bluuebunny/crossref_metadata_2025 huggingface dataset:
Undulating fins produce off-axis thrust and flow structures
Authors: Neveln Izaak D. , Bale Rahul , Bhalla Amneet P. S. , Curet Oscar M. , Patankar Neelesh A. , Maciver Malcolm A.
Published: September 2013

While wake structures of many forms of swimming and flying are well characterized, the wake generated by a freely-swimming undulating fin has not yet been analyzed. These elongated fins allow fish to achieve enhanced agility exemplified by the forward, backward, and vertical swimming capabilities of knifefish and also have potential applications in the design of more maneuverable underwater vehicles. We present the flow structure of an undulating robotic fin model using particle image velocimetry to measure fluid velocity fields in the wake. We supplement the experimental robotic work with high-fidelity computational fluid dynamics, simulating the hydrodynamics of both a virtual fish whose fin kinematics and fin plus body morphology are measured from a freely-swimming knifefish as well as a virtual rendering of our robot. Our results indicate a series of linked vortex tubes is shed off the long edge of the fin as the undulatory wave travels lengthwise along the fin. A jet at an oblique angle to the fin is associated with the successive vortex tubes, propelling the fish forward. The vortex structure bears similarity to the linked vortex ring structure trailing the oscillating caudal fin of a carangiform swimmer, though the vortex rings are distorted due to the undulatory kinematics of the elongated fin.
Seasonal changes in the behaviour and respiration physiology of the freshwater duck musselAnodonta anatina.
Authors: Lurman Glenn J. , Walter Johanna , Hoppeler Hans
Published: September 2013

For low-energy organisms like bivalves, the costs of thermal compensation of biological rates (synonymous with acclimation and acclimatization) may be higher than the benefits. In the first experiment, we examined the effects of seasonal temperature changes on the bivalve Anodonta anatina, making measurements each month for a year at the corresponding temperature for that time of year. Only burrowing rate was partially compensated. There was no evidence for compensation of valve closure duration, frequency or locomotory speed. In a second experiment, we compared A. anatina at summer and winter temperatures (24 and 4°C respectively) and found no evidence for compensation of the burrowing rate, valve closure duration, frequency, or oxygen consumption rates during burrowing, immediately after valve closure and at rest. Within the experimental error of this study, the evidence suggests that thermal compensation of biological rates is not a strategy employed by A. anatina. We argue that this is due to a lack of evolutionary pressure to acclimatize, or evolutionary pressure to not acclimatize. Firstly, there is little incentive to increase metabolic rate to enhance predatory ability given that these are filter feeders. Secondly, maintained low energetic demand, enhanced at winter temperatures, is essential for predator avoidance, i.e. valve closure. Thus, we suggest that the costs of acclimatization outweigh the benefits in A. anatina.
A simple and affordable calorespirometer for assessing metabolic rates of fishes
Authors: Regan Matthew D. , Gosline John M. , Richards Jeffrey G.
Published: September 2013

Calorimetry is the measurement of the heat liberated during energy transformations in chemical reactions. When applied to living organisms, it measures the heat released due to the energy transformations associated with metabolism under both aerobic and anaerobic conditions. This is in contrast to the often-used respirometric techniques for assessing energy turnover, which can only be used under fully aerobic conditions. Accordingly, calorimetry is considered the 'gold standard' for quantifying metabolic rate, yet despite this, it remains a seldom-used technique among comparative physiologists. The reasons for this are related to the expense and perceived difficulty of the technique. We have designed and constructed an inexpensive flow-through calorespirometer capable of detecting rates of metabolic heat loss and oxygen consumption (ṀO2) in fishes under a variety of environmental conditions over long-term experiments. The metabolic heat of the fish is detected as a (micro)voltage by a collection of Peltier units wired in series, while oxygen optodes placed on the inflowing and outflowing water lines are used for the calculation of ṀO2. The apparatus is constructed in a differential fashion to account for ambient temperature fluctuations. This paper describes the design and construction of the calorespirometer for ~$1,300 CDN. Using the goldfish (Carassius auratus auratus), we show that the calorespirometer is sensitive to changes in metabolic rate brought about by pharmacological manipulation and severe hypoxia exposures.
Preparation of Nanoribbons of Blue Potassium Molybdenum Bronze
Authors: Nishida Takamasa , Eda Kazuo , Takahashi Kazuyuki , Sakurai Takahiro , Ohta Hitoshi , Whittingham M Stanley
Published: September 2013

We have successfully prepared nanoribbons of blue potassium molybdenum bronze (K0.3MoO3) from hydrogen molybdenum bronze (H0.3MoO3) by using crystallite splitting induced by solid-phase transformation and subsequent selective growth under hydrothermal conditions. The obtained nanoribbons were single crystals with a size of ca. 100 µm × 100 nm × 10 nm, well-elongated to the crystal b axis that corresponds to the conduction direction as a quasi-one-dimensional metal. A simple deaeration procedure necessary for preparing a single phase of blue potassium bronze is also given.
Towards a natural classification of Sapotaceae subfamily Chrysophylloideae in Oceania and Southeast Asia based on nuclear sequence data
Authors: Swenson Ulf , Nylinder Stephan , Munzinger Jérôme
Published: September 2013

Generic limits within subfamily Chrysophylloideae (Sapotaceae) from Oceania and Southeast Asia are reconciled based on a molecular phylogeny. We analysed sequences of nuclear ribosomal DNA (ETS, ITS) and the nuclear gene RPB2 with BEAST and parsimony jackknifing, using a sample of 168 terminals. Eight morphological characters were traced on a condensed majority–rule consensus tree to identify diagnostic character combinations for the genera. Accepted genera with character support are Magodendron, Pichonia, Planchonella, Pycnandra, Sersalisia, and Van–royena, while Beccariella and Niemeyera require amendment. Beccariella, a widely distributed group, is an illegitimate later homonym and we propose that the genus Pleioluma is resurrected in its place. The Australian genus Niemeyera is paraphyletic, but it is rendered monophyletic by reinstating Amorphospermum for N. antiloga. Beauvisagea, Blabeia, Fontbrunea, and Krausella are all segregates of Planchonella and rejected, while Wokoia is a later synonym of Pichonia. Planchonella baillonii, an endemic species of New Caledonia, is the sole member of an old lineage and firmly placed as the sister to a clade comprising the other congeners. Planchonella sandwicensis, a Hawaiian species, previously proposed to be a distinct genus, is a member of Planchonella. In the Pacific, P. tahitensis (including P. grayana) is a polymorphic species, widely distributed and adapted to a wide range of habitats. We provide a generic key (excluding Xantolis), diagnostic character combinations for all genera, and the necessary taxonomic combinations for Pichonia, Planchonella, Pleioluma, and Sersalisia to render each genus monophyletic.
Analysis of DNA polymorphism in ancient barley herbarium material: Validation of the KASP SNP genotyping platform
Authors: Lister Diane L. , Jones Huw , Jones Martin K. , O'Sullivan Donal M. , Cockram James
Published: September 2013

The availability of crop specimens archived in herbaria and old seed collections represent valuable resources for the analysis of plant genetic diversity and crop domestication. The ability to extract ancient DNA (aDNA) from such samples has recently allowed molecular genetic investigations to be undertaken in ancient materials. While analyses of aDNA initially focused on the use of markers which occur in multiple copies such as the internal transcribed spacer region (ITS) within ribosomal DNA and those requiring amplification of short DNA regions of variable length such as simple sequence repeats (SSRs), emphasis is now moving towards the genotyping of single nucleotide polymorphisms (SNPs), traditionally undertaken in aDNA by Sanger sequencing. Here, using a panel of barley aDNA samples previously surveyed by Sanger sequencing for putative causative SNPs within the flowering–time gene PPD–H1, we assess the utility of the Kompetitive Allele Specific PCR (KASP) genotyping platform for aDNA analysis. We find KASP to out–perform Sanger sequencing in the genotyping of aDNA samples (78% versus 61% success, respectively), as well as being robust to contamination. The small template size (≥46 bp) and one–step, closed–tube amplification/genotyping process make this platform ideally suited to the genotypic analysis of aDNA, a process which is often hampered by template DNA degradation and sample cross–contamination. Such attributes, as well as its flexibility of use and relatively low cost, make KASP particularly relevant to the genetic analysis of aDNA samples. Furthermore, KASP provides a common platform for the genotyping and analysis of corresponding SNPs in ancient, landrace and modern plant materials. The extended haplotype analysis of PPD–H1 undertaken here (allelic variation at which is thought to be important for the spread of domestication and local adaptation) provides further resolution to the previously identified geographic cline of flowering–time allele distribution, illustrating how KASP can be used to aid genetic analyses of aDNA from plant species. We further demonstrate the utility of KASP by genotyping ten additional genetic markers diagnostic for morphological traits in barley, shedding light on the phenotypic traits, alleles and allele combinations present in these unviable ancient specimens, as well as their geographic distributions.
Total spondylectomy following carbon ion radiotherapy to treat chordoma of the mobile spine
Authors: Matsumoto T. , Imagama S. , Ito Z. , Imai R. , Kamada T. , Shimoyama Y. , Matsuyama Y. , Ishiguro N.
Published: September 2013

The main form of treatment of a chordoma of the mobile spine is total en bloc spondylectomy (TES), but the clinical results are not satisfactory. Stand-alone carbon ion radiotherapy (CIRT) for bone and soft-tissue sarcomas has recently been reported to have a high rate of local control with a low rate of local recurrence.

We report two patients who underwent TES after CIRT for treating a chordoma in the lumbar spine with good medium-term outcomes. At operation, there remained histological evidence of viable tumour cells in both cases. After the combination use of TES following CIRT, neither patient showed signs of recurrence at the follow-up examination. These two cases suggest that CIRT should be combined with total spondylectomy in the treatment of chordoma of the mobile spine.

Cite this article: Bone Joint J 2013;95-B:1392–5.
Restoring the anatomical tibial slope and limb axis may maximise post-operative flexion in posterior-stabilised total knee replacements
Authors: Singh G. , Tan J. H. , Sng B. Y. , Awiszus F. , Lohmann C. H. , Nathan S. S.
Published: September 2013

The optimal management of the tibial slope in achieving a high flexion angle in posterior-stabilised (PS) total knee replacement (TKR) is not well understood, and most studies evaluating the posterior tibial slope have been conducted on cruciate-retaining TKRs. We analysed pre- and post-operative tibial slope differences, pre- and post-operative coronal knee alignment and post-operative maximum flexion angle in 167 patients undergoing 209 TKRs. The mean pre-operative posterior tibial slope was 8.6° (1.3° to 17°) and post-operatively it was 8.0° (0.1° to 16.7°). Multiple linear regression analysis showed that the absolute difference between pre- and post-operative tibial slope (p < 0.001), post-operative coronal alignment (p = 0.02) and pre-operative range of movement (p < 0.001) predicted post-operative flexion. The variance of change in tibial slope became larger as the post-operative maximum flexion angle decreased. The odds ratio of having a post-operative flexion angle < 100° was 17.6 if the slope change was > 2°. Our data suggest that recreation of the anatomical tibial slope appears to improve maximum flexion after posterior-stabilised TKR, provided coronal alignment has been restored.

Cite this article: Bone Joint J 2013;95-B:1354–8.
Internal fixation of intracapsular fractures of the hip using a dynamic locking plate
Authors: Parker M. , Cawley S. , Palial V.
Published: September 2013

A consecutive series of 320 patients with an intracapsular fracture of the hip treated with a dynamic locking plate (Targon Femoral Neck (TFN)) were reviewed. All surviving patients were followed for a minimum of two years. During the follow-up period 109 patients died.

There were 112 undisplaced fractures, of which three (2.7%) developed nonunion or re-displacement and five (4.5%) developed avascular necrosis of the femoral head. Revision to an arthroplasty was required for five patients (4.5%). A further six patients (5.4%) had elective removal of the plate and screws.

There were 208 displaced fractures, of which 32 (15.4%) developed nonunion or re-displacement and 23 (11.1%) developed avascular necrosis. A further four patients (1.9%) developed a secondary fracture around the TFN. Revision to a hip replacement was required for 43 patients (20.7%) patients and a further seven (3.3%) had elective removal of the plate and screws.

It is suggested that the stronger distal fixation combined with rotational stability may lead to a reduced incidence of complications related to the healing of the fracture when compared with other contemporary fixation devices but this needs to be confirmed in further studies.

Cite this article: Bone Joint J 2013;95-B:1402–5.
Differences in the locations and modes of labral tearing between dysplastic hips and those with femoroacetabular impingement
Authors: Tamura S. , Nishii T. , Takao M. , Sakai T. , Yoshikawa H. , Sugano N.
Published: September 2013

We investigated differences in the location and mode of labral tears between dysplastic hips and hips with femoroacetabular impingement (FAI). We also investigated the relationship between labral tear and adjacent cartilage damage. We retrospectively studied 72 symptomatic hips (in 68 patients: 19 men and 49 women) with radiological evidence of dysplasia or FAI on high-resolution CT arthrography. The incidence and location of labral tears and modes of tear associated with the base of the labrum (Mode 1) or body of the labrum (Mode 2) were compared among FAI, mildly dysplastic and severely dysplastic hips. The locations predominantly involved with labral tears were different in FAI and mild dysplastic hips (anterior and anterosuperior zones) and in severely dysplastic hips (anterosuperior and superior zones) around the acetabulum. Significant differences were observed in the prevalence of Mode 1 versus Mode 2 tears in FAI hips (72% (n = 13) vs 28% (n = 5)) and severe dysplastic hips (25% (n = 2) vs 75% (n = 6)). The frequency of cartilage damage adjacent to Mode 1 tears was significantly higher (42% (n = 14)) than that adjacent to Mode 2 tears (14% (n = 3)).

Hip pathology is significantly related to the locations and modes of labral tears. Mode 1 tears may be a risk factor for the development of adjacent acetabular cartilage damage.

Cite this article: Bone Joint J 2013;95-B:1320–5.
Surgical correction of a rotational deformity of the shoulder in patients with obstetric brachial plexus palsy
Authors: Hultgren T. , Jönsson K. , Pettersson H. , Hammarberg H.
Published: September 2013

We evaluated results at one year after surgical correction of internal rotation deformities in the shoulders of 270 patients with obstetric brachial plexus palsy. The mean age at surgery was 6.2 years (0.6 to 35). Two techniques were used: open subscapularis elongation and latissimus dorsi to infraspinatus transfer. In addition, open relocation was performed or attempted in all patients with subluxed or dislocated joints. A mixed effects model approach was used to evaluate the effects of surgery on internal and external rotation, abduction, flexion and Mallet score. Independent factors included operative status (pre- or post-operative), gender, age, the condition of the joint, and whether or not transfer was performed. The overall mean improvement in external rotation following surgery was 84.6° (95% confidence interval (CI) 80.2 to 89.1) and the mean Mallet score improved by 4.0 (95% CI 3.7 to 4.2). There was a mean decrease in internal rotation of between 27.6° and 34.4° in the relocated joint groups and 8.6° (95% CI 5.2 to 12.0) in the normal joint group. Abduction and flexion were unchanged following surgery. Adding a latissimus dorsi transfer did not result in greater improvement in the mean external rotation compared with elongation of the subscapularis alone.

Cite this article: Bone Joint J 2013;95-B:1432–8.
The recovery position for posterior surgery of the ankle and hindfoot
Authors: Gougoulias N. , Dawe E. J. C. , Sakellariou A.
Published: September 2013

Most posterior hindfoot procedures have been described with the patient positioned prone. This affords excellent access to posterior hindfoot structures but has several disadvantages for the management of the airway, the requirement for an endotracheal tube in all patients, difficulty with ventilation and an increased risk of pressure injuries, especially with regard to reduced ocular perfusion.

We describe use of the ‘recovery position’, which affords equivalent access to the posterior aspect of the ankle and hindfoot without the morbidity associated with the prone position. A laryngeal mask rather than endotracheal tube may be used in most patients. In this annotation we describe this technique, which offers a safe and simple alternative method of positioning patients for posterior hindfoot and ankle surgery.

Cite this article: Bone Joint J 2013;95-B:1317–19.
Good Administration as a Fundamental Right
Authors: Kristjánsdóttir Margrét Vala
Published: September 2013

The EU Charter of Fundamental Rights lists good administration as a fundamental right. The scope of this right, as defined in Article 41 of the EU Charter, is limited to situations in which persons are dealing with the institutions and bodies of the European Union; this gives it a narrower scope than that of the Charter as a whole. This paper discusses the status of this right as a subjective, fundamental right and a codified principle of EU law. The focus is on the question of applicability of the right to situations in which persons are dealing with the institutions and bodies of Member States and questions are raised regarding the implications of Article 41 in this respect. The paper concludes that Article 41 of the Charter in fact limits the applicability of good administration to the institutions and bodies of the EU. This does not however, preclude the applicability of a general principle of good administration, as established by the European Court of Justice, to Member States and the formal recognition of this principle in the EU Charter seems to affect legal reasoning and contribute to some extent to the protection of administrative rules in the implementation of EU law.
Revenue Comparison in Asymmetric Auctions with Discrete Valuations
Authors: Doni Nicola , Menicucci Domenico
Published: September 2013

We consider an asymmetric auction setting with two bidders such that the valuation of each bidder has a binary support. First, we characterize the unique equilibrium outcome in the first price auction for any values of parameters. Then we compare the first price auction with the second price auction in terms of expected revenue. Under the assumption that the probabilities of low values are the same for the two bidders, we obtain two main results: (i) the second price auction yields a higher revenue unless the distribution of a bidder’s valuation first-order stochastically dominates the distribution of the other bidder’s valuation “in a strong sense” and (ii) introducing reserve prices implies that the first price auction is never superior to the second price auction. In addition, in some cases, the revenue in the first price auction decreases when all the valuations increase.
On Cardinal Spline Interpolation
Authors: Grigorieff Rolf D.
Published: September 2013

In the present paper it is shown that the interpolation problem for multiple knot cardinal splines subject to general interpolation conditions has a unique solution with polynomial growth if the data grow correspondingly provided a certain determinantal condition is satisfied. An application to Hs
error estimates for the interpolation with periodic multiple knot splines is given.
Implementing Galerkin Finite Element Methods for Semilinear Elliptic Differential Inclusions
Authors: Rieger Janosch
Published: September 2013

This paper presents the first feasible method for the approximation of solution sets
of semi-linear elliptic partial differential inclusions. It is based on a new Galerkin Finite Element
approach that projects the original differential inclusion to a finite-dimensional subspace of .
The problem that remains is to discretize the unknown solution set of the resulting finite-dimensional
algebraic inclusion in such a way that efficient algorithms for its computation can be designed
and error estimates can be proved.
One such discretization and the corresponding basic algorithm are presented along with several enhancements, and the algorithm is applied to two model problems.
Efficiency and Optimality of Some Weighted-Residual Error Estimator for Adaptive 2D Boundary Element Methods
Authors: Aurada Markus , Feischl Michael , Führer Thomas , Karkulik Michael , Praetorius Dirk
Published: September 2013

We prove convergence and quasi-optimality of a lowest-order adaptive
boundary element method for a weakly-singular integral equation in 2D.
The adaptive mesh-refinement is driven by the weighted-residual
error estimator. By proving that this estimator is not only reliable, but under some
regularity assumptions on the given data also efficient on locally refined meshes, we characterize the approximation class in terms of the Galerkin error only.
In particular, this yields that no
adaptive strategy can do better, and the weighted-residual error estimator is thus an optimal choice to steer the adaptive mesh-refinement. As a side result, we prove a
weak form of the saturation assumption.
Artificial Immune System for Multi-Area Economic Dispatch
Authors: De Shankha Suvra , Hazra Abhik , Basu Mousumi
Published: September 2013

This article presents artificial immune system for solving multi-area economic dispatch (MAED) problem with tie line constraints considering transmission losses, multiple fuels, valve-point loading and prohibited operating zones. Artificial immune system is based on the clonal selection principle which implements adaptive cloning, hyper mutation, aging operator and tournament selection. The effectiveness of the proposed algorithm has been verified on three different test systems, both small and large, involving varying degree of complexity. Compared with differential evolution, evolutionary programming and real-coded genetic algorithm, considering the quality of the solution obtained, the proposed algorithm seems to be a promising alternative approach for solving the MAED problems in practical power system.
An Advanced Modeling & Simulation Tool for Investigating the Behavior of a Manufacturing System in the Hazelnuts Industry Sector
Authors: Bruzzone Agostino G. , Longo Francesco
Published: September 2013

Abstract: This article proposes an advanced java-based simulation tool developed in order to support decision making in a manufacturing system operating in the hazelnuts industry sector. By providing the user with high flexibility in terms of manufacturing scenarios definition, the simulation tool can be used as an advanced decision-making tool to understand the dynamic interactions between multiple performance measures (that include both production lines and inventory system performances) and a set of user-defined factors (the latter defined by the production manager according to his/her needs in terms of manufacturing scenarios investigation). To understand how the simulation model can be used as decision-making tool and for testing the tool effectiveness, simulation results analyses and analytical meta-models are provided for different manufacturing scenarios.
Route dialogue partitions: Interactions between semantics and pragmatics
Authors: Mosca, Monica
Published: September 2013

This article proposes a model for route description dialogues based on the integration of the theories about route directions with those related to specific spatial instructions. This proposal is based empirically on a corpus of spoken Italian. The analysis of the corpus has shown that the basic dialogue strategy proposed by previous researchers requires further integration and elaboration. Also the model of spatial language developed in cognitive linguistics applies to the description of the giver�s instructions and directions, despite the fact that the literature in the field often overlooks this approach. This way of accounting for route descriptions is suitable to explain the lexicalization of the conceptualization of the displacements the follower must accomplish. A model of dialogue partitions integrated with the cognitive modelling of spatial language is proposed and supported by examples from the linguistic data.
Hospitalist and Nonhospitalist Adherence to Evidence-Based Quality Metrics for Bronchiolitis
Authors: McCulloh Russell J. , Smitherman Sarah , Adelsky Solomon , Congdon Morgan , Librizzi Jamie , Koehn Kristin , Alverson Brian
Published: September 2013

Objectives:

Hospitalists are a new subgroup of pediatricians. However, data comparing quality of care between hospitalists and nonhospitalists are limited. Bronchiolitis, a common cause of pediatric hospital admission, is an appropriate condition for evaluating inpatient quality of care. The goal of this study was to identify quality indicators for the evaluation and treatment of children hospitalized with bronchiolitis based on the 2006 American Academy of Pediatrics guidelines and to assess differences in adherence rates to these indicators between hospitalist and nonhospitalist pediatricians.

Methods:

This was a retrospective chart review of children admitted to 2 academic centers in 2007 and 2008. Reviewers selected charts with a discharge diagnosis of bronchiolitis and collected data on evaluation, treatment, length of stay, readmission, and adverse outcomes.

Results:

Reviewers analyzed 713 charts. In children without objective response to bronchodilator therapy, hospitalists and nonhospitalists discontinued albuterol and racemic epinephrine similarly. Hospitalists discontinued unnecessary systemic corticosteroid therapy (75.0% vs 42.4%; P = .001) and antibiotic therapy (71.0% vs 48.6%; P = .007) more frequently than nonhospitalists.

Conclusions:

These data suggest hospitalists better adhere to selected portions of the American Academy of Pediatrics bronchiolitis guidelines, thus providing higher quality of care. Quality indicators used in this study can distinguish physician performance in the inpatient management of bronchiolitis.
Risk Factors for Complications in Hospitalized Young Infants Presenting With Uncomplicated Pertussis
Authors: Wallace Sowdhamini S. , Cruz Andrea T. , Quinonez Ricardo A. , Caviness A. Chantal
Published: September 2013

Objective:

We sought to identify risk factors for complications in hospitalized young infants with uncomplicated pertussis.

Methods:

Retrospective cohort study of hospitalized infants 0 to 6 months of age with confirmed pertussis from 2005 to 2009. Subjects presenting without complications or need for initial intensive care admission were deemed to have uncomplicated pertussis. Complications during hospitalization were defined as apnea, pneumonia, seizures, or encephalopathy. Univariate analysis was performed by estimating odds ratios (OR) and 95% confidence intervals (CI) for the association between each variable and the occurrence of complications. Multivariable analysis was performed using logistic regression. Clinical variables included demographics, historical, laboratory, and imaging data.

Results:

Of 126 study subjects, 46 (36.5%) developed complications in the hospital: 43 with apnea (two required endotracheal intubation), seven with pneumonia, and three with seizures; there were no cases of encephalopathy and no deaths. Age less than 60 days (OR, 2.71; 95% CI, 1.08-6.82), cough duration less than 7 days (OR, 5.38; 95% CI, 1.79-16.18), history of color change (OR, 5.24; 95% CI, 1.14-24.07), parental intervention (OR, 10.05; 95% CI, 1.67-60.39), and need for oxygen in the emergency department (OR. 3.94; 95% CI. 1.37-11.36) were associated with development of complications. The median duration of cough at the time of complication was 9 days (range 2-30 days). Initial complete blood cell count and radiographic findings were not associated with complications.

Conclusions:

Infants with uncomplicated pertussis may be at low risk for developing respiratory failure or death. Historical information may assist practitioners in determining risk for serious complications.
Should blood cultures be obtained in all infants 3 to 36 months presenting with significant fever?
Authors: Rappaport David I. , Cooperberg David , Fliegel Jonathan
Published: September 2013

Context:

Fever without source (FWS) in children 3-36 months is a common presenting complaint. Because of changes in immunization practices and their effects on rates of bacteremia, older guidelines may no longer be applicable. We reviewed the literature regarding the necessity of obtaining a blood culture in non-toxic children in this age group with FWS.

Data Sources:

We conducted a MEDLINE search on the topic of bacteremia in febrile children 3-36 months from 2004-present.

Results:

Eight studies were included. Although the studies varied in terms of approach and analysis, all suggested a rate of bacteremia in a non-toxic, febrile child 3-36 months of age to be less than 1%.

Conclusions:

Strong consideration should be given for foregoing blood culture in a non-toxic child 3-36 months of age with FWS.
Pediatric Hospitalists’ Perspectives on the Care of Children With Medical Complexity
Authors: Adame Noemi , Rocha Mary E.M. , Louden Chris , Agrawal Rishi
Published: September 2013

Objective:

The aims of this study were to identify pediatric hospitalists’ perceived views of (1) barriers to delivering care to children with medical complexity (CMC) and (2) their preferred model of inpatient health care delivery for CMC.

Subjects:

American Academy of Pediatrics Section on Hospital Medicine (AAP-SOHM) Listserv subscribers.

Methods:

We conducted a cross-sectional survey of subscribers of the AAP-SOHM Listserv using the survey instrument SurveyMonkey®. Our survey was coadministered with a survey on pediatric hospitalist career satisfaction.

Results:

The most significant barriers to delivering care to CMC were (1) time constraints (89%), (2) inadequate postdischarge resources (75%), and (3) lack of evidence-based guidelines (64%). Although most pediatric hospitalists in an inpatient service currently care for both CMC and non-CMC patients (91%), only 25% perceive this to be the optimal service model for CMC. The majority of hospitalists (56%) believe that CMC are better served by either an inpatient service dedicated to CMC (30%) or comanaged with an inpatient consult service for CMC (26%).

Conclusions:

Identifying the perceived barriers to delivering care to CMC can assist pediatric hospitalists to design studies determining if care delivery is affected by these barriers. Most hospitalists care for CMC on the same service as uncomplicated patients, yet over half perceive that a different model of care delivery would better serve the needs of CMC.
Residency Factors That Influence Pediatric In-Training Examination Score Improvement
Authors: Chase Lindsay H. , Highbaugh-Battle Angela P. , Buchter Susie
Published: September 2013

Objective:

The goal of this study was to determine which measurable factors of resident training experience contribute to improvement of in-training examination (ITE) and certifying examination (CE) scores.

Methods:

This is a descriptive retrospective study analyzing data from July 2003 through June 2006 at a large academic pediatric training program. Pediatric categorical residents beginning residency in July 2003 were included. Regression analyses were used to determine if the number of admissions performed, core lectures attended, acute care topics heard, grand rounds attended, continuity clinic patients encountered, or procedures performed correlated with improvement of ITE scores. These factors were then analyzed in relation to CE scores.

Results:

Seventeen residents were included in this study. The number of general pediatric admissions was the only factor found to correlate with an increase in ITE score (P = .04). Scores for the ITE at pediatric levels 1 and 3 were predictive of CE scores. No other factors measured were found to influence CE scores.

Conclusions:

Although all experiences of pediatric residents likely contribute to professional competence, some experiences may have more effect on ITE and CE scores. In this study, only general pediatric admissions correlated significantly with an improvement in ITE scores from year 1 to year 3. Further study is needed to identify which elements of the residency experience contribute most to CE success. This would be helpful in optimizing residency program structure and curriculum within the limitations of duty hour regulations.
Prevalence, Characteristics, and Opinions of Pediatric Rapid Response Teams in the United States
Authors: Chen J. Gene , Kemper Alex R. , Odetola Folafoluwa , Cheifetz Ira M. , Turner David A.
Published: September 2013

Objective:

Rapid response teams (RRTs) have been proposed as patient safety initiatives for hospitalized children. The aim of this study was to determine the prevalence, characteristics, and opinions of RRTs in hospitals with PICUs in the United States.

Methods:

This study was conducted as a cross-sectional survey of PICU physicians in adult and children’s hospitals that care for children. One survey was sent to the PICU medical director in each hospital. The primary outcome was the presence of an RRT. Other outcomes included RRT characteristics and beliefs regarding their impact on patient safety.

Results:

The survey response rate was 64% (134 of 210). Of the responding institutions, 79% (103) had an RRT; most of these teams were implemented in the last 5 years. Family activation was present in 69%, and automatic triggers existed in 34% of cases. RRTs included a median of 3 members and were composed of physicians in 77%, nurses in 100%, and respiratory therapists in 89% of institutions. Respondents with RRTs were more likely to agree that RRTs improve patient safety than respondents without RRTs (76% vs 52%) and more likely to disagree that they are not worth the money invested (82% vs 63%).

Conclusions:

Although the evidence and opinions on the benefit of RRTs are mixed, the majority of US hospitals with PICUs have implemented RRTs. These systems demonstrate variability in activation mechanisms and team composition. Hospitals may be empirically adopting these initiatives without knowledge of the specific characteristics that are optimal for patient outcomes.
Assessment of Pediatric Residents’ Communication and Interpersonal Skills During Family-Centered Rounds
Authors: Osorio Snezana Nena , Ward Mary J. , Siew Lawrence , Bylund Carma , Konopasek Lyuba
Published: September 2013

Objectives:

Residency training programs are required to assess and document residents’ competency in communication. Multisource evaluations that include direct resident observations are preferred. Previous studies have often used methods of asking faculty members to evaluate residents on behaviors they did not witness.

Methods:

Twenty first year pediatric residents (interns) were evaluated preand post-FCR introduction by a faculty member, a parent, and a nurse after the encounter with the patients and their families during rounds. All participants used the CAT. Mean CAT scores and associations between the evaluator groups were determined.

Results:

Nurses and faculty were significantly more likely to observe how interns communicated with the parents in the post-FCR period (P < .001). Pre-FCR, compared to parent scores, intern scores were significantly lower (P < .05) and the scores were not correlated (P = .84). Post-FCR, the difference in internparent scores disappeared and their scores were significantly correlated (r18 = 0.73, P < .001). Intern scores did not correlate with faculty and nurse scores. Cronbach a coefficients for the CAT ranged from 0.90 to 0.99.

Conclusions:

Family-centered rounds provide more opportunities for direct observation of residents’ competence in accordance with Accreditation Council for Graduate Medical Education guidelines. This rounds format also encourages a climate that improves residents’ ability to self-assess. Residents’ communication skills can be assessed by using the Communication Assessment Tool in an efficient and timely manner, because all evaluators are present at the bedside during family-centered rounds.
Pediatric Renal Abscess: A 10-year Single-Center Retrospective Analysis
Authors: Seguias Luis , Srinivasan Karthik , Mehta Amit
Published: September 2013

Objective:

The objective of this retrospective series is to describe the demographics and treatment of patients with renal abscesses and to determine if abscess size influences management.

Methods:

We reviewed all pediatric cases of renal abscesses treated over a 10-year period in our medical center. Clinical, laboratory, imaging data, and treatment modalities were analyzed.

Results:

Thirty-six patients were evaluated, with renal abscesses found in all age groups. The median age was 9.3 years, and 64% of patients affected were female. Fever and abdominal pain were the most common clinical symptoms. A premorbid genitourinary condition was present in 31% of patients. Previous urinary tract infection was documented in 31% of the cases. Initial elevation of C-reactive protein or erythrocyte sedimentation rate, when obtained, was observed in >80% of cases. Abnormal urinalysis was recognized in two-thirds of encounters. Escherichia coli, the most common microorganism isolated, was found in half the cases. Staphylococcus aureus was isolated in 11%. Ultrasound and computed tomography were the most used diagnostic imaging modalities. Eighty-nine percent of the patients who received intravenous antibiotics alone as an initial treatment regimen did not require percutaneous drainage or surgery.

Conclusions:

Ten of the 14 patients with an abscess size ≥3 cm had an invasive intervention, but only 1 of these 10 had an initial 48-hour trial of antibiotics alone. In contrast, only 2 of the 22 patients who had an abscess size <3 cm received an invasive intervention (Fisher P= .0002). We conclude that conservative treatment with intravenous antibiotics may be a reasonable initial approach.
A Time-Motion Study of Inpatient Rounds Using a Family-Centered Rounds Model
Authors: Bhansali Priti , Birch Sarah , Campbell Joyce K. , Agrawal Dewesh , Hoffner Wendy , Manicone Paul , Shah Kyle , Krieger Evelina , Ottolini Mary
Published: September 2013

Objective:

Family-centered rounds (FCR) have become increasingly prevalent in pediatric hospital settings. The objective of our study was to describe time use and discrete events during pediatric inpatient rounds by using a FCR model.

Methods:

We conducted a prospective observational study at Children’s National Medical Center between September 2010 and February 2011. Investigators directly observed rounds on hospitalist and neurology services. Events were timed, and key features were recorded by using a Microsoft Access-based program. Associations with increased time spent during rounds were determined by using regression analyses.

Results:

One hundred fifty-nine rounding encounters were observed. Rounds lasted 7.9 minutes on average per patient. An average of 1.3 minutes was spent between patients during rounds. Eighty-six (54%) encounters occurred outside the patient’s room, 3% of the time because of the family’s request. Infectious isolation was associated with rounds occurring outside the room (P < .0001). Participation of the parent, location of rounds inside or outside the patient’s room, most teaching behaviors, and interruptions were not significantly associated with increased time spent during rounds. Teaching physical examination techniques by allowing multiple trainees to examine the patient was associated with increased rounding time (P = .02).

Conclusions:

The majority of rounds occurred outside the patient’s room, yet rarely at the parent’s request. Patients on infectious isolation were more likely to have rounds occur outside the patient’s room. Neither parental participation nor most teaching behaviors were associated with increased time spent on rounds. These findings will enrich the evidence base needed to establish FCR best practices.
Length of Stay and Readmission Among Late Preterm Infants: An Instrumental Variable Approach
Authors: Goyal Neera , Zubizarreta José R. , Small Dylan S. , Lorch Scott A.
Published: September 2013

Objective:

Evidence to guide safe discharge for late preterm infants (34–36 weeks’ gestation) is lacking. Previous studies have demonstrated the increased risk of neonatal readmission for these infants compared with those born at term (≥37 weeks’ gestation). The purpose of this study was to estimate the effect of length of stay (LOS) on 7-day readmissions in this population.

Methods:

This was a retrospective study using hospital discharge data linked with vital records for late preterm infants delivered vaginally in California from 1993 to 2005. Exclusion criteria included complications likely requiring neonatal intensive care. The effect of LOS was assessed by using birth hour as an instrumental variable to account for unmeasured confounding. By using a matching algorithm, we created pairs of infants with different LOS based on birth hour but otherwise matched on known confounders for readmission risk, including birth year, hospital, and clinical and demographic covariates such as gestational age, birth weight, race, and insurance.

Results:

We produced 80 600 matched pairs of infants with different LOS based on birth hour. In 122 pairs, both infants were readmitted within 7 days, and in 75 362 pairs, neither infant was readmitted. Of the remaining 5116 matched pairs in which only 1 infant was readmitted, 2456 infants with long LOS and 2660 infants with short LOS were readmitted. We found no evidence that longer LOS reduces the odds of readmission (1-sided P value = .99).

Conclusions:

By using an instrumental variable approach and matching algorithm, longer LOS was not associated with decreased readmission within 7 days of discharge for these late preterm infants.
Simulation Training as a Mechanism for Procedural and Resuscitation Education for Pediatric Residents: A Systematic Review
Authors: Mills David M. , Williams Daniel C. , Dobson Joseph V.
Published: September 2013

Background:

Pediatric residents often finish their training lacking sufficient procedural proficiency and resuscitation experience in the care of critically ill children. Simulation is gaining favor in pediatric residency programs as a modality for procedural and resuscitation education. We reviewed the literature assessing simulation and its role in pediatric resident training.

Methods:

We conducted a Medline and PubMed search of simulation training in pediatric resident education from January 2007 to July 2012.

Results:

Eight studies were included and divided into simulated procedural assessments and simulated resuscitation scenario assessments. The studies varied widely in their approach and analysis, and they yielded mixed results.

Conclusions:

Although some studies show the merits of simulation in the procedural and resuscitation training of pediatric residents, more research is needed to assess the effectiveness of simulation as an educational tool. Goals of future simulation research should include creation of validated assessment tools and applying skills learned to patient care outcomes.
Care of the Complex Chronically Ill Child by Generalist Pediatricians: Lessons Learned From Pediatric Palliative Care
Authors: Walter Jennifer K. , DeCamp Lisa Ross , Warrier Kavita S. , Murphy Terrance P. , Keefer Patricia M.
Published: September 2013

Background and Objective:

Parents of children with complex chronic conditions report fragmented care, unmet medical needs, and financial strain from health care costs. The aim of this study was to identify both prevalent themes discussed during pediatric palliative care consultation of patients with complex chronic conditions cared for by pediatric generalists and variation in consultation content by age and timing of consultation in disease course.

Methods:

Forty randomly selected initial inpatient or outpatient consultation notes authored by the pediatric palliative care team at an academic, tertiary care children’s hospital. Inclusion required that patients were primarily cared for by general pediatricians, pediatric hospitalists, or pediatric intensivists, instead of subspecialists. Qualitative analysis by 5 team members utilizing consensus-based findings was used to develop themes. Descriptive statistics were used to describe variations in themes across age and disease course.

Results:

Common themes included thorough review of patient baseline functioning, current symptoms, assessment of family’s understanding of the prognosis of the patient, coordination of communication with other medical teams and outpatient health care services, consideration of caregiver resources and burdens, and offering a framework for decision-making. Variation in consult themes by age/disease course included more discussion of communication problems and symptom management when patients were at their baseline, but otherwise little variation was found.

Conclusions:

Common themes covered in initial consultations correspond with documented unmet needs for chronically ill children. There was no significant variation in consultation themes by age/disease course, suggesting that generalists could broadly apply palliative care techniques to improve family-centered care.