bluuebunny/crossref_metadata_2025 huggingface dataset:
The effects of domestic violence and sexual abuse on mental health
Authors: Itzin Catherine , Bailey Susan , Bentovim Arnon
Published: December 2008

The Department of Health and National Institute for Mental Health in England have undertaken a programme of research and policy development since spring 2004 in partnership with the Home Office which has important implications for the practice of psychiatry. This article looks at the Victims of Violence and Abuse Prevention Programme (VVAPP) guide ‘Tackling the Health and Mental Health Effects of Domestic and Sexual Violence and Abuse’ launched in 2006, supported by Department of Health and Home Office ministers and national clinical directors.
Making a difference. Invited commentary on … Effects of domestic violence and sexual abuse on mental health
Authors: Mason Fiona L.
Published: December 2008

When I qualified in 1987, I was appalled to learn that the vast majority of the on-call forensic medical examiners who examined women subjected to serious sexual assault and rape in the Metropolitan Police area were men. I was subsequently involved in the establishment of an on-call rota of women doctors who were prepared to examine victims of sexual violence. Nowadays, services deliver holistic non-judgemental intervention, particularly in sexual assault centres. These centres are specialist services providing 24-h forensic examinations, other medical and psychological services and aftercare in a secure and sensitive setting (Lovett et al, 2004; Kelly et al, 2008). This model is now being extended.
Photoaccelerated Reductive Coupling of Acid Chlorides with Conjugate Dienes and Styrenes by Use of Neodymium Metal in N,N-Dimethylacetamide
Authors: Li Zhi-fang , Tomisaka Yuri , Nomoto Akihiro , Zhang Yongmin , Ogawa Akiya
Published: December 2008

Upon photoirradiation, neodymium metal powder in N,N-dimethylacetamide (DMAC) exhibits excellent reducing ability for the reductive coupling of benzoyl chlorides with conjugate dienes and styrenes.
Mechanism of Catalytic Chalcogen Atom Replacement of Phosphine Chalcogenides and Separation of the Intermediate Phosphine
Authors: Aizawa Sen-ichi , Majumder Arpi , Maeda Daisuke , Kitamura Akina
Published: December 2008

The reaction mechanism of the chalcogen atom replacement of phosphine chalcogenides has been revealed to be dissociative from a kinetic investigation for the reaction of phosphine selenide with sulfur. The dissociation is enthalpically promoted by the catalysis of Pd0. For a bidentate phosphine chalcogenide, the intermediate phosphine was separated as the PdII complex by the catalysis and oxidative addition of Pd0 complex. The novel catalytic replacement and dissociation of chalcogen atom are applicable to regeneration of phosphines from their oxides via the phosphine sulfides.
Task Specific Ionic Liquids for Cellulose Technology
Authors: Ohno Hiroyuki , Fukaya Yukinobu
Published: December 2008

Design of ionic liquids for dissolution, depolymerization, and energy conversion of cellulose and their derivatives is described. Importance of physicochemical properties such as polarity and hydrogen-bonding ability of the ionic liquids is described, and some practical approaches to prepare novel ionic liquids as solvents for cellulose technology are reviewed with latest results.
Self-organization of Multilayered Oil Droplet in Water
Authors: Suzuki Kosuke , Akthar Rumana Jahan , Mahara Hitoshi , Hashimoto Hajime , Iwatsubo Takashi , Nishimura Satoshi , Yamaguchi Tomohiko
Published: December 2008

Dynamic behavior of initially sessile droplets of oleic acid with sodium oleate was investigated in an aqueous buffer solution. The interface of droplet highly fluctuated at pH 9.0 and concomitantly grew a multilayered structure inside of the droplet. Volume change of the droplet suggested the existence of three independent mass-transport processes. This phenomenon was observed under specific conditions of pH and oil composition.
Submicron Distribution of Organic Matter of Carbonaceous Chondrite Using Near-field Infrared Microspectroscopy
Authors: Kebukawa Yoko , Nakashima Satoru , Nakamura-Messenger Keiko , Zolensky Michael E
Published: December 2008

Carbonaceous chondrites are known to contain up to a few wt % organic carbon. Organic materials are disseminated in the clayish matrix, and some of them have been reported to be in the form of submicron organic globules. However, little is known about the nature of these microscopic organics. The organic matter distribution of the Bells (CM2) carbonaceous chondrite has been studied using a near-field infrared (NFIR) microspectrometer. Organic matter distribution and mineral associations at the submicron scale spatial resolution were observed.
Characterization of a Fluoride-bridged Mixed-valent Tetrairon(II,II,III,III) Complex
Authors: Miyazato Yuji , Ohba Masaaki , Hayami Shinya , Maeda Yonezo , Tadokoro Makoto , Okawa Hisashi
Published: December 2008

A di-μ-fluoride mixed-valent tetrairon(II,II,III,III) complex, [{Fe2(L)(dnba)}2(μ-F)2](BF4)2, was synthesized and characterized by X-ray structural analysis, UV–vis–NIR spectroscopy, and Mössbauer measurement.
Synthesis of Biologically Active Carbazole Alkaloids Using Selective Transition-metal-catalyzed Coupling Reactions
Authors: Knölker Hans-Joachim
Published: December 2008

Highly convergent syntheses of substituted carbazoles are most conveniently achieved using organometallic chemistry. Construction of the carbazole framework via the iron-mediated route proceeds by a sequence of C–C and C–N bond formation. In the highly efficient palladium-catalyzed route the C–N bond is formed first followed by generation of the C–C bond. This article highlights some recent developments and applications to the total synthesis of biologically active carbazole alkaloids.
Service users' acceptability of videoconferencing as a form of service delivery
Authors: Styles Victoria
Published: December 2008

We conducted a study of videoconferencing for delivering an Augmentative and Alternative Communication (AAC) service. AAC is a clinical field that attempts to compensate for the impairment and disability of people with severe expressive communication disorders. A total of 12 participant groups trialled initial AAC assessments via videoconference at a bandwidth of 768 kbit/s. The participant groups consisted of the client, the assessing speech and language therapist, and those who accompanied them to the session (usually their local speech and language therapist and any relatives or carers). Six of these groups progressed to receive review appointments. Following each of the sessions, all of the participants completed a questionnaire. Participants indicated an 88% satisfaction with the videoconference assessment session and a 95% satisfaction with review videoconference sessions. Clients provided the most positive feedback in their questionnaires, while the speech and language therapists were the most critical of the process. The findings suggest that an AAC service can be delivered effectively by videoconference.
Experience with the implementation of a web-based teledermatology system in a nursing home in Singapore
Authors: Janardhanan Lavanya , Leow Yung H , Chio Martin TW , Kim Yongmin , Soh Cheong B
Published: December 2008

We introduced a web-based teledermatology system, the distributed personal health information management system (DPHIMS), into a nursing home in Singapore. The introduction was conducted in two phases. Five staff nurses in Phase 1 and nine nurse aides in Phase 2 performed the data entry and uploaded digital images of the resident's skin condition. By the end of Phase 2, there were 50 residents registered with DPHIMS. The average age of the participants was 82 years and 84% were women. There were 31 first-time referral requests registered in the system during Phase 2. The average time taken to complete a referral request was 86 minutes. The average time taken by the dermatologist to prepare and submit a diagnosis/treatment report was 11 minutes. An online survey form was given to the nurses and the dermatologists to gauge their level of satisfaction and their experience of using DPHIMS. All the nurses said they would readily recommend DPHIMS to other nurses. Overall, the dermatologists felt that DPHIMS was helpful in obtaining specialist care for the residents. However, some skin conditions required a face-to-face consultation. Thus a mixture of face-to-face consultations and consultations via teledermatology may be necessary to provide complete diagnosis and treatment to patients. Our experience suggests that understanding and addressing the organizational concerns is as important as solving the technical problems.
Email for distance diagnosis of oral diseases: a preliminary study of teledentistry
Authors: Torres-Pereira Cassius , Possebon Renata Seleme , Simões André , Bortoluzzi Marcelo Carlos , Leão Jair Carneiro , Giovanini Allan Fernando , Piazetta Cleto Mariosvaldo
Published: December 2008

We examined the feasibility of distance diagnosis of oral diseases, using transmission of digital images by email. Twenty-five cases of oral lesions were documented during a 12-month study in a primary care public health clinic in Paraná in Southern Brazil. Clinical electronic charts and images were produced and sent by email to two oral medicine specialists with a median of 10 years experience in the field. The consultants provided a maximum of two clinical hypotheses for each case. In 15 of the 25 cases (60%) both consultants made a correct diagnosis; in seven cases (28%) only one consultant made a correct diagnosis; and in three cases (12%) neither consultant made a correct diagnosis. Thus in 88% of cases, at least one consultant was able to provide the correct diagnosis. The results suggest that distant diagnosis can be an effective alternative in the diagnosis of oral lesions and that the using two distant consultants improves diagnostic accuracy. Primary care public health clinics may benefit from the use of email and digital cameras for telehealth in remote areas where oral medicine specialists are not available.
The effectiveness of low-cost teleconsultation for emergency head computer tomography in patients with suspected stroke
Authors: Phabphal Kanitpong , Hirunpatch Siriporn
Published: December 2008

Teleradiology in an emergency situation can be used to support rapid neurological decision-making when specialists are remote from the hospital concerned. We have developed a low-cost system using a PDA phone as the receiving equipment. The experimental system was based on a notebook PC to send the images and a PDA phone to receive them. We used commercially available toolbar software for transmitting the information through the mobile phone network. A total of 100 images from clinically suspected strokes within the previous 24 hours were transmitted to a neurologist. The mean size of the original picture was 20.9 kByte and the images were compressed by approximately 2:1 before transmission. The mean transmission time was 48 s per image. The diagnosis from the PDA phone image was in complete agreement with the diagnosis from the original image in cases of acute ischaemic stroke, intracerebral haemorrhage, metastasis and in normal scans. However, there was agreement in only 7 of the 8 cases (88%) of subarachnoid haemorrhage. The overall transmission cost was 400 Thai baht per case. The study showed that good accuracy can be achieved with a low-cost system for teleradiology consultation in stroke.
Care coordination assisted by technology for multiethnic caregivers of persons with dementia: a pilot clinical demonstration project on caregiver burden and depression
Authors: Dang Stuti , Remon Nilber , Harris Julia , Malphurs Julie , Sandals Lauran , Cabrera Angeles Lozada , Nedd Nicole
Published: December 2008

We evaluated a care-coordination project assisted by a screen-phone to support and educate caregivers. A total of 113 caregivers of home-dwelling veterans with dementia were recruited to the study: 72 were white, 32 were African American and nine were Hispanic. Caregivers were assessed for burden, depression, coping, quality of life, knowledge and satisfaction. None of the outcome measures changed significantly after 12 months. Forty care-recipient and caregiver dyads responded to the 12-month telephone satisfaction survey. The respondents were more satisfied with the care-coordination (90%) aspect of the programme than the education (77%) or the monitoring (50%). The pilot project suggests that care coordination aided by screen-phones may be a useful model for caregiver support in a managed-care setting. A systematic study is now required.
Seasonal variability in Dinophysis spp. abundances and diarrhetic shellfish poisoning outbreaks along the eastern Adriatic coast
Authors: Ninčević-Gladan Živana , Skejić Sanda , Bužančić Mia , Marasović Ivona , Arapov Jasna , Ujević Ivana , Bojanić Natalia , Grbec Branka , Kušpilić Grozdan , Vidjak Olja
Published: December 2008

Annual dynamics and ecological characteristics of the genus Dinophysis spp. and associated shellfish toxicity events were studied from 2001 to 2005 during monitoring fieldwork in the coastal waters of the eastern Adriatic Sea. Analysis of the seasonal occurrence of Dinophysis species identified D. acuminata and D. sacculus as typical spring species, D. caudata, D. fortii and D. rotundata as summer and late summer species and D. tripos as a winter species. The highest abundances occurred when there were large differences between surface and bottom temperatures and salinities. D. caudata, D. sacculus and D. rotundata abundances had significant relationships with Δt, while the highest abundances of D. acuta, D. fortii and D. tripos were associated with high Δs values. Much higher abundances of D. caudata and D. fortii in offshore compared to inshore waters of the northern Adriatic Sea and the significant inverse relationship of these species' abundances with salinity suggested the possibility of their transport by Italian river-influenced coastal waters towards the eastern Croatian coast during the summer season and under stratified conditions. Toxicity events occurred more frequently in the more eutrophicated northern Adriatic Sea than in the southern Adriatic Sea and mostly succeeded the rainfall periods. Diarrhetic shellfish poisoning (DSP) toxin profile analyses identified okadaic acid and yessotoxin as the main DSP toxins occurring in Croatian waters.
Genetic Selection for Enhanced Health Characteristics
Authors: Miah Andy
Published: December 2008

This paper examines the UK regulatory framework and the ethical arguments surrounding the use of genetic tests, specifically considering how they would apply to selecting for enhanced health characteristics. It discusses the Human Genetic Commission reports on the use of genetic information more broadly, identifying the implied values and concerns arising from their conclusions. It argues that the HGC conflates the concepts of ‘best’ and ‘enhancement’ and this limits the persuasiveness of their moral stance
A Framework Interpreting Bender Element Tests, Combining Time-Domain and Frequency-Domain Methods
Authors: Viana da Fonseca António , Ferreira Cristiana , Fahey Martin
Published: December 2008

Bender element (BE) testing is a powerful and increasingly common laboratory technique for determining the shear S-wave velocity of geomaterials. There are several advantages of BE testing, but there is no standard developed for the testing procedures or for the interpretation of the results. This leads to high degree of uncertainty and subjectivity in the interpretation. In this paper, the authors review the most common methods for the interpretation of BE tests, discuss some important technical requirements to minimize errors, and propose a practical framework for BE testing, based on the comparison of different interpretation techniques in order to obtain the most reliable value for the travel time. This new procedure consists of the application of a methodical, systematic, and objective approach for the interpretation of the results, in the time and frequency domains. The use of an automated tool enables unbiased information to be obtained regarding variations in the results to assist in the decision of the travel time. Two natural soils were tested: residual soil from Porto granite, and Toyoura sand. Specimens were subjected to the same isotropic stress conditions and the results obtained provided insights on the effects of soil type and confining stress on the interpretation of BE results; namely, the differences in testing dry versus saturated soils, and in testing uniform versus well-graded soils.
Development of a Direct Simple Shear Apparatus for Peat Soils
Authors: Boylan Noel , Long Michael
Published: December 2008

This paper discusses the design and development of a new direct simple shear (DSS) apparatus for testing peat soils. The apparatus has been designed to test peat at low effective stresses, representative of its in situ condition and allow the deformation of the specimen to be monitored. This device uses particle image velocimetry (PIV) image analysis techniques to monitor the side of the peat specimen and provide an insight into the behavior of peat during shearing. A set of comparative tests on reconstituted clay have been conducted with another widely used DSS apparatus and has shown both to yield similar undrained strength ratios (su/σvc′) for a range of stress levels. Application of the apparatus to peat soils is demonstrated by a set of tests on a high water content blanket bog peat. Analysis of these tests using the PIV technique reveals the complex shear strain and volumetric strain behavior of peat undergoing shearing. Identification of partial slippage of a specimen is also shown through these analyses.
Chapter 1: Introduction to the Building of Materials Databases
Authors: Newton CH
Published: December 2008

This chapter provides an introduction to the development of material property databases. The value of material property databases is discussed. Key concepts that are used throughout the manual are introduced. The standards organizations involved in materials property databases are discussed. This manual focuses on the use of standards developed by or in cooperation with ASTM Committee E-49 on the Computerization of Material and Chemical Property Data. ASTM Committee E-49 is at the forefront in developing standards in this area. The final section of this chapter introduces the steps involved in the design of a materials property database. The steps highlight the use of the ASTM E-49 standards and the other chapters in the manual.
Chapter 5: Nomenclature and Current Standards for Recording of Test Results and Properties
Authors: Wardle MW
Published: December 2008

One of the important tasks associated with the design phase of a materials properties database is defining and understanding the exact nature of the data to be stored in the database. Among the key questions are: (1) What are the data types: character strings, numbers, numerical arrays, graphics, images? (2) For numerical data, what is their format: integer, floating point, exponential? How many decimals? How many significant figures? (3) What metadata need to be associated with the data, and what is their form?
Chapter 6: Data Evaluation, Validation, and Quality
Authors: Barrett AJ
Published: December 2008

The term “data” means scientific or technical measurements, values, or facts, which can be represented by numbers or in other ways. These values or facts form the basis of calculations and of technical or scientific decisions. To be more specific, materials data should accurately represent such values as ultimate strength in tension, stiffness in torsion, hardness, and up to 50 or more similar mechanical properties in addition to numerous electrical, electronic, thermal, and other physical properties, corrosion, oxidation, and processing characteristics. Each data value corresponds to a particular loading condition, time of application, and set of values for each of several possible ambient environmental and other parameters. First, however, the material itself needs to be identified unambiguously in terms of its chemical composition, form, heat and other treatment, source, and more. Finally, beyond the mechanical and physical properties, data may be required on the cost of a target material, on its availability, its environmental impacts, and even, perhaps, its aesthetic qualities. Most of these data are numeric values, but they do not stand alone. The mechanical properties, for example, are dependent upon the test methods or predictive mathematical models that were used to determine them.
Chapter 2-Radon and the Natural Environment
Authors: Sextro RG
Published: December 2008

RADON HAS COME TO BE RECOGNIZED as one of the most important environmental pollutants to which humans are exposed, in part due to the fact that it is widespread-indeed, radon is present in all houses-and due to the health risks associated with even average concentrations. Although the existence of radon has been known since the beginning of this century and the health effects associated with exposure to mine atmospheres (both uranium and nonuranium mines) have been studied for several decades, our understanding of it as an indoor air contaminant in ordinary houses has developed substantially only within the past decade. Some of the earliest indications of elevated concentrations in U.S. homes were associated with the use of uranium mill tailings as backfill in house construction or in other areas where radium concentrations were elevated, such as parts of central Florida, where buildings were built on lands reclaimed from phosphate mining . However, by the late 1970s, researchers had found homes in other parts of the U.S. with elevated radon concentrations for which there were no radon sources that could be associated with technological activities . The discovery of high-to-very-high indoor concentrations in eastern Pennsylvania in the mid 1980s did not offer a new scientific perspective on the radon question; rather, it focused the attention of the public and local and federal governmental agencies on the issue. This chapter provides a broad overview of radon and its radioactive decay products. A number of topics are introduced in this discussion that are covered in greater detail in later chapters.
Chapter 4-Measurement Methods and Instrumentation
Authors: Fortmann RC
Published: December 2008

THE RECOGNITION THAT INDOOR ENVIRONMENTS may be potentially important sites of exposure to elevated levels of the decay products of radon has resulted in an increased demand for measurements of radon and radon decay products indoors. Practical methods and instruments for the measurements of radon and radon decay products have been available since the 1950s as a result of the need to assess radiological exposures to radon-222 decay products in the uranium mining industry . The methods developed for measurements in the uranium mining industry still form the basis for most methods used today in nonindustrial indoor environments. However, improvements have been made to the instrumentation, incorporating advanced technology to improve sensitivity and other performance parameters, ease of use, and size. There have been substantial advances in the development of passive sampling devices, which are relatively low cost and easy to use by homeowners and in largescale screening surveys. Research in the area of radon decay product measurements has advanced significantly, resulting in improved understanding of their characteristics and development of improved measurement methods. Advances in radon and radon decay product measurement technology over the last 40 years have resulted in reliable, easy to use, portable, and relatively low-cost methods.
Chapter 6-Geology and Occurrence of Radon
Authors: Schumann RR , Gundersen LCS , Tanner AB
Published: December 2008

THE ACCUMULATION OF RADON INDOORS is commonly due to movement of radon from adjacent soil and rock into a building foundation through joints, utility openings, cracks, or porous block walls. When air pressure inside the building is lower than that in the soil, pressure-driven flow of radonbearing soil gas can occur (see Chapter 2). Whether or not an indoor radon problem results depends on: (1) the radium concentration in the soil and underlying rock, (2) the ability of radon to escape from the solid material holding the parent radium, and (3) the ability of radon to move through the rock and soil fractures and pores.
Manual on Drilling, Sampling, and Analysis of Coal, Compiled by ASTM Subcommittees D05.18 and D05.23
Authors: Luppens JA , Wilson SE , Stanton RW
Published: December 2008

Description

Guidelines on state-of-the-art aspects of drilling and sampling coal. Can be modified as necessary to fit your specific needs (for example, you can use them to prepare your own field manual to standardize exploration activities). Chapters include: drilling equipment; • geophysical logging; • description of coal and rocks; • sampling of coal cores; • laboratory analysis of coal and rock drill core samples; • and evaluation of core data.

Also serves as a reference document for those who use the core sampling ASTM standard Practice for Collection of Coal Samples from Core (D 5192) (included in the Appendix).
Methicillin-resistant Staphylococcus aureus in Previously Healthy Neonates
Authors: Fortunov Régine M. , Kaplan Sheldon L.
Published: December 2008

Methicillin-resistant Staphylococcus aureus infections are increasing in previously healthy term and late preterm neonates. Male infants are at greater risk, with symptom onset most often occurring between 7 and 12 days of age. Infants and mothers may have concurrent infection, and a family history of skin or soft-tissue infection is a significant risk factor. Infections range in severity from pustulosis to invasive infection. Evaluation strategies vary but should be based on the severity of infection. Abscesses often require drainage. Some infections may be associated with sterile cerebrospinal fluid pleocytosis. Treatment strategies also vary. Community isolate antibiotic susceptibility patterns should determine the empiric antibiotic choice. Antibiotic coverage should be adjusted after antibiotic susceptibility results are available for the patient's specific isolate. Some patients who have no systemic symptoms, a reliable family, and good follow-up may complete treatment safely at home. Outpatients should be monitored closely for treatment failure. The appropriate length of treatment is not known but should continue at least until all symptoms have resolved for 48 hours. Recurrence of infection months or years after the neonatal infection is possible.
Eight-Year Clinical Outcomes of Long-Term Enzyme Replacement Therapy for 884 Children With Gaucher Disease Type 1
Authors: Andersson Hans , Kaplan Paige , Kacena Katherine , Yee John
Published: December 2008

OBJECTIVE. The goal was to analyze the clinical responses to enzyme replacement therapy with alglucerase or imiglucerase in a large international cohort of children with Gaucher disease type 1.

METHODS. Anonymized data from 884 children in the International Collaborative Gaucher Group Gaucher Registry were analyzed to determine the effects of long-term enzyme replacement therapy with alglucerase or imiglucerase on hematologic and visceral manifestations, linear growth, and skeletal disease. The parameters measured were hemoglobin levels, platelet counts, spleen and liver volumes, z scores for height and bone mineral density, and reports of bone pain and bone crises.

RESULTS. The median height z score for the study population was −1.4 at baseline. After 8 years of treatment, the median height approximated the median value for the normal population. Anemia, although not severe, was present in >50% of patients at baseline and resolved for all patients after 8 years of treatment. More than 50% of patients had platelet counts of <100000 platelets per mm3 at baseline, but >95% had platelet counts above this level after 8 years of treatment. Liver and spleen volumes decreased over 8 years of treatment. The mean bone mineral density z score was −0.34 at baseline, and values normalized within 6.6 years of treatment. Seventeen percent of patients reported a bone crisis before treatment and in the first 2 years of treatment, but no bone crises were reported after 2 years of enzyme replacement therapy. Few patients (2.5%) without bone crises before enzyme replacement therapy had a crisis after the start of treatment.

CONCLUSIONS. These longitudinal data quantitate the benefits of continuous enzyme replacement therapy with alglucerase/imiglucerase for children with Gaucher disease type 1. Within 8 years of enzyme replacement therapy, most clinical parameters studied became normal or nearly normal.
Descriptive Epidemiological Features of Bronchiolitis in a Population-Based Cohort
Authors: Koehoorn Mieke , Karr Catherine J. , Demers Paul A. , Lencar Cornel , Tamburic Lillian , Brauer Michael
Published: December 2008

OBJECTIVE. The goal was to investigate the epidemiological features of incident bronchiolitis by using a population-based infant cohort.

METHODS. Outpatient and inpatient health records were used to identify incident bronchiolitis cases among 93 058 singleton infants born in the Georgia Air Basin between 1999 and 2002. Additional health-related databases were linked to provide data on sociodemographic variables, maternal characteristics, and birth outcome measures.

RESULTS. From 1999 to 2002, bronchiolitis accounted for 12 474 incident health care encounters (inpatient or outpatient contacts) during the first year of life (134.2 cases per 1000 person-years). A total of 1588 hospitalized bronchiolitis cases were identified (17.1 cases per 1000 person-years). Adjusted Cox proportional-hazard analyses for both case definitions indicated an increased risk of incident bronchiolitis in the first year of life (follow-up period: 2–12 months) for boys, infants of First Nations status, infants with older siblings, and infants living in neighborhoods with smaller proportions of maternal postsecondary education. The risk also was elevated for infants born to young mothers (<20 years of age) or mothers who did not initiate breastfeeding in the hospital. Infants with low (1500–2400 g) or very low (<1500 g) birth weight and those with congenital anomalies also had increased risk. Maternal smoking during pregnancy increased the risk of hospitalized bronchiolitis.

CONCLUSIONS. This population-based study of the epidemiological features of bronchiolitis provides evidence for intervening with high-risk infants and their families. Clinical and public health interventions are recommended for the modifiable risk factors of maternal breastfeeding and smoking and for modification of vulnerable environments where possible (eg, limiting exposure to other young children), during high-risk periods such as the first few months of life or the winter season.
Prevalence and Impact of Respiratory Viral Infections in Young Children With Cystic Fibrosis: Prospective Cohort Study
Authors: van Ewijk Bart E. , van der Zalm Marieke M. , Wolfs Tom F. W. , Fleer Andre , Kimpen Jan L. L. , Wilbrink Berry , van der Ent Cornelis K.
Published: December 2008

OBJECTIVE. We aimed to investigate differences in upper and lower respiratory tract symptoms in relation to respiratory viral infections detected with polymerase chain reaction assays in young children with cystic fibrosis and healthy control subjects.

METHODS. In a 6-month winter period, 20 young children with cystic fibrosis and 18 age-matched, healthy, control subjects were contacted twice per week for detection of symptoms of an acute respiratory illness. If any symptom was present, then a home visit was made for physical examination and collection of nasopharyngeal swabs for viral analysis. In addition, parents were instructed to collect nasopharyngeal swabs every 2 weeks.

RESULTS. Children with cystic fibrosis and healthy control subjects had similar frequencies of acute respiratory illnesses (3.8 ± 1.0 and 4.2 ± 1.7 episodes, respectively). Although there were no significant differences in upper respiratory tract symptoms, the children with cystic fibrosis had longer periods of lower respiratory tract symptoms (22.4 ± 22.2 vs 12.8 ± 13.8 days) and a higher mean severity score per episode (2.35 ± 0.64 vs 1.92 ± 0.46). In addition, similar increases in upper respiratory tract symptom scores were associated with significantly greater increases in lower respiratory tract symptom scores in children with cystic fibrosis. No differences in the seasonal occurrences and distributions of respiratory viruses were observed, with picornaviruses and coronaviruses being the most prevalent.

CONCLUSIONS. Although there were no differences in the seasonal occurrences and distributions of polymerase chain reaction-detected respiratory viruses, acute respiratory illnesses were frequently associated with increased lower respiratory tract morbidity in young children with cystic fibrosis.
Cost-Effectiveness of Ambulatory Blood Pressure Monitoring in the Initial Evaluation of Hypertension in Children
Authors: Swartz Sarah J. , Srivaths Poyyapakkam R. , Croix Beth , Feig Daniel I.
Published: December 2008

OBJECTIVE. The goal was to determine the cost-effectiveness of ambulatory blood pressure monitoring in the initial evaluation of stage 1 hypertension.

METHODS. Retrospective chart review of data for children referred to Texas Children's Hospital hypertension clinic between January 2005 and August 2006 was performed. We compared the costs of standard evaluations versus the initial use of ambulatory blood pressure monitoring for children with clinic blood pressure measurements suggesting stage 1 hypertension. Charges for clinic visits, laboratory tests, and imaging were obtained from the Texas Children's Hospital billing department.

RESULTS. A total of 267 children were referred. One hundred thirty-nine children did not receive ambulatory blood pressure monitoring; 54 met clinical indications for ambulatory blood pressure monitoring but did not receive it because it was not a covered expense (44 children) or the family refused the study (10 children). One hundred twenty-six children received clinically indicated ambulatory blood pressure monitoring, paid for either through insurance or by the family. Fifty-eight children (46%) had confirmed white-coat hypertension, 62 (49%) stage 1 hypertension, and 6 (5%) stage 2 hypertension. With the observed prevalence of white-coat hypertension, initial ambulatory blood pressure monitoring use yielded net savings after evaluation of 3 patients, with projected savings of $2.4 million per 1000 patients.

CONCLUSIONS. Ambulatory blood pressure monitoring in the initial evaluation of suspected childhood hypertension is highly cost-effective. Awareness of cost saving potential may increase the availability of ambulatory blood pressure monitoring for evaluation of new-onset hypertension.
Postdischarge Growth and Development in a Predominantly Hispanic, Very Low Birth Weight Population
Authors: Powers George C. , Ramamurthy Rajam , Schoolfield John , Matula Kathleen
Published: December 2008

OBJECTIVES. The goals were to assess postdischarge growth and developmental progress of very low birth weight (birth weight: <1500 g) premature infants in a predominantly Hispanic population and to identify predictors for neurodevelopmental impairment at 3 years of age.

METHODS. A cohort of 135 very low birth weight infants (gestational age: 23 to 35 weeks) were monitored to 3 years of age. Maternal and neonatal characteristics, anthropometric z scores, and developmental performance (using corrected age until 24 months) were analyzed collectively and according to gestational age groups. Specific criteria for failure to thrive and microcephaly were used.

RESULTS. A characteristic pattern of poor weight gain in the first 12 months was followed by accelerated weight gain starting at 18 months, whereas head growth decreased at 18 months, with recovery beginning at 30 months of age. Infants born at gestational age of ≤26 weeks remained growth-impaired at 3 years of age, whereas infants born at gestational age of ≥27 weeks achieved catch-up growth by 30 months of age. Mean developmental scores also decreased in infancy, with improvements in motor development emerging at 18 months and cognitive skills at 30 months. Growth z scores, particularly for head growth, correlated with developmental scores. Infants born at gestational age of ≤26 weeks were most likely to have neonatal morbidities, failure to thrive, and neurodevelopmental impairment. With adjustment for gestational age and neonatal morbidities, Hispanic acculturation, failure to thrive, and microcephaly were predictive of neurodevelopmental impairment.

CONCLUSIONS. Very low birth weight infants exhibited growth patterns that coincided with developmental progress in the first 3 years of life. Birth at gestational age of ≤26 weeks was associated with greatest risk for developmental impairment, whereas failure to thrive and microcephaly increased neurodevelopmental impairment risk regardless of gestational age.
Unintentional Child Poisonings Treated in United States Hospital Emergency Departments: National Estimates of Incident Cases, Population-Based Poisoning Rates, and Product Involvement
Authors: Franklin Robert L. , Rodgers Gregory B.
Published: December 2008

OBJECTIVES. The goals were to develop national estimates of unintentional child poisoning cases treated in US hospital emergency departments, to determine population-based poisoning rates, and to evaluate characteristics of the victims and the products involved.

METHODS. Cases reported through the US Consumer Product Safety Commission National Electronic Injury Surveillance System, involving a national probability sample of US hospital emergency departments, were used as a basis for developing national estimates of product-related poisonings involving children <5 years of age treated in US hospital emergency departments in 2004.

RESULTS. There were an estimated 86194 child poisoning incidents treated in US hospital emergency departments in 2004, amounting to 429.4 poisonings per 100000 children. Approximately 70% of the poisonings involved children 1 or 2 years of age, slightly more than one half involved boys, and 13.3% resulted in hospital admission. Approximately 59.5% of the poisonings involved oral prescription drugs, oral nonprescription drugs, or supplements. Other major product categories resulting in poisonings included cleaning products (13.2%), drugs and ointment preparations intended for external use (4.9%), and personal care products (4.7%). Approximately 54.7% of the poisonings involved products already subject to child-resistant packaging requirements under the Poison Prevention Packaging Act.

CONCLUSIONS. Despite advances in recent years, unintentional child poisonings remain an important public health concern. The circumstances surrounding poisonings need to be evaluated further, and intervention strategies need to be developed.
Screening for Environmental Tobacco Smoke Exposure Among Inner-City Children With Asthma
Authors: Halterman Jill S. , Borrelli Belinda , Tremblay Paul , Conn Kelly M. , Fagnano Maria , Montes Guillermo , Hernandez Telva
Published: December 2008

OBJECTIVES. The goals were (1) to develop an index measure of environmental tobacco smoke based on parent self-report of smoking behaviors and (2) to determine whether the index score was associated with children's present and future cotinine levels.

METHODS. Data were drawn from a community intervention for inner-city children with persistent asthma (N = 226; response rate: 72%). Measures of child salivary cotinine levels and parent self-reported environmental tobacco smoke-related behaviors were obtained at baseline and 7 to 9 months later. To develop the index score, we used a 15-fold cross-validation method, with 70% of our data, that considered combinations of smoke exposure variables and controlled for demographic features. We chose the most parsimonious model that minimized the mean square predictive error. The resulting index score included primary caregiver smoking and home smoking ban status. We validated our model with the remaining 30% of the data. Analysis of variance and multivariate analyses were used to determine the association of the index score with children's cotinine levels.

RESULTS. Fifty-four percent of children with asthma lived with ≥1 smoker, and 51% of caregivers reported a complete home smoking ban. The children's mean baseline cotinine level was 1.55 ng/mL (range: 0.0–21.3 ng/mL). Children's baseline and follow-up cotinine levels increased as scores on the index measure increased. In a linear regression, the index score was significantly positively associated with children's cotinine measurements at baseline and 7 to 9 months later.

CONCLUSION. An index measure with combined information regarding primary caregiver smoking and household smoking restrictions helped to identify children with asthma with the greatest exposure to environmental tobacco smoke and could predict which children would have elevated cotinine levels 7 to 9 months later.
Glucose Intolerance and Cardiometabolic Risk in Children Exposed to Maternal Gestational Diabetes Mellitus in Utero
Authors: Tam Wing Hung , Ma Ronald Ching Wan , Yang Xilin , Ko Gary Tin Choi , Tong Peter Chun Yip , Cockram Clive Stewart , Sahota Daljit Singh , Rogers Michael Scott , Chan Juliana Chung Ngor
Published: December 2008

OBJECTIVE. The goal was to examine the carbohydrate tolerance and cardiometabolic risk among children exposed to maternal gestational diabetes mellitus in utero.

METHODS. In this study, 164 Chinese children whose mothers had participated in a previous study on the screening and diagnosis of gestational diabetes mellitus (63 had gestational diabetes mellitus and 101 had normal glucose tolerance during the index pregnancies) underwent follow-up evaluations at a median age of 8 years (range: 7–10 years). Children's weight, height, hip and waist circumferences, and blood pressure were measured, and weight-adjusted oral glucose tolerance tests were performed.

RESULTS. Six children (3.7%) demonstrated impaired glucose regulation or diabetes mellitus at the follow-up evaluation. Children exposed to maternal gestational diabetes mellitus had significantly higher systolic (94 ± 1.2 vs 88 ± 0.9 mmHg) and diastolic (62 ± 0.8 vs 57 ± 0.6 mmHg) blood pressure values and lower high-density lipoprotein cholesterol (1.58 ± 0.04 vs 1.71 ± 0.03 mmol/L) levels, after adjustment for age and gender. A high (≥90th percentile) umbilical cord insulin level at birth was associated with abnormal glucose tolerance in the offspring.

CONCLUSIONS. Maternal gestational diabetes mellitus increases the offspring's cardiometabolic risk, and in utero hyperinsulinemia is an independent predictor of abnormal glucose tolerance in childhood.
Effectiveness of a Clinical Pathway for the Emergency Treatment of Patients With Inborn Errors of Metabolism
Authors: Zand Dina J. , Brown Kathleen M. , Lichter-Konecki Uta , Campbell Joyce K. , Salehi Vesta , Chamberlain James M.
Published: December 2008

OBJECTIVE. The goal was to measure the effectiveness of a clinical pathway for the emergency department care of patients with inborn errors of metabolism.

METHODS. Two years after the implementation of a multidisciplinary clinical pathway for patients with inborn errors of metabolism in our urban, academic, pediatric emergency department, we compared measures of timeliness and effectiveness for patients treated before the pathway with the same measures for patients treated after implementation of the pathway. Measures of timeliness included time to room, time to doctor, time to glucose infusion, and total emergency department length of stay. Measures of clinical effectiveness included the proportion of patients receiving adequate glucose infusions, proportion of patients admitted, inpatient length of stay, and proportion of patients requiring PICU admission.

RESULTS. A total of 214 emergency department visits for patients with inborn errors of metabolism were analyzed, 90 before and 124 after initiation of the pathway. All measures of timeliness of care except total emergency department length of stay demonstrated significant improvement in comparisons of values before and after initiation of the pathway. Measures of clinical effectiveness also demonstrated significant improvements after initiation of the pathway. There was improvement in the proportion of patients who received adequate glucose infusions, with a decrease in the proportion of patients who required admission to the PICU. Emergency department length of stay, inpatient length of stay, and the proportion of patients admitted to the hospital were not affected.

CONCLUSIONS. Most measures of timeliness and 2 measures of effectiveness showed improvement after implementation of an emergency department pathway for patients with inborn errors of metabolism. Therefore, a clinical pathway can improve the emergency care of patients with inborn errors of metabolism.
Outcomes of 5-Year Survivors of Pediatric Liver Transplantation: Report on 461 Children From a North American Multicenter Registry
Authors: Ng Vicky Lee , Fecteau Annie , Shepherd Ross , Magee John , Bucuvalas John , Alonso Estella , McDiarmid Suzanne , Cohen Geoff , Anand Ravinder ,   and the Studies of Pediatric Liver Transplantation Research Group
Published: December 2008

OBJECTIVES. Although liver transplantation has been the standard of care therapy for life-threatening liver diseases for >20 years, data on the long-term impact of liver transplantation in children have been primarily limited to single-center experiences. The objective of this study was to characterize and evaluate the clinical course of children who have survived ≥5 years after pediatric liver transplantation in multiple centers across North America.

PATIENTS AND METHODS. Patients enrolled in the Studies of Pediatric Liver Transplantation database registry who had undergone liver transplantation at 1 of 45 pediatric centers between 1996 and 2001 and survived >5 years from liver transplantation were identified and their clinical courses retrospectively reviewed.

RESULTS. The first graft survival for 461 five-year survivors was 88%, with 55 (12%) and 10 (2%) children undergoing a second and third liver transplantation. At the 5-year anniversary clinic visit, liver function was preserved in the majority with daily use of immunosuppression therapy, including a calcineurin inhibitor and oral prednisone, reported by 97% and 25% of children, respectively. The probability of an episode of acute cellular rejection occurring within 5 years after liver transplantation was 60%. Chronic rejection occurred in 5% patients. Posttransplant lymphoproliferative disease was diagnosed in 6% children. Calculated glomerular filtration rate was <90 mL/minute per 1.73 m2 in 13% of 5-year survivors. Age- and gender-adjusted BMI >95th percentile was noted in 12%, with height below the 10th percentile in 29%.

CONCLUSIONS. Children who are 5-year survivors of liver transplantation have good graft function, but chronic medical conditions and posttransplantation complications affect extrahepatic organs. A comprehensive approach to the management of these patients' multiple unique needs requires the expertise and commitment of health care providers both beyond and within transplant centers to further optimize long-term outcomes for pediatric liver transplant recipients.
Medical Diagnoses Commonly Associated With Pediatric Malpractice Lawsuits in the United States
Authors: McAbee Gary N. , Donn Steven M. , Mendelson Robert A. , McDonnell William M. , Gonzalez Jose L. , Ake Julie Kersten
Published: December 2008

In this article we discuss the medical diagnoses underlying the most common lawsuits involving pediatricians in the United States. Where applicable, specific and general risk-management techniques are noted as a means of increasing patient safety and reducing the risk of medical malpractice exposure.