bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Vertical and Horizontal Reactive Strength Index Variants and Association With Change of Direction Performance
Authors: Šarabon Nejc , Kozinc Žiga , Bishop Chris
Published: December 2021

Šarabon, N, Kozinc, Ž, and Bishop, C. A comparison of vertical and horizontal reactive strength index variants and association with change of direction performance. J Strength Cond Res 37(1): 84–90, 2023—This study sought to investigate the interrelationship between different vertical and horizontal variants of reactive strength index (RSI) and change of direction (CoD) performance. Thirty-one male volleyball players (age: 22.4 ± 3.9 years) performed bilateral drop jumps (DJs), bilateral and unilateral countermovement jumps (CMJs), and triple hops for distance. The RSI was calculated as the ratio of jump height and contact time (DJ), jump height and time to takeoff (CMJ), flight time or hop distance and contact time (triple hop), and 505 CoD test. Reactive strength index obtained from DJ and CMJ tasks exhibited excellent trial-to-trial reliability (intraclass correlation coefficient [ICC] = 0.91–0.94), whereas triple hop–based RSI had only moderate reliability (ICC = 0.67–0.74). The relationships among different RSI variants were moderate to high (i.e., DJ to CMJ: r = 0.57–0.69, p ≤ 0.004; DJ to triple hop: r = 0.54–0.66, p ≤ 0.021; and CMJ to triple hop: r = 0.42–0.63, p ≤ 0.037). For the triple hop, the associations between RSI based on hop flight time and RSI based on hop distance were high for hop 1–2 (r = 0.77–0.83; p < 0.001) and very high for hop 2–3 (r = 0.91–0.92; p < 0.001). All RSI variants were in small to moderate negative correlation with 505 test performance (r = −0.38 to −0.45; p ≤ 0.042). The agreement in interlimb asymmetry direction between RSI from unilateral CMJ and triple hop RSI variables was slight to moderate (kappa coefficient = 0.06–0.36). In conclusion, although interrelationships between RSI variants were moderate to high, the direction of interlimb asymmetry was inconsistent, highlighting the notion of movement variability in limb dominance.
THE DEFENSE OF PRICE DISCRIMINATION IN NETWORK AND INFORMATION GOODS MARKETS
Authors: Soukal Ivan
Published: December 2021

It is not uncommon that articles focused on consumer-price interaction in the network and information goods market swiftly condemn price discrimination as an obfuscation, on-purpose price complexity, or market failure. The reason is a general neoclassical rule of an efficient market where prices are set at marginal cost with no price discrimination. However, the matter is more complicated. This review provides authors an overview of why, where, and which type of price discrimination should be viewed by different optics. Goods such as software, cell carrier services, electronic newspapers subscription, electric energy supply, payment accounts, books, copyrighted content streaming, etc, cannot be treated like manufactured goods. The reasons are specific conditions – substantial and/or repeated fixed/sunk cost, economies of scale, and demand heterogeneity. Recognized economist W. J. Baumol described marginal cost set prices under these conditions as an ‘economic suicide’. Reviewed articles showed that firms are forced to adopt price discrimination in order to recover their costs and to serve more consumer segments. Reviewed authors provided facts to support the use of multipart tariffs, dynamic pricing, versioning, bundling, and Ramsey pricing. These conclusions are used for suggestions on how several studies of information and network goods should be modified. Modifications are related mostly to model assumptions and pricing conclusions. I argue that, in the case of information and network goods, there is justified price discrimination. Hence, there is a certain justified level of price complexity that has to be accepted and not taken as automated evidence of inefficiency, market power, and consumer exploitation.
TOWARDS AN EFFICIENT APPROACH FOR IDENTIFICATION AND SELECTION OF STAKEHOLDER ENGAGEMENT STRATEGIES: A CASE STUDY
Authors: Khalilzadeh Mohammad , Kebriyaii Omid , Šaparauskas Jonas , Lepkova Natalija
Published: December 2021

The goals and objectives of a project as well as the needs, requirements and expectations of the project stakeholders may contradict or non-fulfillment of them may have different detrimental and negative consequences for the project. Therefore, project stakeholders should be effectively managed, but it is not possible to satisfy all project stakeholders and meet all of their expectations and requirements. As a result, project team must strike a balance between the project goals and objectives and the needs, requirements and expectations of the project stakeholders in order to complete the project successfully. Despite highlighting the significant importance of project stakeholder management, there exists a notable gap in exerting an effective decision support system to adopt stakeholder engagement strategies particularly in oil and gas construction projects. This study proposes a comprehensive framework for the identification, prioritization and selection of the stakeholder engagement strategies in one of the large size oil and gas construction projects in Iran. In this paper, a hybrid method which is the combination of the SWOT (strengths, weakness, opportunities and threat) analysis and fuzzy Delphi method is first exploited for identifying the appropriate stakeholder engagement strategies. Subsequently, fuzzy SWARA (Step-wise Weight Assessment Ratio Analysis) is employed to weight the crucial criteria, and finally, fuzzy WASPAS (Weighted Aggregated Sum Product Assessment) is utilized to prioritize the identified stakeholder engagement strategies. This research contributes to the body of knowledge on project stakeholder management by presenting a novel framework for identifying, ranking and selecting the suitable strategies for effective stakeholder engagement considering one of the largest oil and gas construction projects in the country. The value of this study is in applicability of the proposed methodology for project managers and practitioners in other oil and gas construction projects.
Socially Dangerous Consequences Of Criminal Offenses In The Field Of Public Procurement
Authors: Cheredarchuk A.M.
Published: December 2021

In the article the author analyzes the national legislation, scientific research and the results of law enforcement activities of law enforcement agencies in the field of public procurement. It has been established that the opacity and inefficiency of mechanisms for controlling the public procurement process leads to the use of corruption schemes to embezzle budget funds, legalize and misappropriate them by unscrupulous officials and, as a consequence, to «shadow» the national economy.

In the current conditions of the country’s development, corruption is perhaps the most negative consequence of criminal acts in the field of public procurement. Corruption in the public procurement system, as in any other area, is associated with the exercise of power, distribution or redistribution of material resources or funds, a phenomenon that is not new or even national.

Another clear example of the consequences of public procurement crime is the threat of unfair competition.

Among the abuses committed by public procurement participants, the greatest degree of security threat is conspiracy of participants. A conspiracy is an agreement between two or more participants in a procurement procedure aimed at setting the price of a competitive bidding offer or a price offer at artificial or non-competitive levels with or without the knowledge of the customer.

The main danger of fictitious entrepreneurship is property damage to legal entities and individuals, the state, which, in turn, is expressed in concealing the facts of prohibited activities, illegal conversion of non-cash into cash, creating preconditions for tax evasion and other illegal goals, promoting legalization ( money laundering) of funds obtained by criminal means, etc.
Internetional Experience Of Legal Regulation Of The Status Of Non-Entrepreneurial Legal Entities
Authors: Zozuliak O.I. , Paruta Yu.I.
Published: December 2021

The article deals with studying the legislation of individual countries on the legal status of non-entrepreneurial legal entities. It is stated that in international practice there is no single term that would describe all non-entrepreneurial legal entities. Typically, several terms are used, such as non-for-profit orgnisation, non­governmental organization, charity organization, private voluntary organization, civil social organization.

In the scientific work authors analyzed the documents that are common to the whole European community and individual countries. The main features of non­entrepreneurial legal entities according to European standards are outlined. Among them: the main goal can not be making a profit, and in the case of making a profit it is aimed at achieving the goals for which the organization was created, non­entrepreneurial legal entities with legal personality acquire the same rights as other legal entities, the possibility of creating member organizations and organizations without membership. It is noted that the division of non-entrepreneurial legal entities on the basis of the system is the fundamental in Poland. That is why non­entrepreneurial legal entities in Poland are divided into companies and foundations. German law provides the creation of not only companies and foundations, but also associations that may not be intended for business purposes.

The scientific work studies not only the provisions of legislative acts, but also the scientific developments of domestic and foreign scientists. In particular, doctrinal approaches to non-entrepreneurial legal entities in Germany, Japan, England and Wales were studied.

It is concluded that it is not possible to accept the legal model of a non­entrepreneurial legal entity of a certain country and introduce it into national legislation, because each country has its own peculiarities.
The Importance Of The General Principles Of European Union Law In Ensuring Public And Private Interests In Environmental Relations
Authors: Moroz H.V.
Published: December 2021

The article is aimed at studying the content of the general principles of European Union (EU) law, their importance in ensuring public and private interests in environmental relations.

It is argued that the principles of law are based on public interests and needs, so the most important characteristic of the principles of law is their ability to put emphasis on the most important values of public life. It is established that the full potential of the principles of law is best manifested in the administration of justice, most clearly reflected in the case law of the European Court of Human Rights, less perfectly - in the judicial system of Ukraine.

The general principles common to the legal systems of the EU member states are the following: 1) the principle of proportionality; 2) the principle of legal certainty; 3) the principle of legitimate expectations.

Performing its functions, the state may intervene in the private sphere within acceptable limits, and the criteria of the principle of proportionality are used to optimize such intervention in order to satisfy the general public interest. The following criteria are defined: 1) the legality of intervention; 2) a legitimate purpose (justification of intervention by the general interest); 3) a fair balance between the interests of property rights and public interests. The intervention should ideally be proportionate, measured, optimal and easy for the entity. In essence, this principle is designed to control the law not only in terms of the legitimacy of the influence of the authorities on fundamental rights but also on its balance in general. Legal certainty requires not only the promulgation of adopted laws or other regulations but also the relative clarity of their content so that individuals can predict and determine their behavior, the limits of manifestation and realization of their interests. The principle of legitimate expectations (reasonable predictability of court decisions) in the procedural sense applies to uniform and consistent law enforcement practice, avoidance of selective justice. The use of the concept of legitimate expectations is effective for application in cases of the protection of private property rights as well as the right to public property and public interests. It is allowed to limit the principle of protection of legitimate expectations, for example, if there is an overriding public interest, which is applicable in terms of environmental relations.

The article argues that the practice of the European Court of Human Rights, as a source of law, provides a legal interpretation of substantive and procedural norms that would be vague without practical explanation. In the meantime, it is argued that in the process of approximating the environmental norms of Ukraine with EU law, the specifics of the environmental sphere and the competitive nature of the interests of entities that implement the corresponding regulations have to be considered.
Approximation properties of multivariate exponential sampling series
Authors: Kurşun S. , Turgay M. , Alagöz O. , Acar T.
Published: December 2021

In this paper, we generalize the family of exponential sampling series for functions of $n$ variables and study their pointwise and uniform convergence as well as the rate of convergence for the functions belonging to space of $\log$-uniformly continuous functions. Furthermore, we state and prove the generalized Mellin-Taylor's expansion of multivariate functions. Using this expansion we establish pointwise asymptotic behaviour of the series by means of Voronovskaja type theorem.
From the Comfort of Your Own Couch: Is the Canadian Broadcasting Corporation’s You Can’t Ask That an Educational Documentary, or a 21st century Freak Show?
Authors: Page Jähne Virginia
Published: December 2021

This interrogation begins with a question — Is the Canadian Broadcasting Corporation’s series, You Can’t Ask That, an educational documentary, or instead, is the series a 21st-century version of the freak show? The answer, as can be said about most discussions pertaining to disability, is not a simple binary. Although the series can be lauded for creating a public space for the experience of persons with disabilities to be heard in the world, the framing of disability in the series is fraught with ableism.
Regelungsautonomie der Sportverbände vs. Kartellverbot – Zum Anwendungsbereich der Meca-Medina-Ausnahme
Authors: Bien Florian , Becker Björn Christian
Published: December 2021

Dieser Beitrag klärt das Verhältnis zwischen sportverbandlicher Regelungsautonomie und Kartellverbot. Ausgangspunkte sind das grundlegende Urteil des EuGH in der Rechtssache Meca-Medina und die Anwendung der vom Gerichtshof in Meca-Medina aufgestellten Grundsätze durch das EuG im Fall ISU. Der Beitrag weist nach, dass die vom Gerichtshof judizierte Einschränkung des Kartellverbots im Fall „rein sportlicher Regelwerke“ ihre Grundlage in der verfassungsrechtlich geschützten Vereinigungsfreiheit und der daraus resultierenden Regelungsautonomie der Verbände hat. Vor diesem Hintergrund lässt sich die vom EuGH in Meca-Medina durchgeführte Verhältnismäßigkeitsprüfung dogmatisch als Versuch deuten, praktische Konkordanz zwischen Verbandsautonomie und Wettbewerbsschutz herzustellen (II.5.). Angesichts der zentralen Bedeutung, die dem Grundrecht der Vereinigungsfreiheit als Bezugspunkt der Meca-Medina-Ausnahme zukommt, wird die sachliche und persönliche Reichweite der Meca-Medina-Ausnahme aufgefächert und abgegrenzt (III.1., III.2.). Unterschieden werden vier Grundtypen verbandlicher Regelwerke (I.2.). Es zeigt sich, dass Sportausübungsregeln im engeren und im weiteren Sinne sowie interne Organisationsregeln (Verbandsregeln des Typs 1 und 2) in den Schutzbereich der Verbandsautonomie fallen, weshalb hier eine Einschränkung des Kartellverbots aufgrund der Verhältnismäßigkeitsprüfung in Betracht kommt. Der darüberhinausgehende Versuch von Sportverbänden, das wettbewerbliche Verhalten von Verbandsmitgliedern gegenüber verbandsexternen Dritten oder gar von verbandsexternen Dritten selbst zu reglementieren (Regelungen des Typs 3 und 4) erfährt demgegenüber keine Privilegierung im Hinblick auf das Kartellverbot.
Frequency of Neonatal Bilirubin Testing and Hyperbilirubinemia in a Large Health Maintenance Organization
Authors: Newman Thomas B. , Escobar Gabriel J. , Gonzales Veronica M. , Armstrong Mary Anne , Gardner Marla N. , Folck Bruce F.
Published: December 2021

Objective.

To determine the frequency and interhospital variation of bilirubin testing and identified hyperbilirubinemia in a large health maintenance organization.

Design.

Retrospective cohort study.

Setting.

Eleven Northern California Kaiser Permanente hospitals.

Subjects.

A total of 51 387 infants born in 1995–1996 at ≥36 weeks' gestation and ≥2000 g.

Main Outcome Measure.

Bilirubin tests and maximum bilirubin levels recorded in the first month after birth.

Results.

The proportion of infants receiving ≥1 bilirubin test varied across hospitals from 17% to 52%. The frequency of bilirubin levels ≥20 mg/dL (342 μmol/L) varied from .9% to 3.4% (mean: 2.0%), but was not associated with the frequency of bilirubin testing (R2 = .02). Maximum bilirubin levels ≥25 mg/dL (428 μmol/L) were identified in .15% of infants and levels ≥30 mg/dL (513 μmol/L) in .01%.

Conclusions.

Significant interhospital differences exist in bilirubin testing and frequency of identified hyperbilirubinemia. Bilirubin levels ≥20 mg/dL were commonly identified, but levels ≥25 mg/dL were not.
Physiologic Stability of Newborns During Cup- and Bottle-feeding
Authors: Howard Cynthia R. , de Blieck Elisabeth A. , ten Hoopen Cynthia B. , Howard Fred M. , Lanphear Bruce P. , Lawrence Ruth A.
Published: December 2021

Background.

To prevent breastfeeding problems, cup-feeding has been recommended as a method of providing medically necessary supplemental feedings to breastfed infants.

Objectives.

To compare amounts ingested, administration time, and infant physiologic stability during cup-, bottle-, and breastfeeding.

Design/Methods.

A total of 98 term, healthy newborns were randomized to either cup-feeding (n = 51) or bottle-feeding (n = 47). The heart (HR), respiratory (RR), and oxygen (O2) saturation rates were monitored on these infants and 25 breastfed newborns during 1 feeding. Differences in amounts ingested and administration times were evaluated with t tests and physiologic data with repeat measures analysis of variance.

Results.

There were no significant differences in administration time, amounts ingested or overall HR, RR, and (O2) saturation rates, between cup and bottle groups. Breastfed infants had longer administration times and lower overall HR, RR, and higher O2 saturation as compared with cup- and bottle-fed infants.

Conclusions.

Administration times, amounts ingested, and infant physiologic stability do not differ with cup- and bottle-feeding. Breastfeeding takes longer than cup- or bottle-feeding, but infants experience less physiologic variability. These data support cup-feeding as an alternative to bottle-feeding for supplying supplements to breastfed infants.
Infant Sleep Position: A Telephone Survey of Inner-city Parents of Color
Authors: Johnson C. Merle , Borkowski Margaret M. , Hunter Kimberly E. , Zunker Christie L. , Waskiewicz Katherine , Evans Jason M. , Hether Nicholas W. , Coletta Frances A.
Published: December 2021

Objective.

To assess what positions parents were placing their infants to sleep and their opinion about sleep positioning.

Design.

A prospective telephone survey of parents of 2-month-old infants with repeated measures at 4 months that began during the second wave of the Back to Sleep campaign in 1994.

Participants.

African-American, Hispanic, Asian, and American Indian parents from inner cities in the north central United States.

Results.

Preference for prone positioning existed at both 2 and 4 months (over 40%). Twenty-four percent of parents disagreed with the recommendations of the American Academy of Pediatrics regarding supine or lateral positioning.

Conclusions.

Although prone sleep positioning has decreased over the past 5 years, many inner-city parents of color prefer this over supine. The Back to Sleep campaign appears effective in changing attitudes and medical personnel appear influential in promoting risk reductions associated with sudden infant death syndrome. More efforts are clearly needed to convince parents who disagree with and resist recommendations.sleep, infants, SIDS, African-Americans, Back to Sleep (campaign).
Differences in Knowledge of Hepatitis B Among Vietnamese, African- American, Hispanic, and White Adolescents in Worcester, Massachusetts
Authors: Wiecha John M.
Published: December 2021

Objective.

To assess the level of knowledge about hepatitis B of Vietnamese adolescents, a group at high risk for hepatitis B, and compare it to the knowledge of adolescents of other races and ethnicities.

Methods.

A sample of 2816 adolescents was surveyed in 1993 in 2 middle schools and 2 high schools in Worcester, Massachusetts, using a self-administered multilingual questionnaire.

Results.

Knowledge of hepatitis B was low overall. Vietnamese respondents were more likely than were other students to know that hepatitis B affects the liver (35.6% vs 22.6%). However, they were much less likely than were other students to correctly identify sex with an infected person as a risk factor for infection (13.7% vs 32.8%). Independent predictors of this knowledge were: white race; older age; attending high school versus middle school; having been taught about hepatitis B in school; knowing the definition of hepatitis B; reporting better grades; having a family member with hepatitis B; and being more highly acculturated.

Conclusions.

Adolescent knowledge about risk of infection was low in this study. Attention should be directed at providing health education on hepatitis B to adolescents, particularly to Vietnamese. Health care providers, community health educators, and others engaged in the effort to control and eradicate hepatitis B should be sensitive to the unique educational and cultural needs of high-risk southeast Asian adolescent populations.
Sink or Swim—Clinicians Don't Often Counsel on Drowning Prevention
Authors: Barkin Shari , Gelberg Lillian
Published: December 2021

Objective.

Drowning is one of the leading causes of injury death for young children in the United States. This study examined primary care providers' knowledge of and counseling on drowning prevention.

Methods.

A random sample of 465 Los Angeles County pediatricians, family physicians, and pediatric nurse practitioners who serve families with young children received mailed questionnaires; 325 (70%) responded.

Results.

About two thirds of clinicians did not know that injury deaths attributable to drowning were more common than those attributable to toxic ingestions and firearm injuries in young children. Only one third of clinicians stated they counseled on drowning prevention. Counseling drowning prevention was positively associated with female gender (odds ratio: 1.97; 95% confidence interval: 1.64, 2.30) and negatively associated with an attitude that drowning prevention counseling was less important than other injury prevention topics (odds ratio: .73; 95% confidence interval: .61, .85). Clinician specialty, age, years out from training, proportion of well-child examinations in a typical week, having children, practice setting, and knowledge of drowning injury deaths were not significant in multivariate analysis.

Conclusion.

The belief of clinicians that it is less important to counsel on drowning prevention than other injury prevention topics poses a substantial challenge to their providing such education to families with young children.drowning, counseling, physician's role.
Final Report of the FOPE II Education of the Pediatrician Workgroup
Authors: Johnson Robert L. , Charney Evan , Cheng Tina L. , Kittredge Diane , Nazarian Lawrence F. , Chesney Russell W. , Mulvey Holly J. , Simon Jimmy L. , Alden Errol R.
Published: December 2021

This report from the FOPE II Education of the Pediatrician Workgroup assesses the current status and future trends of pediatric education. The attributes of each level of the education process (undergraduate, residency, fellowship, continuing medical education [CME]) are considered within the framework of lifelong learning. The pediatric education of nonpediatrician providers is carefully considered. The Workgroup proposes and describes a new model for pediatric education that encompasses educational needs assessment, curriculum development and outcomes evaluation. Particular attention is paid to CME, with a review of the strengths and problems of the current system. The proposal for improving CME in the 21st century highlights the need for each pediatrician to have a “CME home,” and several models and scenarios are explored. Appendices summarize the results of several surveys conducted on behalf of the Workgroup, and list societal trends and advances in pediatric health care that will influence pediatric education in the future.Pediatrics 2000;106(suppl):1175–1198; pediatric education, educational needs assessment, curriculum development, outcomes evaluation.
Inhaled Corticosteroid Therapy for Asthma in Preschool Children: Growth Issues
Authors: Allen David B.
Published: December 2021

Although inhaled corticosteroids (ICS) have emerged as the preventive treatment of choice for persistent asthma, few studies have been conducted in infants and very young children that assess the benefits and risks of ICS therapy, particularly with regard to growth. Oral glucocorticoids inhibit growth at multiple levels by blunting pulsatile growth hormone (GH) secretion, decreasing insulin-like growth factor-1 bioactivity, and directly inhibiting new collagen synthesis. Normal childhood growth can be divided conceptually into 3 phases according to primary growth-supporting factors: nutrition-dependent growth of infancy, GH-dependent childhood growth, and sex steroid/GH stimulation of pubertal growth. Susceptibility to glucocorticoid-induced growth suppression appears to increase during periods of transition from one phase to another, particularly in the immediate prepubertal years. Studies using ICS at varying dosages demonstrate the possibility of short-term growth suppression, but long-term studies suggest a negligible effect, if any, on final adult height or bone mineral density. Although certain speculations regarding the safety of ICS use in infants and very young children can be made based on these data, age-specific studies are needed to account for effects of differences in oral versus airway deposition and growth axis resiliency, which may occur in these patients.
Balancing Safety and Efficacy in Pediatric Asthma Management
Authors: Skoner David P.
Published: December 2021

In the treatment of childhood asthma, balancing safety and efficacy is key to achieving optimal therapeutic benefit. Inhaled corticosteroids (ICS), because of their efficacy, remain a cornerstone in managing persistent pediatric asthma, but also are associated with significant adverse effects, including growth suppression. Consequently, careful attention must be given to balancing their safety and efficacy, which should include an understanding of airway patency and systemic absorption (dose, disease severity, propellant and lipophilicity of inhalant), bioavailability (inhalation technique, propellant, delivery devices, and hepatic first-pass metabolism), techniques for using minimum effective doses (dosing time, add-on therapy), and reduction of other exacerbating conditions (allergens, influenza, upper-respiratory diseases). The growth-suppressive effects of ICS may be most evident in children with: 1) mild asthma because the relatively high airway patency may facilitate increased levels of deposition and steroid absorption in more distal airways, and 2) evening dosing that may reduce nocturnal growth hormone activity. A step-down approach targeting a minimum effective dose and once-daily morning dosing is suggested for achieving the most acceptable safety/efficacy balance with ICS. The achievement of regular, safe, and correct ICS use requires significant knowledge and time for both caregiver and patient. Chromones, methylxanthines, long-acting β-agonists, and leukotriene receptor antagonists are currently available alternatives to ICS for the control of persistent childhood asthma. Chromones are safe but, like methylxanthines, are difficult to use and frequently result in compromised effectiveness. Long-acting β-agonists are not recommended as monotherapy for persistent asthma. Several factors that support leukotriene receptor antagonists as a therapeutic option for mild-to-moderate persistent pediatric asthma include established efficacy, good safety profiles, and simple, oral dosing. Physicians must evaluate and compare the balance of safety and efficacy for each agent to determine the appropriate asthma therapy for individual patients.
A Consensus Statement on Health Care Transitions for Young Adults With Special Health Care Needs
Authors:   American Academy of Pediatrics,   American Academy of Family Physicians,   American College of Physicians-American Society of Internal Medicine
Published: December 2021

This policy statement represents a consensus on the critical first steps that the medical profession needs to take to realize the vision of a family-centered, continuous, comprehensive, coordinated, compassionate, and culturally competent health care system that is as developmentally appropriate as it is technically sophisticated. The goal of transition in health care for young adults with special health care needs is to maximize lifelong functioning and potential through the provision of high-quality, developmentally appropriate health care services that continue uninterrupted as the individual moves from adolescence to adulthood. This consensus document has now been approved as policy by the boards of the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Physicians-American Society of Internal Medicine.
Health Care Transition: Destinations Unknown
Authors: Reiss John , Gibson Robert
Published: December 2021

The movement of young adults with special health care needs from pediatric-oriented care to adult-oriented care has been a growing concern in the health care literature over the past 20 years. This article reviews the development and evaluation of health care transition policy over that period of time. These health care transition policies are discussed in light of the preliminary results from a qualitative study of the experience of health care transition. This article concludes with suggestions regarding future policy development and research efforts around health care transition.
Reducing the Risk of Alcohol-Exposed Pregnancies: A Study of a Motivational Intervention in Community Settings
Authors:   The Project CHOICES Intervention Research Group*
Published: December 2021

Objectives. To test the feasibility and impact of a motivational intervention in reducing drinking and/or increasing effective contraception in women who are at risk for an alcohol-exposed pregnancy.

Methods. A multisite single-arm pilot study was conducted in 6 community settings in 3 large cities. A total of 2384 women were screened for eligibility; 230 were eligible on the basis of their alcohol use and lack of contraception. Of the eligible women, 190 consented and were enrolled, and 143 (75.3%) completed the 6-month follow-up. The intervention consisted of 4 manual-guided motivational counseling sessions delivered by mental health clinicians and 1 contraceptive counseling session delivered by a family planning clinician. Outcome measures include intervention completion rates, alcohol use (frequency, quantity, and bingeing), contraceptive use and effectiveness, and risk for alcohol-exposed pregnancy.

Results. Among women who completed the 6-month follow-up, 68.5% were no longer at risk of having an alcohol-exposed pregnancy; 12.6% of women who completed the program reduced drinking only; 23.1% used effective contraception only; and 32.9% reported both. Results were consistent across the 6 diverse high-risk settings.

Conclusions. This study provides evidence that providing 4 sessions of motivational interviewing plus a contraception counseling session is feasible and strongly suggests that this intervention can decrease the risk of alcohol-exposed pregnancy in women in high-risk settings. Additional investigation in a randomized controlled trial is warranted.
Sharing Prescription Medication Among Teenage Girls: Potential Danger to Unplanned/Undiagnosed Pregnancies
Authors: Daniel Katherine Lyon , Honein Margaret A. , Moore Cynthia A.
Published: December 2021

Objective. The objective of this study was to determine how often children and adolescents share prescription medications and, because of teratogenic concerns, assess specific reasons why girls might engage in medication-sharing behaviors.

Methods. Data were collected as part of Youthstyles, a mail survey of children and adolescents 9 through 18 years of age (764 girls and 804 boys) about health issues, attitudinal variables, and media preferences. Information collected by the survey included the respondent’s history of borrowing or sharing prescription medications, the frequency with which sharing occurred, the reasons why medications might be borrowed or shared, and who influences their decisions to borrow or share medication.

Results. A total of 20.1% of girls and 13.4% of boys reported ever borrowing or sharing medications. Of the girls surveyed, 15.7% reported borrowing prescription medications from others, and 14.5% reported sharing their prescription medication with someone else. The reported likelihood of sharing increased with age. Medication sharing or borrowing was not a “one time only” emergency use for many: 7.3% of girls 15 through 18 years of age had shared medications >3 times. Reasons that girls gave for why they would share medications included having a prescription for the same medicine (40.2%), getting the medication from a family member (33.4%), having the same problem as the person who had the medication (29%), or wanting something strong for pimples or oily skin (10.5%).

Conclusions. Medication sharing is relatively common among children and adolescents and is more common among girls than boys. An adolescent who receives a medication via sharing does not receive the appropriate information about its actions and possible negative interactions with other medications or any other associated risks. Sharing potentially teratogenic drugs is of special concern. Many barriers exist to communicating the risk about teratogenic drugs to women and girls, particularly if they are not planning a pregnancy or are unaware that they are already pregnant. These findings suggest the need for basic research on issues related to the dangers of medication sharing and teratogenic risks, as well as the development of successful approaches to communicate these risks.
Attention-Deficit/Hyperactivity Disorder in School-Aged Children: Association With Maternal Mental Health and Use of Health Care Resources
Authors: Lesesne Catherine A. , Visser Susanna N. , White Carla P.
Published: December 2021

Objective. To investigate the association between the mental health status of mothers and attention-deficit/hyperactivity disorder (ADHD) in their school-aged children and to characterize the health care access and utilization of families affected by ADHD.

Methods. Survey logistic regression procedures were used to investigate the association between activity-limiting mental health conditions in mothers and ADHD in their school-aged children using 1998 National Health Interview Survey data. A total of 9529 mother-child dyads were included in the final analysis.

Results. The prevalence of ADHD among children aged 4 to 17 years was 6.3%. Survey logistic regression statistics revealed an association between an activity-limiting depression, anxiety, or emotional problem in mothers and ADHD in their children. This association persisted after controlling for the gender, age, and race of the child; household income (as a function of the 1997 poverty level); and type of family structure as reported by the mother (adjusted odds ratio [OR]: 4.2; 95% confidence interval [CI]: 2.2–8.1). Mothers of a child with ADHD were 13 times more likely to have consulted with a mental health professional about their child’s health within the past year despite reporting an inability to afford prescription medications (OR: 3.3; 95% CI: 2.2–4.9) and mental health care (OR: 7.4; 95% CI: 4.6, 11.8) for the child.

Conclusions. Maternal mental health is significantly associated with the presence of ADHD in school-aged children. This finding further supports a link between maternal mental health and behavioral outcomes in children. Health care utilization and access findings support a family-oriented system of care.
Food Allergen Avoidance in the Prevention of Food Allergy in Infants and Children
Authors: Zeiger Robert S.
Published: December 2021

Food allergy afflicts an increasing number of infants and children and is associated with both clinical and familial burdens. To help lessen this burden, the Nutritional Committees from the American Academy of Pediatrics and jointly the European Society for Pediatric Allergology and Clinical Immunology and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition published recommendations to prevent and treat food allergy. Although there is much in common with these recommendations, differences exist. This review compares, contrasts, and reconciles them, presenting the evidence that has led to their statements.
Safety of Thimerosal-Containing Vaccines: A Two-Phased Study of Computerized Health Maintenance Organization Databases
Authors: Verstraeten Thomas , Davis Robert L. , DeStefano Frank , Lieu Tracy A. , Rhodes Philip H. , Black Steven B. , Shinefield Henry , Chen Robert T. ,   for the Vaccine Safety Datalink Team
Published: December 2021

Objective. To assess the possible toxicity of thimerosal-containing vaccines (TCVs) among infants.

Methods. A 2-phased retrospective cohort study was conducted using computerized health maintenance organization (HMO) databases. Phase I screened for associations between neurodevelopmental disorders and thimerosal exposure among 124 170 infants who were born during 1992 to 1999 at 2 HMOs (A and B). In phase II, the most common disorders associated with exposure in phase I were reevaluated among 16 717 children who were born during 1991 to 1997 in another HMO (C). Relative risks for neurodevelopmental disorders were calculated per increase of 12.5 μg of estimated cumulative mercury exposure from TCVs in the first, third, and seventh months of life.

Results. In phase I at HMO A, cumulative exposure at 3 months resulted in a significant positive association with tics (relative risk [RR]: 1.89; 95% confidence interval [CI]: 1.05–3.38). At HMO B, increased risks of language delay were found for cumulative exposure at 3 months (RR: 1.13; 95% CI: 1.01–1.27) and 7 months (RR: 1.07; 95% CI: 1.01–1.13). In phase II at HMO C, no significant associations were found. In no analyses were significant increased risks found for autism or attention-deficit disorder.

Conclusions. No consistent significant associations were found between TCVs and neurodevelopmental outcomes. Conflicting results were found at different HMOs for certain outcomes. For resolving the conflicting findings, studies with uniform neurodevelopmental assessments of children with a range of cumulative thimerosal exposures are needed.
Environmental Risk Communication for the Clinician
Authors: Miller Mark , Solomon Gina
Published: December 2021

Although they are accustomed to discussing risks in the medical arena through the process of informed consent, primary care clinicians may have difficulty communicating with their patients and communities about environmental health risks. Clinicians are generally trusted and can play important roles as educators, alert practitioners, or even advocates talking about environmental health risks with individuals and groups. Communication of risk requires an understanding of how scientists and clinicians assess risk—the process of quantitative or qualitative risk assessment. Risk is never a purely scientific issue; risk is perceived differently depending on some well-understood characteristics of the hazard, the individual perceiving the risk, and the social context. Many low-income communities of color have faced and continue to face disproportionate environmental exposures and disease burdens. The issue of environmental justice can significantly affect the context of a discussion about a specific environmental risk. The essence of risk communication has been well described and requires careful evaluation of the science and the social context, honesty, listening to and partnering with the community, and a clear, compassionate team approach.
Policy for Child Health in the United Kingdom
Authors: Law Catherine
Published: December 2021

The Issue. It is argued that health policy is determined by many influences, including research evidence. However, the evidence base needs further development if it is to be used effectively. If health policy is to promote equity in child health, then it must not be confined to health services. This article is, essentially, a personal perspective on UK health policy for children, particularly as it relates to inequalities in health and using scientific evidence. Many issues are general and apply to all health policy, including child health. Furthermore, in cases in which children can be included in mainstream policy agendas, we may make faster progress in improving child health than when we have to make a special case.
Community Pediatrics: Role of Physicians and Organizations
Authors: Lynch Margaret
Published: December 2021

The Issue. This article focuses on the work of the Royal College of Paediatrics and Child Health (RCPCH) related to advocacy and the efforts of the RCPCH to influence the planning and provision of children’s services. This should be considered in the context of the current UK government agenda. As the RCPCH agrees with the aims of this agenda, the challenge becomes how to influence the process of achieving them. In 1999 in a document, “Our Healthier Nation,” the UK government clearly stated that it is committed to improving the health of the population, reducing inequalities, reducing social exclusion, and improving access and quality of health care while increasing responsiveness to local needs. This commitment of the UK government is important to children, as among the 11 to 12 million children in the country, there are 300 000 to 400 000 children in need, including 53 000 children who are in public care (usually placed in foster care), where the state has direct responsibility to ensure that they receive appropriate health care. These are children who may need support from social services or child care services in addition to health services. There also are 32 000 children on our child protection registers. Overall, approximately 4 million of our 11 million children are considered vulnerable for one reason or another.
Impact of the Phenylalanine Hydroxylase Gene on Maternal Phenylketonuria Outcome
Authors: Güttler Flemming , Azen Colleen , Guldberg Per , Romstad Anne , Hanley William B. , Levy Harvey L. , Matalon Reuben , Rouse Bobbye M. , Trefz Friedrich , de la Cruz Felix , Koch Richard
Published: December 2021

Objective. The aim of the present study was to examine to what extent maternal and offspring phenylalanine hydroxylase (PAH) genotypes in conjunction with maternal IQ and dietary control during pregnancy are related to cognitive development in offspring of women with phenylketonuria (PKU).

Methods. PAH gene mutations were determined in 196 maternal PKU subjects and their offspring. The women were grouped according to PAH genotype, which predicts the metabolic phenotype (severe PKU, mild PKU, and mild hyperphenylalaninemia [MHP]). IQ was determined in both the mothers (Wechsler Adult Intelligence Scale–Revised at >18 years) and their children (Wechsler Intelligence Scale for Children–Revised at ≥6–7 years of age).

Results. According to PAH genotypes, 62% of the women exhibited severe PKU, 19% exhibited mild PKU, and 19% exhibited MHP. Maternal IQ increased, and the assigned phenylalanine (Phe) levels decreased with decreasing severity of PAH genotype. In offspring of mild maternal PKU, multiple regression analysis showed offspring IQ to be significantly related to maternal IQ but not to Phe exposure during pregnancy, which was <750 μmol/L in all cases of mild PKU. In offspring of mothers with severe PKU and average Phe exposure during pregnancy of 360 to 750 μmol/L, multiple regression analysis revealed both maternal IQ and Phe exposure to be significant predictors of offspring IQ. When average Phe exposure was <360 μmol/L, cognitive development was normal (mean IQ: 105), whereas an average Phe exposure of >750 μmol/L severely depressed offspring IQ (mean IQ: 56) in this group regardless of maternal IQ. It could not be documented that the offspring PAH genotype affects cognitive development.

Conclusion. Female individuals with severe PKU should be offered a diet for a lifetime. If good metabolic control is established, then women with PKU will have children with IQ scores that are not influenced by their disease.
The Neonatal Intensive Care Unit Network Neurobehavioral Scale Procedures
Authors: Lester Barry M. , Tronick Edward Z. ,   in collaboration with T. Berry Brazelton, MD
Published: December 2021

The procedures for the Neonatal Intensive Care Unit Network Neurobehavioral Scale includes a brief background, description of the examination, key concepts, a summary of the procedures, and order of administration of the items described in “packages,” information about the testing kit, scoring issues, and summary scores. This is followed by presentation of the 115 items that are scored. Each item is described, including (where appropriate) specific procedures for how to manipulate or handle the infant. Rating scales with scoring criteria are provided for each item. With training and certification, users of the manual will be able to reliably administer and score the Neonatal Intensive Care Unit Network Neurobehavioral Scale.
The “Every Child Deserves a Medical Home” Training Program: More Than a Traditional Continuing Medical Education Course
Authors: Moore Bob , Tonniges Thomas F.
Published: December 2021

Objectives. 1) To develop and implement an innovative, interactive, and nontraditional continuing medical education (CME) curriculum to educate primary care physicians, pediatric office staff, child health advocates, allied health care professionals, and parents of children with special health care needs (CSHCN) about the medical home concept of care and 2) to identify key partners in communities to plan the CME program and ultimately plan for fostering medical homes at the community and state levels.

Methods. Participant outcomes for the CME program and planning process include 1) explaining the elements of the medical home concept as applied to their practice environment or child’s care; 2) understanding the concepts, skills, and information necessary to care successfully for CSHCN who are enrolled in managed care organizations; 3) accurately describing trends and developments in caring for CSHCN; 4) identifying programs in the community that serve CSHCN; and 5) assessing and, if necessary, improving pediatric office practices to ensure that they are sensitive to families of children and youths with special health care needs.

Conclusion. A diverse national committee that included physicians, nonphysicians, and family members developed the Medical Home Training Program curriculum. The medical home curriculum was written to meet the needs of the local community. The training program can offer CME credit and use a direct, outcome-based adult learning technique (eg, determine short- and long-term goals). Furthermore, the program parallels and complements the Healthy People 2010 goals and objectives.