bluuebunny/crossref_metadata_2025 huggingface dataset:
Youth Leadership Development Through School-Based Civic Engagement Activities: A Case Study
Authors: Horstmeier Robin Peiter , Ricketts Kristina G.
Published: July 2013

Leadership development through a civic engagement activity in a local FFA chapter is explored. Through a case study design, researchers illuminate a project that encouraged youth leadership development through the creation and execution of a civic engagement project in their own local community. Holistically, FFA members viewed the project as a resounding success. Leadership development was experienced at many levels - individual, chapter, and community. FFA members felt particularly engaged when seen as partners with the community. This was accomplished through developing networks and participating in the planning, decision making, and execution of the project. The primary barrier cited was a lack of engagement from all chapter members. Implications include the important role civic engagement plays in youth leadership development, employing civic engagement projects to assist in developing higher level leadership skills, and the need for further research partnerships between career and technical student organizational members and local community citizens.
Global Leadership Study: A Theoretical Framework
Authors: Perkins Anne W.
Published: July 2013

Traditional leadership theory and research courses do not adequately prepare students for cross-cultural leadership. This article notes six premises of Western theories and demonstrates the limitations of these premises in non-Western settings. A framework for the study of cross-cultural leadership, The Global Leadership-Learning Pyramid, is proposed, and the theoretical foundations are discussed.
The Levels of Leadership and Transcendent Servant Leadership Development
Authors: McClellan Jeffrey L.
Published: July 2013

This paper addresses the challenges associated with defining and conceptualizing leadership amidst the plethora of theoretical constructs and definitions of leadership and proposes a model for developing transcendent servant-leaders. Based on a review of the literature, three categorical levels of leadership are outlined and discussed that describe the motives that drive leaders, their means of influence, and the outcomes they strive to achieve at each level. These levels include everyday leadership, effective organizational leadership, and transcendent servant leadership. Having delineated these leadership levels, a holistic model for leadership development and education that facilitates the transcendence of effective organizational leaders and ensures their sustaining power of influence is outlined and described.
A Modern Technology in the Leadership Classroom: Using B logs for Critical Thinking Development
Authors: Gifford Gregory T.
Published: July 2013

Web-based resources are increasing both in number and conventionality. In particular, blogs have become a popular method for self-expression. Educators have been encouraged to utilize blogs in the classroom. This paper presents a model for effectively using blogs in the leadership classroom to enhance critical thinking capacity and provide leadership students with more effective reflection opportunities.
How Literature Informs Notions of Leadership
Authors: Eastwood Gregory L.
Published: July 2013

Novels, short stories, plays, and poetry can help us understand the character traits, abilities, and contexts of leadership in ways that didactic methods cannot. I present examples of the use of literature in its several forms to stimulate thought and discussion and to enrich the understanding of the characteristics and dynamics of leadership. I consider the character traits of honesty, courage, adherence to principles, respect, ego, humility, calmness, and perseverance, and the abilities to listen, to select good people, and to know oneself. I also identify some of the conditions and contexts of leadership, such as chance, environment, interdependence, and the roles of heroes, mentors, and peers. These examples from literature are not intended to be authoritative but rather illustrative, with the intent that they will encourage others to seek and use their own examples in the process of understanding leadership and becoming good leaders.
Leadership Attitudes and Beliefs of Incoming First-Year College Students
Authors: Fischer Donald V. , Overland Maribeth , Adams Laura
Published: July 2013

Due to limited resources available for leadership development programming at colleges and universities, there is a need to better understand the leadership attitudes and beliefs of incoming first-year students in order to most efficiently develop effective leadership. The purpose of this study was to examine the leadership attitudes and beliefs of incoming first-year college students within the context of ecological leadership in order to determine if gender or ethnic differences in the leadership attitudes and beliefs exist. Implications for leadership development programs are discussed.
Evaluating a New and Aspiring County Extension Director Leadership Education Program: Determining Outcomes and Needed Improvements
Authors: Jayaratne K. S. U. , Owen Mitchell , Jones David
Published: July 2013

This leadership education evaluation study explored the leadership development outcomes of potential county extension directors and the ways to improve the program. The leadership education program aimed to improve participants’ leadership abilities in understanding self, building relationships and managing resources. The analysis of quantitative and qualitative data confirmed that the leadership training institute was effective in building participants’ leadership skills and improving leadership behavior. The incorporation of participants’ learning needs into the program, use of hands-on experiential learning activities and problem solving activities combined with small group discussions were the contributing factors for the success of this leadership education program. The participants suggested the use of more hands-on and problem solving activities, team building exercises and condensing the time gap between the pre and post sessions as strategies for further improvement of this program.
Leadership and the Millennials: Transforming Today’s Technological Teens into Tomorrow’s Leaders
Authors: Wisniewski Mary Ann
Published: July 2013

Although older and younger generations unfailingly tend to disagree on values and are inclined to perceive one another with a degree of skepticism and disapproval, it is an unmistakable reality that because of technology today’s youth are approaching life differently than previous generations. It is also clear that today’s Millennials are tomorrow’s leaders. How then do we help facilitate the leadership capacity of today’s youth? This article documents a year-long research study of university students’ perceptions of the factors that characterize effective teaching and learning, in general, and more specifically, leadership education. The data suggests that traditional approaches to teaching will likely be met with resistance. A leadership education model for the Millennials detailing the purposes and content, along with strategies for teaching and learning is presented.
The Impact of Boys & Girls Club/Keystone Club Participation on Alumni
Authors: Swigert Tami , Boyd Barry L.
Published: July 2013

This study examined the impact of the Boys & Girls Clubs of America (BGC), and its Keystone Club (KC) component, on the leadership and citizenship development of its alumni. 14 alumni were interviewed using a structured interview technique. The constant comparative method was utilized to identify leadership traits and skills that alumni perceived they had developed as members of either organization. It was found that alumni from both organizations felt that they had developed the ability to lead groups, and developed the traits of integrity, honesty and patience. In addition, their participation in BGC/KC gave them the confidence to pursue leadership roles outside of BGC/KC. These traits and skills also carried over into their adult lives.
Administrators’ Descriptions of Their Leadership Roles in a Precollege Program
Authors: Owens Michael A.
Published: July 2013

The purpose of this work is to describe how leaders of the Upward Bound (UB) program at a university in the western United States described their leadership roles in the program. It is a qualitative study based on data drawn from interviews, observations, written material, and field observations conducted over two years. Participants described their leadership roles as helper, guide, and protector. These roles highlighted the nurturing part they felt they played in their students’ and program’s success. Participants varied widely in their understanding of leadership and their roles. Most relied onad hocor common sense conceptions to guide them in describing their roles. This work suggests that UB leaders and others who often come from non-leadership backgrounds may benefit from formal and informal leadership training.
Antecedents of Emotional Intelligence: An Empirical Study
Authors: Barbuto John E. , Story Joana S.
Published: July 2013

This study examined the relationships between emotional intelligence, locus of control, and mental boundaries. Three hundred and eighty-two county employees were sampled using a cross-sectional survey design. The results indicated internal locus of control and thin mental boundaries are positively related to emotional intelligence. A hierarchical regression revealed that internal locus of control and thin mental boundaries together explained 18% of the variance in emotional intelligence for this population. Implications and future research directions are discussed.
Serving the Once and Future King: Using the TV Series Merlin to Teach Servant-Leadership and Leadership Ethics in Schools
Authors: Oliver Laura M. , Reynolds Kae
Published: July 2013

The recent financial crisis has brought business ethics issues to the forefront. While most colleges have formal training in business ethics, a person’s ethical standards have often developed before college age. This application brief proposes using digital popular media to teach servant-leadership principles to public school adolescents. The purpose is to illustrate the advantage of using secular content from the television series Merlin (Wilkie, 2008) to demonstrate an ethics-based leadership perspective through a medium that is accessible to the virtual/video generation.
Developing Life-Long Learners Through Personal Growth Projects
Authors: Boyd Barry , Williams Jennifer
Published: July 2013

Leaders must become life-long learners if they are to remain effective in an environment that is both global and changing at an exponential pace. As Day (1992) noted, personal growth is essential in the leadership development process. In a personal leadership development course, students are required to complete a personal growth project in order to add to their personal leadership development. In this assignment, students choose a project that will stretch their personal comfort zone and allow their strengths to be utilized in a new way. Reflection is a key element of the process in which they tie their experiences with the personal growth project to their values, strengths, and leadership behaviors.
Bet You Never Heard of this Leadership Trait
Authors: Thomas Joseph J.
Published: July 2013

This is a commentary on educating leaders within the constraints of a highly technical curriculum. The U.S. Naval Academy’s mission is to produce leaders for the nation. Many things compete for the time and attention of Midshipmen (the Academy’s students). Greater attention must be paid to interpersonal communications skills in the formal and informal curriculum.
Examining Gender Differences of Servant Leadership: An Analysis of the Agentic and Communal Properties of the Servant Leadership Questionnaire
Authors: Barbuto John E. , Gifford Gregory T.
Published: July 2013

This study examined the use of five servant leadership dimensions including altruistic calling, emotional healing, wisdom, persuasive mapping, and organizational stewardship by male and female servant leaders. Staff members (368) employed in county government offices across a Midwestern state were sampled using the Servant Leadership Questionnaire and a series of demographic questions. Results indicated males and females equally and effectively utilized both communal and agentic servant leadership dimensions. These findings contest prevailing gender role stereotypes in leadership.
Using Achievement Motivation Theory to Explain Student Participation in a Residential Leadership Learning Community
Authors: Moore Lori L. , Grabsch Dustin K. , Rotter Craig
Published: July 2013

This study sought to examine student motives for participating in a residential leadership learning community for incoming freshmen using McClelland’s Achievement Motivation Theory (McClelland, 1958, 1961). Eighty-nine students began the program in the Fall 2009 semester and were administered a single, researcher-developed instrument. Responses to an open-ended question that asked students what their primary motive for participating in the voluntary, residential leadership learning community were analyzed using deductive content analysis techniques (Fraenkel & Wallen, 2009; Patton, 2002) and categorized according to McClelland’s Achievement Motivation Theory as the need for Achievement, the need for Power, the need for Affiliation, or any combination thereof. Results demonstrated that while all three needs were found within the responses, the need for Achievement and the need for Affiliation were more common motives for joining the voluntary, residential leadership learning community.
4-H Made Me a Leader: A College-Level Alumni Perspective of Leadership Life Skill Development
Authors: Anderson Jessica , Bruce Jacklyn , Mouton Lauren
Published: July 2013

The purposes of this qualitative study were to determine the contribution of 4-H experiences to leadership life skill development of college-level 4-H alumni and to determine the effect of those skills on collegiate alumni’s desire to continue involvement in 4-H. The research methods included semi-structured interviews. Major findings of the study noted that the interviewees’ 4-H experiences positively contributed to leadership life skill development, closely following the pattern of the four essential elements which serve as the foundation of 4-H programming. Also identified was a strong desire of college-level 4-H alumni to continue their participation with 4-H. Recommendations include specifically targeting this generation of alumni for greater utilization because of their strong desire to stay connected.
Creating Meaningful Environments for Leadership Education
Authors: Guthrie Kathy L. , Thompson Sara
Published: July 2013

As leadership educators we aim to provide students with opportunities necessary to gain knowledge and appropriate leadership skills. Valuable opportunities developed through Student Affairs and Academic Affairs collaborations which enhance learning through co-curricular and curricular experiences in leadership education will be explored. Present in these intentional environments are opportunities for students to have meaningful leadership learning when comprised of education, experience, and reflection. Specific examples from two institutions will be highlighted.
Transformational Leadership and its Relationship to Adult 4-H Volunteers’ Sense of Empowerment in Youth Development Settings
Authors: Rose Pamela
Published: July 2013

This study examined the relationship of adult 4-H volunteers’ perceived leadership styles of 4-H Youth Development Educators to the adult 4-H volunteer sense of empowerment. There were 498 Oregon adult 4-H volunteers randomly selected to participate. Participants rated the leadership style of their 4-H Youth Development Educator (YDE) using Bass and Avoilio’s (1990) Multifactor Leadership Questionnaire and self assessed their sense of empowerment using Spreitzer’s (19915) Psychological Empowerment Instrument. In the structural model, transformational leadership style was shown to have a significant positive relationship ( = 0.031) to adult 4-H volunteer sense of empowerment. The 4-H YDEs who were rated as using transformational leadership were very likely to be empowering adult 4-H volunteers.
Students’ Attitudes and Perceptions about the Use of Cooperative Exams in an Introductory Leadership Class
Authors: Moore Lori L.
Published: July 2013

This study sought to examine student perceptions related to the use of cooperative exams in an introductory leadership class. In this study, cooperative exams were used as a collaborative learning activity in which students took class exams individually first and then as a peer group. The majority of students (n=41, 61.4%) had not previously taken a class that incorporated cooperative exams. Four advantages of cooperative exams were identified: the opportunity for discussion to increase understanding, the opportunity to increase the overall grade on the exam, the opportunity for collaboration and teamwork, and increased individual accountability. Two disadvantages of cooperative exams were identified: the reliance of some students on the efforts of others and the conflict that can arise from peer pressure in the peer group portion of the exam. Overall, students enjoyed the cooperative exams and think they should continue to be used in the class.
The Effects of Teaching Methods in Leadership Knowledge Retention: An Experimental Design of Lecture, Experiential, and Public Pedagogy
Authors: Williams Jennifer , McClure Megan
Published: July 2013

Finding an effective teaching methodology for leadership educators is daunting. In this experimental study undergraduate leadership students’ retention of knowledge was tested after receiving leadership instruction via lecture, experiential learning, and public pedagogy. Results show lecture is an inferior method of teaching leadership while public pedagogy had effective and consistent results.
Impact of Group Development Knowledge on Students’ Perceived Importance and Confidence of Group Work Skills
Authors: Coers Natalie , Williams Jennifer , Duncan Dennis
Published: July 2013

This study explored the impact of emphasis on the group development process on the perceived importance of and confidence in group work skills and students’ perception of group work use in the collegiate classroom as developed by Tuckman and Jensen (1977). The purposive sample utilized in this study included 33 undergraduate students enrolled in an introductory leadership and service course at a southern, land-grant institution. Knowledge of the group development process enhances a student’s perceived importance and confidence in group work skills. The emphasis on group development process also positively impacted students’ perception of group work being utilized in the collegiate classroom. The importance of group work skills continues to be reflective of the demand from employers; therefore, educators must continue to develop these transferable skills in today’s students. Although relevant across disciplines, leadership educators should take a leading role in developing such skills in students.
On the Approximate Linear Programming Approach for Network Revenue Management Problems
Authors: Tong Chaoxu , Topaloglu Huseyin
Published: July 2013

One method to obtain high-quality bid prices for network revenue management problems involves using the approximate linear programming approach on the dynamic programming formulation of the problem. This approach ends up with a linear program whose number of constraints increases exponentially with the number of flight legs in the airline network. The linear program is solved using constraint generation, where each constraint can be generated by solving a separate integer program. The necessity to solve integer programs and the slow convergence behavior of constraint generation are generally recognized as drawbacks of this approach. In this paper, we show how to effectively eliminate these drawbacks. In particular, we establish that constraint generation can actually be carried out by solving minimum-cost network flow problems with natural integer solutions. Furthermore, using the structure of minimum-cost network flow problems, we a priori reduce the number of constraints in the linear program from exponential to linear in the number of flight legs. It turns out that the reduced linear program can be solved without using separate problems to generate constraints. The reduced linear program also provides a practically appealing interpretation. Computational experiments indicate that our results can speed up the computation time for the approximate linear programming approach by a factor ranging between 13 and 135.
Dynamic Container Deployment: Two-Stage Robust Model, Complexity, and Computational Results
Authors: Shu Jia , Song Miao
Published: July 2013

Containers are widely used in the shipping industry mainly because of their capability to facilitate multimodal transportation. How to effectively reposition the nonrevenue empty containers is the key to reduce the cost and improve the service in the liner shipping industry. In this paper, we propose a two-stage robust optimization model that takes into account the laden containers routing as well as the empty container repositioning, and define the robustness for this model with uncertainties in the supply and demand of the empty containers. Based on this definition, we present the robust formulations for the uncertainty sets corresponding to the ℓp-norm, where p = 1, 2, and ∞, and analyze the computational complexities for all of these formulations. The only polynomial-time solvable case corresponds to the ℓ1-norm, which we use to conduct the numerical study. We compare our approach with both the deterministic model and the stochastic model for the same problem in the rolling horizon simulation environment. The computational results establish the potential practical usefulness of the proposed approach.
Mathematical Programming Formulations and Algorithms for Discrete k-Median Clustering of Time-Series Data
Authors: Seref Onur , Fan Ya-Ju , Chaovalitwongse Wanpracha Art
Published: July 2013

Discrete k-median (DKM) clustering problems arise in many real-life applications that involve time-series data sets, in which nondiscrete clustering methods may not represent the problem domain adequately. In this study, we propose mathematical programming formulations and solution methods to efficiently solve the DKM clustering problem. We develop approximation algorithms from a bilinear formulation of the discrete k-median problem using an uncoupled bilinear program algorithm. This approximation algorithm, which we refer to as DKM-L, is composed of two alternating linear programs, where one can be solved in linear time and the other is a minimum cost assignment problem. We then modify this algorithm by replacing the assignment problem with an efficient sequential algorithm for a faster approximation, which we call DKM-S. We also propose a compact exact integer formulation, DKM-I, and a more efficient network design-based exact mixed-integer formulation, DKM-M. All of our methods use arbitrary pairwise distance matrices as input. We apply our methods to simulated single-variate and multivariate random walk time-series data. We report comparative clustering performances using normalized mutual information (NMI) and solution speeds among the DKM methods we propose. We also compare our methods to other clustering algorithms that can operate with distance matrices, such as hierarchical cluster trees (HCT) and partition around medoids (PAM). We present NMI scores and classification accuracies of our DKM algorithms compared to HCT and PAM using five different distance measures on simluated data, as well as public benchmark and real-life neural time-series data sets. We show that DKM-S is much faster than HCT, PAM, and all other DKM methods and produces consistently good clustering results on all data sets.
‘Mirror with a memory’: Theories of light and preternatural negatives in Herman Melville’s Moby-Dick
Authors: Thwaites Sarah
Published: July 2013

This article explores theories of light in the American Romantic period as a way of addressing image–text relations in the dynamic early decades of photography. It addresses the gothic nature of the daguerreotype’s ambiguous negative/positive picture and its temporal and spatial implications in relation to Melville’s aesthetic of light in his Romantic epic Moby-Dick. Upon the daguerreotype’s arrival in 1839, it was greeted by Americans with both fascination and suspicion: not only were the chemical exchanges viewed as wizardry and the picture deemed to take possession of the sitter’s spirit, but when tilted under light, the daguerreotype’s ghostly negative image is revealed. For Romantic artists, Daguerre’s process, ‘the art of writing with light’, held equally complex implications for the conception of Nature. Newton’s theory of light had already exposed its intricate character, but Goethe’s nineteenth-century Colour Theory, with its descriptions of the individual nature of seeing, showed that the Romantic notion of Nature as ‘light Divine’ was deeply problematic. In Moby-Dick, Ishmael conflates meanings of whiteness, colour and light for more congruous poetic interpretations that mirror the daguerreotype’s uncanny paradigm of light.
The griot and the renku: Interactive generative media and algorithmic imagetext in the work of D. Fox Harrell
Authors: Smith Hazel
Published: July 2013

An interactive generative system is a computational system for creating artworks that produces new versions or sequences of a text, image or sound each time it is activated. It interrogates ideas of authorship and the stable, monolithic, text. This article argues that interactive generative media can result in a new approach to imagetext as algorithmic imagetext. In algorithmic imagetext, text and image are not necessarily juxtaposed but share the same or similar algorithms. The essay focuses on interactive generative media and algorithmic imagetext in the work of ‘post-black’ African American multimedia artist and writer D. Fox Harrell. It explicates his programming of algorithmic processes to generate both verbal and visual texts through the interactive generative GRIOT system, and suggests how programming relates to the semiotics of text and image. The essay examines Harrell’s adaptation of the GRIOT system to generate the polypoem ‘The Girl with Skin of Haints and Seraphs’ and then, in collaboration with Kenny Chow, to create the generative visual renku – a transformation of the traditional verbal Japanese renku into interactive image tiles. In addition, it looks briefly at the way Harrell combines the verbal and visual in multimedia work. The article also analyses how Harrell attempts to employ algorithmic imagetext to overturn stereotypes of racial and gender identity, and to problematize the tensions and interactions that occur through globalization.
Review
Authors: Gander Catherine
Published: July 2013

Touching Photographs, Margaret Olin (2012) Chicago and London: The University of Chicago Press, 278 pp.;
38 colour plates, 84 monochromes, ISBN-13: 978-0-226-62646-8, Paperback, £22.50
SMS freeforms for illumination
Authors: Benitez Pablo , Miñano Juan C. , Chaves Julio , Santamaría Asunción
Published: July 2013

SMS 3D (simultaneous multiple surfaces in their three-dimensional version) is a well-known design method comprising two freeform surfaces that allow the perfect coupling of two wavefronts with another two. The design algorithm provides a collection of line pairs on both surfaces (called SMS spines), whose three-dimensional shape seems arbitrary at first sight. This paper shows that the shapes of the spines are partially governed by applying the étendue conservation theorem to the biparametric bundle of rays linking the paired spines, which is one lesser known étendue invariants found by Poincaré. The resulting formulae for the spines in three-dimensional space happen to coincide with the conventional étendue formulas of two-dimensional geometry, like for instance, the Hottel formula.
New record of the seagrass species Halophila major (Zoll.) Miquel in Vietnam: evidence from leaf morphology and ITS analysis
Authors: Vy Nguyen Xuan , Holzmeyer Laura , Papenbrock Jutta
Published: July 2013

The seagrass Halophila major (Zoll.) Miquel is reported for the first time from Vietnam. It was found growing with other seagrass species nearshore, 4–6 m deep at Tre Island, Nha Trang Bay. Leaf morphology and phylogenetic analysis based on ribosomal internal transcribed spacer sequences confirmed the identification. There was very little sequence differentiation among samples of H. major collected in Vietnam and other countries in the Western Pacific region. A very low evolutionary divergence among H. major populations was found.
Sur la présentation des représentations supersingulières de GL2(F)
Authors: Schraen Benjamin
Published: July 2013

Soit F une extension quadratique de ℚ
p
. Nous prouvons que les représentations lisses irréductibles supersingulières à caractère central de GL2(F) ne sont pas de présentation finie.
Let F be a quadratic extension of ℚ
p
. We prove that smooth irreducible supersingular representations with central character of GL2(F) are not of finite presentation.
Facile synthetic entry into rotationally restricted 9-arylacridines
Authors: Zhang Jianguo , Sączewski Jarosław , Wolińska Ewa , Strekowski Lucjan
Published: July 2013

The treatment of 2-(trifluoromethyl)aniline with 2,6-dimethylphenylmagnesium bromide yields 1-methyl-9-(2,6-dimethylphenyl)acridine by the formal reaction of one equivalent of the aniline and two equivalents of the Grignard reagent. Interestingly, one of the methyl groups is eliminated during the reaction, and the product contains three methyl groups only. In a similar way, the reaction of 2-(trifluoromethyl)aniline with 2-ethylphenylmagnesium bromide furnishes 9-(2-ethylphenyl)acridine devoid of one ethyl group. The mechanism is discussed.
Hepatoprotective role of kaempferol during alcohol- and ΔPUFA-induced oxidative stress
Authors: Shakya Garima , Manjini Selva , Hoda Muddasarul , Rajagopalan Rukkumani
Published: July 2013

Background: The present study aimed to analyze the effect of kaempferol on oxidative stress induced by alcohol and thermally oxidized polyunsaturated fatty acid (ΔPUFA) in male albino Wistar rats.

Methods: The rats were divided into four groups. The animals in group 1 served as the normal group (standard diet), group 2 served as the hepatotoxic group (alcohol+ΔPUFA), group 3 served as the treated group (alcohol+ΔPUFA+kaempferol), and group 4 served as kaempferol control. The levels of marker enzyme γ-glutamyl transferase (GGT), lipid peroxidation markers [thiobarbituric acid reactive substances (TBARS) and lipid hydroperoxides (LH)], enzymatic antioxidants (catalase, superoxide dismutase, and glutathione peroxidase), and nonenzymatic antioxidants (reduced glutathione, vitamin E, and vitamin C) were analyzed in liver to evaluate the effects of kaempferol.

Results: The levels of GGT, TBARS, and LH were significantly increased in liver of the alcohol+ΔPUFA group and were found to be reduced on treatment with kaempferol. The levels of both enzymatic and nonenzymatic antioxidants were decreased in liver of the alcohol+ΔPUFA group and were found to be restored on treatment with kaempferol.

Conclusions: From the results obtained, we conclude that kaempferol protects the liver against alcohol- and ΔPUFA- induced oxidative stress.
The Internet, Adolescent Males, and Homemade Blowgun Darts: A Recipe for Foreign Body Aspiration
Authors: Walz Patrick C. , Scholes Melissa A. , Merz Meredith N. , Elmaraghy Charles A. , Jatana Kris R.
Published: July 2013

We describe our experience with blowgun dart aspiration via an illustrative case series and review the resources available to teach children how to construct these objects. A 15-year-old boy presented with cough, wheeze, and eventually admitted to aspiration of a homemade blowgun dart. This instance heightened the awareness of our experience with blowgun dart aspiration as 3 cases presented within a 3-month period. Patients uniformly presented with cough and reported aspiration, and wheezing was noted in 2 of the 3. Although all ultimately admitted their behavior, 2 were initially reluctant to admit aspirating the blowgun dart. Radiographic findings of a needle-shaped metallic airway foreign body were consistent in all patients. Each admitted to finding instructions for blowgun dart construction on the Internet. Emergent rigid bronchoscopy with blowgun dart removal resulted in symptom resolution in all without complication. This represents the largest series of blowgun dart aspiration to date. During deep inhalation, when preparing to propel a blowgun dart, the vocal folds maximally abduct, leading to increased risk for aspiration. Twenty websites were identified providing instructions for the construction of homemade blowgun darts. With the accessibility of the Internet and number of instructional websites, this clinical entity may become more common in the future. Unfortunately, only a few of the websites provide any safety warnings. Certainly, prompt treatment can result in good outcomes; however, serious potential complications, including death, could occur especially given the hesitance our patients showed in divulging the truth of the inciting event.
Acute Kernicterus in a Neonate With O/B Blood Group Incompatibility and a Mutation in SLC4A1
Authors: Christensen Robert D. , Yaish Hassan M. , Nussenzveig Roberto H. , Reading N. Scott , Agarwal Archana M. , Eggert Larry D. , Prchal Josef T.
Published: July 2013

We cared for a term female newborn, who at 108 hours of age, with a total serum bilirubin of 15.4 mg/dL, was discharged from the hospital on home phototherapy. At a return appointment 44 hours later, her total serum bilirubin was 41.7 mg/dL and signs of acute kernicterus were present. Maternal/fetal blood group O/B incompatibility was identified, with a negative direct antiglobulin test, which was positive on retesting. She had abundant spherocytes on blood smear, and these persisted at follow-up, but neither parent had spherocytes identified. A heterozygous SLC4A1E508K mutation (gene encoding erythrocyte membrane protein band 3) was found, and in silico predicted to result in damaged erythrocyte cytoskeletal protein function. No mutations were identified in other red cell cytoskeleton genes (ANK1, SPTA1, SPTB, EPB41, EPB42) and the UGT1A1 promoter region was normal. Neurologic follow-up at 2 and 4 months showed developmental delays consistent with mild kernicterus.
Neonatal Infection and 5-year Neurodevelopmental Outcome of Very Preterm Infants
Authors: Mitha Ayoub , Foix-L’Hélias Laurence , Arnaud Catherine , Marret Stéphane , Vieux Rachel , Aujard Yannick , Thiriez Gérard , Larroque Béatrice , Cambonie Gilles , Burguet Antoine , Boileau Pascal , Rozé Jean Christophe , Kaminski Monique , Truffert Patrick , Ancel Pierre-Yves
Published: July 2013

OBJECTIVE:

To determine whether neonatal infections are associated with a higher risk of adverse neurodevelopment at 5 years of age in a population-based cohort of very preterm children.

METHODS:

We included all live births between 22 and 32 weeks of gestation, from 9 regions in France, in 1997 (EPIPAGE study). Of the 2665 live births, 2277 were eligible for a follow-up evaluation at 5 years of age: 1769 had a medical examination and 1495 underwent cognitive assessment. Cerebral palsy and cognitive impairment were studied as a function of early-onset sepsis (EOS) and late-onset sepsis (LOS), after adjustment for potential confounding factors, in multivariate logistic regression models.

RESULTS:

A total of 139 (5%) of the 2665 live births included in the study presented with EOS alone (without associated LOS), 752 (28%) had LOS alone (without associated EOS), and 64 (2%) displayed both EOS and LOS. At 5 years of age, the frequency of cerebral palsy was 9% (157 of 1769) and that of cognitive impairment was 12% (177 of 1495). The frequency of cerebral palsy was higher in infants with isolated EOS (odds ratio [OR]: 1.70 [95% confidence interval (CI): 0.84−3.45]) or isolated LOS (OR: 1.71 [95% CI: 1.14−2.56]) than in uninfected infants, and this risk was even higher in cases of combined EOS and LOS (OR: 2.33 [95% CI: 1.02−5.33]). There was no association between neonatal infection and cognitive impairment.

CONCLUSIONS:

Neonatal infections in these very preterm infants were associated with a higher risk of cerebral palsy at the age of 5 years, particularly in infants presenting with both EOS and LOS.
General Movements in Very Preterm Children and Neurodevelopment at 2 and 4 Years
Authors: Spittle Alicia J. , Spencer-Smith Megan M. , Cheong Jeanie L.Y. , Eeles Abbey L. , Lee Katherine J. , Anderson Peter J. , Doyle Lex W.
Published: July 2013

OBJECTIVE:

Although ∼50% of very preterm (VP) children have neurodevelopmental impairments, early prediction of infants who will experience problems later in life remains a challenge. This study evaluated the predictive value of general movements (GM; spontaneous and endogenous movements) at 1 and 3 months’ corrected age for neurodevelopment at 2 and 4 years of age in VP children.

METHODS:

At 1 and 3 months’ corrected age, infants born <30 weeks’ gestation had GM assessed as normal or abnormal. Motor, cognitive, and language development at 2 years was assessed by using the Bayley Scales of Infant and Toddler Development, Third Edition. At 4 years, cognitive and language outcomes were assessed by using the Differential Ability Scale–Second Edition and motor outcomes with the Movement Assessment Battery for Children–Second Edition; a diagnosis of cerebral palsy was documented.

RESULTS:

Ninety-nine VP infants were recruited, with 97% and 88% of survivors followed up at age 2 and 4 years, respectively. Abnormal GM at 1 month were associated with worse motor outcomes at 2 and 4 years but not language or cognitive outcomes. Abnormal GM at 3 months were associated with worse motor, cognitive, and language outcomes at both 2 and 4 years. Overall, GM at 1 month demonstrated better sensitivity to impairments at 2 and 4 years, whereas GM at 3 months had better specificity and were more accurate overall at distinguishing between children with and without impairment.

CONCLUSIONS:

Abnormal GM in VP infants, particularly at 3 months postterm, are predictive of worse neurodevelopment at ages 2 and 4 years.
Patterns of Retinal Hemorrhage Associated With Increased Intracranial Pressure in Children
Authors: Binenbaum Gil , Rogers David L. , Forbes Brian J. , Levin Alex V. , Clark Sireesha A. , Christian Cindy W. , Liu Grant T. , Avery Robert
Published: July 2013

OBJECTIVE:

Raised intracranial pressure (ICP) has been proposed as an isolated cause of retinal hemorrhages (RHs) in children with suspected traumatic head injury. We examined the incidence and patterns of RHs associated with increased ICP in children without trauma, measured by lumbar puncture (LP).

METHODS:

Children undergoing LP as part of their routine clinical care were studied prospectively at the Children's Hospital of Philadelphia and retrospectively at Nationwide Children’s Hospital. Inclusion criteria were absence of trauma, LP opening pressure (OP) ≥20 cm of water (cm H2O), and a dilated fundus examination by an ophthalmologist or neuro-ophthalmologist.

RESULTS:

One hundred children were studied (mean age: 12 years; range: 3–17 years). Mean OP was 35 cm H2O (range: 20–56 cm H2O); 68 (68%) children had OP >28 cm H2O. The most frequent etiology was idiopathic intracranial hypertension (70%). Seventy-four children had papilledema. Sixteen children had RH: 8 had superficial intraretinal peripapillary RH adjacent to a swollen optic disc, and 8 had only splinter hemorrhages directly on a swollen disc. All had significantly elevated OP (mean: 42 cm H2O).

CONCLUSIONS:

Only a small proportion of children with nontraumatic elevated ICP have RHs. When present, RHs are associated with markedly elevated OP, intraretinal, and invariably located adjacent to a swollen optic disc. This peripapillary pattern is distinct from the multilayered, widespread pattern of RH in abusive head trauma. When RHs are numerous, multilayered, or not near a swollen optic disc (eg, elsewhere in the posterior pole or in the retinal periphery), increased ICP alone is unlikely to be the cause.
Incidental Findings in Children With Blunt Head Trauma Evaluated With Cranial CT Scans
Authors: Rogers Alexander J. , Maher Cormac O. , Schunk Jeff E. , Quayle Kimberly , Jacobs Elizabeth , Lichenstein Richard , Powell Elizabeth , Miskin Michelle , Dayan Peter , Holmes James F. , Kuppermann Nathan
Published: July 2013

OBJECTIVE:

Cranial computed tomography (CT) scans are frequently obtained in the evaluation of blunt head trauma in children. These scans may detect unexpected incidental findings. The objectives of this study were to determine the prevalence and significance of incidental findings on cranial CT scans in children evaluated for blunt head trauma.

METHODS:

This was a secondary analysis of a multicenter study of pediatric blunt head trauma. Patients <18 years of age with blunt head trauma were eligible, with those undergoing cranial CT scan included in this substudy. Patients with coagulopathies, ventricular shunts, known previous brain surgery or abnormalities were excluded. We abstracted radiology reports for nontraumatic findings. We reviewed and categorized findings by their clinical urgency.

RESULTS:

Of the 43 904 head-injured children enrolled in the parent study, 15 831 underwent CT scans, and these latter patients serve as the study cohort. On 670 of these scans, nontraumatic findings were identified, with 16 excluded due to previously known abnormalities or surgeries. The remaining 654 represent a 4% prevalence of incidental findings. Of these, 195 (30%), representing 1% of the overall sample, warranted immediate intervention or outpatient follow-up.

CONCLUSIONS:

A small but important number of children evaluated with CT scans after blunt head trauma had incidental findings. Physicians who order cranial CTs must be prepared to interpret incidental findings, communicate with families, and ensure appropriate follow-up. There are ethical implications and potential health impacts of informing patients about incidental findings.
Respiratory Syncytial Virus–Associated Hospitalizations Among Children Less Than 24 Months of Age
Authors: Hall Caroline Breese , Weinberg Geoffrey A. , Blumkin Aaron K. , Edwards Kathryn M. , Staat Mary A. , Schultz Andrew F. , Poehling Katherine A. , Szilagyi Peter G. , Griffin Marie R. , Williams John V. , Zhu Yuwei , Grijalva Carlos G. , Prill Mila M. , Iwane Marika K.
Published: July 2013

BACKGROUND:

Respiratory syncytial virus (RSV) infection is a leading cause of hospitalization among infants. However, estimates of the RSV hospitalization burden have varied, and precision has been limited by the use of age strata grouped in blocks of 6 to ≥12 months.

METHODS:

We analyzed data from a 5-year, prospective, population-based surveillance for young children who were hospitalized with laboratory-confirmed (reverse-transcriptase polymerase chain reaction) RSV acute respiratory illness (ARI) during October through March 2000–2005. The total population at risk was stratified by month of age by birth certificate information to yield hospitalization rates.

RESULTS:

There were 559 (26%) RSV-infected children among the 2149 enrolled children hospitalized with ARI (85% of all eligible children with ARI). The average RSV hospitalization rate was 5.2 per 1000 children <24 months old. The highest age-specific rate was in infants 1 month old (25.9 per 1000 children). Infants ≤2 months of age, who comprised 44% of RSV-hospitalized children, had a hospitalization rate of 17.9 per 1000 children. Most children (79%) were previously healthy. Very preterm infants (<30 weeks’ gestation) accounted for only 3% of RSV cases but had RSV hospitalization rates 3 times that of term infants.

CONCLUSIONS:

Young infants, especially those who were 1 month old, were at greatest risk of RSV hospitalization. Four-fifths of RSV-hospitalized infants were previously healthy. To substantially reduce the burden of RSV hospitalizations, effective general preventive strategies will be required for all young infants, not just those with risk factors.
Variation in Resource Use and Readmission for Diabetic Ketoacidosis in Children’s Hospitals
Authors: Tieder Joel S. , McLeod Lisa , Keren Ron , Luan Xianqun , Localio Russell , Mahant Sanjay , Malik Faisal , Shah Samir S. , Wilson Karen M. , Srivastava Rajendu
Published: July 2013

OBJECTIVE:

We sought to characterize variation in hospital resource utilization and readmission for diabetic ketoacidosis (DKA) across US children’s hospitals.

METHODS:

The study sample included a retrospective cohort of children aged 2 to 18 years with a diagnosis of DKA at 38 children’s hospitals between 2004 and 2009. The main outcomes were resource utilization as determined by total standardized cost per hospitalization, overall and non-ICU length of stay (LOS), and readmission for DKA within 30 and 365 days.

RESULTS:

There were 24 890 DKA admissions, and 20.3% of these were readmissions within 1 year. The mean hospital-level total standardized cost was $7142 (range $4125–$11 916). The mean hospital-level LOS was 2.5 days (1.5–3.7), and the non-ICU portion was 1.9 days (0.7–2.7). The mean hospital-level readmission within 365 days was 18.7% (6.5%–41.1%) and within 30 days was 2.5% (0.0%–7.1%). Hospital bed days overall, and in particular the non-ICU portion, accounted for the majority of the total standardized cost per hospitalization (overall 57%; non-ICU 36%) and explained most of the variation in resource use. Even after adjusting for difference in patient characteristics across hospitals, widespread differences existed across hospitals in total standardized cost, LOS, and readmission rates (P < .001).

CONCLUSIONS:

Readmission for DKA within a year of hospitalization is common. US children’s hospitals vary widely in resource use, hospital LOS, and readmission rates for patients with DKA. Our study highlights the need for additional research to understand these differences and to identify the most cost-effective strategies for managing diabetes across the continuum of care.
Use of Ecallantide in Pediatric Hereditary Angioedema
Authors: MacGinnitie Andrew J. , Davis-Lorton Mark , Stolz Leslie E. , Tachdjian Raffi
Published: July 2013

OBJECTIVE:

Hereditary angioedema (HAE) due to C1-inhbitor deficiency is a rare autosomal dominant disease that manifests as sudden unpredictable attacks of subcutaneous or submucosal edema affecting the skin, intestine, and upper airway. Ecallantide is a plasma kallikrein inhibitor indicated for treatment of HAE attacks in patients aged 16 years and older. This analysis examines safety and efficacy of ecallantide for treatment of HAE attacks in patients <18 years of age.

METHODS:

Data for patients aged 9 to 17 years treated subcutaneously with 30 mg ecallantide or placebo were pooled from 4 clinical studies (2 double-blind, placebo-controlled and 2 open-label). Efficacy end points included 2 HAE-specific patient-reported outcome measures: mean symptom complex severity (MSCS) score and treatment outcome score (TOS). Times to initial improvement, sustained improvement, and complete or near-complete symptom resolution were calculated. Treatment-emergent adverse events were examined.

RESULTS:

Overall, 29 pediatric patients were included; 25 of them received ecallantide for 62 total HAE attacks, and 10 received placebo for 10 total attacks. Ecallantide-treated attacks revealed clinically relevant reduction in symptom severity at 4 hours postdosing based on mean change in MSCS score (−1.4 ± 0.9 ecallantide versus −0.9 ± 0.6 placebo) and TOS (73.9 ± 35.50 ecallantide versus 45.0 ± 43.78 placebo). Patients treated with ecallantide showed rapid improvement in symptoms (median time to complete or near-complete symptom resolution: 181 minutes). No serious adverse events related to treatment were observed.

CONCLUSIONS:

Ecallantide appears effective for HAE attacks in adolescents, with rapid symptom improvement. No unexpected safety issues were identified.