bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of the performance of hip implants with data from different arthroplasty registers
Authors: Migliore A. , Perrini M. R. , Romanini E. , Fella D. , Cavallo A. , Cerbo M. , Jefferson T.
Published: November 2009

This study evaluated the feasibility of using published data from more than one register to define the performance of different hip implants. In order to obtain estimates of performance for specific types of hip system from different register, we analysed data from the annual reports of five national and one Italian regional register. We extracted the number of implants and rates of implant survival at different periods of follow-up. Our aim was to assess whether estimates of cumulative survival rate were comparable with data from registers from different countries, and our conclusion was that such a comparison could only be performed incompletely.
Does smoking influence outcome after autologous chondrocyte implantation?
Authors: Jaiswal P. K. , Macmull S. , Bentley G. , Carrington R. W. J. , Skinner J. A. , Briggs T. W. R.
Published: November 2009

Smoking is known to have an adverse effect on wound healing and musculoskeletal conditions. This case-controlled study looked at whether smoking has a deleterious effect in the outcome of autologous chondrocyte implantation for the treatment of full thickness chondral defects of the knee.

The mean Modified Cincinatti Knee score was statistically significantly lower in smokers (n = 48) than in non-smokers (n = 66) both before and after surgery (p < 0.05). Smokers experienced significantly less improvement in the knee score two years after surgery (p < 0.05). Graft failures were only seen in smokers (p = 0.016). There was a strong negative correlation between the number of cigarettes smoked and the outcome following surgery (Pearson’s correlation coefficient −0.65, p = 0.004).

These results suggest that patients who smoke have worse pre-operative function and obtain less benefit from this procedure than non-smokers. The counselling of patients undergoing autologous chondrocyte implantation should include smoking, not only as a general cardiopulmonary risk but also because poorer results can be expected in smokers following this procedure.
Bullying among siblings: The role of personality and relational variables
Authors: Menesini Ersilia. , Camodeca Marina. , Nocentini Annalaura.
Published: November 2009

This study aimed to investigate: (1) the influence of gender, sibling age, and sibling gender on sibling bullying and victimization; (2) the links between personality characteristics, quality of the sibling relationship, and sibling bullying/victimization; (3) the association between sibling and school bullying/victimization, and the direct and indirect associations between personality variables and school bullying/victimization. The sample comprised 195 children (98 boys and 97 girls, aged 10–12 years). Instruments included: a self‐report questionnaire for bullying and victimization, the Big Five Questionnaire for Children and the Sibling Inventory of Behaviour. Results highlighted that the presence of an older brother is a risk factor for the emergence of sibling victimization. For both boys and girls, high levels of conflict in the dyad and low levels of empathy were significantly related to sibling bullying and sibling victimization. For males, energy was associated with sibling bullying and indirectly to school bullying; friendliness and high emotional instability were directly associated with school bullying. School victimization was directly associated with emotional instability for both males and females. Finally, both sibling bullying and sibling victimization were associated with bullying and victimization at school. The discussion highlights the role of a multi‐contextual approach to understand and prevent bullying.
Children's reasoning about the self‐presentational consequences of apologies and excuses following rule violations
Authors: Banerjee Robin. , Bennett Mark. , Luke Nikki.
Published: November 2009

The accounts given by those who have violated a rule are likely to have important self‐presentational consequences, potentially reducing the negative impact of the breach on social evaluations of transgressors. However, little is known about young children's self‐presentational reasoning about such accounts. In the present study, a sample of 120 4‐ to 9‐year‐olds responded to rule violation stories where the transgressor uses either an apology, an excuse, or no account. Results showed that whereas children rated both account types similarly in terms of their impact on punishment consequences, even the youngest saw apologies as leading to significantly more positive social evaluation than excuses. Correspondingly, children were more likely to identify prosocial motives for apologies than for excuses, and more likely to identify self‐protective motives for excuses than for apologies. Explicit references to self‐presentational motives when explaining the accounts increased significantly with age, and were more likely following social‐conventional rather than moral rule violations.
Replacement Children: The Transgenerational Transmission of Traumatic Loss
Authors: Schwab Gabriele
Published: November 2009

Interweaving a close reading of Philippe Grimbert's memoir, Secret , with an autobiographical narrative, this paper examines the psychology of the "replacement child" as a widespread response to the traumatic loss of a child after a violent historical event. The death of a child is always a wound and an outrage, an improper death, a death that haunts parents, siblings, and sometimes entire communities. Parents are unconsciously compelled to try to undo for themselves and their affective life what should not be. But there is more at stake—namely, a culture's specific relationship to loss, death, mortality, and mourning, especially in cases of a traumatic collective history such as that bequeathed by World War II and the Holocaust. Drawing on the work of Nicholas Abraham and Maria Torok, the author shows that family secrets and taboos placed on traumatic histories haunt the children like unknown ghosts of the past and condemn them to become the carriers of another person's or another generation's unconscious. She argues that this dynamic is at work in both children of victims and children of perpetrators, and utilizes a psychoanalytic perspective to trace the effects of violent histories on both sides of the divide. The analysis of several related literary texts illustrates the dynamic of transgenerational haunting while at the same time exemplifying how the powerful work of mourning and integration can be performed.
Mourning Vertigo
Authors: Fabe Marilyn
Published: November 2009

This paper sheds light on the psychological underpinnings of the enduring popularity of Vertigo location tours, and, more generally, on what people may be hoping to find or experience by visiting the literal remains of filmed fantasies. Those who desire to return to the places where Vertigo was filmed, it is argued, replicate the actions of its hero in the second half of the film. Scottie embarks on a futile quest to restore an unreal woman, an empty façade, an illusion created by Gavin Elster, trying to make a fictional image "real." Madeleine resembles what is described by Christian Metz as an "imaginary signifier" that is infinitely desirable but never possessible. Vertigo 's convoluted plot plays out and replays a perverse scenario that brilliantly depicts the experience of melancholia, as theorized by Giorgio Agamben as a state in which "the libido stages a simulation where what cannot be lost because it has never been possessed appears as lost" (1979, 20). Scottie's behavior is likened to that of a child who has suffered an insecure attachment to a "dead" (depressed and therefore inattentive) mother and, as a result, never develops the capacity to love truly or mourn successfully. By leaving the viewer in a painful state of unresolved suspense about Scottie's fate at the end of the film, Hitchcock reveals his inability to resolve his own issues around fear of loss and aggression toward desirable women. Those who seek out the locations of Vertigo continue Scottie's doomed quest to make a fantasy real, to diminish the gap between representation and reality, and thereby cling to an illusory means by which to overcome loss.
Government Centralization in Late Second and Third Century A.D. Asia Minor: A Working Hypothesis
Authors: Zuiderhoek Arjan
Published: November 2009

This paper offers the working hypothesis that increased central government intervention in civic and provincial affairs in the late second-and third-century A.D. Roman Empire can be partly explained by the effects of the demographic contraction following the Antonine Plague pandemic. The sharp reduction in the number of people who could work and pay rents and taxes posed a direct threat to government revenues and elite incomes. The result, growing central government attempts at direct control of local surpluses and increased exploitation of the non-elite population, is then tentatively documented for Roman Asia Minor.
The Key to Epic Life?: Classical Study in George Eliot's Middlemarch
Authors: Mackie Hilary
Published: November 2009

The Middlemarch narrator invokes the classical genre of epic in the "Prelude," introducing Dorothea Brooke as a character disposed for "epic life." Within the fiction of the novel, however, we see Dorothea and other characters try in various ways, but fail, to make sense of their lives through the study, employment, or imitation of classical models. Nevertheless, the narrator ultimately seems to suggest that classical study and classical models can have value for understanding contemporary life—provided one recognizes that "the past" is not a fixed thing, but a series of ideas and images always open to reinterpretation, preferably in a playful manner.
The Hymn to Hermes and the Athenian Altar of the Twelve Gods
Authors: Johnston Richard W. , Mulroy David
Published: November 2009

Newly observed congruencies between Homeric Hymn (4) to Hermes and circumstances in Peisistratid Athens lend credence to Norman O. Brown's hypothesis that the hymn was motivated by the establishment of the Altar of the Twelve Gods in Athens in 522/521 B.C. Relevant details in the hymn include the use by Hermes of a gluphanos , a sculptor's chisel, his unmotivated journey to Pylos, and the location of his sacrifice on the banks of the Alpheios River. The last two details seemed designed to conjure up a connection between the cult of the Twelve Gods and the ancient Neleids, Peisistratus' supposed ancestors.
Exploring Relationships: Amicitia and Familia in Cicero's de Amicitia
Authors: Gruber-Miller John
Published: November 2009

In Cicero's de Amicitia , it is striking that Cicero utilizes the vocabulary of family relationships to describe friendship and creates a dialogue that focuses on interlocutors who are both friends and family members who are joined through marriage. After briefly introducing readers to the intersection between friendship and familial relationships in the dialogue, a set of learning activities is presented to help students explore the dynamics of family and friendship in Roman society, to compare Roman concepts of family and friendship to contemporary ideas, and finally to compare Cicero's idealized version of friendship in the dialogue with actual relationships seen in the letters.
The Perils of "Pure Democracy": Minority Rights, Liquor Politics, and Popular Sovereignty in Antebellum America
Authors: Volk Kyle G.
Published: November 2009

Examining conflict over local option liquor license laws passed in numerous states during the mid-1840s, this article exposes a pioneering moment in the history of direct democracy. Spurred by the temperance movement's crusade against alcohol and liquor licensing, local option laws empowered local voting majorities, in a referendum-like manner, to decide annually at the ballot box whether or not licenses would be issued. Based on investigation of reform literature, legislative reports, newspapers, and court opinions, this article illustrates how reformers' enlistment of the ideas of majority rule and popular political empowerment to legitimate local option prompted debates that moved beyond the propriety of restrictive liquor regulation and resulted in a widespread reassessment of fundamental tenets of American popular sovereignty. Turning to the activities of liquor dealers and others who resisted local option, this article uncovers a groundbreaking strain of dissent that coalesced in Delaware. By suggesting limits to popular political empowerment and majority rule and stressing the ability of representative democracies to protect minority rights, attorneys representing pro-liquor forces convinced Delaware's highest court to declare local option unconstitutional. Not only did their ideas reverberate in other court decisions and policy debates of the period, but they established a lasting practice of questioning ballot box legislation grounded in the ideas of James Madison and other elite thinkers concerned about the threat of majority tyranny. In the process, pro-liquor groups helped democratize the tradition of questioning majority rule for future use by other nonelite minorities.
Beyond Virtually Jewish: New Authenticities and Real Imaginary Spaces in Europe
Authors: Gruber Ruth Ellen
Published: November 2009

This essay explores two “real imaginary” worlds in Europe -- the “virtually Jewish” and the “imaginary wild west.” The author describes some of the ways that European non-Jews adopt, enact and transform elements of Jewish culture, using Jewish culture at times to create, mold, or find, their own identities. She also describes a surprising and remarkably multi-faceted Far West subculture in Europe that, stoked, marketed and even created by popular culture, forms a connected collection of “Wild Western spaces.” There are major differences between the “virtually Jewish” phenomenon and the “virtually western” European response to the American Frontier saga. One has to do with a real, traumatic issue: coming to terms with the Holocaust and its legacy of guilt and loss. The other is the embrace and elaboration of a collective fantasy and its translation into personal experience. But in certain ways they can be viewed as analogous phenomena. Both have to do with identity, and the ways in which people use other cultures to shape their own identities. In addition, in both “virtually Jewish” and “imaginary western” realms, the issue of “authenticity” is involved, as well as the distinction between creative cultural appropriation and mere imitation. Both entail the creation of “new authenticities” -- things, places and experiences that in themselves are real, with all the trappings of reality, but that are quite different from the “realities” on which they are modeled or that they are attempting to evoke. The process has led to the formation of models, stereotypes, modes of behavior and even traditions.
B. R. Ambedkar, John Dewey, and the Meaning of Democracy
Authors: Mukherjee Arun P.
Published: November 2009

This paper looks at the influence of American pragmatist philosopher, John Dewey, on Indian leader and intellectual, B. R. Ambedkar and Ambedkar’s refashioning of Deweyan thought into a tool for his own investigations of Indian society. Ambedkar studied at Columbia University from 1913 to 1916, and Dewey was his favorite teacher there. Ambedkar’s writings quote widely from Dewey, especially his book

Democracy and Education

. Ambedkar was deeply influenced by Deweyan idea of democracy as “associated life” which went beyond electing a government at regular intervals. Indeed, for both Ambedkar and Dewey, this idea encapsulated their understanding of humans as both products of their social environment and as agents who continuously changed their social environment through communication and education. Ambedkar used these Deweyan ideas about the human and social life to critique the caste-based Hindu society, to fight for the rights of untouchables, and to envision an Indian democracy based on the ideals of equality, liberty and fraternity.
Attuned Listening in Ricardo Piglia’s Plata quemada
Authors: Jagoe Eva-Lynn
Published: November 2009

This article argues that Ricardo Piglia’s novel Plata quemada should be read not simply as a postmodern experiment in polyvocal narration but as a collage of sounds of all kinds, of which voices are but one, and which should be experienced “musically.” An attuned listening is proposed as a way to approach the text. This listening is modeled on the Lacanian psychoanalyst who seeks to attend to the articulations of the analys and without imposing his or her ego onto the process of analysis. This approach to the novel does not close itself off through guilt, defensiveness, emotionality, or narcissism, but rather attends to the form of the text rather than interpreting its content. By attuning our reading to the complex and intimate music that makes up a novel, we can begin to understand the ways that form renders intelligible complex social formations and subject positions. This offers a reading of the novel that it is attentive to its formal and technological interest in addition to its political concerns.
Plasma homocysteine, apolipoprotein E status and vascular disease in elderly patients with mental illness
Authors: Nilsson Karin , Gustafson Lars , Nornholm Michael , Hultberg Björn
Published: November 2009

Background:Total plasma homocysteine (tHcy) concentration is increased in elderly patients with mental illness. Also, patients with vascular disease have significantly higher plasma tHcy concentration compared with patients without vascular disease. Apolipoprotein E (apoE) status is associated with cardiovascular disease and a major genetic risk factor is inheritance of thee4allele. In the present study, we investigated the association between plasma tHcy and apoE status.

Methods:The relation between apoE status, plasma tHcy and vascular disease was investigated in a cohort of consecutively enrolled elderly patients with mental illness (n=328).

Results:Plasma tHcy concentrations were increased (p<0.01) in carriers ofAPOE4(13.6 μmol/L; 9.2–21.7 μmol/L) compared to non-carriers (12.4 μmol/L; 8.3–19.9 μmol/L). The proportion of patients with vascular disease was significantly (p<0.001) increased among carriers (61%) compared to non-carriers (42%). An increased percentage (p<0.001) ofAPOE4carriers was observed in patients with Alzheimer's disease (AD) with (71%) or without vascular disease (42%), and in patients with vascular dementia (VaD) (54%) compared to a reference group (34%).

Conclusions:Since carriers ofAPOE4showed an increased likelihood of vascular disease, these patients need more intensive control of other modifiable vascular risk factors. Furthermore, the association between plasma tHcy and the presence ofAPOE4might be attributed to an increased proportion of vascular disease inAPOE4carriers.

Clin Chem Lab Med 2010;48:129–35.
Analytical validation of serum bone alkaline phosphatase (BAP OSTASE) on Liaison
Authors: Cavalier Etienne , Rozet Eric , Carlisi Agnès , Bekaert Anne-Catherine , Rousselle Olivier , Hubert Philippe , Chapelle Jean-Paul , Delanaye Pierre
Published: November 2009

Background: The goal of this study was to validate the DiaSorin Liaison BAP OSTASE, a new method for measurement of bone alkaline phosphatase (BAP), and to compare this method with the Beckman-Coulter Access Ostase. We also wanted to establish the reference range for BAP in adults and children.

Methods: We determined the precision, functional sensitivity, recovery, linearity and measurement uncertainty, accuracy profile and β-expectation limits. We defined an adult reference interval using individuals with 25-OH vitamin D >80 nmol/L, parathormone <58 ng/L, and normal calcium, phosphorous and estimated glomerular filtration rate. Each adult subclass (men/non-menopausal women/menopause women) contained 120 individuals. We also determined the 2.5th and 97.5th percentiles from a population of 450 children, stratified according to age and gender.

Results: The results of the validation showed: precision <6%, functional sensitivity <0.74 μg/L, mean recovery 98.8±4.2% and good linearity. Relative uncertainty ranged from 9.0% to 12.9%, and the risk of one result falling out of the ±15% acceptance limits was <5% for concentrations between 7 and 94 μg/L. The Bland-Altman plot showed no systematic bias between the two methods. In adults, we did not find any statistical difference between the different subclasses. The upper limit of normality observed in the entire population (n=360) was 21.3 μg/L (90% CI: 18.3–24.2 μg/L).

Conclusions: The Liaison BAP OSTASE is a robust method, and is completely validated between 7 and 93 μg/L: in this range, 95% of the values obtained will be within ±15% of the true value.

Clin Chem Lab Med 2010;48:67–72.
Laboratory reference intervals during pregnancy, delivery and the early postpartum period
Authors: Klajnbard Anna , Szecsi Pal B. , Colov Nina P. , Andersen Malene R. , Jørgensen Maja , Bjørngaard Brian , Barfoed Anne , Haahr Katrine , Stender Steen
Published: November 2009

Background: Physiological changes during pregnancy may affect laboratory parameters. Reference values based on samples from non-pregnant women are not necessarily useful for clinical decisions during pregnancy. There is a need to establish reference values during pregnancy in order to recognize pathological conditions.

Methods: Eight hundred and one women with expected normal pregnancies were included in the study. Of these, 391 had no complications during pregnancy, delivery, or the early postpartum period. Blood samples were obtained at gestational weeks 13–20, 21–28, 29–34, 35–42, at labor, and 1 and 2 days postpartum. Reference intervals were calculated for 36 tests as recommended by the International Federation of Clinical Chemistry and Laboratory Medicine.

Results: Many tests showed such large variations indicating that gestational age-specific reference intervals were necessary. Other tests had different but stable values when compared to non-pregnant women. A minor decrease in albumin levels was observed. This was not only due to pregnancy-associated hemodilution, since other components with the same or a larger molecular diameter did not show a similar decrease. Many tests exhibited a broad distribution around vaginal delivery and in the early postpartum period.

Conclusions: Only a few parameters were unaffected during uncomplicated pregnancy, delivery, and the early postpartum period suggesting that implementation of gestational age-specific reference intervals is necessary.

Clin Chem Lab Med 2010;48:237–48.
The Beckman DxI 800 prolactin assay demonstrates superior specificity for monomeric prolactin
Authors: Byrne Brendan , O'Shea Paula , Barrett Patricia , Tormey William
Published: November 2009

Background: Commercially available prolactin immunoassays detect macroprolactin to variable degrees. Best practice requires laboratories to assess the cross-reactivity of their prolactin assay with macroprolactin, and where appropriate, introduce a screen for the presence of macroprolactin. Our policy has been to reanalyse hyperprolactinaemic samples following polyethylene glycol (PEG) precipitation and to report the resultant value as the monomeric prolactin content of the sample. The goal of this study was to determine the need to continue PEG precipitation when prolactin measurements with the Wallac AutoDELFIA were replaced by the Beckman DxI 800.

Methods: A total of 317 apparently hyperprolactinaemic samples were analysed for prolactin using the Beckman DxI 800 and results compared with those determined with the PEG screening technique on the Wallac AutoDELFIA. Any samples demonstrating a discordance of >25% were re-analysed using gel filtration chromatography (GFC) for a definitive result.

Results: The results indicate the Beckman DxI overestimates the prolactin concentration in 1%–2% of hyperprolactinaemic samples. PEG precipitation prior to analysis with the Wallac AutoDELFIA resulted in a 1% false negative diagnosis of hyperprolactinaemia.

Conclusions: Prolactin results can be reported directly from the DxI. When results are discordant with the clinical presentation, prolactin should be measured using GFC.

Clin Chem Lab Med 2010;48:205–8.
Extralimital presence of small mammals in north-eastern Algerian Sahara
Authors: Brahmi Karima , Khechekhouche El Amin , Mostefaoui Otman , Bebba Kaouther , Hadjoudj Moussa , Doumandji Salahedine , Baziz Belkacem , Aulagnier Stéphane
Published: November 2009

No abstract available
Radiation Exposure in 212 Very Low and Extremely Low Birth Weight Infants
Authors: Puch-Kapst Kathrin , Juran Ralf , Stoever Brigitte , Wauer Roland R.
Published: November 2009

OBJECTIVE: We determined the frequency and estimated effective radiation dose (E) from conventional diagnostic radiographs for infants who had birth weight of ≤1500 g (very low birth weight [VLBW] infants) and were treated in a NICU.

METHODS: Entrance skin doses were experimentally measured for all standard weight-dependent exposure settings. For each radiograph in the radiologic file, the exposed area on the film was measured manually. Together with clinical data obtained from the Vermont Oxford Network, medical charts, and radiologic files, we estimated E. E values per radiograph and per child were compared with recommended reference values and annual natural background radiation (NBR). We used reference data to estimate the risk for radiation-induced cancers.

RESULTS: Of 212 VLBW infants, 194 required at least 1 conventional radiograph. Measured entrance skin dose varied between 11.8 and 15.0 μGy. Calculated E received was 16 microsievert (μSv; median) per radiograph and 71.5 μSv (median) per infant for the whole stay. Infants with birth weight ≤750 g, length of stay ≥16 weeks, congenital malformations, or oxygen dependence for ≥36 weeks were at risk for high numbers of radiographs and high radiation dose. Compared with the annual NBR, the median of 4 radiographs per infant contributes 12 days of NBR. We estimated that only 1 of 60000 NICU-treated VLBW infants will develop a fatal malignancy up to 15 years of age.

CONCLUSIONS: We found that NICU-treated VLBW infants had low radiation exposure compared with the annual NBR.
The Changing Face of Childhood Celiac Disease in North America: Impact of Serological Testing
Authors: McGowan Kelly E. , Castiglione Derek A. , Butzner J. Decker
Published: November 2009

OBJECTIVE: The goal was to evaluate the impact of immunoglobulin A endomysial antibody testing on the incidence and clinical presentation of childhood celiac disease.

METHODS: The incidence and clinical presentation of celiac disease in patients <18 years of age in 1990–1996 (pretesting group) versus 2000–2006 (testing group) were compared.

RESULTS: The median age at diagnosis was 2 years (95% confidence interval: 2–4 years) in the pretesting group (N = 36), compared with 9 years (95% confidence interval: 8–10 years) in the testing group (N = 199; P < .001); the female/male ratios (1.6:1) were similar (P = .982). The incidence of celiac disease increased from 2.0 cases per 100000 children (pretesting group) to 7.3 cases per 100000 children (testing group; P = .0256). The frequency of classic celiac disease presentations decreased from 67% (pretesting group) to 19% (testing group; P < .001), but the incidence of classic celiac disease did not differ (0.8 vs 1.6 cases per 100000; P = .154). In the testing group, 13 previously unrecognized clinical presentations were observed in 98 children, including 35 with family history, 18 with abdominal pain, and 14 with type 1 diabetes mellitus. The frequency of Marsh IIIc lesions decreased from 64% (pretesting group) to 44% (testing group; P = .0403). In the testing group, classic celiac disease remained predominant (67%) in young children (<3 years), whereas atypical gastrointestinal and silent presentations predominated in older children.

CONCLUSIONS: Antibody testing for celiac disease tripled the incidence of celiac disease and quadrupled the median age at diagnosis.
Rectal Fecal Impaction Treatment in Childhood Constipation: Enemas Versus High Doses Oral PEG
Authors: Bekkali Noor-L-Houda , van den Berg Maartje-Maria , Dijkgraaf Marcel G.W. , van Wijk Michiel P. , Bongers Marloes E.J. , Liem Olivia , Benninga Marc A.
Published: November 2009

OBJECTIVE: We hypothesized that enemas and polyethylene glycol (PEG) would be equally effective in treating rectal fecal impaction (RFI) but enemas would be less well tolerated and colonic transit time (CTT) would improve during disimpaction.

METHODS: Children (4–16 years) with functional constipation and RFI participated. One week before disimpaction, a rectal examination was performed, symptoms of constipation were recorded, and the first CTT measurement was started. If RFI was determined, then patients were assigned randomly to receive enemas once daily or PEG (1.5 g/kg per day) for 6 consecutive days. During this period, the second CTT measurement was started and a child's behavior questionnaire was administered. Successful rectal disimpaction, defecation and fecal incontinence frequencies, occurrence of abdominal pain and watery stools, CTTs (before and after disimpaction), and behavior scores were assessed.

RESULTS: Ninety-five patients were eligible, of whom 90 participated (male, n = 60; mean age: 7.5 ± 2.8 years). Forty-six patients received enemas and 44 PEG, with 5 dropouts in each group. Successful disimpaction was achieved with enemas (80%) and PEG (68%; P = .28). Fecal incontinence and watery stools were reported more frequently with PEG (P < .01), but defecation frequency (P = .64), abdominal pain (P = .33), and behavior scores were comparable between groups. CTT normalized equally (P = .85) in the 2 groups.

CONCLUSION: Enemas and PEG were equally effective in treating RFI in children. Compared with enemas, PEG caused more fecal incontinence, with comparable behavior scores. The treatments should be considered equally as first-line therapy for RFI.
Improving Asthma Outcomes in Minority Children: A Randomized, Controlled Trial of Parent Mentors
Authors: Flores Glenn , Bridon Christina , Torres Sylvia , Perez Ruth , Walter Tim , Brotanek Jane , Lin Hua , Tomany-Korman Sandy
Published: November 2009

OBJECTIVE: Because asthma disproportionately affects minorities, we evaluated the effects of parent mentors (PMs) on asthma outcomes in minority children.

METHODS: This randomized, controlled trial allocated minority asthmatic children to the PM intervention or traditional asthma care. Intervention families were assigned PMs (experienced parents of asthmatic children who received specialized training). PMs met monthly with children and families at community sites, phoned parents monthly, and made home visits. Ten asthma outcomes and costs were monitored for 1 year. Outcomes were examined by using both intention-to-treat analyses and stratified analyses for high participants (attending ≥25% of community meetings and completing ≥50% of PM phone interactions).

RESULTS: Patients were randomly assigned to PMs (n = 112) or the control group (n = 108). In intention-to-treat analyses, intervention but not control children experienced significantly reduced rapid-breathing episodes, asthma exacerbations, and emergency department (ED) visits. High participants (but not controls or low participants) experienced significantly reduced wheezing, asthma exacerbations, and ED visits and improved parental efficacy in knowing when breathing problems are controllable at home. Mean reductions in missed parental work days were greater for high participants than controls. The average monthly cost per patient for the PM program was $60.42, and net savings of $46.16 for high participants.

CONCLUSIONS: For asthmatic minority children, PMs can reduce wheezing, asthma exacerbations, ED visits, and missed parental work days while improving parental self-efficacy. These outcomes are achieved at a reasonable cost and with net cost savings for high participants. PMs may be a promising, cost-effective means for reducing childhood asthma disparities.
Prenatal Di(2-ethylhexyl)Phthalate Exposure and Length of Gestation Among an Inner-City Cohort
Authors: Whyatt Robin M. , Adibi Jennifer J. , Calafat Antonia M. , Camann David E. , Rauh Virgina , Bhat Hari K. , Perera Frederica P. , Andrews Howard , Just Allan C. , Hoepner Lori , Tang Deliang , Hauser Russ
Published: November 2009

OBJECTIVE: Our objective was to assess the relationship between di(2-ethylhexyl)phthalate (DEHP) exposure during pregnancy and gestational age at delivery among 311 African American or Dominican women from New York City.

METHODS: Forty-eight-hour personal air and/or spot urine samples were collected during the third trimester. DEHP levels were measured in air samples and 4 DEHP metabolite levels were measured in urine. Specific gravity was used to adjust for urinary dilution. Gestational age was abstracted from newborn medical records (n = 289) or calculated from the expected date of delivery (n = 42). Multivariate linear regression models controlled for potential confounders.

RESULTS: DEHP was detected in 100% of personal air samples (geometric mean: 0.20 μg/m3 [95% confidence interval [CI]: 0.18–0.21 μg/m3]); natural logarithms of air concentrations were inversely but not significantly associated with gestational age. Two or more of the DEHP metabolites were detected in 100% of urine samples (geometric mean: 4.8–38.9 ng/mL [95% CI: 4.1–44.3 ng/mL]). Controlling for potential confounders, gestational age was shorter by 1.1 days (95% CI: 0.2–1.8 days) for each 1-logarithmic unit increase in specific gravity-adjusted mono(2-ethylhexyl)phthalate concentrations (P = .01) and averaged 5.0 days (95% CI: 2.1–8.0 days) less among subjects with the highest versus lowest quartile concentrations (P = .001). Results were similar and statistically significant for the other DEHP metabolites.

CONCLUSIONS: Prenatal DEHP exposure was associated with shorter gestation but, given inconsistencies with previous findings for other study populations, results should be interpreted with caution, and additional research is warranted.
Intellectual Outcome from Preschool Traumatic Brain Injury: A 5-Year Prospective, Longitudinal Study
Authors: Anderson Vicki , Catroppa Cathy , Morse Sue , Haritou Flora , Rosenfeld Jeffrey V.
Published: November 2009

INTRODUCTION: Traumatic brain injury (TBI) is a common, acquired disability that may be used as a model to understand the impact of early brain injury on brain structure and function. To date, few studies have followed very young children over time after insult.

OBJECTIVE: To plot recovery and outcome of intellectual ability after early TBI over the 5 years after injury, and to identify predictors of outcome including injury, sociodemographic and preinjury characteristics, and acute functional recovery.

DESIGN: Children aged between 2 and 7 years who were diagnosed with TBI (N = 54) were consecutively recruited on admission to the Royal Children's Hospital, Victoria, Australia, to participate in a prospective, longitudinal study. Our study had a between-factor design that used injury severity as the independent variable. The participants were categorized into groups according to injury severity (mild, moderate, or severe), and were compared with healthy control participants (n = 16) at the acute time point, and at 12 months, 30 months, and 5 years after injury. Intellectual measures, including verbal and nonverbal skills, attention, and processing speed, were administered.

RESULTS: Children with severe injuries demonstrated slower recovery and poorer cognitive outcomes up to 5 years after injury than did those who were observed for less severe injuries. Recovery trajectories were associated with injury severity over the first 30 months after injury, with the greatest deterioration in function observed for more severe injuries. From 30 months to 5 years after injury, progress was stable. Only injury severity (as determined by the Glasgow Coma Scale score) and acute cognitive performance were strong predictors of 5-year outcomes.

CONCLUSIONS: This study has confirmed the high risk of persisting and global deficits associated with severe brain insult in early childhood. Contrary to previous speculation about “growing into deficits,” children with severe brain insults have more protracted recovery periods but do not continue to lose ground compared with their peers. By 30 months after insult, recovery seems to stabilize and children begin to make appropriate developmental gains.
Prevalence of Down Syndrome Among Children and Adolescents in 10 Regions of the United States
Authors: Shin Mikyong , Besser Lilah M. , Kucik James E. , Lu Chengxing , Siffel Csaba , Correa Adolfo ,   the Congenital Anomaly Multistate Prevalence and Survival (CAMPS) Collaborative
Published: November 2009

OBJECTIVE: We aimed to estimate the prevalence of Down syndrome (DS) among children and adolescents aged 0 to 19 years in 10 regions of the United States.

METHODS: This study was a cross-sectional analysis of live-born infants with DS during 1979–2003 from 10 population-based birth defects registries in the United States. We estimated the prevalence of DS at birth and among children aged 0 to 19 years in each region and in all regions pooled. The prevalence of DS among children and adolescents was calculated overall and according to age group, race/ethnicity, infant gender, and presence of a major heart defect.

RESULTS: From 1979 through 2003, the prevalence of DS at birth increased by 31.1%, from 9.0 to 11.8 per 10000 live births in 10 US regions. In 2002, the prevalence among children and adolescents (0–19 years old) was 10.3 per 10000. The prevalence of DS among children in a given age group consistently increased over time but decreased with age within a given birth cohort. The pooled prevalence of DS among children and adolescents was lower among non-Hispanic black individuals and other racial/ethnic groups compared with non-Hispanic white individuals; it was also lower among females than males.

CONCLUSIONS: This study provides prevalence estimates of DS among children and adolescents from 10 US regions. These estimates varied according to region, race/ethnicity, and gender, suggesting possible variation in prevalence at birth or in survival rates on the basis of these characteristics.
Outcome of Term Infants Using Apgar Scores at 10 Minutes Following Hypoxic-Ischemic Encephalopathy
Authors: Laptook Abbot R. , Shankaran Seetha , Ambalavanan Namasivayam , Carlo Waldemar A. , McDonald Scott A. , Higgins Rosemary D. , Das Abhik ,   the Hypothermia Subcommittee of the NICHD Neonatal Research Network
Published: November 2009

OBJECTIVE: The objective of this study was to determine whether Apgar scores at 10 minutes are associated with death or disability in early childhood after perinatal hypoxic-ischemic encephalopathy.

METHODS: This was a secondary analysis of infants who were enrolled in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network hypothermia trial. Infants who were born at ≥36 weeks’ gestation and had clinical and/or biochemical abnormalities at birth and encephalopathy at <6 hours were studied. Logistic regression and classification and regression-tree analysis were used to determine associations between Apgar scores at 10 minutes and neurodevelopmental outcome, adjusting for covariates. Death or disability (moderate or severe) at 18 to 22 months of age was the measured outcome.

RESULTS: Twenty of 208 infants were excluded (missing data). More than 90% of the infants had Apgar scores of 0 to 2 at 1 minute, and Apgar scores at 5 and 10 minutes shifted to progressively higher values; at 10 minutes, 27% of infants had Apgar scores of 0 to 2. After adjustment, each point decrease in Apgar score at 10 minutes was associated with a 45% increase in the odds of death or disability. Death or disability occurred in 76%, 82%, and 80% of infants with 10-minute Apgar scores of 0, 1, and 2, respectively. Classification and regression-tree analysis indicated that Apgar scores at 10 minutes were discriminators of outcome.

CONCLUSIONS: Apgar scores at 10 minutes provide useful prognostic data before other evaluations are available for infants with hypoxic-ischemic encephalopathy. Death or moderate/severe disability is common but not uniform with Apgar scores of <3; caution is needed before adopting a specific time interval to guide duration of resuscitation.
Neurodevelopmental Outcome of Infants With Unilateral or Bilateral Periventricular Hemorrhagic Infarction
Authors: Maitre Nathalie L. , Marshall Diane D. , Price Wayne A. , Slaughter James C. , O'Shea Thomas M. , Maxfield Charles , Goldstein Ricki F.
Published: November 2009

OBJECTIVE: Periventricular hemorrhagic infarction (PVHI) is a major contributing factor to poor neurodevelopmental outcomes in preterm infants. We hypothesized that surviving infants with unilateral PVHI would have more favorable outcomes than those with bilateral PVHI.

METHODS: This was a multicenter, retrospective study of infants who were admitted to 3 NICUs in North Carolina from 1998 to 2004. The clinical course and late neuroimaging studies and neurodevelopmental outcomes of 69 infants who weighed <1500 g and had confirmed PVHI on early cranial ultrasonography were reviewed. A predictive model for Bayley Scales of Infant Development, Second Edition, Mental Developmental Index (MDI) <70 was constructed by using radiologic and clinical variables.

RESULTS: Infants with unilateral PVHI had higher median MDI (82 vs 49) and Psychomotor Developmental Index (53 vs 49) than infants with bilateral PVHI. Infants with unilateral PVHI were less likely to have severe cerebral palsy (adjusted odds ratio: 0.15 [95% confidence interval (CI): 0.05–0.45]) than infants with bilateral PVHI. Infants who had unilateral PVHI and developed periventricular leukomalacia and retinopathy of prematurity that required surgery had an increased probability of having MDI <70 compared with those without these complications (probability of MDI <70: 89% [95% CI: 0.64–1.00] vs 11% [95% CI: 0.01–0.28]).

CONCLUSIONS: Infants with unilateral PVHI had better motor and cognitive outcomes than infants with bilateral PVHI. By combining laterality of PVHI, periventricular leukomalacia, and retinopathy of prematurity it is possible to estimate the probability of having an MDI <70, which will assist clinicians when counseling families.
Skin-to-Skin Contact and/or Oral 25% Dextrose for Procedural Pain Relief for Term Newborn Infants
Authors: Chermont Aurimery Gomes , Falcão Luis Fábio Magno , de Souza Silva Eduardo Henrique Laurindo , de Cássia Xavier Balda Rita , Guinsburg Ruth
Published: November 2009

OBJECTIVE: The goal was to compare the efficacy of oral 25% dextrose treatment and/or skin-to-skin contact for analgesia in term newborns during intramuscular injection of a hepatitis B vaccine.

METHODS: A prospective, randomized, partially blinded, clinical trial was performed with 640 healthy term newborns. Infants at 12 to 72 hours of life were assigned randomly to receive an intramuscular injection of hepatitis B vaccine in the right thigh according to 4 analgesia groups, that is, no analgesia (routine); oral 25% dextrose treatment, given 2 minutes before the injection; skin-to-skin contact, initiated 2 minutes before the injection and persisting throughout the procedure; and a combination of the oral dextrose treatment and skin-to-skin contact strategies. For all groups, Neonatal Facial Coding System and Neonatal Infant Pain Scale scores were evaluated before the procedure, during thigh cleansing, during the injection, and 2 minutes after the injection. Premature Infant Pain Profile scores also were assessed for all infants. Pain scores were compared among the 4 groups.

RESULTS: The use of oral 25% dextrose treatment reduced the duration of procedural pain in the studied population. Skin-to-skin contact decreased injection pain and duration. The combination of the 2 analgesic measures was more effective than either measure separately for term newborns.

CONCLUSIONS: Nonpharmacologic analgesic measures were effective for the treatment of procedural pain in term infants. The combination of oral 25% dextrose treatment and skin-to-skin contact acted synergistically to decrease acute pain in healthy neonates.
The Effect of State Early Intervention Eligibility Policy on Participation Among a Cohort of Young CSHCN
Authors: McManus Beth , McCormick Marie C. , Acevedo-Garcia Dolores , Ganz Michael , Hauser-Cram Penny
Published: November 2009

OBJECTIVE: This purpose of this study was to describe differences in early intervention (EI) participation according to state among a cohort of young children with parent-reported developmental delays and disabilities.

METHODS: Data were obtained from the 2005–2006 National Survey of Children With Special Health Care Needs to describe state differences in EI participation. Multilevel modeling was used to estimate the relative contributions of child sociodemographic and developmental characteristics, and state EI eligibility policy on EI participation.

RESULTS: The overall rate of EI participation was 45.7% (23.1%–83.3% across the states). EI participants were less likely to be Hispanic, live in a multiracial family, be poor, have a developmental delay, or have a less severe condition/delay. The predicted probability of receiving EI was lower for children who lived in states with more strict EI eligibility criteria than those with liberal criteria (.43 vs .52). Poverty influenced this association, with the adjusted probabilities of receiving EI for poor (<100% federal poverty level) and nonpoor (>185% federal poverty level) children being .18 and .36, respectively (P < .05). Among nonpoor children, those who lived in states with strict eligibility criteria were nearly as likely as poor children who lived in states with liberal eligibility criteria to receive EI (.33 vs .36; P < .05).

CONCLUSIONS: The results of this study reveal marked disparities and unmet needs in EI participation as a function of both characteristics of the child and the state program. Improving developmental services for vulnerable populations requires addressing these sources of disparity.
What Factors Are Associated With State Performance on Provision of Transition Services to CSHCN?
Authors: Kane Debra J. , Kasehagen Laurin , Punyko Judy , Carle Adam C. , Penziner Andy , Thorson Sarah
Published: November 2009

OBJECTIVE: To examine whether individual, condition-related, and system-related characteristics are associated with state performance (high, medium, low) on the provision of transition services to children with special health care needs (CSHCN).

METHODS: We conducted descriptive, bivariate, and multivariable analyses of 16876 children aged 12 to 17 years by using data from the 2005–2006 National Survey of Children With Special Health Care Needs. Polytomous logistic regression was used to compare the characteristics of CSHCN residing within high-, medium-, and low-performance states, with low-performance states serving as the reference group.

RESULTS: Compared with non-Hispanic white CSHCN, Hispanic (adjusted odds ratio [aOR]: 0.25 [95% confidence interval (CI): 0.17–0.37]) and non-Hispanic black (aOR: 0.44 [95% CI: 0.30–0.62]) CSHCN were less likely to reside in a high-performance than in a low-performance state. Compared with CSHCN who had a medical home or adequate insurance coverage, CSHCN who did not have a medical home or adequate insurance coverage were less likely to reside in a high-performance than in a low-performance state (aOR: 0.73 [95% CI: 0.57–0.95]; aOR: 0.73 [95% CI: 0.58–0.93], respectively).

CONCLUSIONS: Key factors found to be important in a state's performance on provision of transition services to CSHCN were race/ethnicity and having a medical home and adequate insurance coverage. Efforts to support the Maternal and Child Health Bureau's integration of system-level factors in quality-improvement activities, particularly establishing a medical home and attaining and maintaining adequate insurance, are likely to help states improve their performance on provision of transition services.