bluuebunny/crossref_metadata_2025 huggingface dataset:
AV nodal reentrant tachycardia with a 2:1 right bundle branch block missed as bidirectional ventricular tachycardia in the first superficial evaluation
Authors: Akbarzadeh Mohammad Ali , Khaheshi Isa , Memaryan Mehdi , Mahjoob Mohammad Parsa , Naderian Mohammadreza
Published: January 2017

A 95-year old woman was admitted to our emergency unit because of acute abdominal pain. After urgent surgery according to the acute abdomen, she was referred to intensive care unit (ICU) of the emergency unit as she was intubated. It was developed a run of new arrhythmia which was diagnosed by cardiology resident as bidirectional ventricular tachycardia due to beat to beat changing the axis of the QRS. However, a second and more precise evaluation of the abnormal ECG suggested a narrow supraventricular tachycardia, most probably AV nodal reentrant tachycardia with a 2:1 right bundle branch block.
Spatial Propagation of the Economic Impacts of Bombing: The Case of the 2006 War in Lebanon
Authors: Haddad Eduardo Amaral , Okuyama Yasuhide
Published: January 2017

This paper assesses the economic effects of the July 2006 War in Lebanon. We estimate the economy-wide impacts on the Lebanese regions resulting from the reduction of physical capital stocks using the estimated damages associated with the bombing events. In doing that, we are able to derive the estimates of the short-run economic costs of the War related to the structural break in the availability of economic infrastructure in the country. A discussion on resiliency is also introduced showing how the lack of redundancy in the country’s infrastructure is associated with stronger higher-order negative effects. Moreover, we show how international trade can act as a shock absorber.
Study on the Spectrum of Photonic Crystal Cavity and Its Application in Measuring the Concentration of NaCl Solution
Authors: Zhang Yun , Xie Xun , Yang Ze-Kun , Hao Jiong-Ju , Xu Zhi-Gang , Yang Hong-Wei
Published: January 2017

In this article, we propose an approach to measure solution concentrations by using photonic crystal cavities. Based on the experimental data, the refractive index of a NaCl solution is proportional to the concentration. Filling the proposed photonic crystal cavity with a NaCl solution, we calculate the spectral transmission using the transfer matrix method. We found that the cavity transmittance was proportional to the refractive index of the NaCl solution, and thus we obtained a linear relationship between cavity transmittance and the concentration of the NaCl solution. The formula was found by fitting the simulation results with experimental data. Such a formula can be applied to the measurement of an unknown concentration of NaCl solution utilizing a photonic crystal cavity.
Swing Rhythm in Classic Drum Breaks From Hip-Hop’s Breakbeat Canon
Authors: Frane Andrew V.
Published: January 2017

Certain recorded drum breaks, i.e., drum patterns played without other instrumentation, have achieved iconic status, largely as a result of being frequently “sampled” in other recordings. Although these highly influential drum breaks (sometimes called breakbeats) have been integral to much of the hip-hop and other music produced in recent decades, there has been little scholarly investigation of their rhythmic features. To that end, this study examined 30 classic drum breaks from the “breakbeat canon,” focusing primarily on sixteenth-note swing (a systematic delay of even-numbered sixteenth-note divisions of the pulse). Such swing was common among the examined drum breaks, though the magnitude of swing was often fairly subtle (median swing ratio = 1.2:1). In contrast to some findings regarding jazz drumming, the magnitude of swing was uncorrelated with tempo, though the ranges of both variables were somewhat constrained. Backbeat delay (a systematic delay of snare drum at even-numbered beats) was found to be frequently present at beat 2, but not at beat 4. Additionally, this study introduces a quantity called “swing density,” defined as the proportion of even-numbered divisions (at the swing level) that contain events. The importance of this quantity to the perceptual effect of swing is discussed.
Global Music Recordings Support the Motor Constraint Hypothesis for Human and Avian Song Contour
Authors: Savage Patrick E. , Tierney Adam T. , Patel Aniruddh D.
Published: January 2017

There has recently been renewed interest in using quantitative data to explore questions about musical universals. One explanation for certain musical universals is that they reflect ways of singing that are most energetically efficient, as opposed to biological specializations for human music. Previous research found support for this “motor constraint hypothesis” by comparing pitch contour shapes in samples of human and avian songs, but the sample of human songs was limited to notated scores of European and Chinese folk songs from the Essen database. Here we test this hypothesis using a more diverse global sample of human music recordings from the Garland Encyclopedia of World Music. By directly comparing pitch contour shapes in a diverse sample of human songs and bird songs, we found that both human and bird songs tend to employ similar descending/arched melodic contours despite substantial differences in absolute pitch and duration. This preference was consistent for both Western and non-Western songs. Surprisingly, we also found that the global samples of human and bird song contours were significantly more correlated with one another than either was with the Essen contours. Our findings of broad cross-cultural and cross-species parallels support the motor constraint hypothesis for melodic contour. More generally, our findings demonstrate the importance of greater collaboration between ethnomusicology and music psychology.
Perceptual Learning of Pitch Direction in Congenital Amusia
Authors: Liu Fang , Jiang Cunmei , Francart Tom , Chan Alice H. D. , Wong Patrick C. M.
Published: January 2017

Congenital amusia is a lifelong disorder of musical processing for which no effective treatments have been found. The present study aimed to treat amusics’ impairments in pitch direction identification through auditory training. Prior to training, twenty Chinese-speaking amusics and 20 matched controls were tested on the Montreal Battery of Evaluation of Amusia (MBEA) and two psychophysical pitch threshold tasks for identification of pitch direction in speech and music. Subsequently, ten of the twenty amusics undertook 10 sessions of adaptive-tracking pitch direction training, while the remaining 10 received no training. Post training, all amusics were retested on the pitch threshold tasks and on the three pitch-based MBEA subtests. Trained amusics demonstrated significantly improved thresholds for pitch direction identification in both speech and music, to the level of non-amusic control participants, although no significant difference was observed between trained and untrained amusics in the MBEA subtests. This provides the first clear positive evidence for improvement in pitch direction processing through auditory training in amusia. Further training studies are required to target different deficit areas in congenital amusia, so as to reveal which aspects of improvement will be most beneficial to the normal functioning of musical processing.
The Development of the Putt.It.In Monitoring Device and the Establishment of Its Reliability: A Solution for Putting-In Analysis in Golf
Authors: Taha Zahari , Mohd Razman Mohd Azraai , Adnan Faeiz Azizi , P.P. Abdul Majeed Anwar , Musa Rabiu Muazu
Published: January 2017

Background: The accurate transfer of information on the athletes’ performance in any sport is essential in enhancing the performance and overall coaching process. The provision of such information is favourable only if it is reliable. A cost-effective golf putting monitoring device namely the Putt.It.In was developed for analysing a golfers’ putting performance. Objectives: This study aims to investigate the reliability of the device in measuring the backswing distance, front swing distance, clubhead speed, ideal front swing distance and swing angle. Methods: A semi- professional golfer (30 years of age ± 5.0 years’ experience) executed four strokes repeatedly from a distance of 2 m and 1 m using a Ram Zebra Mallet putter on a PGM golf mat. Kolmogorov/Smirnov test was utilised to ascertain the reliability of the application in measuring the aforementioned parameters over test re-test between first two strokes of 2 m distance and the last two strokes of 1 m distance. Results: The Kolmogorov/Smirnov test re-test suggests that there is no significant difference between first two meters strokes p > 0.05, and second 1-meter strokes p > 0.05 highlighting its ability to recognise the pattern of the strokes applied in the four successive strokes. Conclusion: The Putt.It.In monitoring device is found to be reliable in measuring the backswing distance, front swing distance, clubhead speed, ideal front swing distance and swing angle. Professional and semi-professional golfers as well coaches could consider Putt.It.In device in monitoring strokes related parameters to enhance their performance due to its effectiveness in providing information on putting performance.
The Impact of Selection at the Amino Acid Level on the Usage of Synonymous Codons
Authors: Błażej Paweł , Mackiewicz Dorota , Wnętrzak Małgorzata , Mackiewicz Paweł
Published: January 2017

There are two main forces that affect usage of synonymous codons: directional mutational pressure and selection. The effectiveness of protein translation is usually considered as the main selectional factor. However, biased codon usage can also be a byproduct of a general selection at the amino acid level interacting with nucleotide replacements. To evaluate the validity and strength of such an effect, we superimposed >3.5 billion unrestricted mutational processes on the selection of nonsynonymous substitutions based on the differences in physicochemical properties of the coded amino acids. Using a modified evolutionary optimization algorithm, we determined the conditions in which the effect on the relative codon usage is maximized. We found that the effect is enhanced by mutational processes generating more adenine and thymine than guanine and cytosine, as well as more purines than pyrimidines. Interestingly, this effect is observed only under an unrestricted model of nucleotide substitution, and disappears when the mutational process is time-reversible. Comparison of the simulation results with data for real protein coding sequences indicates that the impact of selection at the amino acid level on synonymous codon usage cannot be neglected. Furthermore, it can considerably interfere, especially in AT-rich genomes, with other selections on codon usage, e.g., translational efficiency. It may also lead to difficulties in the recognition of other effects influencing codon bias, and an overestimation of protein coding sequences whose codon usage is subjected to adaptational selection.
De NovoGenome and Transcriptome Assembly of the Canadian Beaver (Castor canadensis)
Authors: Lok Si , Paton Tara A , Wang Zhuozhi , Kaur Gaganjot , Walker Susan , Yuen Ryan K C , Sung Wilson W L , Whitney Joseph , Buchanan Janet A , Trost Brett , Singh Naina , Apresto Beverly , Chen Nan , Coole Matthew , Dawson Travis J , Ho Karen , Hu Zhizhou , Pullenayegum Sanjeev , Samler Kozue , Shipstone Arun , Tsoi Fiona , Wang Ting , Pereira Sergio L , Rostami Pirooz , Ryan Carol Ann , Tong Amy Hin Yan , Ng Karen , Sundaravadanam Yogi , Simpson Jared T , Lim Burton K , Engstrom Mark D , Dutton Christopher J , Kerr Kevin C R , Franke Maria , Rapley William , Wintle Richard F , Scherer Stephen W
Published: January 2017

The Canadian beaver (Castor canadensis) is the largest indigenous rodent in North America. We report a draft annotated assembly of the beaver genome, the first for a large rodent and the first mammalian genome assembled directly from uncorrected and moderate coverage (< 30 ×) long reads generated by single-molecule sequencing. The genome size is 2.7 Gb estimated by k-mer analysis. We assembled the beaver genome using the new Canu assembler optimized for noisy reads. The resulting assembly was refined using Pilon supported by short reads (80 ×) and checked for accuracy by congruency against an independent short read assembly. We scaffolded the assembly using the exon–gene models derived from 9805 full-length open reading frames (FL-ORFs) constructed from the beaver leukocyte and muscle transcriptomes. The final assembly comprised 22,515 contigs with an N50 of 278,680 bp and an N50-scaffold of 317,558 bp. Maximum contig and scaffold lengths were 3.3 and 4.2 Mb, respectively, with a combined scaffold length representing 92% of the estimated genome size. The completeness and accuracy of the scaffold assembly was demonstrated by the precise exon placement for 91.1% of the 9805 assembled FL-ORFs and 83.1% of the BUSCO (Benchmarking Universal Single-Copy Orthologs) gene set used to assess the quality of genome assemblies. Well-represented were genes involved in dentition and enamel deposition, defining characteristics of rodents with which the beaver is well-endowed. The study provides insights for genome assembly and an important genomics resource for Castoridae and rodent evolutionary biology.
Landfill Hunter: Learning about Waste through Public Participation
Authors: Johnson Nicholas E. , Grey François
Published: January 2017

Landfills are the most ubiquitous and expedient means of waste disposal, prevailing over any economic, logistic or political obstacles.  Landfills, however, are far removed from most of society and their administration, operation and maintenance are often opaque.  This research uses public participation to generate, verify and enhance existing data about the size and location of current landfills in the US while simultaneously providing users an innovative way to see and explore landfills.  An online crowdsourcing tool, Landfill Hunter, was built to facilitate participation and populated with data from the Environmental Protection Agency (EPA).  Participants identified a total of 729 landfills.  Using this data, we estimate the area of individual landfills and calculate the cumulative land area of landfills in the US, which is approximately twice the size of New York City. In this paper, we emphasize learning outcomes that participation in this crowdsourcing initiative can generate, both online and offline, as well as creative ways that participants can visualize the resulting data.
Agroecology: A Fertile Field for Human Computation
Authors: Hanappe Peter , Dunlop Rob , Maes Annemie , Steels Luc , Duval Nicolas
Published: January 2017

Agroecology -- the science of sustainable agriculture -- offers a new and positive perspective for the creation of sustainable food systems. We argue that, from the outset, it is important to involve citizens in this development to create the necessary, bottom-up support for change in agriculture and to re-establish the ties between food production and consumption. Human Computation and Citizen Science offer opportunities to include citizens in the planning, monitoring and evaluation of agro-ecosystems. In the P2P Food Lab project, we also seek new ways to engage them more creatively by setting up a shared online/offline platform in which they can learn, practice, innovate, and share observations on agroecological techniques. This paper gives a description and the underlying motivations of our ongoing work.
Design Guidelines for the User-Centred Collaborative Citizen Science Platforms
Authors: Yadav Poonam , Darlington John
Published: January 2017

Online Citizen Science platforms are good examples of socio-technical systems where technology-enabled interactions occur between scientists and the general public (volunteers). Citizen Science platforms usually host multiple Citizen Science projects, and allow volunteers to choose the ones to participate in. Recent work in the area has demonstrated a positive feedback loop between participation and learning and creativity in Citizen Science projects, which is one of the motivating factors both for scientists and the volunteers. This emphasises the importance of creating successful Citizen Science platforms, which support this feedback process, and enable  enhanced learning and creativity to occur through knowledge sharing and diverse participation. In this paper, we discuss how scientists' and volunteers' motivation and participation influence the design of Citizen Science platforms.  We present our summary as guidelines for designing these platforms as user-inspired socio-technical systems. We also present the case-studies on popular Citizen Science platforms, including our own CitizenGrid platform, developed as part of the CCL EU project, as well as Zooniverse, World Community Grid, CrowdCrafting and EpiCollect+ to see how closely these platforms follow our proposed guidelines and how these may be further improved to incorporate the creativity enabled by the collective knowledge sharing.
Creativity and Learning in Citizen Cyberscience – Lessons from the Citizen Cyberlab Summit
Authors: Ramanauskaitė Eglė Marija , Haklay Mordechai
Published: January 2017

This article summarizes the Citizen Cyberlab (CCL) Summit, which took place at University of Geneva on 17-18th September 2015, and introduces the special issue on “Learning and Creativity in Citizen Science”. As the final event of a 3-year EU FP7 CCL project, the Summit sought to disseminate project results and reflect on the issue of citizen science (CS) as a participatory environment where opportunities for self-development and various types of creativity can arise. A number of interesting themes emerged at the intersection of the work presented by project collaborators and external partners, including the different types of creativity that are evident in CS, the role of the community as the main medium for innovation and participant learning to occur, and the common challenges concerning the design, initiation and management of CS projects.The current issue presents work done during the CCL project, as well as external project contributions, for which the main focus is on learning and creativity in CS. The set of articles addresses diverse aspects of the topic, ranging from empirical research on the phenomena themselves, to tools, platforms and frameworks developed specifically for citizen cyberscience (CCS) with creativity and learning in mind, and distinct CS cases where these phenomena manifest in previously undescribed and unexpected ways. We hope that the issue will be useful to researchers and practitioners who aim to study, evaluate or design for learning and creativity in a range of CCS projects.
Severity of Respiratory Syncytial Virus Bronchiolitis Is Affected by Cigarette Smoke Exposure and Atopy
Authors: Bradley Joseph P. , Bacharier Leonard B. , Bonfiglio JoAnn , Schechtman Kenneth B. , Strunk Robert , Storch Gregory , Castro Mario
Published: January 2017

Objective. Respiratory syncytial virus (RSV) bronchiolitis is a common cause of hospitalizations in children and has been increasingly identified as a risk factor in the development of asthma. Little is known about what determines the severity of RSV bronchiolitis, which may be helpful in the initial assessment of these children.

Design. We evaluated a variety of environmental and host factors that may contribute to the severity of RSV bronchiolitis in the RSV Bronchiolitis in Early Life prospective cohort study. Severity of bronchiolitis was based on the quantization of lowest O2 saturation and the length of stay. These factors included the child's and family's demographics, presence of household allergens (dust mite, cat, dog, and cockroach), peripheral blood eosinophil count, immunoglobulin E level, infant feeding, prior illnesses, exposure to intrauterine and postnatal cigarette smoke, and family history of atopy.

Patients. We prospectively enrolled 206 hospitalized infants, all under 12 months old (4.0 ± 3.3 months old), with their first episode of severe RSV bronchiolitis (mean O2 saturation: 91.6 ± 7.3%; length of stay: 2.5 ± 2.5 days; presence of radiographic opacities: 75%). Patients were excluded for a variety of reasons including previous wheezing, regular use of bronchodilator or antiinflammatory medications, any preexisting lung disease including asthma, chronic lung disease of prematurity/bronchopulmonary dysplasia, or cystic fibrosis; gastroesophageal reflux disease on medical therapy; or congenital anomalies of the chest or lung.

Results. Age was found to be a significant factor in the severity of infection. The younger an infant was, the more severe the infection tended to be as measured by the lowest oxygen (O2) saturation. We also found that infants exposed to postnatal cigarette smoke from the mother had a lower O2 saturation than those not exposed. However, there was no significant difference in RSV bronchiolitis severity between infants exposed only to intrauterine smoke and those infants never exposed to cigarette smoke. Infants with a family history of atopy, especially a maternal history of asthma or hay fever, had a higher O2 saturation. Although a history of maternal atopy seemed to be protective, there was no association between allergens and bronchiolitis severity, although 25% of households had elevated allergen levels. Black infants demonstrated less severe RSV bronchiolitis than their white counterparts. Multivariate analysis revealed age, race, maternal atopy, and smoking to be associated with severity of RSV bronchiolitis.

Conclusion. The severity of RSV bronchiolitis early in life seems modified by postnatal maternal cigarette smoke exposure and atopy and age of the infant, not by levels of allergens in the home environment.
Helicobacter pyloriInfection Is Not Associated With Specific Symptoms in Nonulcer-Dyspeptic Children
Authors: Kalach Nicolas , Mention Karine , Guimber Dominique , Michaud Laurent , Spyckerelle Claire , Gottrand Fréderic
Published: January 2017

Objectives. To assess symptoms associated with Helicobacter pylori infection in children presenting with nonulcer dyspepsia (NUD).

Study Design. A prospective double-blind study was conducted between March 2001 and April 2002 in children at least 6 years old with NUD who had been referred for upper gastrointestinal endoscopy for epigastric pain. A standardized questionnaire was administered blindly by a pediatric gastroenterologist. This questionnaire characterized epigastric pain and associated factors. Infection was confirmed by positive culture and histologic examination of the gastric mucosa.

Results. From 100 children enrolled, 26 proved infected (12 female, 14 male; mean age: 11.4 ± 2.6 years), and 74 were noninfected (44 female, 30 male; mean age: 10.4 ± 3.1 years). There were no differences in age or symptom characteristics between groups except for epigastric pain during meals that was more frequent in noninfected than in infected children (25.6% vs 3.8%).

Conclusion. There were no specific characteristics of symptoms in nonulcer-dyspeptic H pylori–infected children as compared with noninfected children.
Kitchen Scalds and Thermal Burns in Children Five Years and Younger
Authors: Drago Dorothy A.
Published: January 2017

Objective. The current study was undertaken to describe patterns of kitchen burns and scalds to young children to understand better why such injuries continue to occur despite intervention efforts.

Methods. Emergency department–treated thermal burns and scalds associated with nonelectric cookware were examined from a national sample, collected by the US Consumer Product Safety Commission's injury surveillance system over a 6-year period, 1997–2002. Data extracted from the cases included age, gender, body part, disposition, case weight, causal substance, and injury pattern. Data were analyzed using Epi Info 2002, with significance assessed by χ2 test.

Results. Scalds were approximately twice as common as were thermal burns. Hot water was the chief causal agent for scalds. The 2 most common scald injury patterns were (1) the child reached up and pulled a pot of hot water off the stove or other elevated surface and (2) the child grabbed, overturned, or spilled a container of hot water onto him- or herself. One-year-olds were at highest risk for scalds and thermal burns. Scalds resulted in significantly more hospitalizations than did thermal burns. In nearly all injury patterns, more boys than girls were injured, but the ratio varied depending on the injury pattern.

Conclusions. Although the kitchen is recognized as a room that is hazardous for young children, parents seem not to recognize or anticipate the risk for burns and scalds. The ability of children, especially toddlers, to reach containers of hot liquids on elevated surfaces is reflected in the injury data and is explained by anthropometry data, yet there is an apparent failure on the part of parents to recognize children's ability to gain access to the hazard and a failure to recognize the potential severity of resulting injury. These failures might explain why behavioral interventions (eg, place pots on back burners of stove) have been nonmotivating and ineffective. A multifaceted spectrum of prevention that has individual, community, and organizational components may prove to be more useful.
A Practical Clinical Approach to Diagnosis of Fetal Alcohol Spectrum Disorders: Clarification of the 1996 Institute of Medicine Criteria
Authors: Hoyme H. Eugene , May Philip A. , Kalberg Wendy O. , Kodituwakku Piyadasa , Gossage J. Phillip , Trujillo Phyllis M. , Buckley David G. , Miller Joseph H. , Aragon Alfredo S. , Khaole Nathaniel , Viljoen Denis L. , Jones Kenneth Lyons , Robinson Luther K.
Published: January 2017

Background. The adverse effects of alcohol on the developing human represent a spectrum of structural anomalies and behavioral and neurocognitive disabilities, most accurately termed fetal alcohol spectrum disorders (FASD). The first descriptions in the modern medical literature of a distinctly recognizable pattern of malformations associated with maternal alcohol abuse were reported in 1968 and 1973. Since that time, substantial progress has been made in developing specific criteria for defining and diagnosing this condition. Two sets of diagnostic criteria are now used most widely for evaluation of children with potential diagnoses in the FASD continuum, ie, the 1996 Institute of Medicine (IOM) criteria and the Washington criteria. Although both approaches have improved the clinical delineation of FASD, both suffer from significant drawbacks in their practical application in pediatric practice.

Objective. The purpose of this report is to present specific clarifications of the 1996 IOM criteria for the diagnosis of FASD, to facilitate their practical application in clinical pediatric practice.

Methods. A large cohort of children who were prenatally exposed to alcohol were identified, through active case-ascertainment methods, in 6 Native American communities in the United States and 1 community in the Western Cape Province of South Africa. The children and their families underwent standardized multidisciplinary evaluations, including a dysmorphology examination, developmental and neuropsychologic testing, and a structured maternal interview, which gathered data about prenatal drinking practices and other demographic and family information. Data for these subjects were analyzed, and revisions and clarifications of the existing IOM FASD diagnostic categories were formulated on the basis of the results.

Results. The revised IOM method defined accurately and completely the spectrum of disabilities among the children in our study. On the basis of this experience, we propose specific diagnostic criteria for fetal alcohol syndrome and partial fetal alcohol syndrome. We also define alcohol-related birth defects and alcohol-related neurodevelopmental disorder from a practical standpoint.

Conclusions. The 1996 IOM criteria remain the most appropriate diagnostic approach for children prenatally exposed to alcohol. The proposed revisions presented here make these criteria applicable in clinical pediatric practice.
Deaths of Pediatric Patients: Relevance to Their Medical Home, an Urban Primary Care Clinic
Authors: Serwint Janet R. , Nellis Marianne E.
Published: January 2017

Background. The Institute of Medicine’s report When Children Die emphasizes the importance of the medical home in end-of-life care, but no research has been conducted from this perspective. Identifying types and locations of patient deaths from the perspective of the medical home is important for developing the needed psychosocial support and addressing the longitudinal needs of bereaved families and staff members.

Objectives. The objectives of this study were to quantify and to characterize the deaths of pediatric patients who received their primary care from an urban, hospital-based, resident continuity clinic, to determine the mechanisms of communication about these deaths, and to compare the characteristics of deaths that were sudden, unexpected, or anticipated.

Methods. Patient deaths were identified through a pediatric department-wide tracking system for institutional deaths and a clinic-initiated tracking system for deaths that occurred outside the institution. Patient medical records were reviewed for patient demographic characteristics, preexisting medical conditions, setting and cause of death, and whether an autopsy was performed.

Results. Thirty-six patient deaths were identified between July 1, 1998, and June 31, 2002, within a clinic population of 7000 patients (average annual mortality rate: 0.13%). Seventeen patient deaths (48%) were identified through the institutional tracking system, and 19 (52%) were identified through the clinic-initiated tracking system for deaths that occurred outside the institution. Only 1 anticipated death occurred in the patient's home. Sixty-six percent of patients had underlying medical conditions, with neuromuscular diseases being the most common (28%). The causes of death differed from national data in the Institute of Medicine report and included specific organ failure (58%), probable sudden infant death syndrome (16%), accidental trauma (6%), intentional trauma (6%), and unspecified causes (14%). Twelve deaths (33%) were classified as sudden, 16 (44%) as unexpected, and 8 (22%) as anticipated. Autopsy was performed for 69% of the patients.

Conclusions. The wide diversity of patient ages and types and causes of deaths suggests that medical home sites need end-of-life services that are flexible enough to meet the individual needs of bereaved families and staff members. The greater relative mortality rate and higher proportion of patients with underlying medical conditions, compared with national data, suggest a greater burden of disease in this continuity setting. Medical home sites should consider tracking systems to identify patients who have died. Future research needs to identify the barriers to patients dying at home and to study the impact of patient deaths on medical home staff members.
Community and Hospital-Based Physicians' Attitudes Regarding Pediatric Hospitalist Systems
Authors: Srivastava Rajendu , Norlin Chuck , James Brent C. , Muret-Wagstaff Sharon , Young Paul C. , Auerbach Andrew
Published: January 2017

Objective. Pediatric hospitalist systems are being implemented widely. Their implementation may be influenced by physician attitudes, which may vary according to practice type (eg, community or hospital-based practice) and personal characteristics (eg, age and practice location). Little evidence exists to describe factors relevant to pediatric systems. The objective of this study was to determine physicians' attitudes regarding hospitalists and associated physician and practice characteristics.

Methods. We used a cross-sectional survey of all physicians with admitting privileges at a tertiary-care, pediatric, teaching hospital in the Intermountain West in April 2002. Outcomes included survey responses indicating attitudes toward the effects of the hospitalist system on quality of care, patient satisfaction, and teaching.

Results. A total of 313 of 368 physicians (85%) responded, 191 of whom (61%) were community physicians; 224 respondents (72%) spent the majority of their time in outpatient care. Community physicians more often characterized inpatient care as an inefficient use of time (45% vs 25%) but were less likely to think that hospitalists would improve the quality of care (49% vs 68%) or increase patient satisfaction (10% vs 30%). In multivariate models examining predictors of overall attitudes toward hospitalists, being a community physician (6.4 points more negative) and admitting patients at >1 hospital (3.3 points more negative) were associated with less favorable attitudes. Being <40 years of age (4.5 points more positive) and practicing >13 miles from the hospital (4.3 points more positive) were associated with more positive attitudes.

Conclusions. Attitudes regarding hospitalist systems differ between physician groups and are influenced by practice characteristics. Understanding these differences and tailoring hospitalist systems to address them will be important as pediatric hospitalist systems are implemented nationwide.
Medical Homes for At-Risk Children: Parental Reports of Clinician-Parent Relationships, Anticipatory Guidance, and Behavior Changes
Authors: Nelson Catherine S. , Higman Susan M. , Sia Calvin , McFarlane Elizabeth , Fuddy Loretta , Duggan Anne K.
Published: January 2017

Background. Family-centeredness, compassion, and trust are 3 attributes of the clinician-parent relationship in the medical home. Among adults, these attributes are associated with patients' adherence to clinicians' advice.

Objectives. The objectives were (1) to measure medical home attributes related to the clinician-parent relationship, (2) to measure provision of anticipatory guidance regarding injury and illness prevention, (3) to relate anticipatory guidance to parental behavior changes, and (4) to relate medical home attributes to anticipatory guidance and parental behavior changes.

Methods. A cross-sectional study of data collected among at-risk families when children were 1 year of age, in a randomized, controlled trial of a home-visiting program to prevent child abuse and neglect, was performed. Modified subscales of the Primary Care Assessment Survey were used to measure parental ratings of clinicians' family-centeredness, compassion, and trust. Parental reports of provision of anticipatory guidance regarding injury and illness prevention topics (smoke alarms, infant walkers, car seats, hot water temperature, stair guards, sunscreen, firearm safety, and bottle propping) and behavior changes were recorded.

Results. Of the 564 mothers interviewed when their children were 1 year of age, 402 (71%) had a primary care provider and had complete data for anticipatory guidance items. By definition, poverty, partner violence, poor maternal mental health, and maternal substance abuse were common in the study sample. Maternal ratings of clinicians' family-centeredness, compassion, and trust were fairly high but ranged widely and varied among population subgroups. Families reported anticipatory guidance for a mean of 4.6 ± 2.2 topics relevant for discussion. Each medical home attribute was positively associated with parental reports of completeness of anticipatory guidance, ie, family-centeredness (β = .026, SE = .004), compassion (β = .019, SE = .005), and trust (β = .016, SE = .005). Parents' perceptions of behavior changes were positively associated with trust (β = .018, SE = .006). Analyses were adjusted for potential confounding by randomized, controlled trial group assignment, receipt of ≥5 well-child visits, and baseline attributes.

Conclusions. Among at-risk families, we found an association between parental ratings of the medical home and parental reports of the completeness of anticipatory guidance regarding selected injury and illness prevention topics. Parents' trust of the clinician was associated with parent-reported behavior changes for discussed topics.
Group A Streptococcal Subdural Empyema as a Complication of Varicella
Authors: Ulloa-Gutierrez Rolando , Dobson Simon , Forbes John
Published: January 2017

Group A β-hemolytic streptococcus and Staphylococcus aureus are the 2 most common pathogens implicated in secondary invasive bacterial disease after varicella. We describe a 3-month-old male infant from British Columbia, Canada, who presented on day 5 of varicella skin rash with fever, seizures, lethargy, and evidence of intracranial hypertension. A prominent subdural empyema was documented, and Streptococcus pyogenes was recovered from the subdural fluid. Central nervous system bacterial complications should be part of the differential diagnosis for infants and children with chickenpox who present with fever, lethargy, focal seizures, or similar neurologic findings. This case illustrates the importance of universal varicella vaccination to prevent associated bacterial complications of chickenpox.
Summary Proceedings From the Cardiology Group on Cardiovascular Instability in Preterm Infants
Authors: Short Billie Lou , Van Meurs Krisa , Evans Jacquelyn R. ,   and the Cardiology Group
Published: January 2017

The appropriate determination of adequate tissue perfusion and the best approach to treatment of perceived abnormalities in blood pressure in the neonate remain controversial. There is no consensus regarding the actual definition of hypotension in the neonate or how best to raise perceived low blood pressure. In addition, there is no direct and prospectively collected information available on the result of treatment of a “low” blood pressure on neonatal morbidity and mortality. It also has not been clearly demonstrated that bringing systemic blood pressure to a “normal” range improve outcomes. However, it is widely accepted by clinicians that early and aggressive treatment of hypotension leads to improved neurologic outcome and survival in the neonate. Commonly used therapeutic maneuvers to correct systemic hypotension in the neonate include volume expansion, inotropic agents, and corticosteroids. Although there is a paucity of research on the cardiovascular response to these commonly used agents in neonates, among the commonly used inotropic drugs dopamine has been shown to be more effective than dobutamine in raising blood pressure in the neonate. The cardiology group focused on the use of inotropes, particularly dopamine and dobutamine, to treat very low birth weight infants with cardiac instability and neonatal postoperative cardiac patients. The cardiology group identified key issues that must be considered when designing studies of inotropic agents in preterm infants and proposed 2 clinical-trial designs: (1) a placebo-controlled trial with rescue for symptomatic infants; and (2) a targeted–blood pressure study. The first trial design would answer questions concerning efficacy of treatment with inotropic agents in this population. The second trial design would address concerns related to the lack of knowledge on normal blood pressure ranges in this population. The group identified specific design elements that would need to be addressed for the complicated trial design to study inotropic agents in neonates.
Summary Proceedings From the Bronchopulmonary Dysplasia Group
Authors: Walsh Michele C. , Szefler Stanley , Davis Jonathan , Allen Marilee , Van Marter Linda , Abman Steve , Blackmon Lillian , Jobe Alan
Published: January 2017

Despite improvements in neonatal care, bronchopulmonary dysplasia (BPD) continues to occur in approximately one third of newborns who have birth weights of <1000 g and contributes to significant morbidity in this population. Gaps in knowledge about the prevention and treatment of BPD remain, resulting in unintended short- and long-term sequelae. In addition to chronic lung disease, preterm newborns with BPD are more likely to develop language delay, cerebral palsy, and cognitive impairments compared with preterm newborns without BPD. The pulmonary group identified 3 critical needs to enhance the design of clinical trials in neonates with BPD: (1) identify the stages of BPD; (2) define BPD more clearly; and (3) identify subtypes of BPD patients. The group determined that trials are needed for 3 areas of BPD: (1) prevention of BPD; (2) treatment of evolving BPD; and (3) treatment of established BPD. The severity of BPD is defined as mild, moderate, and severe, and subgroups among those with BPD are described. Here we identify gaps in basic science and pharmacologic knowledge that hamper investigators' ability to conduct effective BPD clinical trials and provide a list of drugs to be studied in BPD trials. Priorities for drug-class evaluation by stage of BPD are given. The pulmonary group proposes a BPD clinical-trials framework that varies according to the different stages of BPD and describes characteristics of the overall design for BPD clinical trials. Finally, we discuss trial-design issues that are common to all neonatal studies.
Status of Newborn Screening Programs in the United States
Authors: Therrell Bradford L. , Johnson Alissa , Williams Donna
Published: January 2017

BACKGROUND. Newborn screening programs have expanded over the years; currently, many programs screen for dozens of congenital conditions that, if not detected and treated early, could result in catastrophic health consequences, including death. Some programs, however, still require universal newborn screening for only a few conditions. Although all 51 US programs (all states and the District of Columbia) have statutory screening requirements and similarities exist in many parts of the different screening systems, the enabling statutes, rules, regulations, protocols, and financing strategies vary dramatically. Consequently, there is a significant lack of equity in newborn screening services across the country.

METHODS. We investigated program variations existing in and around January 2005 and provide baseline information with which future program comparisons can be made. We used program surveys, electronic searches of legislation, and individual input (validation) from program decision-makers to create a reservoir of program information.

RESULTS. Included is a compilation of pertinent newborn screening statutes, information from genetic privacy statutes that potentially affects newborn screening programs, and a review of state laws that affect specimen and information retention. In addition, program policies related to the use of residual newborn screening blood spots are reviewed, along with the developmental processes affecting program informational brochures, including the information contained and the strategies for brochure dissemination.

CONCLUSIONS. Building on a progressive and successful history, newborn screening continues as an example of an essential population genetic screening program. As the intricacies of screening systems have increased in complexity, so have the policy issues that shape program successes and failures. The summary information in this article provides a basis for national and individual program evaluation. Indeed, some of the information reported here has already been useful for program refinements reported elsewhere in this supplement.
Newborn Screening: Toward a Uniform Screening Panel and System—Executive Summary
Authors: Watson Michael S. , Mann Marie Y. , Lloyd-Puryear Michele A. , Rinaldo Piero , Howell R. Rodney ,   American College of Medical Genetics Newborn Screening Expert Group
Published: January 2017

The Maternal and Child Health Bureau commissioned the American College of Medical Genetics to outline a process of standardization of outcomes and guidelines for state newborn screening programs and to define responsibilities for collecting and evaluating outcome data, including a recommended uniform panel of conditions to include in state newborn screening programs. The expert panel identified 29 conditions for which screening should be mandated. An additional 25 conditions were identified because they are part of the differential diagnosis of a condition in the core panel, they are clinically significant and revealed with screening technology but lack an efficacious treatment, or they represent incidental findings for which there is potential clinical significance. The process of identification is described, and recommendations are provided.
Recommendations for Effective Newborn Screening Communication: Results of Focus Groups With Parents, Providers, and Experts
Authors: Davis Terry C. , Humiston Sharon G. , Arnold Connie L. , Bocchini Joseph A. , Bass Pat F. , Kennen Estela M. , Bocchini Anna , Williams Donna , Kyler Penny , Lloyd-Puryear Michele
Published: January 2017

OBJECTIVES. The aims of this study were to determine parent and provider knowledge and awareness of newborn screening; to gather opinions from parents, providers, and newborn screening professionals about the content and timing of newborn screening education; and to use consensus data to formulate recommendations and to develop educational materials for parents and providers.

METHODS. We conducted 22 focus groups and 3 individual interviews between October 2003 and May 2004, with English- and Spanish-speaking parents of infants <1 year of age who had experience with initial testing, retesting, or false-positive screenings; health professionals who provide prenatal care or health care for newborns; and state newborn screening program health professionals.

RESULTS. Parents and providers had limited knowledge and awareness about newborn screening practices. Parents wanted brief to-the-point information on newborn screening and its benefits, including the possible need for retesting and the importance of returning promptly for retesting if initial results are abnormal. Parents wanted the information orally from the primary care provider. Parents, providers, and newborn screening professionals all thought that an accompanying concise, easy-to-read brochure with contact information would be helpful. All focus group participants thought that parents should receive this information before the birth of the infant, preferably in the third trimester of pregnancy. Providers wanted a brief checklist of information and resources to prepare them to educate parents effectively.

CONCLUSIONS. We recommend prenatal and primary care providers be more involved in educating parents about newborn screening. Professional societies and state health officials should work together to encourage parent and provider education. User-friendly patient and provider education materials, such as those we developed, could form the basis for this educational approach.