bluuebunny/crossref_metadata_2025 huggingface dataset:
Crime Data Forecasting Using Machine Learning and Big Data Analytics
Authors: Brindha R. , Thillaikarasi Dr.M.
Published: December 2021

Big data analytics (BDA) is a system based method with an aim to recognize and examine different designs, patterns and trends under the big dataset. In this paper, BDA is used to visualize and trends the prediction where exploratory data analysis examines the crime data. “A successive facts and patterns have been taken in following cities of California, Washington and Florida by using statistical analysis and visualization”. The predictive result gives the performance using Keras Prophet Model, LSTM and neural network models followed by prophet model which are the existing methods used to find the crime data under BDA technique. But the crime actions increases day by day which is greater task for the people to overcome the challenging crime activities. Some ignored the essential rate of influential aspects. To overcome these challenging problems of big data, many studies have been developed with limited one or two features. “This paper introduces a big data introduces to analyze the influential aspects about the crime incidents, and examine it on New York City. The proposed structure relates the dynamic machine learning algorithms and geographical information system (GIS) to consider the contiguous reasons of crime data. Recursive feature elimination (RFE) is used to select the optimum characteristic data. Exploitation of gradient boost decision tree (GBDT), logistic regression (LR), support vector machine (SVM) and artificial neural network (ANN) are related to develop the optimum data model. Significant impact features were then reviewed by applying GBDT and GIS”. The experimental results illustrates that GBDT along with GIS model combination can identify the crime ranking with high performance and accuracy compared to existing method.”
Effective Brain Tumor Classification on MRI Using Deep Belief-convolutional Neural Network with Pixel Change Detection based on Pixel Mapping Technique
Authors: Shiny K.V. , Sugitha N.
Published: December 2021

Brain tumor is a kind of cancer, in which tissues in the brain grows rapidly and unevenly in the brains and causes huge threats on human life. Brain tumor is recognized as one of the common dreadful cancers among adults and it also affects the children too. This kind of cancer is categorized into two types, such as benign tumor and malignant tumor. However, benign tumor is curable, whereas recovering of patients whoever affected by malignant tumor has less chance to survive. Nowadays, MR images are usually employed to detect the kinds of brain tumor. Early classification and identification of tumor is significant to treat the tumor and saves the human life from early death. However, the classification of brain tumor and percentage in change detection using pre-operative and post-operative MR images is a very challenging task. In order to overcome such issues, this research proposes a new effective technique for brain tumor classification and determination of pixel change detection using proposed Deep Belief Network (DBN) + Deep Convolutional Neural Network (DCNN). The process involves four phases, such as pre-processing, segmentation, feature extraction, and classification. The combination of DBN + CNN is employed for decision making based on error function. The DBN + CNN are trained utilizing the developed BirCat algorithm. Moreover, the proposed approach achieved a maximum accuracy of 0.957, sensitivity of 0.967, and specificity of 0.918.
A Global Optimization Algorithm for Unconstrained Non-linear Optimization Problems Using Chaotic Neuron Map and Golden Number
Authors: Rani G. Sandhya , Jayan Sarada
Published: December 2021

This paper presents aninnovative global multi-variable optimization algorithm using one of the best chaotic sequences, the neuron map, a description of which is also provided in the paper. The algorithm uses neuron map in the first stage to move near the global minimum point, as well as in each iteration of the second stage of local search that is done using the N-dimensional golden section search algorithm. The generation and mapping of the neuron variables to the optimization variables along with the stagewise search for the global minimum is explained conscientiously in the work. Numerical results on some benchmark functions and the comparison with a latest state-of-the-art algorithm ispresented in order to demonstrate the efficiency of the proposed algorithm.
Aggression During Playful and Athletic Activity in the Greek Primary School
Authors: Zaragas Harilaos , Vasilios Koutras , Maria Sakellariou , Lambros Kalliaras
Published: December 2021

The purpose of this pan- Hellenic research was to study the aggressive behavior of students during sports activities and play in the school yard. Specifically, through the answers of 562 (100%) teachers (396 teachers 70% and 166 physical education 30%) the following were investigated: a) the existence and forms, the individual characteristics of children who receive or show aggression, the training of teachers and coping practices that help minimize forms of aggression, and b) differences in teachers' responses to gender, years of service, and specialization. A relevant questionnaire with a five-point scale was prepared and distributed electronically to all primary schools in Greece.  Before descriptive and inductive statistics, the a-Cronbach test had showed a value of 0.898 and the control of bifurcation (Guttman) had showed a value of 0,789 which indicates that the questionnaire has good reliability.   They were carried out the t-test control for independent samples, ANOVA and x2 control for the differences in the teachers’ answers regarding teachers’ gender, specialty, and years of service. The results showed that all teachers agree that there are forms of aggression during play and sports activity in the elementary school yard and these are distinguished into physical (pushing, kicking, pulling), verbal (swearing, mocking performance), emotional (social exclusion) and some are repetitive and deliberate. We have a significant difference between the teachers in terms of the methods they suggest and the actions they take to deal with the phenomenon. The teachers have done relevant training but this is not enough. They need even more to deal with the phenomenon on their part more effectively.
Synthesis of tert-amylbenzene for side-chain alkylation of cumene catalyzed by a solid superbase
Authors: Zhou Xin , Gao Ge , He Guangxiang , Guo Xiaoyan , Jin Haibo , Ma Lei
Published: December 2021

The side-chain alkylation of cumene and ethylene over a solid superbase catalyst K/KOH/γ-Al2O3 is investigated. The effects of the reaction temperature, pressure, and time on the conversion of cumene and selectivity of tert-amylbenzene (TAB) are discussed. The experimental results show that the conversion of cumene to tert-pentylbenzene increases with the increase in reaction temperature and ethylene pressure. The catalytic reaction has certain operational flexibility in terms of the reaction temperature, pressure, and time. In addition, the catalytic reaction can achieve directional conversion. The optimum operating conditions are obtained using a single factor test. The conversion of cumene is 99.8% and the selectivity toward TAB is 97.9% under catalyst concentration of 4 wt%, reaction temperature of 55°C, reaction pressure of 0.45 MPa, and reaction time of 30 min. The deactivation of catalyst is mainly caused by oxygen and water in the raw material.
Anticandidal potentiality of biosynthesized and decorated nanometals with fucoidan
Authors: Alghuthaymi Mousa A. , El-Sersy Zainab R. , Tayel Ahmed A. , Alsieni Mohammed A. , Abd El Maksoud Ahmed I.
Published: December 2021

Candidagenus includes many hazardous and risky species that can develop resistance toward various antifungal types. Metals nanoparticles (NPs) possess powerful antimicrobial actions, but their potential human toxicity could limit their practices. The algal polysaccharide fucoidan (Fu) was extracted from the macro-brown algae,Cystoseira barbata, analyzed, and used for biosynthesizing nanoparticles of silver (Ag-NPs) and selenium (Se-NPs). The extracted Fu had elevated fucose levels (58.73% of total monosaccharides) and exhibited the main biochemical characteristic of customary Fu. The Fu biosynthesis of Ag-NPs and Se-NPs was achieved via facile direct protocol; Fu-synthesized NPs had 12.86 and 16.18 nm average diameters, respectively. The ultrastructure of Fu-synthesized NPs emphasized well-distributed and spherical particles that were embedded/capped in Fu as combined clusters. The Fu/Ag-NPs and Fu/Se-NPs anticandidal assessments, againstCandida albicans,Candida glabrata, andCandida parapsilosis, revealed that both NPs had powerful fungicidal actions against the examined pathogens. The ultrastructure imaging of subjectedC. albicansandC. parapsilosisto NPs revealed that Fu/Ag-NPs and Fu/Se-NPs triggered remarkable distortions, pore formation, and destructive lysis in cell surfaces within 10 h of exposure. The innovative usage ofC. barbataFu for Ag-NP and Se-NP synthesis and the application of their composites as powerful anticandidal agents, with minimized human toxicity, are concluded.
Preparation and characterization of sodium alginate/acrylic acid composite hydrogels conjugated to silver nanoparticles as an antibiotic delivery system
Authors: Mohamadinia Parvaneh , Anarjan Navideh , Jafarizadeh-Malmiri Hoda
Published: December 2021

Hydrogels are promising drug delivery systems attributable to their unique characteristics such as high hydrophilicity, controllability, biocompatibility, and facile production routines. The aim of this research was the preparation of sodium alginate/acrylic acid (AAc) composite hydrogels conjugated to silver nanoparticles to deliver the cephalexin as a model antibiotic compound. The reduction of silver ions into silver nanoparticles as well as the stabilization of created nanoparticles ensued simultaneously with hydrogel backbone formulation during microwave irradiation and monomer cross-linking processes. The impact of AAc and silver ion concentrations and the radiation time of microwave were then investigated on the main characteristics of hydrogels. The results indicated that the hydrogels’ characteristics could be significantly predicted by studying all independent parameters through various second-order polynomial models. The multiple optimization analysis suggested that the prepared hydrogels using 7.8 g AAc and 1.5 g silver nitrate and 1 min microwave radiation could give the best hydrogels with the highest swelling degree, gel fraction, cephalexin absorption, and antibacterial activity. The morphology and either absorption or release kinetics of cephalexin by the optimum prepared hydrogels were also investigated. No significant differences between the experimental and predicted data confirmed the suitability of the suggested models.
Conditional as-if analyses in randomized experiments
Authors: Pashley Nicole E. , Basse Guillaume W. , Miratrix Luke W.
Published: December 2021

The injunction to “analyze the way you randomize” is well known to statisticians since Fisher advocated for randomization as the basis of inference. Yet even those convinced by the merits of randomization-based inference seldom follow this injunction to the letter. Bernoulli randomized experiments are often analyzed as completely randomized experiments, and completely randomized experiments are analyzed as if they had been stratified; more generally, it is not uncommon to analyze an experiment as if it had been randomized differently. This article examines the theoretical foundation behind this practice within a randomization-based framework. Specifically, we ask when is it legitimate to analyze an experiment randomized according to one design as if it had been randomized according to some other design. We show that a sufficient condition for this type of analysis to be valid is that the design used for analysis should be derived from the original design by an appropriate form of conditioning. We use our theory to justify certain existing methods, question others, and finally suggest new methodological insights such as conditioning on approximate covariate balance.
Theoretical and experimental investigation of MWCNT dispersion effect on the elastic modulus of flexible PDMS/MWCNT nanocomposites
Authors: Ghahramani Pardis , Behdinan Kamran , Moradi-Dastjerdi Rasool , Naguib Hani E.
Published: December 2021

In this article, Young’s modulus of a flexible piezoresistive nanocomposite made of a certain amount of multiwalled carbon nanotube (MWCNT) contents dispersed in polydimethylsiloxane (PDMS) has been investigated using theoretical and experimental approaches. The PDMS/MWCNT nanocomposites with the governing factor of MWCNT weight fraction (e.g., 0.1, 0.25, and 0.5 wt%) were synthesized by the solution casting fabrication method. The nanocomposite samples were subjected to a standard compression test to measure their elastic modulus using Instron Universal testing machine under force control displacement mode. Due to the costs and limitations of experimental tests, theoretical predictions on the elasticity modulus of such flexible nanocomposites have also been performed using Eshelby–Mori–Tanaka (EMT) and Halpin–Tsai (HT) approaches. The theoretical results showed that HT’s approach at lower MWCNT contents and EMT’s approach at higher MWCNT contents have a better agreement to experimental results in predicting the elastic modulus of PDMS/MWCNT nanocomposites. The experimental results indicated that the inclusion of MWCNT in the PDMS matrix resulted in a noticeable improvement in Young’s modulus of PDMS/MWCNT nanocomposite at small values of MWCNT contents (up to w
f = 0.25%); however, exceeding this nanofiller content did not elevate Young’s modulus due to the emergence of MWCNT agglomerations in the nanocomposite structure.
Correlation between methylene tetrahydrofolate reductase (MTHFR) gene rs1801133 C>T polymorphisms and risk of osteoporosis
Authors: Chen Xiao , Zhang Weiran , Huang Jingmin
Published: December 2021

Objective

To evaluate the correlation between methylene tetrahydrofolate reductase (MTHFR) gene rs1801133 C>T polymorphisms and risk of osteoporosis.

Methods

We searched the clinical studies related to MTHFR gene rs1801133 C>T polymorphisms and risk of osteoporosis in the electronic databases of PubMed, Web of Science, EMBASE, China National Knowledge Infrastructure (CNKI), Chinese BioMedical Literature Database (CBM) and included the suitable publications in the present meta-analysis according to the inclusion and exclusion criteria. The data of included studies were extracted and pooled by a random or fixed-effect model. The odds ratio (OR) and 95% confidence interval (95% CI) were applied to demonstrate the correlation between MTHFR gene rs1801133 C>T polymorphisms and the risk of osteoporosis. Publication bias was assessed by Begg’s funnel plot and Egger’s line regression test.

Results

Seven case–control clinical studies were included and a data combination was made. The data was pooled by the fixed effect model because of no obvious statistical heterogeneity. The pooled results indicated that people with the T allele had increased risk of developing osteoporosis under the homologous gene model (TT vs CC) (OR = 2.36, 95% CI: 1.81–3.08, p < 0.05), dominant gene model (TT + CT) vs CC (OR = 1.47, 95% CI: 1.21–1.77, p < 0.05) and recessive gene model TT vs (CC + CT) (OR = 2.16, 95% CI: 1.71–2.74, p < 0.05). Egger’s line regression test indicated no significant publication bias for the present meta-analysis in the above homologous, dominant, and recessive gene models.

Conclusion

The MTHFR gene rs1801133 C>T polymorphisms are associated with osteoporosis and subjects with the T allele have an increased risk of developing osteoporosis.
Stability analysis of functionals in variational data assimilation with respect to uncertainties of input data for a sea thermodynamics model
Authors: Shutyaev Victor , Parmuzin Eugene , Gejadze Igor
Published: December 2021

The problem of stability and sensitivity of functionals of the optimal solution of the variational data assimilation of sea surface temperature for the model of sea thermodynamics is considered. The variational data assimilation problem is formulated as an optimal control problem to find the initial state and the boundary heat flux. The sensitivity of the response functions as functionals of the optimal solution with respect to the observation data is studied. Computing the gradient of the response function reduces to the solution of a non-standard problem being a coupled system of direct and adjoint equations with mutually dependent initial and boundary values. The algorithm to compute the gradient of the response function is presented, based on the Hessian of the original cost functional. Stability analysis of the response function with respect to uncertainties of input data is given. Numerical examples are presented for the Black and Azov seas thermodynamics model.
Investigation of the influence of recyclate content on Poisson number of composites
Authors: Żuk Daria , Abramczyk Norbert , Drewing Sebastian
Published: December 2021

Composite materials are used in many industries. Their mechanical and physical properties as well as their low weight make them suitable for use in many constructions. Their wide application generates a problem with their disposal. Therefore, it is necessary to design new materials based on waste from polyester–glass laminates in order to introduce a closed circuit in the composite production process. The article presents research aimed at determining solid material composites with polyester–glass recyclate, in order to use these materials for modeling the structure. The aim of this study was to determine the effect of the addition of recyclate to the polyester–glass composite on the deformation and the value of the Poisson number of the material. During the study, samples from composites with the addition of polyester–glass recyclate were used. Samples made in accordance with the standard for plastics PN-EN ISO 527-4_2000P were subjected to static tensile test on a universal testing machine, with variable load parameters. During the test, the longitudinal and transverse elongations of the samples were measured using a strain gauge measuring system. On the basis of the measurements, the values of Poisson numbers were determined, which allowed for a preliminary assessment of the impact of the recyclate content in the composite on its deformability.
On some reciprocal matrices with elliptical components of their Kippenhahn curves
Authors: Jiang Muyan , Spitkovsky Ilya M.
Published: December 2021

By definition, reciprocal matrices are tridiagonal n-by-n matrices A with constant main diagonal and such that ai

,

i

+1
ai

+1,

i
= 1 for i = 1, . . ., n − 1. We establish some properties of the numerical range generating curves C(A) (also called Kippenhahn curves) of such matrices, in particular concerning the location of their elliptical components. For n ≤ 6, in particular, we describe completely the cases when C(A) consist entirely of ellipses. As a corollary, we also provide a complete description of higher rank numerical ranges when these criteria are met.
Graphs with the second signless Laplacian eigenvalue ≤ 4
Authors: Drury Stephen
Published: December 2021

We discuss the question of classifying the connected simple graphsHfor which the second largest eigenvalue of the signless LaplacianQ(H) is ≤ 4. We discover that the question is inextricable linked to a knapsack problem with infinitely many allowed weights. We take the first few steps towards the general solution. We prove that this class of graphs is minor closed.
Galvanic vestibular stimulation with low intensity improves dynamic balance
Authors: Chen Hongmei , Hu Zhen , Chai Yujuan , Tao Enxiang , Chen Kai , Asakawa Tetsuya
Published: December 2021

Background

Dynamic balance is associated with fall risk. The aim of this study is to explore the effects of galvanic vestibular stimulation with very low intensity direct current (dcGVS) on dynamic balance.

Methodology

We used a rocker force platform for assessing the dynamic balance performance. Center-of-pressure (COP) coordinates were acquired and decomposed to rambling (RA) and trembling (TR). We measured sway parameters, including length, average speed, and average range, affected by dcGVS at 0.01 mA with eyes open (EO) and eyes closed (EC).

Results

We assessed 33 young healthy subjects and found that all sway parameters were shorter in the EO condition, indicating a better dynamic balance performance. dcGVS significantly improved the dynamic balance performance both in EO and EC conditions. All the sway parameters in COP in EO were significantly shorter than those in EC, indicating a better dynamic balance performance in EO. In EO, RA had greater improvement rates than TR. In EC, only average speed had a greater improvement rate in RA, whereas length and average range had greater improvement rates in TR. These results indicate a different modulation model between EO and EC.

Conclusion

These findings indicate that very low intensity dcGVS improved the sway parameters of dynamic balance in young healthy subjects. Moreover, our results suggest different dynamic balance control models between having EO and EC. The mechanisms of these phenomena caused by very low intensity dcGVS require further investigation.
Bilder in Vorlesungen, Hörsäle als Bilder: diagrammatische Überlegungen
Authors: Bubenhofer Noah
Published: December 2021

Visual material plays a central role in lectures to illustrate the spoken word or to show objects of knowledge. Historically, the question arises as to when which methods were used and what their functions were and still are today. In a further diagrammatic perspective on the setting of the lecture, however, other aspects of pictoriality must be included: For example, there is a tradition of storing, commenting on, processing and editing lectures by the audience, which leads, for example, to transcripts that transform the lecture medially. Yet these techniques are embedded in an ensemble of diagrammatic practices of lecture organisation, which can be understood as „instructions for use“ for both lecturers and listeners. From a diagrammatic perspective, it becomes clear that the diagrammatic orders applied in and by lectures are not simply ornaments of the lecture, but have a knowledge-constitutive effect.
An Attachment Point for Meaningful Musculoskeletal Learning
Authors: Olson Alister R. , Clough Michael P.
Published: December 2021

A robust understanding of body systems is elusive for many students. For instance, musculoskeletal structures and mechanisms often remain abstract and difficult for students to truly understand, even when teachers provide visual representations and accurate anatomical and physiological information. This article (1) presents a lesson for teaching about the musculoskeletal system by having students develop and build a physical model of an arm and (2) describes how teachers can use this experience to promote a deep understanding of the role of muscles, ligaments, and tendons in movement. This concrete learning experience and resulting arm model establishes a foundation for developing a more robust understanding of anatomical, physiological, and general biological principles. This lesson sequence also embeds questions that overtly draw students’ attention to important features of scientific models, which is an important nature of science issue appearing in the Next Generation Science Standards. The instructional sequence has been utilized as the foundation of an entire musculoskeletal unit in an elective anatomy and physiology course for ninth grade students, and it can easily be adapted for use in a middle school life science class or a general high school biology course.
Thinking About Blackness in the Pacific
Authors: Jerry Anthony , Borucki Alex , Smith Sabrina
Published: December 2021

Anthony Jerry discusses the history and challenges for recognitions of Black Mexico and the broader Pacific region of Latin America. Jerry describes his research on a Black Mexican community of Costa Chica and its complex racial identity development. Responding to Jerry’s presentation, Alex Borucki describes the potential value of conducting comparative research that connects the movements of, as well as the locations where, Black communities developed in the Pacific regions of Latin America. Sabrina Smith suggests more attention to the transpacific slave trade, as well as the emergence of significant social and racial contestations by Afro-Mexicans in both historical and contemporary contexts.
The Protection of the Fundamental Procedural Rights of Business Entitiesby Applying Sanctions and the Results of the Legal Systematization of These Rights
Authors: Pogužinskė Eimantė
Published: December 2021

The present article analyses the extent of influence the adopted Article of the Law on Public Administration of the Republic of Lithuania (Art. 368, currently Art. 37), which systematises the basic procedural rights of business entities, has on the protection of business entities’ procedural rights, which are assured by the Supreme Administrative Court of Lithuania in its case law. The precise provisions invoked as basis for procedural rights protection in the case law of the Supreme Administrative Court of Lithuania regarding sanctions imposed on business entities are showcased. Furthermore, the results and plausible reasons for the application or non-application of procedural rights systematized in the Law on Public Administration are appraised.
Похибки можуть приносити користь
Authors: Сергієнко Іван Васильович , Хіміч Олександр Миколайович , Швідченко Інна Віталіївна
Published: December 2021

12 листопада 2021 р. виповнюється 80 років видатному вченому в галузі обчислювальної математики, цифрової обробки сигналів, інформаційної безпеки, співзасновнику відомої у світі міжнародної наукової школи з оптимізації обчислень, лауреату Державної премії України в галузі науки і техніки (2009) та Державної премії України в галузі освіти (2018), заслуженому діячеві науки і техніки України (2007), лауреату премій імені В.М. Глушкова (2003) та імені А.О. Дородніцина (2019) НАН України, заступнику академіка-секретаря Відділення інформатики НАН України, доктору фізико-математичних наук (1982), професору (1991), академіку НАН України (2015) Валерію Костянтиновичу Задіраці.
Видатна особистість титанової науки
Authors: Марковський Павло Євгенович , Саввакін Дмитро Георгійович
Published: December 2021

8 листопада виповнюється 75 років видатному вченому в галузі фізики металів і фізичного матеріалознавства, лауреату двох Державних премій України в галузі науки і техніки (1993, 2005), заслуженому діячеві науки і техніки України (1998), лауреату премії ім. К.Д. Синельникова НАН України (1987), премії президентів академій наук України, Білорусі та Молдови (2002), директору Інституту металофізики ім. Г.В. Курдюмова НАН України (2011—2019), доктору технічних наук (1987), професору (1992), академіку НАН України (2003) Оресту Михайловичу Івасишину.
Increasing Timely Family Meetings in Neonatal Intensive Care: A Quality Improvement Project
Authors: Sabnis Animesh , Hagen Eunice , Tarn Derjung M. , Zeltzer Lonnie
Published: December 2021

OBJECTIVES:

Timely multidisciplinary family meetings (TMFMs) promote shared decision-making. Despite guidelines that recommend meetings for all patients with serious illness, our NICU TMFM rate was 10%. In this study, we aimed to document a meeting within 5 days of hospitalization for 50% of all new NICU patients hospitalized for ≥5 days within 1 year of introducing interventions.

METHODS:

A multidisciplinary improvement team used the Model for Improvement to achieve the study aim by targeting key drivers of change. To make meetings easier, we introduced scheduling and documentation tools. To make meetings more customary, we provided education and reminders to professionals. We defined a TMFM as a documented discussion between a parent, a neonatologist, and a nonphysician professional, such as a nurse, within 5 days of hospitalization. We used statistical process control charts to assess the monthly proportion of new patients with a TMFM. In surveys and feedback sessions, family and clinician satisfaction with communication was assessed.

RESULTS:

TMFM documentation tripled during the intervention year when compared with the previous year (28 of 267 [10.5%] vs 70 of 224 [31.3%]; P < .001), revealing evidence of special cause variation on the statistical process control chart. Clinicians predominantly used ad hoc documentation instead of our scheduling and documentation tools. Parental satisfaction with care and communication did not vary significantly after interventions. Most physicians reported satisfaction with meetings. Nurses reported feeling empowered to request meetings.

CONCLUSIONS:

An academic, quaternary-care NICU tripled TMFM documentation after introducing a multifaceted intervention. This improvement may represent changes in professionals’ attitudes about providing and documenting family meetings.
Otitis Media—Principles of Judicious Use of Antimicrobial Agents
Authors: Dowell Scott F. , Marcy S. Michael , Phillips William R. , Gerber Michael A. , Schwartz Benjamin
Published: December 2021

Otitis media is the leading indication for outpatient antimicrobial use in the United States. Overdiagnosis of and unnecessary prescribing for this condition has contributed to the spread of antimicrobial resistance. A critical step in reducing unnecessary prescribing is to identify the subset of patients who are unlikely to benefit from antibiotics. Conscientiously distinguishing acute otitis media (AOM) from otitis media with effusion (OME), and deferring antibiotics for OME will accomplish this goal, and will avoid up to 8 million unnecessary courses of antibiotics annually. Criteria for defining these conditions are presented, as well as the evidence supporting deferring antibiotic treatment. Discussions of shortened courses of antibiotics for AOM and restricted indications for antimicrobial prophylaxis are also presented.
Growth Hormone Treatment of Girls With Turner Syndrome: The National Cooperative Growth Study Experience
Authors: Plotnick Leslie , Attie Kenneth M. , Blethen Sandra L. , Sy Judy P.
Published: December 2021

Objective. To evaluate growth rate and adult height with recombinant growth hormone (GH) treatment in girls with Turner syndrome (TS) and predictors of their growth response.

Methods. Data on girls with TS who were treated with GH in the National Cooperative Growth Study (NCGS) were evaluated. As of January 1997, there were 2798 girls with TS in the NCGS database, 2652 of whom had not previously received GH. Follow-up data on growth were available for 2475 subjects, and data on adult height were available for 622.

Results. The average age of girls with TS at enrollment in the NCGS was 10.1 ± 3.6 years. These patients had severely short stature compared with that of unaffected American girls (height, 118.5 ± 16.5 cm; height standard deviation score [SDS], −3.1 ± 0.9), but their heights were typical of those of American girls with TS (TS-specific height SDS, 0.01 ± 0.9). Treatment with GH for an average duration of 3.2 ± 2.0 years resulted in an increase in height SDS of 0.8 ± 0.7 compared with unaffected girls and of 1.2 ± 0.8 compared with TS standards. Growth rates increased from 4.0 ± 2.3 cm/year before treatment to 7.5 ± 2.0 cm/year after 1 year of treatment. Duration of treatment with GH was the strongest predictor of change in height SDS. After 6 to 7 years of treatment with GH, there was a cumulative change of 2.0 in mean height SDS.

The 622 girls who reached adult height were older when they began taking GH. Their mean height gain over pre-GH projected height was 6.4 ± 4.9 cm after 3.7 ± 1.9 years of treatment. Their adult height was 148.3 ± 5.6 cm.

Conclusions. Although the response to treatment with GH varied, it was associated with highly significant gains in growth and adult height in girls with TS. Duration of treatment with GH was the most important variable predicting adult height.
Optimizing Estrogen Replacement Treatment in Turner Syndrome
Authors: Rosenfield Robert L. , Perovic Nancy , Devine Nancy , Mauras Nelly , Moshang Tom , Root Allen W. , Sy Judy P.
Published: December 2021

Estrogen has a biphasic effect on growth, stimulatory at low doses but inhibitory at higher doses. Therefore, designing optimal sex hormone replacement treatment in girls with Turner syndrome (TS) who are being treated with growth hormone (GH) involves considering the dose and form of the estrogen as well as the route and timing of its administration. We report here a preliminary analysis of a study to test the concept that an optimal estrogen replacement regimen should consist of estradiol administered in a low dose by a systemic route.

The study population consisted of 9 girls with TS who had been treated with GH for 6 or more months. When the girls were 12 to 15 years old, we added depot estradiol at a monthly intramuscular dose of 0.2 mg and increased the dose at 6-month intervals to 0.4, 0.6, and, in 7 of the girls, 0.8 mg. We compared the results in these subjects with those in a matched group of 37 patients with TS in whom routine estrogen treatment had been started at similar ages and who were treated with a similar course of GH therapy.

The gain in height at 2 years was 2.6 cm greater in those who were treated with depot estradiol than in those who were treated with routine estrogen. The bone age in the patients who were treated with depot estradiol increased in proportion to their chronologic age, suggesting that this difference indicates an increase in their predicted adult height. We conclude that using very low doses of systemic estradiol to induce puberty before the age of 15 years in girls with TS who are treated with GH, instead of using routine estrogen therapy, can result in increased final heights.
Growth Deficits in Children With Attention Deficit Hyperactivity Disorder
Authors: Spencer Thomas , Biederman Joseph , Wilens Timothy
Published: December 2021

Stimulant-associated growth deficits in children with attention deficit hyperactivity disorder (ADHD) have long been a concern. Height deficits in preadolescence have been reported, but adult heights have been reported to be uncompromised. It is possible that the catch-up growth that occurs is related to ADHD-associated delayed maturation and not to the cessation of stimulant treatment. To date, no consistent neurohormonal pathophysiology to explain stimulant-associated height deficits has been identified nor have the initial associations of height and weight deficits been replicated. Attention deficit hyperactivity disorder is associated with dysregulation of several neurotransmitter systems, especially the catecholamines, that may alter neuroendocrine function and lead to growth delays. The literature on neuroendocrine aspects of growth and treatment in ADHD and on growth in boys with ADHD who are treated with psychotropics is reviewed, and the results of a controlled study in 124 boys with ADHD are presented. Small but significant differences in height were found between children with and without ADHD. However, the height deficits were evident in early, but not late, adolescence and were not related to the use of psychotropic medications. There was no evidence of weight deficits in children with ADHD relative to control subjects and no relationship between measures of malnutrition and short stature was found. These findings suggest that ADHD may be associated with temporary deficits in height gain through midadolescence that may normalize by late adolescence. This effect appears to be mediated by ADHD and not by its treatment.
Lack of Correlation Between Growth Hormone Provocative Test Results and Subsequent Growth Rates During Growth Hormone Therapy
Authors: Bell Jennifer J. , Dana Ken
Published: December 2021

Objectives. To determine whether there is a relationship between the peak GH level in pituitary stimulation tests and the growth rate in response to treatment with recombinant human growth hormone (GH).

Methods. We identified 24 843 patients in the National Cooperative Growth Study database who had not been treated previously with GH therapy and divided them into three groups according to the peak GH level in pituitary stimulation testing: 1) <10 μg/L (n = 14 132); 2) ≥10 μg/L (n = 7476); and 3) no test results reported (n = 3235). Growth rates in each group in response to GH therapy were examined.

Results. The children in each of the groups responded to GH therapy with a vigorous increase in growth rates (means, 8.4 to 9.5 cm/y) in the first year, followed by a gradual decline and then stabilization at 1.0 to 1.9 cm/y greater than the pretreatment values. There were large overlaps in the growth rates among the groups, but the differences were significant.

The growth rates in a smaller group of children (n = 187) who had normal GH responses and normal growth rates before GH therapy increased similarly in the first year of therapy (to 7.7 to 9.2 cm/y), but then declined rapidly to the pretreatment values or lower.

Conclusion. Because the GH response to pituitary stimulation testing is inadequate for diagnosing GH deficiency, such testing also is inadequate for determining whether GH treatment should be prescribed in a child with short stature. In addition, the waning response to GH therapy in normally growing short children suggests that this treatment may not have a sustained benefit in these children.
Biological Basis of Emotions: Brain Systems and Brain Development
Authors: Chugani Harry T.
Published: December 2021

Functional neuroimaging techniques such as positron emission tomography have made it possible to investigate brain metabolism noninvasively during development. Studies have revealed a dynamic period of metabolic maturation and neuronal growth corresponding to the processes of synaptic proliferation and pruning of unused pathways. This physiologic plasticity is believed to be the biological basis for a critical period of learning and emotional development.
Emotions and Social Development: Infants' Recognition of Emotions in Others
Authors: Walker-Andrews Arlene S.
Published: December 2021

Infants generally begin to recognize emotional expressions after 6 months of age; some reports have even observed recognition in neonates. Emotional recognition is important for social referencing, in which infants “read” their parents' expressions to understand events. Three methods for studying how infants come to recognize emotion are described in this article: peek-a-boo, matching faces and voices, and multimodal presentation.
Emotional Characteristics of Infants Associated With Maternal Depression and Anxiety
Authors: Weinberg M. Katherine , Tronick Edward Z.
Published: December 2021

Infants as young as 3 months are able to detect depression in their mothers. Depressed mothers are sufficiently different from nondepressed mothers in affect and interaction that the social, emotional, and cognitive functioning of their infants are compromised. This article reviews current findings on the effects of maternal depression and psychiatric illness on infants.
Immunization Performance Measurement in a Changing Immunization Environment
Authors: Rodewald Lance , Maes Edmond , Stevenson John , Lyons Bridget , Stokley Shannon , Szilagyi Peter
Published: December 2021

Objective.

The measurement of performance in the delivery of recommended vaccinations for children is used frequently as a marker for quality of care and as an outcome for studies of interventions to improve immunization coverage levels. The critical element of immunization performance measurement is the determination of immunization status. This methodologic review 1) discusses immunization status as a measure of quality of primary care for children, 2) describes immunization status measures used in immunization intervention studies, and 3) examines selected technical issues of immunization status measurement.

Methods and Topics.

1) Description of the characteristics of immunization status measurements obtained by a systematic review of studies published between 1980 and 1997 on interventions to raise immunization coverage, and 2) illustration of technical considerations for immunization status measurement using one local database and one national database of immunization histories. Technical issues for immunization status measurement include 1) the need to use documented immunization histories rather than parental recall to determine immunization status, 2) the need to link records across providers to obtain complete records, 3) the sensitivity of immunization status to missing immunization data, and 4) the potential of measures incorporating combinations of immunizations to underestimate the degree of vaccination in a population.

Conclusions.

Immunization performance measurement has many characteristics of a robust quality of care measure, including high acceptance by primary care providers of routine vaccination, association of immunization status with the conduct of other clinical preventive services, agreed-on technical and programmatic standards of care, and legislative requirements for medical record documentation. However, it is not without challenges. Careful attention to technical issues has potential to improve immunization delivery health services research.
The Social Ecology of Addiction: Race, Risk, and Resilience
Authors: Wallace John M.
Published: December 2021

Objective.

The purposes of this article are to inform pediatricians and other health professionals of key contextual risk factors that elevate black and Hispanic Americans' likelihood to use substances and to discuss selected protective mechanisms that may shield members of these populations against substance use.

Method.

The article selectively reviews the literature on the epidemiology, etiology, and consequences of alcohol and other drug use among white, black, and Hispanic adults and youth.

Results.

The extant research suggests that historical and contemporary racialized practices and ideologies influence racial/ethnic differences in substance use outcomes, both directly and indirectly, through their influence on the communities in which people of different racial/ethnic groups are placed, through their influence on the structure and process of people's interpersonal relationships, and through the impact that they have on individuals' psychology and behavior.

Conclusions.

Although the emphasis of pediatricians' and many other helping professionals' work focuses on individuals and individual-level behaviors, these behaviors can only be properly examined, diagnosed, and treated when they are understood in light of the community and societal contexts in which they occur.
Using Employer Purchasing Power to Improve the Quality of Perinatal Care
Authors: Castles Anne G. , Milstein Arnold , Damberg Cheryl L.
Published: December 2021

Large employers have become increasingly involved in helping to set the agenda for quality measurement and improvement. Moreover, they are beginning to hold health care organizations accountable for their performance through marketplace incentives, including the public reporting of comparative quality data and the linkage of reimbursement to performance on quality measures. The Pacific Business Group on Health (PBGH) is an employer coalition that has been prominent in establishing models for collaborative quality measurement and improvement in the California marketplace.

PBGH's involvement in quality stems from an environment in which purchasers were faced with high health care costs, yet virtually no information with which to assess the value their employees received from that care. Research indicating widespread variation in performance across health care organizations and seemingly limited oversight for quality of care within the industry has further motivated purchasers' efforts to better understand the quality of care being delivered to their em-ployees.

Using the purchasing power of employers representing 2.5-million covered lives, PBGH endeavors to encourage the transition of the health care marketplace from one that competes solely on price to one that competes on price and quality. This entails collaborating with the health care industry to develop and publicly report valid performance data for use by both large employers and consumers of health care services. It also includes communicating to the marketplace purchasers' commitment to making purchasing decisions based on quality as well as cost. PBGH efforts to measure, report, and improve quality have been demonstrated by several undertakings in the perinatal care arena, including research to assess cesarean section rates and newborn readmission rates across California hospitals. employer coalition, purchaser, quality measurement, quality improvement, report cards, perinatal quality of care.
Structure and Performance of Different DRG Classification Systems for Neonatal Medicine
Authors: Muldoon John H.
Published: December 2021

There are a number of Diagnosis-Related Group (DRG) classification systems that have evolved over the past 2 decades, each with their own strengths and weaknesses. DRG systems are used for case-mix trending, utilization management and quality improvement, comparative reporting, prospective payment, and price negotiations. For any of these applications it is essential to know the accuracy with which the DRG system classifies patients, specifically for predicting resource use and also mortality.

The objective of this study was to assess the adequacy of the three most commonly used DRG systems for neonatal patients—Medicare DRGs, All Patient Diagnosis-Related Groups (AP-DRGs), and All Patient Refined Diagnosis-Related Groups (APR-DRGs). A 2-part methodology is used to assess adequacy. The first part is a descriptive analysis that examines the structural characteristics of each system. This provides a framework for understanding the inherent strengths and weaknesses of each system and for interpreting their statistical performance. The second part examines the statistical performance of each system on a large nationally representative hospital database.

The analysis identifies major differences in the structure and statistical performance of the three DRG systems for neonates. The Medicare DRGs are structurally the least developed and yield the poorest overall statistical performance (cost R2 = 0.292; mortality R2 = 0.083). The APR-DRGs are structurally the most developed and yield the best statistical performance (cost R2 = 0.627; mortality R2 = 0.416). The AP-DRGs are intermediate to Medicare DRGs and APR-DRGs, although closer to APR-DRGs (cost R2 = 0.507; mortality R2 = 0.304).

An analysis of payment impacts and systematic effects identifies there are major systematic biases with the Medicare DRGs. At the patient level, there is substantial underpayment for surgical neonates, transferred-in neonates, neonates discharged to home health services, and neonates who die. In contrast, there is substantial overpayment for normal newborns. At the facility level, there is substantial underpayment for freestanding acute children's hospitals and major teaching general hospitals. There is overpayment for other urban general hospitals but this pattern varies by hospital size. There is very substantial overpayment for other rural hospitals. The AP-DRGs remove the majority of the systematic effects but significant biases remain. The APR-DRGs remove most of the systematic effects but some biases remain.