bluuebunny/crossref_metadata_2025 huggingface dataset:
Deranged liver function tests in pregnancy: the importance of postnatal follow-up
Authors: Stone Sophia , Girling Joanna C
Published: March 2009

We report an asymptomatic 40-year-old woman with persistently deranged liver function tests found incidentally in the first trimester of her second pregnancy. No cause was apparent clinically, serologically or with imaging studies until a new finding of hepatomegaly led to a repeat ultrasound scan six weeks following delivery. A mass in the region of the common hepatic duct was confirmed to be a cholangiocarcinoma, with vascular invasion precluding curative surgical resection. This case highlights the need for close vigilance of patients with unexplained and persistently abnormal liver function tests, antenatally and postdelivery.
Pregnancy after bariatric surgery: no problem?
Authors: Gidiri Muchabayiwa , Greer Ian A
Published: March 2009

Bariatric surgery is highly effective for weight loss in morbid obesity. With the high prevalence of severe obesity in the developed world, and the acknowledgement of the effectiveness of these procedures by National Institute for Clinical Excellence (in the UK) and the Food and Drug Administration (in the USA), women with severe obesity will increasingly seek such treatment. As the majority of these patients are women of reproductive age, obstetricians will encounter these patients frequently during pregnancy. It is therefore important for obstetricians to gain an insight into the types of surgery performed, the potential complications, including nutritional deficiency, and appropriate management of pregnancy following weight-loss surgery. In general, bariatric surgery is associated with a reduction in obesity related complication, with no apparent increased risk of adverse perinatal outcomes.
Termination is not the treatment of choice for severe hyperemesis gravidarum: Successful management using prednisolone
Authors: Al-Ozairi E , Waugh J J S , Taylor R
Published: March 2009

Summary

Severe hyperemesis gravidarum causes profound maternal morbidity. Termination of pregnancy is still offered before the use of medical therapy. This report describes management of a woman who had undergone two previous terminations for hyperemesis, and additionally presents the dosage profile of prednisolone used to successfully manage a consecutive series of 33 women with severe hyperemesis gravidarum. The treatment protocol is described. The group had a median weight loss in pregnancy of 5.5 kg (range 2.0–12.5 kg), had been admitted on a median of 3.0 (range 0–9) occasions and had spent 7.5 (range 0–25) days on i.v. fluids. Continuing vomiting prevented oral steroid therapy in 14 women and i.v. hydrocortisone (50 mg t.i.d.; two women required 100 mg t.i.d.) was used initially for 24–48 h. Nineteen women commenced prednisolone 10 mg t.i.d. and this achieved suppression of vomiting within 48 h in all but two women who required 15 mg t.i.d. Two distinct subtypes of hyperemesis gravidarum were identified. Remitting hyperemesis spontaneously ceases between 14 and 22 weeks gestation and accounts for approximately 80% of cases. In contrast, full-term hyperemesis persists until minutes after delivery. These separate sub-types have not previously been described. Steroid treatment of hyperemesis should be considered in women who fulfil the criteria of severe disease.
Intrauterine growth rate in pregnancies complicated by type 1, type 2 and gestational diabetes
Authors: Lim E L , Burden T , Marshall S M , Davison J M , Blott M J , Waugh J S J , Taylor R
Published: March 2009

Fetal macrosomia is a feature of all subtypes of maternal diabetes. The intrauterine time course of development of macrosomia in type 1, type 2 and gestational diabetes (GDM) could identify the times of more rapid growth, which differ as a result of different influences in subtypes of diabetes. Higher maternal weight in type 2 and GDM may be expected to contribute to macrosomia and the blood glucose control will exert an additional influence. Information was collected prospectively on 217 pregnancies in insulin-treated women at a single centre over a six-year period. All women were managed by a single team of obstetricians and diabetologists at a Joint Obstetric Medical Clinic. The rate of increase in abdominal circumference from 28 weeks was identical in each subtype of diabetes and there were no differences between subtypes at the earliest gestation assessed. Use of customized growth centiles showed rates of macrosomia to be similar in type 1, type 2 and GDM (43.0%, 50.0% and 41.8%, respectively). The intrauterine time course to macrosomia is similar in type 1, type 2 and GDM. The relationship of macrosomia to extent of elevation of mean blood glucose control is weak, implying a low threshold for maximal effect on the rate of fetal growth.
Research at The Margins of Schooling: Biographical Inquiry and Third-Site Pedagogy
Authors: Wilson Brent
Published: March 2009

The value of art education rests with its power to shape the ways people live their lives in art and visual culture beyond schools and schooling. A logical place to research the effectiveness of art education is to examine peoples' lives when they are outside school and after they have
left school. The paper provides theoretical insights about the relative effectiveness of informal and formal pedagogy gained from biographical studies of the beyond-schooling lives of individuals who attended an unusual British secondary modern school during the 1950s and 1960s. Individuals'
lives were influenced by a museum-like space, by informal contacts with individual from the art world, and visual cultural experiences at the margins of the art classroom more than they were influenced by the structured art curriculum. Biographical inquiry also provides a useful means for
studying children who create their own visual culture based on comic books and other popular media. When researchers study informal contacts between students and teachers, their inquiry is set within a third inquiry site and it is directed to a third pedagogical site which is different from
the self-initiated visual culture produced by students (the first pedagogical site) and formal art instruction (the second pedagogical site).
The role of cooperative learning in the introductory stages of art teacher training programmes in Japan
Authors: Naoe Toshio
Published: March 2009

In this article the outcomes and issues of cooperative learning in teacher training programmes for undergraduate art students are examined. Cooperative learning utilizes human interaction in small groups in pursuit of shared goals. The author designed and delivered two introductory
courses at the University of Tsukuba that were added to the teacher training programme as a result of reforms to the Japanese national teacher education system in 2000. The courses, which were informed by principles and methods of cooperative learning, had a positive impact on student engagement
and satisfaction. Although the study workload is heavier since these reforms were put into place there has been a steady increase in numbers of art students entering and finishing teacher training.
New directions in Latin American university-industry-government interactions
Authors: de Mello Jos Manoel Carvalho , Etzkowitz Henry
Published: March 2009

New directions in universityindustrygovernment interactions are taking place in Latin American countries. The idea that the university should play an economic role is a relatively new one. The articles in this special issue deal with issues involved in establishing the groundwork for
this new academic role.
Adaptation, Translation, Multimediality: A Hungarian Bestseller Across Cultures
Authors: Komporaly Jozefina , Minier Mrta
Published: March 2009

This contribution examines some of the challenges arising from adaptation as intergeneric transfer (from novel to playtext), and interrogates aspects of intersemiotic translation from playtext to performance. Drawing on the international interest in Embers, the paper juxtaposes the
source text, the 1942 novel by the Hungarian writer Sndor Mrai, with references to its versions in fictional and dramatic format in various languages: with a special emphasis on Christopher Hampton's stage adaptation, Michael Blakemore's 2006 West End production and (to a lesser extent) Lou
Stein's radio drama. The article primarily concentrates on the editing Hampton carries out in his adaptation process, and considers play and performance against the backdrop of the current British theatrical system.
Translating Words into Visual Signs: Face Photography in The Summer of Aviya and The Island on Bird Street
Authors: Weissbrod Rachel
Published: March 2009

The article has two purposes: (1) to provide a theoretical framework for dealing with a specific aspect of adaptation: the use of face photography in general, and close-ups of the face in particular, to depict an inner world which literature describes by using words; (2) to examine
the applicability of this framework by analyzing face photography in two films: The Summer of Aviya and The Island on Bird Street. Based on works from various disciplines (semiotics, cinema studies, philosophy), the article suggests that face photography does not just replace
literary devices, rather, it brings its own meaning into the adapted works. The films under consideration have been selected not only because face photography is significant in both of them, but also because they deal with a highly charged topic the Holocaust and use face photography to evoke
moral dilemmas related to it. The way the films handle these dilemmas is especially important because both of them are directed toward children and may affect the way their young viewers perceive and judge people's behaviour during and after the Holocaust.
Textures and Translations: B(earth) in between Extended Voice and Visual Arts
Authors: Allegue Ludivine , Bonenfant Yvon
Published: March 2009

In this article, which is accompanied by a DVD included in this issue, Ludivine Allegue and Yvon Bonenfant draw the reader inside the creative process underpinning an engagement with collaboration. The article explores the creation of the installation B(earth) (20078) by Bonenfant
and Allegue. It attempts to represent the encounter between specific disciplines, personalities, theoretical backgrounds and ways of thinking about creative process from each of their perspectives as well as from a combined perspective. In so doing, and through focusing on encounter, the article
posits other ways of thinking about processes of adaptation and translation. Translations between artists, between corporealities and between ways of thinking about creative impulse are foregrounded as the writing style voyages from academic reflection to poetic reflection and explores territories
in between these. The DVD allows the reader to get a taste of the installation itself and its component parts: painting, light, video and extended voice practice.
Revisiting the glorious and problematic legacy of the jazz age and depression musical
Authors: Block Geoffrey
Published: March 2009

In this essay I will argue that the main obstacle to the preservation of the musical comedy species circa 192040 is not the absence of source material or even the difficulties in gaining access to them. The fault lies not in the sources but in ourselves. What should we do with them,
and how do we come to grips with the strengths and limitations of these works? How do we reconcile the competing agendas of authenticity (what was actually said and sung) and accessibility (what works for commercial audiences in a later era)? What can we do about the expectations, tastes and
the social and aesthetic sensibilities we bring to them? To particularize these issues, I will explore the source legacy of Rodgers and Hart's Jumbo (1935), including the exciting discovery of contemporary live Texaco radio programmes. I will also use Jumbo to represent the many
forgotten shows of this era in which the songs, generally treated by historians and performers as autonomous and self-contained, originally served characters and contexts and were often chosen and crafted with care.
Rouben Mamoulian's Applause and the birth of the disenchanted musical
Authors: Lecomte Jean-Marie
Published: March 2009

In 1929, when Hollywood cinema was converting to sound, Rouben Mamoulian left Broadway to directApplause, a backstage musical, for Paramount. It was believed that his expertise in musical theatre could be harnessed to benefit the fledgling talking medium. But the Broadway director quickly grasped the fundamentals of sound film and turnedApplauseinto an aesthetic experiment in unstaging a Broadway musical. It was neither a critical nor a financial success. Audiences expected Mamoulian (and his star Helen Morgan) to reproduce the glory of Broadway, not to subvert it. In the disenchanted screen world ofApplause, songs and musical numbers often recede in the background of the visuals. When they intrude, they come as props of the fictional world, as circumstantial elements, not as leading spectaculars. Sound naturalism seems to have motivated Mamoulian, in his innovative uses of sound perspective, layering and counterpointing. He experimented with split screen, sound perspective, rack focus, acousmatic voices, off-screen and internal sound. Finally, he combined a new aesthetics and poetics of filmic viewpoint with a favourable treatment of women's singing voices, in a way that was more avant-garde than mainstream Hollywood.
Underneath the ground: Jud and the community in Oklahoma!
Authors: Miller Derek
Published: March 2009

In their groundbreaking analyses ofOklahoma!, Andrea Most and Bruce Kirle present convincing arguments that the play is partially an examination of the place of Jews in American society. Their readings emphasize Ali Hakim's Jewishness and suggest that Jud's threatening otherness throws the harmlessness of Ali's ethnicity into relief (Most 2004: 116). This essay argues that Jud himself can be read as a Jewish character. Jud is the play's contemptible villain, yet as the antagonist he serves a crucial role in resolvingOklahoma!'s conflict, making him a version of the classic anti-Semitic paradox, a Jew who is both worthless and foundational. By exploring Jud's power and how it serves the community that slanders him, this article recasts the play's figuration of Jewishness to encompass both performed and buried Jewish stereotypes.
James Nelson Barker's The Indian Princess: the role of the operatic melodrama in the establishment of an American belles-lettres
Authors: Bak John S
Published: March 2009

James Nelson Barker'sThe Indian Princess; or, La Belle Sauvage, is the first extant play based on the Pocahontas myth and one of the first American operatic melodramas. Such was the impactThe Indian Princesshad on the burgeoning theatrical scene in America that it also elevated the Pocahontas story to one of the nation's most celebrated myths, which speaks volumes about what it did for the nation's belles-lettres as well. Was it the myth alone that lent the play its wide appeal, or was it more the musical genre so popular then on the British stage that attracted American audiences? To be sure, the myth and the genre were both recognizable traits of the Georgian theatre, and what was deemed the best of American theatre was essentially derivative in nature. And yet the operatic melodrama also evokes much of what was then at stake for a nation in search of its own belles-lettres, for Barker was less interested in evoking the mysteries of an intercultural romance than he was in penning the nation's first play. This essay proposes to studyThe Indian Princessin light of that theatrical context to determine to what extent the Native American story and the British musical genre competed or combined to lend the melodrama its Americanness.
Carmen Jones: a Carmen la Afro-American
Authors: Depardieu Benot
Published: March 2009

This study intends to examine the unconscious desires and the phantasmatic substratum lying at the core of two adaptations of Georges Bizet's Carmen: the musical Carmen Jones by Oscar Hammerstein II (1943) and Otto Preminger's film Carmen Jones (1954). After analysing
the differences from the original story by Prosper Mrime and the changes operated by Bizet's librettists which led to the creation of the myth of Carmen, the study focuses on Hammerstein's own justification of his choice of the African-American community to replace the gypsy one. The close
examination of Hammerstein's use of words then reveals the fantasy which produced the transference leading to the transformation of Carmen into Carmen Jones. By resorting to various psychoanalytical theories and concepts, it is made clear that Hammerstein's choice originated in some kind of
projected fantasy. Otto Preminger's film adaptation of Hammerstein's musical bears the mark of the same fantasy and participates in the construction of a blackness which is but a white construct. This was even strengthened by the decision to dub the leading role by a white singer, obviously
raising the problem of the unconscious nature of the voice.
Eliza, where the devil are my songs?: negotiating voice, text and performance analysis in Rex Harrison's Henry Higgins
Authors: Macpherson Ben
Published: March 2009

This article seeks to address differing perspectives on text, performance and voice in musical theatre, examining in particular the potential advantages and capacity for realism in performance by non-singing actors in demanding vocal roles. This analysis takes the form of a case study
focussing on Rex Harrison's portrayal of Professor Henry Higgins in Lerner and Loewe's My Fair Lady (1956). A classically trained actor, Harrison's interpretation of Loewe's score was spoken on pitch. In this paper I will examine the effect this technique had on the realism of his character,
informing this with a psychoanalytical reading of his relationship with the antagonist Eliza Doolittle, focussing on the process of transformative identification (after Freud and Lacan). I will assess two specific moments in Harrison's portrayal of Henry Higgins against theories of dramatic
structure and performance, in order to comment on how interdisciplinary assessment of literary text and embodied performer may contribute to a fuller understanding of the potentials of the musical stage.
The Story of Oh: the aesthetics and rhetoric of a common vowel sound
Authors: Symonds Dominic
Published: March 2009

This article investigates the use of the word Oh in a variety of different performance idioms. Despite its lack of meaning, the sound is used in both conversation and poetic discourse, and I discuss how it operates communicatively and expressively through contextual resonances, aesthetic manipulation and rhetorical signification. The article first considers the aesthetically modernist work of Cathy Berberian in Bussotti'sLa Passion Selon Sade: then it considers the rhetorically inflected use of Oh to construct social resonance in popular song; finally, it discusses two important uses of the sound Oh which bookend the Broadway musicalOklahoma!, serving to consolidate the allegorical and musico-dramatic narrative of the show.
Drawing attention to the significant: exploring the functions of music in The Overcoat (1998)
Authors: Taylor Millie
Published: March 2009

The Overcoat (1998) is a music theatre piece created by The Clod Ensemble and based on a short story by Nikolai Gogol. Peter Brooks refers to Gogol as one of a group of social melodramatists whose works include a dual engagement with the representation of man's social existence,
the way he lives in the ordinary, and with the moral drama implicated by and in his existence (Brooks 1976: 22). Brooks speaks of encounters that matter and drawing attention to the significant. This article explores how music is used to draw attention to the significant in this work in order
to highlight some of the functions of music in a work of music theatre. The aim of the authors of The Overcoat was to create a piece in which music and drama are integrated. This can be seen in the atmospheric creation of mood, the pacing of scenes, the depiction of characters through
thematic development and culturally recognizable musical signifiers and genres. The effect of all these is that characterizations created visually are fleshed out through illustrative music, actions are supported by programmatic music. However, it is the presentation of contrapuntal imagery
that allows narrative voices to be read; the moments of unexpected dissonance or counterpoint between image and sound, or of intra-textual reference, create moments of black comedy and the moments of greatest significance that are most open to interpretation.
Integration and performance: the usefulness of books in musical theatre training
Authors: Napier Kate
Published: March 2009

In the field of musical theatre, and its training, integration is a much-discussed topic. The ability of performers to be, and to be trained to be, proficient in acting, singing and dance each of which have their own separate and often conflicting demands is treated as a basic criterion
for judging competency of both individual performers and the programmes which seek to train them. In the light of the publication this year of three books which offer students and teachers the tools needed to acquire this kind of proficiency, this article considers the extent to which book-learning
can contribute to professional training.
Reviews
Authors: Herbert Trevor , Doughty Ruth , Poston-Anderson Barbara
Published: March 2009

Sigmund Romberg, William A. Everett (2007) Yale Broadway Masters Series, New Haven and London: Yale University Press, 362 pp., ISBN 978030011835 (hardback), 30.00

Jerome Kern, Stephen Banfield (2006) Yale Broadway Masters Series, New Haven and London:
Yale University Press, 375 pp., ISBN 9780300110470 (hardback), 20.00

The Gendered Score: Music in 1940s Melodrama and the Woman's Film, Heather Laing (2007) Ashgate Popular and Folk Music Series, Aldershot: Ashgate, 196 pp., ISBN 9780754651000 (Hardback), 52.25

The
Theater Will Rock: A History of the Rock Musical, from Hair to Hedwig, Elizabeth L. Wollman (2006) Ann Arbor: University of Michigan Press, 271 pp., ISBN: 9780472115761 (Hardback), 25.50
Dipeptidyl-peptidase IV and B-type natriuretic peptide. From bench to bedside
Authors: Vanderheyden Marc , Bartunek Jozef , Goethals Marc , Verstreken Sofie , Lambeir Anne-Marie , De Meester Ingrid , Scharpé Simon
Published: March 2009

B-type natriuretic peptide (BNP) has emerged as a reliable biomarker in patients with congestive heart failure. The mature, biologically active B-type natriuretic peptide, BNP

Clin Chem Lab Med 2009;47:248–52.
Bedside Cerebral Monitoring to Predict Neurodevelopmental Outcomes
Authors: Chock Valerie Y. , Davis Alexis S.
Published: March 2009

Emerging neurodiagnostic technologies for bedside application allow earlier detection of neonatal cerebral injury, especially in critically ill infants for whom advanced neuroimaging may not be feasible. To date, no single bedside cerebral monitoring technique has been shown to provide early, accurate prediction of neurodevelopmental outcome in neonates. Multimodal cerebral monitoring may improve predictive capabilities by combining measurements of cerebral function such as electrical activation, oxygenation, and autoregulation of blood flow. This review focuses on two specific cerebral monitoring techniques that are easy to apply in a neonatal intensive care unit (NICU) and amenable to interpretation by a neonatologist who has limited training: aEEG and NIRS. Their role in the prediction of neurodevelopmental outcomes is discussed.
Long-term Outcomes of Very Preterm or Tiny Infants
Authors: Doyle Lex W. , Saigal Saroj
Published: March 2009

Survival rates have improved dramatically in recent years for very preterm or tiny infants. However, such infants remain at significant risk for a wide array of long-term morbidities that are mostly inversely related to gestational age. In early childhood, neurodevelopmental disabilities and recurrent health problems take a significant toll. Subsequently “hidden disabilities” such as school difficulties and behavioral problems become apparent and persist through adolescence. Reassuringly, however, most children born very preterm adjust remarkably during their transition to adulthood. As mortality rates continue to fall, the focus for perinatal interventions must be strategies to reduce long-term morbidity. In addition, follow-up to middle age and later adulthood is warranted to determine the risks, especially for cardiovascular, respiratory, and metabolic problems, and other lifestyle issues likely to be confronted by very preterm or tiny survivors.
Vascular Endothelial Growth Factor as Marker for Tissue Hypoxia and Transfusion Need in Anemic Infants: A Prospective Clinical Study
Authors: Tschirch Edda , Weber Benedikt , Koehne Petra , Guthmann Florian , von Gise Alexander , Wauer Roland R. , Rüdiger Mario
Published: March 2009

OBJECTIVE. Oxygen-carrying capacity of blood is reduced in anemic infants because of low hemoglobin levels. Red blood cell transfusions become necessary if low hematocrit causes tissue hypoxia. No reliable parameters exist for detecting chronic tissue hypoxia. Vascular endothelial growth factor is upregulated by hypoxia; hence, elevated vascular endothelial growth factor levels may be a marker for tissue hypoxia and may indicate the need for red blood cell transfusions.

METHODS. In a prospective study, plasma vascular endothelial growth factor levels were measured in 3 groups of infants suspected of requiring red blood cell transfusions to find a vascular endothelial growth factor cutoff value indicative of tissue hypoxia. The 3 groups were acute anemic (an episode of acute bleeding [hematocrit drop > 5%] per day); chronic anemic (hematocrit drop < 5% per day); and nontransfused (hematocrit drop < 5% per day) but not meeting clinical criteria for a transfusion. Blood was sampled before transfusion and again 48 hours after transfusion if required. Plasma vascular endothelial growth factor and erythropoietin concentrations were measured.

RESULTS. Vascular endothelial growth factor concentrations were lower in acutely anemic compared with chronically anemic infants, whereas erythropoietin levels did not differ between these groups. The vascular endothelial growth factor concentration was <140 pg/mL in all acutely anemic infants, and this was deemed the threshold level indicating sufficient tissue oxygenation in subsequent analysis. We found that 30% of chronically anemic and 43% of nontransfused infants had vascular endothelial growth factor levels of >140 pg/mL. In transfused infants, with elevated vascular endothelial growth factor levels, red blood cell transfusion resulted in lowering of vascular endothelial growth factor concentrations.

CONCLUSIONS. Vascular endothelial growth factor concentrations of >140 pg/mL may indicate insufficient oxygen delivery to tissues and may serve as a marker of the need for transfusion or of tissue hypoxia in other diseases.
Interaction of Hemolysis and Hyperbilirubinemia on Neurodevelopmental Outcomes in the Collaborative Perinatal Project
Authors: Kuzniewicz Michael , Newman Thomas B.
Published: March 2009

OBJECTIVE. Our objective was to reanalyze data from the Collaborative Perinatal Project to investigate whether bilirubin is more neurotoxic in newborns with a positive direct antiglobulin test.

PATIENTS AND METHODS. The Collaborative Perinatal Project enrolled 54795 newborns at 12 centers in the United States between 1959 and 1966. We restricted our analysis to those with a birth weight of ≥2000 g and gestational age of ≥36 weeks who had follow-up at 7 to 8 years of age (n = 32808 for IQ testing; n = 33278 for neurologic examination, and n = 16354 for hearing testing). We examined the association between maximum total serum bilirubin levels and these 3 neurodevelopmental outcomes by using multiple linear and logistic regression models. We included interaction terms for the effect of bilirubin category and direct antiglobulin test result on the neurodevelopmental outcome.

RESULTS. Overall, maximum total serum bilirubin level was not a significant predictor of IQ scores. However, there was a statistically significant interaction between a positive direct antiglobulin test and a maximum total serum bilirubin level of ≥25 mg/dL on IQ scores (eg, full-scale IQ: −6.7 points). No similar direct antiglobulin test interaction was seen for those with those with a total serum bilirubin of 20 to 24.9 mg/dL (eg, full-scale IQ: −1.7 points). We found no evidence of an interaction between a positive direct antiglobulin test and total serum bilirubin levels on the risk of an abnormal or suspicious neurologic examination or sensorineural hearing loss.

CONCLUSIONS. In the Collaborative Perinatal Project, evidence of increased bilirubin toxicity in those with a positive direct antiglobulin test result was confined to an adverse association with IQ in those with total serum bilirubin of ≥25 mg/dL.
Prevalence and Natural History of Gastroesophageal Reflux: Pediatric Prospective Survey
Authors: Campanozzi Angelo , Boccia Gabriella , Pensabene Licia , Panetta Fabio , Marseglia Antonio , Strisciuglio Pietro , Barbera Cristiana , Magazzù Giuseppe , Pettoello-Mantovani Massimo , Staiano Annamaria
Published: March 2009

OBJECTIVE. The prevalence and natural history of gastroesophageal reflux in infants have been poorly documented. The aim of this study was to evaluate the prevalence and natural history of infant regurgitation in Italian children during the first 2 years of life.

METHODS. A detailed questionnaire, according to the Rome II criteria, was completed by 59 primary care pediatricians to assess infant regurgitation in consecutive patients seen in their office over a 3-month period. A total of 2642 patients aged 0 to 12 months were prospectively enrolled during this 3-month period. Follow-up was performed at 6, 12, 18, and 24 months of age.

RESULTS. A total of 313 children (12%; 147 girls) received the diagnosis of infant regurgitation. Vomiting was present in 34 of 313 patients. Their score for the Infant Gastroesophageal Reflux Questionnaire was 8.51 ± 4.75 (mean ± SD). Follow-up visits were conducted to the end in 210 of 313 subjects. Regurgitation had disappeared in 56 of 210 infants by the first 6 months of age, in 128 by the first 12 months, in 23 at 18 months, and in 3 patients by the first 24 months. At follow-up, 1 of 210 patients had developed a gastroesophageal reflux disease with esophagitis, proven endoscopically and histologically; another patient received a diagnosis of cow milk protein intolerance. The Infant Gastroesophageal Reflux Questionnaire score reached 0 after 8.2 ± 3.9 months in breastfed infants (89 of 210) and after 9.6 ± 4.1 months in artificially fed infants.

CONCLUSIONS. We found that 12% of Italian infants satisfied the Rome II criteria for infant regurgitation. Eighty-eight percent of 210 infants who had completed a 24-month follow-up period had improved at the age of 12 months. Only 1 patient later turned out to have gastroesophageal reflux disease. Use of breast milk was associated with a shorter time necessary to reach an Infant Gastroesophageal Reflux Questionnaire score of 0.
Pain Symptoms and Stooling Patterns Do Not Drive Diagnostic Costs for Children With Functional Abdominal Pain and Irritable Bowel Syndrome in Primary or Tertiary Care
Authors: Lane Mariella M. , Weidler Erica M. , Czyzewski Danita I. , Shulman Robert J.
Published: March 2009

OBJECTIVE. The objectives of this study were to (1) compare the cost of medical evaluation for children with functional abdominal pain or irritable bowel syndrome brought to a pediatric gastroenterologist versus children who remained in the care of their pediatrician, (2) compare symptom characteristics for the children in primary versus tertiary care, and (3) examine if symptom characteristics predicted the cost of medical evaluation.

METHODS. Eighty-nine children aged 7 to 10 years with functional abdominal pain or irritable bowel syndrome seen by a gastroenterologist (n = 46) or seen only by a pediatrician (n = 43) completed daily pain and stool diaries for 2 weeks. Mothers provided retrospective reports of their children's symptoms in the previous year. Cost of medical evaluation was calculated via chart review of diagnostic tests and application of prices as if the patients were self-pay.

RESULTS. Child-reported diary data reflected no significant group differences with respect to pain, interference with activities, or stool characteristics. In contrast, mothers of children evaluated by a gastroenterologist viewed their children as having higher maximum pain intensity in the previous year. Excluding endoscopy costs, cost of medical evaluation was fivefold higher for children evaluated by a gastroenterologist, with higher cost across blood work, stool studies, breath testing, and diagnostic imaging. Symptom characteristics did not predict cost of care for either group.

CONCLUSIONS. Despite the lack of difference in symptom characteristics between children in primary and tertiary care, a notable differential in cost of evaluation exists in accordance with level of care. Symptom characteristics do not seem to drive diagnostic evaluation in either primary or tertiary care. Given the lack of differences in child-reported symptoms and the maternal perspective that children evaluated by a gastroenterologist had more severe pain, we speculate that parent perception of child symptoms may be a primary factor in seeking tertiary care.
Evaluation of Vaccine Coverage for Low Birth Weight Infants During the First Year of Life in a Large Managed Care Population
Authors: Batra Jagmohan S. , Eriksen Eileen M. , Zangwill Kenneth M. , Lee Martin , Marcy S. Michael , Ward Joel I. ,   for the Vaccine Safety Datalink
Published: March 2009

OBJECTIVE. There are few recent population-based assessments of vaccine coverage in premature infants available. This study assesses and compares age- and dose-specific immunization coverage in children of different birth weight categories during the first year of life.

METHODS. We performed a retrospective cohort analysis of computerized vaccination data from a large managed care organization in southern California. The participants were children born between January 1, 1997, and December 31, 2002, and continuously enrolled from birth to at least 12 months of age in the Southern California Kaiser Permanente health plan. We measured age-specific up-to-date and age-appropriate immunization rates according to birth weight (extremely low birth weight: <1000 g; very low birth weight: 1000–1499 g; low birth weight: 1500–2499 g; normal birth weight: ≥2500 g) for 4 vaccines (hepatitis B, diphtheria and tetanus toxoids with pertussis, Haemophilus influenzae type b, and poliovirus) through the first year of life.

RESULTS. We identified 127 833 infants born during the study period and continuously enrolled through the first year of life; 120 048 were normal birth weight infants; 6491 were low birth weight infants; 788 were very low birth weight infants; and 506 were extremely low birth weight infants. Vaccine-specific age-appropriate immunization rates were 3% to 15% lower for low birth weight infants and 17% to 33% lower for extremely low birth weight infants compared with the rates for normal birth weight infants in the first 6 months of life. Extremely low birth weight infants had the lowest age-specific up-to-date immunization levels (5%–31% lower) compared with normal birth weight infants at each age assessed. By 12 months, extremely low birth weight infants still had significantly lower up-to-date levels (87%) compared with very low birth weight, low birth weight, and normal birth weight infants (91%–92%).

CONCLUSIONS. Despite recommendations that lower birth weight infants be vaccinated as the same chronological age as normal birth weight infants, extremely low birth weight and very low birth weight infants are immunized at significantly lower rates relative to low birth weight and normal birth weight infants at 2, 4, and 6 months of age. However, by 12 months of age this finding persists only in extremely low birth weight infants.
Altered Heart Rhythm Dynamics in Very Low Birth Weight Infants With Impending Intraventricular Hemorrhage
Authors: Tuzcu Volkan , Nas Selman , Ulusar Umit , Ugur Ahmet , Kaiser Jeffrey R.
Published: March 2009

OBJECTIVE. Intraventricular hemorrhage remains an important problem among very low birth weight infants and may result in long-term neurodevelopmental disabilities. Neonatologists have been unable to accurately predict impending intraventricular hemorrhage. Because alterations in the autonomic nervous system's control of heart rhythm have been associated with intraventricular hemorrhage after its development, we sought to determine if early subtle alterations of heart rhythm could be predictive of impending intraventricular hemorrhage in very low birth weight infants.

METHODS. This case-control study included 10 newborn very low birth weight infants with intraventricular hemorrhage (5 grade IV, 4 grade III, and 1 grade II) and 14 control infants without intraventricular hemorrhage. Heart rhythm data from the first day of life before the development of intraventricular hemorrhage were evaluated. Detrended fluctuation analysis, a nonlinear fractal heart rate variability method, was used to assess the fractal dynamics of the heart rhythm. Fractal scaling exponents were calculated by using this analysis.

RESULTS. Twenty-four infants (mean ± SD, birth weight: 845 ± 213g: gestational age: 26.1 ± 1.9 weeks) participated in the study. The short-term scaling exponent was significantly larger in infants who later developed intraventricular hemorrhage compared with those who did not (0.60 ± 0.1 vs 0.45 ± 0.1). A value of 0.52 resulted in 70% sensitivity and positive predictive value and 79% specificity and negative predictive value. The short-term scaling exponent was the only significant predictor of intraventricular hemorrhage.

CONCLUSIONS. Fractal dynamics of the heart rhythm is significantly altered in very low birth weight infants before developing intraventricular hemorrhage and may be predictive of impending intraventricular hemorrhage.
Private Cord Blood Banking: Experiences and Views of Pediatric Hematopoietic Cell Transplantation Physicians
Authors: Thornley Ian , Eapen Mary , Sung Lillian , Lee Stephanie J. , Davies Stella M. , Joffe Steven
Published: March 2009

OBJECTIVE. Private cord blood banks are for-profit companies that facilitate storage of umbilical cord blood for personal or family use. Pediatric hematopoietic cell transplantation physicians are currently best situated to use cord blood therapeutically. We sought to describe the experiences and views of these physicians regarding private cord blood banking.

PARTICIPANTS AND METHODS. We e-mailed a cross-sectional survey to pediatric hematopoietic cell transplantation physicians in the United States and Canada; 93 of 152 potentially eligible physicians (93 of 130 confirmed survey recipients) from 57 centers responded. Questions addressed the number of transplants performed by using privately banked cord blood, willingness to use banked autologous cord blood in specific clinical settings, and recommendations to parents regarding private cord blood banking.

RESULTS. Respondents reported having performed 9 autologous and 41 allogeneic transplants using privately banked cord blood. In 36 of 40 allogeneic cases for which data were available, the cord blood had been collected because of a known indication in the recipient. Few respondents would choose autologous cord blood over alternative stem cell sources for treatment of acute lymphoblastic leukemia in second remission. In contrast, 55% would choose autologous cord blood to treat high-risk neuroblastoma, or to treat severe aplastic anemia in the absence of an available sibling donor. No respondent would recommend private cord blood banking for a newborn with 1 healthy sibling when both parents were of northern European descent; 11% would recommend banking when parents were of different minority ethnicities.

CONCLUSIONS. Few transplants have been performed by using cord blood stored in the absence of a known indication in the recipient. Willingness to use banked autologous cord blood varies depending on disease and availability of alternative stem cell sources. Few pediatric hematopoietic cell transplantation physicians endorse private cord blood banking in the absence of an identified recipient, even for mixed-ethnicity children for whom finding a suitably matched unrelated donor may be difficult.
Socioeconomic, Family, and Pediatric Practice Factors That Affect Level of Asthma Control
Authors: Bloomberg Gordon R. , Banister Christina , Sterkel Randall , Epstein Jay , Bruns Julie , Swerczek Lisa , Wells Suzanne , Yan Yan , Garbutt Jane M.
Published: March 2009

BACKGROUND. Multiple issues play a role in the effective control of childhood asthma.

OBJECTIVE. To identify factors related to the level of asthma control in children receiving asthma care from community pediatricians.

PATIENTS AND METHODS. Data for 362 children participating in an intervention study to reduce asthma morbidity were collected by a telephone-administered questionnaire. Level of asthma control (well controlled, partially controlled, or poorly controlled) was derived from measures of recent impairment (symptoms, activity limitations, albuterol use) and the number of exacerbations in a 12-month period. Data also included demographic characteristics, asthma-related quality of life, pediatric management practices, and medication usage. Univariable and multivariable analyses were used to identify factors associated with poor asthma control and to explore the relationship between control and use of daily controller medications.

RESULTS. Asthma was well controlled for 24% of children, partially controlled for 20%, and poorly controlled for 56%. Medicaid insurance, the presence of another family member with asthma, and maternal employment outside the home were significant univariable factors associated with poor asthma control. Medicaid insurance had an independent association with poor control. Seventy-six percent of children were reported by parents as receiving a daily controller medication. Comparison of guideline recommended controller medication with current level of asthma control indicated that a higher step level of medication would have been appropriate for 74% of these children. Significantly lower overall quality-of-life scores were observed in both parents and children with poor control.

CONCLUSIONS. Despite substantial use of daily controller medication, children with asthma continue to experience poorly controlled asthma and reduced quality of life. Although Medicaid insurance and aspects of family structure are significant factors associated with poorly controlled asthma, attention to medication use and quality-of-life indicators may further reduce morbidity.
Disparities in Academic Achievement and Health: The Intersection of Child Education and Health Policy
Authors: Fiscella Kevin , Kitzman Harriet
Published: March 2009

Recent data suggest that that the United States is failing to make significant progress toward the Healthy People 2010 goal of eliminating health disparities. One missing element from the US strategy for achieving this goal is a focus on gaps in child development and achievement. Academic achievement and education seem to be critical determinants of health across the life span and disparities in one contribute to disparities in the other. Despite these linkages, national policy treats child education and health as separate. Landmark education legislation, the No Child Left Behind Act of 2001, is due for Congressional reauthorization. It seeks to eliminate gaps in academic child achievement by 2014. It does so by introducing accountability for states, school districts, and schools. In this special article, we review health disparities and contributors to child achievement gaps. We review changes in achievement gaps over time and potential contributors to the limited success of the No Child Left Behind Act of 2001, including its unfunded mandates and unfounded assumptions. We conclude with key reforms, which include addressing gaps in child school readiness through adequate investment in child health and early education and reductions in child poverty; closing the gap in child achievement by ensuring equity in school accountability standards; and, importantly, ensuring equity in school funding so that resources are allocated on the basis of the needs of the students. This will ensure that schools, particularly those serving large numbers of poor and minority children, have the resources necessary to promote optimal learning.
Outcomes of Meningococcal Disease in Adolescence: Prospective, Matched-Cohort Study
Authors: Borg Jennie , Christie Deborah , Coen Pietro G. , Booy Robert , Viner Russell M.
Published: March 2009

OBJECTIVE. We examined the physical, cognitive, educational, social, and psychological outcomes of invasive meningococcal disease in adolescence, as well as demographic and disease factors associated with outcomes.

METHODS. A population-based, matched-cohort study was performed. A total of 101 gender- and age-matched case-control pairs (15–19 years of age at the time of disease; 46% male) from 6 regions of England underwent follow-up evaluations 18 to 36 months after invasive meningococcal disease. Educational, social, and vocational function, mental health, social support, self-efficacy, and quality-of-life data were collected by using standardized questionnaires and neuropsychological tests.

RESULTS. Fifty-seven percent of case subjects (n = 58) had major physical sequelae. Survivors had greater depressive symptoms, greater fatigue, less social support, greater reduction in quality of life, and lower educational attainment compared with control subjects. Survivors with serogroup C disease had greater physical sequelae than did those with serogroup B disease. Greater cognitive deficits were associated with younger age at diagnosis. Only 53 of 101 case subjects reported any medical follow-up care after invasive meningococcal disease.

CONCLUSIONS. Survivors of invasive meningococcal disease in adolescence have a disturbing series of deficits, including poorer physical and mental health, quality of life, and educational achievement. Serogroup C is associated with poorer outcomes. Invasive meningococcal disease attributable to serogroup B disease remains a major cause of morbidity and death among adolescents. Medical care is poor after discharge from the hospital. Routine follow-up care of adolescent survivors may prevent or ameliorate physical and psychosocial morbidity after invasive meningococcal disease.