample from 1993–2003, we analyzed hospital discharges among children <18 years of age, excluding births, deaths, and transfers. Hospitalizations with lengths of stay of 0 and 1 night were designated as “high turnover.” Serial cross-sectional analyses were conducted to compare the proportion of high-turnover stays across and within years according to patient and hospital-level characteristics. Diagnosis-related groups and hospital charges associated with these observation-length stays were examined.

RESULTS. In 2003, there were an estimated 441 363 high-turnover hospitalizations compared with 388 701 in 1993. The proportion of high-turnover stays increased from 24.9% in 1993 to 29.9% in 1999 and has remained ≥30.0% since that time. Diagnosis-related groups for high-turnover stays reflect common pediatric medical and surgical conditions requiring hospitalization, including respiratory illness, gastrointestinal/metabolic disorders, seizure/headache, and appendectomy. Significant increases in the proportion of high-turnover stays during the study period were noted across patient and hospital-level characteristics, including age group, payer, hospital location, teaching status, bed size, and admission source. High-turnover stays contributed $1.3 billion (22%) to aggregate hospital charges in 2003, an increase from $494 million (12%) in 1993.

CONCLUSIONS. Consistently since 1999, nearly one third of children hospitalized in the United States experience a high-turnover stay. These high-turnover cases constitute hospitalizations, that may be eligible for care in an alternative setting. Observation units provide 1 model for an efficient and cost-effective alternative to inpatient care, in which resources and provider interactions with patients and each other are geared toward shorter stays with more timely discharge processes.
Explaining the Low Risk of Preterm Birth Among Arab Americans in the United States: An Analysis of 617451 Births
Authors: El-Sayed Abdulrahman M. , Galea Sandro
Published: March 2009

OBJECTIVES. Arab Americans have a lower risk for preterm birth than white Americans. We assessed factors that may contribute to the association between ethnicity and preterm birth risk in Michigan, the state with the largest concentration of Arab Americans in the United States. Factors assessed as potential contributors to the ethnicity/preterm birth risk association were maternal age, parity, education, marital status, tobacco use, and maternal birthplace.

METHODS. Data were collected about all births in Michigan between 2000 and 2005. Stratified analyses, trivariate analyses, and manual stepwise logistic regression model building were used to assess potential contributors to the ethnicity/preterm birth risk association.

RESULTS. Arab ethnicity was associated with lower preterm birth risk compared with non-Arab white subjects in the unadjusted model. Maternal birthplace inside or outside the United States explained 0.17 of the difference in preterm birth risk between Arab ethnicity and non-Arab white mothers; ethnic differences in marital status and tobacco use explained less of the observed ethnic difference in preterm birth risk. In the final model adjusted for all explanatory variables, Arab ethnicity was no longer associated with preterm birth risk.

CONCLUSIONS. Maternal birthplace, marital status, and tobacco use may contribute to the preterm birth risk difference between Arab ethnicity and non-Arab white mothers. Additional work is needed to consider the mechanisms relating factors such as maternal birthplace and marital status to ethnic differences in preterm birth risk.