bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-term changes in macroalgal assemblages after increased sedimentation and turbidity in Western Port, Victoria, Australia
Authors: Shepherd Scoresby A. , Watson Jeanette E. , Womersley H. Bryan S. , Carey Janet M.
Published: May 2009

The long-term impacts of declining water quality from coastal development on macro-algal communities can be devastating, but are rarely known because of lack of baseline studies. This study examines the effect of increased sediment and reduced water quality over 35 years in an Australian temperate coastal embayment. The algal assemblage on Crawfish Rock in northern Western Port was surveyed in 1967–1971 and in 2002–2006. During the 1980s, water quality declined following large-scale seagrass loss. In 1971, the Rock had a rich algal flora with 138 recorded species, including 97 species of Rhodophyta. The biomass and cover of canopy and understorey species were measured at sites of strong and slight current on a depth gradient. In 1971, fucoid or laminarian canopy species were dominant from ∼1–8 m depth, and an algal understorey extended from the intertidal zone to 12–13 m depth. In 2002–2006 the canopy species extended to only 3 m depth and the algal understorey to ∼4 m depth, and 66% of the algal species had disappeared, although a few additional species were present. Persistent, sediment-tolerant species included several phaeophycean canopy species, some chlorophytes (Caulerpa spp.) and a few rhodophytes.
On k-Imperfect Numbers
Authors: Zhou Weiyi , Zhu Long
Published: May 2009

A positive integer
The Shortest Game of Chinese Checkers and Related Problems
Authors: Bell George I.
Published: May 2009

In 1979, David Fabian found a complete game of two-person Chinese Checkers in 30 moves (15 by each player). This solution requires that the two players cooperate to generate a win as quickly as possible for one of them. We show, using computational search techniques, that no shorter game is possible. We also consider a solitaire version of Chinese Checkers where one player attempts to move her pieces across the board in as few moves as possible. In 1971, Octave Levenspiel found a solution in 27 moves; we demonstrate that no shorter solution exists. To show optimality, we employ a variant of A* search, as well as bidirectional search.
On Rapid Generation of SL2(𝔽 q )
Authors: Chapman Jeremy , Iosevich Alex
Published: May 2009

We prove that if

The proof relies on a result, previously established by D. Hart and the author (Iosevich, Contemporary Math.), which implies that if |

|{(
Integer Partitions into Arithmetic Progressions with an Odd Common Difference
Authors: Bouroubi Sadek , Tani Nesrine Benyahia
Published: May 2009

Thomas E. Mason has shown that the number of ways in which a number
On Asymptotic Constants Related to Products of Bernoulli Numbers and Factorials
Authors: Kellner Bernd C.
Published: May 2009

We discuss the asymptotic expansions of certain products of Bernoulli numbers and factorials, e.g.,

for integers
Action in cognition: The case of language
Authors: Taylor Lawrence J. , Zwaan Rolf A.
Published: May 2009

Empirical research has shown that the processing of words and sentences is accompanied by activation of the brain's motor system in language users. The degree of precision observed in this activation seems to be contingent upon (1) the meaning of a linguistic construction and (2) the depth with which readers process that construction. In addition, neurological evidence shows a correspondence between a disruption in the neural correlates of overt action and the disruption of semantic processing of language about action. These converging lines of evidence can be taken to support the hypotheses that motor processes (1) are recruited to understand language that focuses on actions and (2) contribute a unique element to conceptual representation. This article explores the role of this motor recruitment in language comprehension. It concludes that extant findings are consistent with the theorized existence of multimodal, embodied representations of the referents of words and the meaning carried by language. Further, an integrative conceptualization of “fault tolerant comprehension” is proposed.
Episodic affordances contribute to language comprehension
Authors: Glenberg Arthur M. , Becker Raymond , Klötzer Susann , Kolanko Lidia , Müller Silvana , Rinck Mike
Published: May 2009

We demonstrate how a particular type of knowledge about objects, their spatial locations and thus how to direct actions toward them, contributes to the comprehension of language about those objects. In four experiments, participants judged if sentences were about normal objects (e.g., “The apple has a stem”) or odd objects (e.g., “The apple has an antenna”). The Normal response key was either on the left of a response box or on the right. The named objects were themselves either on the left or the right of the response box. We demonstrate a compatibility effect in which responding Normal to the side where the object was located was faster than responding Normal to the opposite side. Furthermore, this effect was equally strong for sentences describing states of the objects (as above) and sentences describing actions (e.g., “Touch the apple at the stem”); the compatibility effect was found when the objects were removed; the effect required compatibility between actions, not just spatial locations; and the effect was found in both English and German. The results are discussed in relation to how action systems are used in language comprehension.
Evaluating Management Options for the Disposal of Dredged Sediments
Authors: Pantazidou Marina , Katsiri Alexandra , Reddy Krishna R.
Published: May 2009

This paper presents a screening framework that evaluates management options for the disposal of dredged sediments on the basis of chemical and toxicological characterization tests. The paper provides a combined brief overview of disposal options for dredged sediments and relevant testing, together with simplified decision rules for the feasibility of each option. The framework provides for two stages of assessment. In Stage I, disposal in open waters is evaluated based on the combination of results from chemical and toxicological analyses, supplemented by physical characteristics of sediments. For sediments that do not meet requirements for open-water disposal, Stage II evaluates the suitability of disposal in landfills or in confined facilities, upland and underwater. Decisions in Stage II are facilitated by well-established effluent criteria applied to ambient water and wastes admitted to landfills, as well as by calculations estimating the impact of sediment contaminants to the vicinity of the subaqueous confining structures. The application of the decision-making methodology is demonstrated using test results from sediment samples from Piraeus Harbor, Greece, and Indiana Harbor, IL, USA. Results showed that the framework is able to discriminate well among sediments from different subareas to be dredged. Disposal to open water is not feasible for most contaminated sediments from areas with increased shipping activities. Disposal in confined facilities (subaqueous or upland) proved to be a viable option for most of the sediments, whereas all sediments were characterized as nonhazardous and can therefore be accepted in an ordinary landfill.
Parental Misinterpretations of Over-the-Counter Pediatric Cough and Cold Medication Labels
Authors: Lokker Nicole , Sanders Lee , Perrin Eliana M. , Kumar Disha , Finkle Joanne , Franco Vivian , Choi Leena , Johnston Philip E. , Rothman Russell L.
Published: May 2009

OBJECTIVE. Concerns about the safety and efficacy of over-the-counter cold medications have led to a recent US Food and Drug Administration public health advisory against their use in children <2 years of age. Our goal was to examine caregiver understanding of the age indication of over-the-counter cold medication labels and identify factors, associated with caregiver understanding.

METHODS. Caregivers of infant children (≤1 year old) were recruited from clinics at 3 institutions. Questions were administered regarding the use of 4 previously common “infant” over-the-counter cold and cough medicines labeled to consult a physician if used in children <2 years of age. Literacy and numeracy skills were assessed with validated instruments.

RESULTS. A total of 182 caregivers were recruited; 87% were the infants' mothers. Mean education level was 12.5 years, and 99% had adequate literacy skills, but only 17% had >9th-grade numeracy skills. When examining the front of the product label, 86% of the time parents thought these products were appropriate for use in children <2 years of age. More than 50% of the time, parents stated they would give these over-the-counter products to a 13-month-old child with cold symptoms. Common factors that influenced parental decisions included label saying “infant,” graphics (eg, infants, teddy bears, droppers), and dosing directions. Caregivers were influenced by the dosing directions only 47% of the time. Caregivers with lower numeracy skills were more likely to provide inappropriate reasons for giving an over-the-counter medication.

CONCLUSIONS. Misunderstanding of over-the-counter cold products is common and could result in harm if medications are given inappropriately. Label language and graphics seem to influence inappropriate interpretation of over-the-counter product age indications. Poorer parental numeracy skills may increase the misinterpretation of these products. Opportunities exist for the Food and Drug Administration and manufacturers to revise existing labels to improve parental comprehension and enhance child safety.
The Effects of Helium/Oxygen Mixture (Heliox) Before and After Extubation in Long-term Mechanically Ventilated Very Low Birth Weight Infants
Authors: Migliori Claudio , Gancia Paolo , Garzoli Elena , Spinoni Vania , Chirico Gaetano
Published: May 2009

OBJECTIVES. Our goal was to evaluate the effects of a helium/oxygen mixture (heliox) on pulmonary mechanics and gas exchange in preterm infants during both conventional and noninvasive ventilation.

PATIENTS AND METHODS. Ten preterm infants, ventilated from birth, were enrolled. Resistive work of breathing, pulmonary compliance, static compliance, respiratory rate, minute ventilation, ventilatory support, and gas exchange were measured before and during treatment. One hour after heliox therapy, subjects who showed a decrease of peak inspiratory pressure of >20% of the initial value were extubated and shifted to nasal bilevel positive airway pressure with heliox for the following 3 hours. Pulmonary mechanics and ventilatory parameters were measured during air/oxygen ventilation and again 10 minutes and 1 hour after starting heliox. Transcutaneous pressure of O2 and CO2, oxygen saturation, and respiratory rate were recorded continuously. Arterial blood gases were measured immediately before and 1 hour after initiating bilevel positive airway pressure. To maintain oxygen saturation at >92% during the bilevel positive airway pressure phase, the mean fraction of inspired oxygen was increased from 0.34 to 0.36.

RESULTS. Mean peak inspiratory pressure decreased from 21.4 to 17.4 cmH2O, work of breathing decreased from 0.46 to 0.22 joule/L, and transcutaneous pressure of CO2 decreased from 52.3 to 49.1 mmHg. Mean transcutaneous pressure of O2 improved from 42.8 to 46.7 mmHg, and minute ventilation improved from 332 to 478 mL/kg per minute. No significant differences were observed in mean airway pressure, respiratory rate, oxygen saturation, pulmonary compliance, and static compliance. Eight infants were extubated. One of them needed to be reintubated after 5 hours.

CONCLUSIONS. Our data show that mechanical ventilation with heliox reduces resistive work of breathing and ventilatory support requirements and improves gas exchange in preterm infants.
Screening for Postpartum Depression at Well-Child Visits: Is Once Enough During the First 6 Months of Life?
Authors: Sheeder Jeanelle , Kabir Karolyn , Stafford Brian
Published: May 2009

OBJECTIVE. Screening for maternal depression is gaining acceptance as a standard component of well-child care. We tested the feasibility of this policy and determined the prevalence and incidence of maternal depression at well-child visits during the first 6 months of life.

METHODS. Providers in an adolescent-oriented maternity program were cued electronically, when they opened the electronic medical records of 0- to 6-month-old infants to conduct well-child visits, to ask the mothers to complete the Edinburgh Postpartum Depression Scale. Incident cases represented mothers who crossed the referral threshold (score of ≥10) after the first screening.

RESULTS. Mothers usually brought their infants to the clinic, and none refused screening. Providers could act on 99% of the 418 screening cues; they administered the Edinburgh Postpartum Depression Scale 98% of the time and always referred mothers with scores of ≥10. Overall, 20% of the mothers scored ≥10. Scores were unstable at ≤3 postpartum weeks (κ = 0.2). Thereafter, the prevalence and incidence of scores of ≥10 decreased from 16.5% at 2 months to 10.3% and 5.7%, respectively, at 4 months. Prevalence increased to 18.5% at the 6-month visit, and incidence decreased to 1.9%. Repeat screening detected only 2 mothers (5.7%) with scores of ≥10.

CONCLUSIONS. Electronic cueing improved compliance with the detection and referral phases of screening for maternal depression at well-child visits. Screening 2 months after delivery detects most mothers who become depressed during the first 6 postpartum months, and screening at the 6-month well-child visit is preferable to screening at the 4-month visit.
Mothers' Intention for Their Daughters and Themselves to Receive the Human Papillomavirus Vaccine: A National Study of Nurses
Authors: Kahn Jessica A. , Ding Lili , Huang Bin , Zimet Gregory D. , Rosenthal Susan L. , Frazier A. Lindsay
Published: May 2009

OBJECTIVES. The aims of this study were to examine mothers' intention to vaccinate their daughters and themselves against human papillomavirus and to determine which demographic, behavioral, and attitudinal factors were associated with intention to vaccinate daughters.

METHODS. We surveyed 10 521 US mothers, all nurses, between June 2006 and February 2007. Multivariable logistic regression models were used to determine which of the following factors were associated with a mother's intention to vaccinate a 9- to 12-year-old daughter: demographic factors, gynecologic history, belief that one's daughter should have regular Papanicolaou testing, beliefs about Papanicolaou testing outcomes (3-item scale), and beliefs about human papillomavirus vaccines (7-item scale measuring beliefs about human papillomavirus vaccine efficacy, impact of vaccination on sexual and Papanicolaou screening behaviors, severity of and susceptibility to human papillomavirus, and anticipated clinician recommendations).

RESULTS. Of the 8832 mothers who completed a survey (84% response rate), 7207 had a daughter. Among mothers with a daughter, 48% intended to vaccinate a daughter if she were 9 to 12 years of age, 68% if she were 13 to 15 years of age, and 86% if she were 16 to 18 years of age. Forty-eight percent intended to receive the vaccine themselves if recommended. In multivariable regression models, variables significantly associated with intention to vaccinate a 9- to 12-year-old daughter included belief that one's daughter should have regular Papanicolaou testing and beliefs about human papillomavirus vaccines.

CONCLUSIONS. In this first national study of mothers' attitudes about human papillomavirus vaccines, mothers' intention to vaccinate a daughter <13 years of age was lower than intention to vaccinate an older daughter, contrasting with national recommendations to target 11- to 12-year-old girls for vaccination. Educational interventions designed to affect mothers' willingness to vaccinate daughters should focus on human papillomavirus vaccine efficacy, behavioral impact of vaccination, perceived risk of human papillomavirus, and clinician support for vaccination.
Soluble Vascular Endothelial Growth Factor Receptor 1 in Tracheal Aspirate Fluid of Preterm Neonates at Birth May Be Predictive of Bronchopulmonary Dysplasia/Chronic Lung Disease
Authors: Hasan Jamal , Beharry Kay D. , Valencia Arwin M. , Strauss Arthur , Modanlou Houchang D.
Published: May 2009

OBJECTIVE. We tested the hypothesis that soluble vascular endothelial growth factor receptors are involved in the development of bronchopulmonary dysplasia/chronic lung disease.

PATIENTS AND METHODS. Neonates with a birth weight of ≤1500 g and/or ≤30 weeks’ gestation, with respiratory failure, requiring O2 and mechanical ventilation within 24 hours, were eligible. Tracheal aspirate fluid samples were collected from 65 neonates before surfactant and/or assisted mechanical ventilation (baseline), at 3 and 7 days after birth, and weekly thereafter until extubation. Samples were analyzed for total vascular endothelial growth factor, soluble vascular endothelial growth factor receptor 1 and 2 levels and compared in infants with bronchopulmonary dysplasia/chronic lung disease (n = 31) versus those with no bronchopulmonary dysplasia/chronic lung disease (n = 34).

RESULTS. Mean gestational age and birth weight were lower in infants with bronchopulmonary dysplasia/chronic lung disease. At baseline, vascular endothelial growth factor levels in the tracheal aspirate fluid were significantly lower, whereas soluble vascular endothelial growth factor receptor 1 levels were higher in the bronchopulmonary dysplasia/chronic lung disease infants compared with infants with no bronchopulmonary dysplasia/chronic lung disease. Vascular endothelial growth factor levels progressively increased from baseline to 4 weeks in all of the infants developing bronchopulmonary dysplasia/chronic lung disease. Conversely, soluble vascular endothelial growth factor receptor 1 declined in both groups from baseline to 5 weeks of age. Similarly, soluble vascular endothelial growth factor receptor 2 declined from baseline to 5 weeks in the control infants, but there were significant increases at 3 and 4 weeks in infants developing bronchopulmonary dysplasia/chronic lung disease.

CONCLUSIONS. We speculate that low vascular endothelial growth factor levels in tracheal aspirate fluid, concurrent with elevated soluble vascular endothelial growth factor receptor 1 levels on the first day of life, are biological markers for the development of bronchopulmonary dysplasia/chronic lung disease in very low birth weight infants requiring O2 and assisted mechanical ventilation.
Shielding Parenteral Nutrition From Light: Does the Available Evidence Support a Randomized, Controlled Trial?
Authors: Sherlock Rebecca , Chessex Philippe
Published: May 2009

BACKGROUND. Exposure of total parenteral nutrition to ambient light induces the generation of peroxides, creating oxidant stress, which potentially compounds complications of prematurity. Photograph protection of total parenteral nutrition reduces the peroxide load and has been shown to be associated with nutritional and biochemical benefits in animals and humans. It is unclear whether this reduction in peroxides from total parenteral nutrition leads to a reduction in the complications of prematurity, such as bronchopulmonary dysplasia. Our hypothesis was that shielding total parenteral nutrition from ambient light is linked to clinical benefits.

OBJECTIVE. The purpose of this work was to determine whether photograph protection of total parenteral nutrition (light protected), as compared with no photoprotection (light exposed), reduces the occurrence of bronchopulmonary dysplasia or death in preterm infants.

METHODS. The Canadian Neonatal Network provided data for infants born in 2006 at <28 weeks' gestation admitted to level 3 NICUs in Canada. A retrospective analysis was performed comparing bronchopulmonary dysplasia and death in infants who received light-exposed or light-protected parenteral nutrition. Data were analyzed by using logistic regression models.

RESULTS. Thirteen NICUs offered partial light-protected (total parenteral nutrition bag only, intravenous tubing exposed) and 13 offered light-exposed parenteral nutrition; not a single NICU offered complete light-protected parenteral nutrition (total parenteral nutrition bag plus intravenous tubing). The incidence of bronchopulmonary dysplasia or death was 66% with light-protected (n = 428) vs 59% with light-exposed (n = 438) parenteral nutrition.

CONCLUSIONS. Partial photograph protection of total parenteral nutrition was not associated with a reduction in bronchopulmonary dysplasia or death as compared with no photograph protection; this relationship is confounded by covariates with strong associations with bronchopulmonary dysplasia. Partial photograph protection of total parenteral nutrition solutions confers no clinical benefit, while consuming valuable resources. A randomized, controlled trial is justified to determine whether there is a true “cause-and-effect” relationship between complete photoprotection of total parenteral nutrition and bronchopulmonary dysplasia or death.
Does Nebulized Lidocaine Reduce the Pain and Distress of Nasogastric Tube Insertion in Young Children? A Randomized, Double-Blind, Placebo-Controlled Trial
Authors: Babl Franz E. , Goldfinch Christopher , Mandrawa Christine , Crellin Dianne , O'Sullivan Ronan , Donath Susan
Published: May 2009

OBJECTIVES. Nasogastric tube insertion is a common procedure in children that is very painful and distressing. Although nebulized lidocaine has been shown to be effective in reducing the pain and discomfort of nasogastric tube insertion in adults, there have been no similar studies in children. We set out to investigate the role of nebulized lidocaine in reducing pain and distress of nasogastric tube insertion in young children.

METHODS. We conducted a randomized, double-blind, placebo-controlled trial of nebulized 2% lidocaine at 4 mg/kg versus saline placebo during nasogastric tube insertion at a tertiary urban pediatric emergency department. Patients were eligible if they were aged from 1 to 5 years with no comorbid disease and a clinical indication for a nasogastric tube. Nebulization occurred for 5 minutes, 5 minutes before nasogastric tube insertion. Video recordings before, during, and after the procedure were rated using the Face, Legs, Activity, Cry, and Consolability (FLACC) pain and distress assessment tool (primary outcome measure) and pain and distress visual analog scale scores (secondary outcome measures). Difficulty of insertion and adverse events were also assessed.

RESULTS. Eighteen participants were nebulized with 2% lidocaine and 18 participants with normal saline. Nebulization was found to be highly distressing. FLACC scores during nasogastric tube insertion were very high in both groups. There was a trend in the post–nasogastric tube insertion period toward lower FLACC scores in the lidocaine group. Visual analog scale scores for this postinsertion period were significantly lower in the lidocaine arm for pain and distress. There were no significant differences between groups in terms of difficulty of insertion and the number of minor adverse events. The study was terminated early because of the distress and treatment delay associated with nebulization.

CONCLUSIONS. Nasogastric tube insertion results in very high FLACC scores irrespective of lidocaine use. Nebulized lidocaine cannot be recommended as pain relief for nasogastric tube insertion in children. The delay and distress of nebulization likely outweigh a possible benefit in the postinsertion period.
Lowering Developmental Screening Thresholds and Raising Quality Improvement for Preterm Children
Authors: Marks Kevin , Hix-Small Hollie , Clark Kathy , Newman Judy
Published: May 2009

OBJECTIVES. Our goal was to determine if (1) preterm children were referred, identified, and received early-intervention/special education services at rates equivalent to term children after implementation of a universal, periodic Ages & Stages Questionnaire screening and surveillance system, (2) pediatricians sufficiently lowered their screening thresholds with preterm children, and (3) quality-improvement opportunities exist.

PATIENT AND METHODS. Secondary analysis was performed on 64 lower-risk, predominantly late-preterm and 1363 term children who originally presented for their 12- or 24-month well-child visits. Higher-risk premature infants already involved with an early-intervention agency or identified with a delay were excluded. Board-certified pediatricians (n = 18) and nurse practitioners (n = 2), who were blind to the Ages & Stages Questionnaire results, were secondary participants. Differences between preterm and term early-intervention agency referrals were examined by comparing pediatric developmental impression to the Ages & Stages Questionnaire under natural clinic conditions using a combined in-office or mail-back data-collection protocol. Medical chart and county early-intervention or special education agency follow-up outcomes were conducted at 36 to 60 months.

RESULTS. Preterm referral rates were 9.5% (term: 5.6%) with pediatric developmental impression and 26.2% (term: 8.1%) with the Ages & Stages Questionnaire. In follow-up, 37.5% of preterm and 20.8% of term children received referrals, of which 50.0% of preterm and 42.4% of term children were eligible for services, 54.2% of preterm children were identified with a developmental-behavioral disorder, and 29.2% of preterm and 20.8% of term children did not follow-up. For the Ages & Stages Questionnaire, only preterm referrals (55.6%) were subsequently identified with an eligible delay or disorder or both. Preterm children were ∼2 times more likely to be eligible than term children.

CONCLUSIONS. Combined referral, quality-improvement, and outcome data suggest that clinicians should lower their threshold for administering a quality developmental screening instrument when providing surveillance for premature infants. Quality improvement exists with diligent developmental surveillance and a standardized, reliable, but more interpersonal referral process.
Parental Refusal of Pertussis Vaccination Is Associated With an Increased Risk of Pertussis Infection in Children
Authors: Glanz Jason M. , McClure David L. , Magid David J. , Daley Matthew F. , France Eric K. , Salmon Daniel A. , Hambidge Simon J.
Published: May 2009

OBJECTIVE. The objective of this study was to determine if children who contracted pertussis infection were more likely to have parents who refused pertussis vaccinations than a similar group of children who did not develop pertussis infection.

METHODS. We conducted a case-control study of children enrolled in the Kaiser Permanente of Colorado health plan between 1996 and 2007. Each pertussis case was matched to 4 randomly selected controls. Pertussis case status and vaccination status were ascertained by medical chart review.

RESULTS. We identified 156 laboratory-confirmed pertussis cases and 595 matched controls. There were 18 (12%) pertussis vaccine refusers among the cases and 3 (0.5%) pertussis vaccine refusers among the controls. Children of parents who refused pertussis immunizations were at an increased risk for pertussis compared with children of parents who accepted vaccinations. In a secondary case-control analysis of children continuously enrolled in Kaiser Permanente of Colorado from 2 to 20 months of age, vaccine refusal was associated with a similarly increased risk of pertussis. In the entire Kaiser Permanente of Colorado pediatric population, 11% of all pertussis cases were attributed to parental vaccine refusal.

CONCLUSIONS. Children of parents who refuse pertussis immunizations are at high risk for pertussis infection relative to vaccinated children. Herd immunity does not seem to completely protect unvaccinated children from pertussis. These findings stress the need to further understand why parents refuse immunizations and to develop strategies for conveying the risks and benefits of immunizations to parents more effectively.
Age of Drinking Onset, Alcohol Use Disorders, Frequent Heavy Drinking, and Unintentionally Injuring Oneself and Others After Drinking
Authors: Hingson Ralph W. , Zha Wenxing
Published: May 2009

OBJECTIVE. To explore whether early age of drinking onset is prospectively associated with respondents unintentionally injuring themselves and others when respondents were under the influence of alcohol, controlling for current alcohol dependence/abuse, frequency of consuming 5 drinks per occasion, and other demographic characteristics.

METHODS. From 2001 to 2002, in-person interviews were conducted with a national multistage probability sample of 43 093 adults aged 18 years older. From 2004 to 2005, of 39 959 eligible respondents, 34 653 were reinterviewed. The cumulative 2-survey response rate was 70.2%. Respondents were asked the age at which they first started drinking (not counting tastes or sips), diagnostic questions for alcohol dependence and abuse, questions about behaviors that increase risk of injury, and whether respondents, when under the influence of alcohol, injured themselves or someone else as a driver in a motor vehicle crash or in some other way.

RESULTS. Logistic regression analyses revealed that the younger respondents were when they started drinking, the greater the likelihood that, between the 2 surveys, they experienced alcohol dependence/abuse, drank 5 drinks per occasion at least weekly drove under the influence of alcohol, and placed themselves in situation after drinking where they could be hurt. After controlling for those injury risk and sociodemographic characteristics, respondents who began drinking at earlier ages remained more likely between the 2 surveys to have, under the influence of alcohol, unintentionally injured themselves and someone else. More than one third of those injuries occurred when respondents 25 years of age were under the influence, although only 7% of respondents were 25 years of age. Persons other than respondents experienced 20% of those unintentional injuries, more than one third of them in traffic.

CONCLUSION. Delaying drinking onset may help reduce unintentional alcohol-related injuries that drinkers may inflict on themselves and others.
Incidence of Early Neonatal Mortality and Morbidity After Late-Preterm and Term Cesarean Delivery
Authors: De Luca Roberta , Boulvain Michel , Irion Olivier , Berner Michel , Pfister Riccardo Erennio
Published: May 2009

OBJECTIVE. To determine the age-stratified risk of intrapartum and neonatal mortality as well as morbidities of clinical relevance after elective cesarean delivery (ECD).

METHODS. This work was a cohort study including 56 549 prospectively recorded late-preterm and term deliveries. We analyzed the effect of cesarean delivery (CD) before the onset of labor on the following multiple neonatal outcomes before hospital discharge, compared with planned vaginal delivery (PVD) and emergency CD: mortality, birth depression, special care admission, and respiratory morbidity. We adjusted for confounders by multivariate analysis and stratified the risk according to gestational age (GA).

RESULTS. Mortality and morbidities had a strong GA-related trend with the lowest incidences consistently found between 38 and 40 weeks of gestation independent of delivery mode. Compared with infants delivered via PVD, infants delivered via ECD had significantly higher rates of mortality (adjusted risk ratio [aRR]: 2.1), risk of special care admission (aRR: 1.4), and respiratory morbidity (aRR: 1.8) but not of depression at birth (aRR: 1.1). Compared with emergency CD, newborns delivered via ECD had less depression at birth (aRR: 0.6) and admission to special care (aRR: 0.8), but mortality (aRR: 0.8) and respiratory morbidity (aRR: 1.0) rates were similar.

CONCLUSIONS. Gestational age–specific risk estimates are lowest between 38 and 40 weeks and should be included in the informed-consent process. The information should also be used to allow for appropriate preparation with respect to adequate staff and equipment. ECD is consistently associated with increased intrapartum and neonatal mortality, risk of admission, and respiratory morbidity compared with PVD and has no advantage over emergency CD in terms of mortality. Neonatal morbidities are lower after ECD than emergency CD only with term births. Our data provide evidence that ECD should not be performed before term.
Are Starting and Continuing Breastfeeding Related to Educational Background? The Generation R Study
Authors: van Rossem Lenie , Oenema Anke , Steegers Eric A. P. , Moll Henriëtte A. , Jaddoe Vincent W. V. , Hofman Albert , Mackenbach Johan P. , Raat Hein
Published: May 2009

OBJECTIVE. To assess the effect of a woman's educational level on starting and continuing breastfeeding and to assess the role of sociodemographic, lifestyle-related, psychosocial, and birth characteristics in this association.

METHODS. We used the data of 2914 participants in a population-based prospective cohort study. Information on educational level, breastfeeding, sociodemographic (maternal age, single parenthood, parity, job status), lifestyle-related (BMI, smoking, alcohol use), psychosocial (whether the pregnancy was planned, stress), and birth (gestational age, birth weight, cesarean delivery, place and type of delivery) characteristics were obtained between pregnancy and 12 months postpartum. Odds ratios and 95% confidence intervals of starting and continuing breastfeeding for educational level were obtained by logistic regression, adjusted for each group of covariates and for all covariates simultaneously.

RESULTS. Of 1031 highest-educated mothers, 985 (95.5%) started breastfeeding; the percentage was 73.1% (255 of 349) in the lowest-educated mothers. At 6 months, 39.3% (405 of 1031) of highest-educated mothers and 15.2% (53 of 349) of lowest-educated mothers were still breastfeeding. Educationally related differences were present in starting breastfeeding and the continuation of breastfeeding until 2 months but not in breastfeeding continuation between 2 and 6 months. Lifestyle-related and birth characteristics attenuated the association between educational level and breastfeeding, but the association was hardly affected by sociodemographic and psychosocial characteristics.

CONCLUSIONS. Decisions to breastfeed were underlain by differences in educational background. The underlying pathways require further research. For the time being, interventions on promoting breastfeeding should start early in pregnancy and should increase their focus on low-educated women.
School-Based Health Centers and Obesity Prevention: Changing Practice Through Quality Improvement
Authors: Oetzel Keri Bolton , Scott Amy Anixter , McGrath Jane
Published: May 2009

Objective

To examine whether a quality improvement initiative aimed at medical providers in school-based health centers would improve the recognition and management of pediatric obesity.

Participants and Methods.

Thirteen school-based health centers, with a total of 22 providers and 6 clinical staff, were enrolled in the study. Quality improvement measures and best medical practices for assessing and treating pediatric obesity were provided during 1 learning collaborative and 2 on-site trainings. Measures included documentation of (1) a BMI percentile, (2) a corresponding weight-category diagnosis, (3) assessing readiness to change, (4) assessing readiness to change for patients with a BMI at ≥85th percentile, and (5) addressing 4 key messages that enhance a healthy lifestyle.

Results

Results of paired-sample t tests indicate that all 5 variables significantly increased from baseline to the midpoint data collection. From midpoint to the final data collection, documentation of BMI percentile and key messages increased, although not significantly. Documentation of weight-category diagnosis and readiness to change for patients with a BMI at ≥85th percentile decreased significantly, whereas documentation of readiness to change decreased, but not significantly.

Conclusions

This study offers promising evidence that school-based health center providers trained in a quality improvement initiative demonstrate consistent improvement in implementing the guidelines for treatment of pediatric overweight. Pediatrics 2009;123:S267–S271
Consistently Inconsistent: A Snapshot of Across- and Within-State Disparities in the Prevalence of Childhood Overweight and Obesity
Authors: Bethell Christina , Read Debra , Goodman Elizabeth , Johnson Jessica , Besl John , Cooper Julie , Simpson Lisa A.
Published: May 2009

BACKGROUND. The epidemic of childhood overweight and obesity is characterized by known disparities. Less is known about how these disparities vary across and within the state in which a child lives.

OBJECTIVE. To examine the magnitude and patterns of across- and within-state differences in the prevalence of childhood overweight and obesity according to children's insurance type (public versus private), household income level, race (non-Hispanic black versus non-Hispanic white), and ethnicity (Hispanic versus non-Hispanic).

METHODS. State-level overweight and obesity prevalence rates for children aged 10–17 were calculated by using data from the 2003 National Survey of Children's Health. Statistical significance of across-state variation was assessed. Disparity ratios assessed within-state equity according to children's insurance type, income, race, and ethnicity. State ranks on overall prevalence and ranks on disparity indices were correlated and regression models were fit to examine within-state consistency, state-level clustering effects and whether the effect of child characteristics varied across key population subgroups.

RESULTS. Prevalence of childhood overweight and obesity varied significantly across states. A total of 31 states had a prevalence lower than the national rate of 30.6% (14 statistically significant), and 20 had higher rates (9 statistically significant). Within-state disparity indices ranged from a low of 1.0 (no disparity) to a high of 3.44 (nearly 3.5 times higher). Correlations between state ranks on overall prevalence and their ranks on disparity indices were not significant for the insurance type, income, or race disparity groups examined. A modest state-clustering effect was found. Compared with non-Hispanic white children, the effect of lower household income and lower household education level education were significantly less for non-Hispanic black and Hispanic children, who were more likely to be overweight or obese regardless of these other factors.

CONCLUSIONS. Disparities in the prevalence of childhood overweight and obesity vary significantly both within and across states. Patterns of variation are inconsistent within states, highlighting the need for states to undertake state- and population-specific analyses and interventions to address the epidemic.
Paying for Obesity: A Changing Landscape
Authors: Simpson Lisa A. , Cooper Julie
Published: May 2009

BACKGROUND. Coverage for obesity related services is highly variable. Despite this, health plans, purchasers, and states have mounted numerous recent initiatives.

OBJECTIVE. To identify the range of approaches being used to address coverage and reimbursement for childhood obesity services.

METHODS. Key informant interviews were conducted using a semi-structured protocol to identify the types of activities they or their organization were engaged in to address childhood obesity, to learn about private payer policies and procedures, to identify best practices, potential resources and/or other key informants. Domains addressed in the protocol included scope of the respondent's organization's activities, the rationale for supporting obesity activities, the degree to which obesity services were a covered benefit and what if any barriers or challenges were encountered in implementation, the policy climate within which the organization operates (e.g. state legislation, initiatives or task forces), and any assessment of the impact and/or cost of implementing their initiatives. The individuals interviewed represented respondents from each of the following categories: employer, health plan, and state insurance programs and conducted by phone between November 2007 and March 2008. In addition to the information gathered by the key informant interviews we conducted a search of the relevant peer review and grey literature between 2005 and 2008 and input from a national expert advisory group.

RESULTS. Significant variation, as well as recent changes, were identified in both the private and public sector. Approaches included new benefits and incentives for parents and providers. Only anecdotal evidence of impact of the recent changes was available.

CONCLUSIONS. There is important forward movement in how public and private players are addressing paying for obesity related services. Medicaid and SCHIP programs have an opportunity to provide additional leadership. Substantial investments in evaluation and research are needed to learn which approaches are most effective.
Dying to Play Video Games: Carbon Monoxide Poisoning From Electrical Generators Used After Hurricane Ike
Authors: Fife Caroline E. , Smith Latisha A. , Maus Erik A. , McCarthy James J. , Koehler Michelle Z. , Hawkins Trina , Hampson Neil B.
Published: May 2009

BACKGROUND. Carbon monoxide (CO) poisoning is common after major storms because of loss of electrical power and use of alternate fuel sources for heat and electricity. In past epidemics of hurricane-related CO poisoning, the source has typically been gasoline-powered electrical generators. Although it is typically believed that generators were used to power air conditioning and refrigeration, this report demonstrates an unsuspected reason for their use.

PATIENTS AND METHODS. After Hurricane Ike's landfall in September 2008, major power outages were associated with an epidemic of CO poisoning from electrical generators, as expected. Staff at Memorial Hermann Hospital-Texas Medical Center treated or telephone-triaged cases from the Houston area. A review of the details of those cases forms the basis of this report.

RESULTS. Memorial Hermann Hospital-Texas Medical Center staff treated or triaged 37 individuals exposed to CO from gasoline-powered electrical generators in 13 incidents in the first 36 hours after landfall of the hurricane. Notably, 54% (20 of 37) of the patients were under the age of 18 years. Symptoms ranged from mild to severe, with 1 child dying at the scene. Eleven patients were treated with hyperbaric oxygen. Among 9 incidents in which the reason for generator use was determined, 5 were due to generators powering video games or televisions to watch movies or programs. These 5 incidents in which video games were being powered accounted for 75% (15 of 20) of the pediatric poisonings.

CONCLUSIONS. Generator-related CO poisoning is indeed common during power outages after hurricanes. However, generators are commonly being used to provide electricity to power entertainment devices for children, such as video games. Additional public education about CO risk is needed, perhaps directed at older children and teenagers through the schools in regions susceptible to hurricanes.
The Influence of Birth Size on Intelligence in Healthy Children
Authors: Broekman Birit F. P. , Chan Yiong-Huak , Chong Yap-Seng , Quek Swee-Chye , Fung Daniel , Low Yen-Ling , Ooi Yoon-Phaik , Gluckman Peter D. , Meaney Michael J. , Wong Tien-Yin , Saw Seang-Mei
Published: May 2009

OBJECTIVE. Birth parameters have been hypothesized to have an influence on IQ. However, studies within the range of normal birth size have been sparse. With this study we examined the associations between birth length, birth weight, head circumference, and gestational age within the normal birth size range in relation to childhood IQ in Asian children.

METHODS. A cohort of 1979 of 2913 Asian children aged 7 to 9 years, recruited from 3 schools in Singapore, were followed yearly from 1999 onward. Birth parameters were recorded by health personnel. Childhood IQ was measured with the Raven's Standard Progressive Matrices at ages 8 to 12.

RESULTS. The mean IQ score across the sample (n = 1645) was 114.2. After controlling for multiple confounders for every 1-cm increment in birth length, 1 kg in birth weight, or 1 cm in head circumference, there was a corresponding increase in IQ of 0.49 points (P for trend < .001), 2.19 points (P for trend = .007) and .62 points (P for trend = .003), respectively. These associations persisted even after exclusion of premature children and children with extreme weights and head circumferences.

CONCLUSIONS. Longer birth length, higher birth weight, or larger head circumferences within the normal birth size range are associated with higher IQ scores in Asian children. Our results suggest that antenatal factors reflected in altered rates of growth but within the normative range of pregnancy experiences play a role in generating cognitive potential. This has implications for targeting early intervention and preventative programs.
The Built Environment: Designing Communities to Promote Physical Activity in Children
Authors:   Committee on Environmental Health
Published: May 2009

This Policy Statement was revised. See https://doi.org/10.1542/peds.2023-064772.

An estimated 32% of American children are overweight, and physical inactivity contributes to this high prevalence of overweight. This policy statement highlights how the built environment of a community affects children's opportunities for physical activity. Neighborhoods and communities can provide opportunities for recreational physical activity with parks and open spaces, and policies must support this capacity. Children can engage in physical activity as a part of their daily lives, such as on their travel to school. Factors such as school location have played a significant role in the decreased rates of walking to school, and changes in policy may help to increase the number of children who are able to walk to school. Environment modification that addresses risks associated with automobile traffic is likely to be conducive to more walking and biking among children. Actions that reduce parental perception and fear of crime may promote outdoor physical activity. Policies that promote more active lifestyles among children and adolescents will enable them to achieve the recommended 60 minutes of daily physical activity. By working with community partners, pediatricians can participate in establishing communities designed for activity and health.
Drinking Water From Private Wells and Risks to Children
Authors:   Committee on Environmental Health and Committee on Infectious Diseases
Published: May 2009

This Policy Statement was reaffirmed January 2013 and September 2019.

Drinking water for approximately one sixth of US households is obtained from private wells. These wells can become contaminated by pollutant chemicals or pathogenic organisms and cause illness. Although the US Environmental Protection Agency and all states offer guidance for construction, maintenance, and testing of private wells, there is little regulation. With few exceptions, well owners are responsible for their own wells. Children may also drink well water at child care or when traveling. Illness resulting from children's ingestion of contaminated water can be severe. This policy statement provides recommendations for inspection, testing, and remediation for wells providing drinking water for children.
Advanced Practice in Neonatal Nursing
Authors:   Committee on Fetus and Newborn
Published: May 2009

This Policy Statement was reaffirmed January 2014 and November 2020.

The participation of advanced practice registered nurses in neonatal care continues to be accepted and supported by the American Academy of Pediatrics. Recognized categories of advanced practice neonatal nursing are the neonatal clinical nurse specialist and the neonatal nurse practitioner.