bluuebunny/crossref_metadata_2025 huggingface dataset:
Gastroesophageal reflux in mechanically ventilated pediatric patients and its relation to ventilator-associated pneumonia
Authors: Abdel-Gawad Tarek A , El-Hodhod Mostafa A , Ibrahim Hanan M , Michael Yousef W
Published: October 2009

Introduction

The objective was to determine the frequency of gastroesophageal reflux (GER) in mechanically ventilated pediatric patients and its role as a risk factor for ventilator-associated pneumonia (VAP), which may be enhanced among those patients.

Methods

The study is a prospective cohort study of mechanically ventilated pediatric patients in the pediatric intensive care unit (PICU) of Ain Shams University Children's Hospital. It was conducted in 24 mechanically ventilated patients (16 of them developed VAP and 8 did not, with mean age of 16.6 +/- 20.5 and 18.6 +/- 22.4 months respectively). Esophageal 24-hour pH-metry beside clinical and laboratory evaluation of their underlying problem and severity of their condition were carried out.

Results

All VAP patients had GER (50% alkaline reflux, 12.5% acidic reflux and 37.5% combined reflux) compared to 75% of non-VAP ones (100% alkaline reflux). The mean total reflux time was significantly longer among VAP (50 minutes) versus non-VAP (3 minutes) patients. There was significant increase in acidic reflux parameters among non-survivors versus survivors (P < 0.001). For VAP mortality, total acidic reflux at a cut-off value of 28.6 minutes is found to be a mortality predictor with a sensitivity of 100% and a specificity of 100%.

Conclusions

GER is a constant incident in mechanically ventilated pediatric patients, with alkaline reflux being more common than acidic reflux. Both acidic and alkaline refluxes were found to be associated with the development of VAP and total reflux time was found to be a reliable predictor of VAP. Moreover, acidic reflux was found to be more related to mortality than alkaline reflux.
Preventing Future Cancers by Testing Women With Ovarian Cancer forBRCAMutations
Authors: Kwon Janice S. , Daniels Molly S. , Sun Charlotte C. , Lu Karen H.
Published: October 2009

Purpose

Women with ovarian cancer have a 10% probability of carrying a BRCA mutation. If a mutation is identified, unaffected family members can undergo genetic testing and cancer risk-reducing strategies. We estimated the net health benefits and cost-effectiveness of different criteria for BRCA mutation testing in women with ovarian cancer, and the downstream benefits for their first-degree relatives (FDRs).

Methods

We developed a Markov Monte Carlo simulation model to compare four criteria for BRCA testing in women with ovarian cancer: no testing (reference); only if personal history of breast cancer, family history of breast/ovarian cancer, or Ashkenazi Jewish ancestry; only if invasive serous cancer; any invasive nonmucinous epithelial cancer. Net health benefit was life expectancy for FDRs and primary outcome was the incremental cost-effectiveness ratio (ICER). The model estimated the number of future breast and ovarian cancer cases in FDRs.

Results

BRCA testing based on personal/family history and ancestry could prevent future cases in FDRs with an ICER of $32,018 per year of life (LY) gained compared with the reference strategy. BRCA testing based on serous or any nonmucinous epithelial ovarian cancer could prevent more cancer cases, but at ICERs of $128,465 and $148,363 per LY gained, respectively.

Conclusion

BRCA testing of women with ovarian cancer based on personal/family history of cancer or Ashkenazi Jewish ancestry is a cost-effective strategy to prevent future breast and ovarian cancers among FDRs. More inclusive testing strategies prevent additional cancer cases but at significant cost.
Cancer During Pregnancy: An Analysis of 215 Patients Emphasizing the Obstetrical and the Neonatal Outcomes
Authors: Van Calsteren Kristel , Heyns Liesbeth , De Smet Frank , Van Eycken Liesbet , Gziri Mina Mhallem , Van Gemert Willemijn , Halaska Michael , Vergote Ignace , Ottevanger Nelleke , Amant Frédéric
Published: October 2009

Purpose

The aim of this study was to assess the management and the obstetrical and neonatal outcomes of pregnancies complicated by cancer.

Patients and Methods

In an international collaborative setting, patients with invasive cancer diagnosed during pregnancy between 1998 and 2008 were identified. Clinical data regarding the cancer diagnosis and treatment and the obstetric and neonatal outcomes were collected and analyzed.

Results

Of 215 patients, five (2.3%) had a pregnancy that ended in a spontaneous miscarriage and 30 (14.0%) pregnancies were interrupted. Treatment was initiated during pregnancy in 122 (56.7%) patients and postpartum in 58 (27.0%) patients. The most frequently encountered cancer types were breast cancer (46%), hematologic malignancies (18%), and dermatologic malignancies (10%). The mean gestational age at delivery was 36.3 ± 2.9 weeks. Delivery was induced in 71.7% of pregnancies, and 54.2% of children were born preterm. In the group of patients prenatally exposed to cytotoxic treatment, the prevalence of preterm labor was increased (11.8%; P = .012). Furthermore, in this group a higher proportion of small-for-gestational-age children (birth weight below 10th percentile) was observed (24.2%; P = .001). Of all neonates, 51.2% were admitted to a neonatal intensive care unit, mainly (85.2%) because of prematurity. There was no increased incidence of congenital malformations.

Conclusion

Pregnant cancer patients should be treated in a multidisciplinary setting with access to maternal and neonatal intensive care units. Prevention of iatrogenic prematurity appears to be an important part of the treatment strategy.
Phase II Trial of Pemetrexed Plus Bevacizumab for Second-Line Therapy of Patients With Advanced Non–Small-Cell Lung Cancer: NCCTG and SWOG Study N0426
Authors: Adjei Alex A. , Mandrekar Sumithra J. , Dy Grace K. , Molina Julian R. , Adjei Araba A. , Gandara David R. , Ziegler Katie L. Allen , Stella Philip J. , Rowland Kendrith M. , Schild Steven E. , Zinner Ralph G.
Published: October 2009

Purpose

To evaluate the efficacy and toxicity of pemetrexed combined with bevacizumab as second-line therapy for patients with advanced non–small-cell lung cancer (NSCLC) and to correlate allelic variants in pemetrexed-metabolizing genes with clinical outcome.

Patients and Methods

Patients with previously treated NSCLC received pemetrexed (500 mg/m2 intravenous) combined with bevacizumab (15 mg/kg intravenous) every 3 weeks. The primary end point, evaluated using a one-stage Fleming design for detecting a true success rate of at least 70%, was the proportion of patients who were progression free and on treatment at 3 months. Polymorphisms in genes responsible for pemetrexed transport (reduced folate carrier [SLC19A1]) and metabolism (folylpolyglutamate synthase [FPGS] and gamma-glutamyl hydrolase [GGH]) evaluated in germline DNA (blood) were correlated with treatment outcome.

Results

Forty-eight evaluable patients (14 females and 34 males) received a median of four cycles (range, one to 20 cycles). The most common grade 3 or 4 nonhematologic adverse events (AEs) were fatigue (13%), dyspnea (10%), and thrombosis (10%). Grade 3 or 4 hematologic AEs were neutropenia (19%) and lymphopenia (13%). Twenty-four (57%; 95% CI, 41% to 72%) of the first 42 patients met the success criteria. Median overall survival (OS) and progression-free survival (PFS) times were 8.6 and 4.0 months, respectively. The exon 6 (2522)C→T polymorphism in SLC19A1 correlated with 3-month progression-free status (P = .01) and with PFS (P = .05). The IVS1(1307)C→T polymorphism in GGH correlated with OS (P = .04).

Conclusion

The study did not meet its primary end point. However, the median PFS time of 4 months is promising. Pharmacogenetic studies in larger cohorts are needed to definitively identify polymorphisms that predict for survival and toxicity of pemetrexed.
A conditional mouse model for human MUC1-positive endometriosis shows the presence of anti-MUC1 antibodies and Foxp3+ regulatory T cells
Authors: Budiu Raluca A. , Diaconu Iulia , Chrissluis Rachel , Dricu Anica , Edwards Robert P. , Vlad Anda M.
Published: October 2009

Endometriosis is defined by the presence of tissue implants resembling endometrial glands outside of the uterus, at ectopic sites, frequently on the ovarian surface. The ectopic lesions are often invasive, resistant to therapy, and may predispose to endometrioid and clear cell ovarian tumors. The complex mechanisms leading to chronic endometriosis are mediated partly by impaired immune surveillance in the host. Although innate immunity has been addressed previously, the response of adaptive immune effectors to specific antigens has not been characterized, mostly because very few endometriosis antigens have been defined to date. We postulated that the mucin 1 (MUC1) glycoprotein, which is normally present on eutopic human endometrial glands and overexpressed in endometrioid and clear cell ovarian tumors, is also present in ectopic lesions of ovarian endometriosis. Furthermore, changes in MUC1 expression in endometriosis could promote adaptive anti-MUC1 immunity that might play a role in the malignant progression. To test our hypothesis, we crossed MUC1 transgenic mice, which express human MUC1 under the endogenous promoter, with the loxP-Stop-loxP-KrasG12D/+ (Kras) mice, in which endometriosis can be induced through Cre-loxP recombination. The double transgenic MUC1Kras mice develop benign, MUC1-positive ovarian lesions, closely resembling human endometriosis. Subsequent to disease induction, the mice generate high titers of IgM and IgG antibodies that are specific for MUC1. Antibodies appear early in disease and the predominance of the IgG1 subclass suggests Th2-driven immunity. Immune phenotyping revealed an accumulation of Foxp3+ CD4 regulatory T cells (Tregs) in the draining lymph nodes at late-stage disease. Furthermore, our observations in human endometriosis showed a similar recruitment of FOXP3+ CD4 T cells. Overall, our results reveal a Th2/Treg-dominant natural immunity in endometriosis with potential implications for cancer progression.
Telomeres and Tetrahymena: an interview with Elizabeth Blackburn
Authors: Kain Kristin H.
Published: October 2009

Elizabeth Blackburn knows that loose ends contribute to aging and many of its associated diseases. She, together with Carol Greider and Jack Szostak, received the 2009 Nobel Prize in Physiology or Medicine for their work on the synthesis and function of telomeres, the unusual DNA sequences at the ends of chromosomes. Telomere changes are now recognized in human diseases ranging from cancer and cardiovascular disease to depression. Here, she discusses her approach to mentorship, how scientists might inform public policy, and new directions in telomere research.
Telomerase reverse transcriptase-dependent telomere equilibration mitigates tissue dysfunction in mTert heterozygotes
Authors: Meznikova Marie , Erdmann Natalie , Allsopp Rich , Harrington Lea A.
Published: October 2009

Autosomal dominant mutations in telomere-associated factors elicit a disease known as dyskeratosis congenita (DKC), and patients suffer proliferative abnormalities associated with telomere erosion. Mice that are heterozygous for telomerase genes (Tert or Terc, hereafter referred to as mTert and mTerc) are useful models of telomerase haploinsufficiency, but do not strictly mimic DKC. In strains with long telomeres (>60 kbp), animals that are heterozygous for mTert undergo telomere erosion for nine generations and remain phenotypically normal. In an mTerc heterozygous strain with short telomeres (<15 kbp), early mortality arises after five to six generations, but dyskeratosis occurs only upon the further loss of mPot1b. We show that prolonged mTert heterozygosity (for greater than ten generations) did not elicit disease, even upon heterozygote interbreeding, and that telomeres reset to wild-type lengths. This lengthening did not occur in nullizygotes, and short telomeres inherited from mTert null parents were rescued only in heterozygous progeny. In the bone marrow, nullizygotes remained competent for radioprotection for three generations. Thus, gradual telomere erosion in the presence of telomerase may enable subsequent telomere extension, similar to that described in budding yeast. We speculate whether such adaptation occurs in normal human cells (or whether it could be induced in DKC-derived cells), and whether it might mitigate the impact of telomerase inhibition upon stem cells during cancer therapy.
Circulating ghrelin exists in both lipoprotein bound and free forms
Authors: Holmes E , Davies I , Lowe G , Ranganath L R
Published: October 2009

Introduction

Ghrelin is a gastric peptide that has been implicated in the development of obesity and cardiovascular disease. It has been reported that ghrelin binds to lipoproteins, although the different binding patterns of acylated ghrelin (AG) and unacylated ghrelin (UAG) are still to be determined.

Methods

Lipoprotein fractions were generated using a self-generating iodixanol gradient. AG and UAG were measured using specific enzyme immunoassays.

Results

AG bound to all lipoproteins in approximately equal concentrations (VLDL 26%, LDL 22%, HDL 23%) and was present as a plasma protein (27%). UAG bound more specifically to HDL (49%) and was present as a plasma protein (48%).

Conclusions

The different binding patterns of AG and UAG may have significant implications for their biological effects, including roles in energy metabolism, the development of obesity and potentially in the modulation of cardiovascular disease.
A healthy choice? Direct payments and healthcare in the English NHS
Authors: Glasby Jon , Grand Julian Le , Duffy Simon
Published: October 2009

This article reviews the social care evidence concerning direct payments/personal budgets, before arguing for an extension of these concepts to the National Health Service (NHS). Despite a commitment to inter-agency health and social care, direct payments/personal budgets have only been available for the ‘social care’ part of people's lives. Moreover, many of the challenges faced by the NHS are precisely those which social care has turned to more individualised funding to help resolve. Against this background, the article speculates as to how such a system might work and seeks to address some popular misconceptions and potential objections.
European citizenship, individual agency and the challenge to social welfare systems: a case study of retirement migration in the European Union
Authors: Coldron Keleigh , Ackers Louise
Published: October 2009

Drawing on two empirical studies of international retirement migration in the European Union, this article examines how retirement migrants are actively negotiating their European and national social rights (and responsibilities) with important implications for both sending and receiving regions. Three types of agency are identified: (1) the exercise of rights; (2) the manipulation of rights; and (3) the abuse of rights. The article tentatively proposes a new framework for understanding the implications of these different types of agency for the welfare systems of receiving regions.
Part-time work in the Dutch welfare state: the ideal combination of work and care?
Authors: Yerkes Mara
Published: October 2009

The Netherlands is often heralded for the success of its ‘part-time model’ of employment. Yet the supposed success of this model raises the question whether the Dutch part-time variant is the ideal gender-neutral policy approach. A comparative, longitudinal analysis of employment transitions in the Netherlands and the UK shows that while the Dutch part-time model may be unique, its outcomes are not. In both cases, gender inequality in employment transitions is evident. Gender inequality is apparent in Dutch care policy as well. Moreover, part-time work is quickly becoming the long-term norm for women's employment, even for women without care responsibilities.
Selling individual budgets, choice and control: local and global influences on UK social care policy for people with learning difficulties
Authors: Boxall Kathy , Dowson Steve , Beresford Peter
Published: October 2009

A range of national and international actors and networks have claimed to support the interests of people with learning difficulties over the last 30 years. This article examines their influence on UK policy for people with learning difficulties, with a particular focus on the recent policy shift towards individualised support and personalisation. Policy changes and developments within the UK are considered in the context of similar developments internationally and the article questions the extent to which personalisation can be sustained in the face of the scale and economic rationality of global markets. Finally, an alternative, more accountable, model of individualised support is proposed.
The positive feedback bias as a response to self‐image threat
Authors: Harber Kent D. , Stafford Reshma , Kennedy Kathleen A.
Published: October 2009

This research examined whether Whites favourably bias their feedback to minorities in order to see themselves as egalitarian. White teacher trainees first had their egalitarian self‐images affirmed, left unchanged, or threatened. They then provided feedback on a poorly written essay supposedly authored by either a Black or a White student. As predicted, trainees in the Black writer/self‐image threat condition selectively rated essay content more favourably, recommended less time for skill development, provided more favourable copy‐editing comments, and generated more equivocating ‘buffers’. In contrast, trainees in the Black writer/self‐image boost condition supplied feedback indistinguishable from feedback provided by trainees in the White writer conditions, which was unaffected by the self‐image conditions. The implications for minority education and intergroup communication are discussed.
Antiepileptic drug use, falls, fractures, and BMD in postmenopausal women: Findings from the women's health initiative (WHI)
Authors: Carbone Laura D , Johnson Karen C , Robbins John , Larson Joseph C , Curb J David , Watson Kathleen , Gass Margery , LaCroix Andrea Z
Published: October 2009

Antiepileptic drugs (AEDs) are used increasingly in clinical practice to treat a number of conditions. However, the relationship between the use of these medications, particularly the newer AEDs, and fracture risk has not been well characterized. We used data from the Women's Health Initiative (WHI) to determine the relationship bewteen the use of AEDs and falls, fractures, and bone mineral density (BMD) over an average of 7.7 years of follow-up. We included 138,667 women (1,385 users of AEDs and 137,282 nonusers) aged 50 to 79 years in this longitudinal cohort analyses. After adjustment for covariates, use of AEDs was positively associated with total fractures [hazard ratio (HR) = 1.44, 95% confidence interval (CI) 1.30–1.61], all site-specific fractures including the hip (HR = 1.51, 95% CI 1.05–2.17), clinical vertebral fractures (HR = 1.60, 95% CI 1.20–2.12), lower arm or wrist fractures (HR = 1.40, 95% CI 1.11–1.76), and other clinical fractures (HR = 1.46, 95% CI 1.29–1.65) and two or more falls (HR = 1.62, 95% CI 1.50–1.74) but not with baseline BMD or changes in BMD (p ≥ .064 for all sites). Use of more than one and use of enzyme-inducing AEDs were significantly associated with total fractures (HR = 1.55, 95% CI 1.15–2.09 and HR = 1.36, 95% CI 1.09–1.69, respectively). We conclude that in clinical practice, postmenopausal women who use AEDs should be considered at increased risk for fracture, and attention to fall prevention may be particularly important in these women. © 2010 American Society for Bone and Mineral Research.
Bone material quality in transiliac bone biopsies of postmenopausal osteoporotic women after 3 years of strontium ranelate treatment
Authors: Roschger Paul , Manjubala Inderchand , Zoeger Norbert , Meirer Florian , Simon Rolf , Li Chenghao , Fratzl-Zelman Nadja , Misof Barbara M , Paschalis Eleftherios P , Streli Christina , Fratzl Peter , Klaushofer Klaus
Published: October 2009

Strontium ranelate (SrR) is a relatively new treatment for osteoporosis. In this study we investigated its potential impact on human bone material quality in transiliac bone biopsies from postmenopausal osteoporotic women treated 3 years with calcium and vitamin D plus either 2 g SrR per day or placebo. Bone mineralization density distribution (BMDD), strontium (Sr) concentration, collagen cross-link ratio, and indentation modulus were analyzed by quantitative backscattered electron imaging, electron-induced X-ray fluorescence analysis, synchrotron radiation induced micro X-ray fluorescence elemental mapping, Fourier transform infrared imaging, and nanoindentation, respectively. The BMDD of SrR-treated patients was shifted to higher atomic numbers (Zmean +1.5%, p < .05 versus placebo). We observed Sr being preferentially incorporated in bone packets formed during SrR treatment up to 6% atom fraction [Sr/(Sr + Ca)] depending on the SrR serum levels of the individuals (correlation r = 0.84, p = .018). Collagen cross-link ratio was preserved in SR-treated bone. The indentation modulus was significantly decreased in younger versus older bone packets for both placebo- (−20.5%, p < .0001) and SrR-treated individuals (−24.3%, p < .001), whereas no differences were found between the treatment groups. In conclusion, our findings indicate that after SrR treatment, Sr is heterogeneously distributed in bone and preferentially present in bone packets formed during treatment. The effect of SrR on BMDD seems to be due mainly to the uptake of Sr and not to changes in bone calcium content. Taken together, these data provide evidence that the investigated bone quality determinants at tissue level were preserved in postmenopausal osteoporotic women after 3-year treatment with 2 g SrR per day plus calcium and vitamin D. © 2010 American Society for Bone and Mineral Research
Hip fracture causes excess mortality owing to cardiovascular and infectious disease in institutionalized older people: A prospective 5-year study
Authors: Cameron Ian D , Chen Jian Sheng , March Lyn M , Simpson Judy M , Cumming Robert G , Seibel Markus J , Sambrook Philip N
Published: October 2009

An increasing risk of death after hip fracture has been well documented, but the duration and causes remain unclear, especially in very frail older people. This is a nested case-control study of 229 hip fracture cases and 229 controls matched by age, gender, institution type, and follow-up period from a cohort of 2005 institutionalized older people. The residents were assessed at baseline and followed up for hip fracture and death for at least 5 years. Time to death was measured from the same time for each case (time of the hip fracture) and the matched control. The study sample consisted of 90 males and 368 females with a mean age of 86 years (range 67 to 102 years). The hazard ratio (HR) of death for the cases compared with the controls was 3.09 [95% confidence interval (CI) 1.83–5.22, p < .001] for the first 3 months, 1.99 (95% CI 1.13–3.51, p = .02) for the period of 3 to 9 months, and 0.88 (95% CI 0.64–1.22, p = .46) for the period beyond 9 months following a fracture, after adjusting for age, gender, institution type, weight, immobility, cognitive function, comorbidities, and number of medications. The main causes of the excess mortality in the first 9 months were infections (HR = 6.66, 95% CI 1.95–22.77, p = .002) for females and cardiac disease (HR = 2.68, 95% CI 1.39–5.15, p = .003) for both males and females. Bisphosphonate use was associated with a reduction in mortality after hip fracture (p = .002). Intensive medical supervision to reduce cardiovascular and infective complications should be provided for frail older people with recent hip fracture to reduce mortality. © 2010 American Society for Bone and Mineral Research.
Neutron powder diffraction study and DFT calculations on the structure of Zr10Sc4O26
Authors: Meyer Stefanie , Schweda Eberhard , Martinez Meta Neil Jesus , Boysen Hans , Hoelzel Markus , Bredow Thomas
Published: October 2009

Powder neutron diffraction was used to investigate Zr10Sc4O26, the so called γ-phase in the zirconia scandia system. This fluorite related anion deficient compound with composition MX1.86 crystallizes in space group R-3 and lattice constants a = 952.7(3) pm and c = 1745.3(4) pm. Anion vacancies are inserted on the 6c sites in R-3. The neutron data as well as the periodic density-functional calculations performed count for a divacancy model. The paired defect is more stable by 29 kJ/mol than any model with unpaired vacancies including the model with the 1/2[111]F (index F = fluorite) vacancy separation along an empty anion cube.
Drosophila Translational Elongation Factor-1γ Is Modified in Response to DOA Kinase Activity and Is Essential for Cellular Viability
Authors: Fan Yujie , Schlierf Michael , Gaspar Ana Cuervo , Dreux Catherine , Kpebe Arlette , Chaney Linda , Mathieu Aurelie , Hitte Christophe , Grémy Olivier , Sarot Emeline , Horn Mark , Zhao Yunlong , Kinzy Terri Goss , Rabinow Leonard
Published: October 2009

Drosophila translational elongation factor-1γ (EF1γ) interacts in the yeast two-hybrid system with DOA, the LAMMER protein kinase of Drosophila. Analysis of mutant EF1γ alleles reveals that the locus encodes a structurally conserved protein essential for both organismal and cellular survival. Although no genetic interactions were detected in combinations with mutations in EF1α, an EF1γ allele enhanced mutant phenotypes of Doa alleles. A predicted LAMMER kinase phosphorylation site conserved near the C terminus of all EF1γ orthologs is a phosphorylation site in vitro for both Drosophila DOA and tobacco PK12 LAMMER kinases. EF1γ protein derived from Doa mutant flies migrates with altered mobility on SDS gels, consistent with it being an in vivo substrate of DOA kinase. However, the aberrant mobility appears to be due to a secondary protein modification, since the mobility of EF1γ protein obtained from wild-type Drosophila is unaltered following treatment with several nonspecific phosphatases. Expression of a construct expressing a serine-to-alanine substitution in the LAMMER kinase phosphorylation site into the fly germline rescued null EF1γ alleles but at reduced efficiency compared to a wild-type construct. Our data suggest that EF1γ functions in vital cellular processes in addition to translational elongation and is a LAMMER kinase substrate in vivo.
Recovery of Cognitive Performance and Fatigue after One Night of Sleep Deprivation
Authors: Ikegami Kazunori , Ogyu Seizo , Arakomo Yuko , Suzuki Kiyomi , Mafune Kosuke , Hiro Hisanori , Nagata Shoji
Published: October 2009

Recovery of Cognitive Performance and Fatigue after One Night of Sleep Deprivation: Kazunori Ikegami, et al. Department of Mental Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan

Objectives

The aim of this study was to investigate how subjective sleepiness, mood states, simple and high‐order cognitive performance change after one night of sleep deprivation (SD) and recover to after 7 h normal recovery sleep opportunity during three recovery days.

Methods

Ten healthy subjects participated in this study. We measured their subjective sleepiness, mood states and their performances of 2 simple tasks and 4 high‐order cognitive tasks twice a day for 5 days, on the baseline day, post‐vigil day and 3 recovery days after SD. This study was conducted considering each participant's motivation for task, learning effect and diurnal variation of performance.

Results

The performances of simple tasks such as addition or short‐term memory were not reduced after SD and were the poorest on the baseline day, and improved gradually; however the high‐order cognitive performances were at their lowest on the post‐vigil day and needed 2 recovery sleep opportunities to return to the baseline level. Fatigue and confusion in mood states and subjective sleepiness were also at their lowest after SD. Subjective sleepiness nearly recovered to the baseline level on the 1st recovery day, but fatigue and confusion reached the baseline levels on the 2nd recovery day.

Conclusion

These results suggest that cognitive deterioration and the recovery process may differ between simple task performance and high‐order cognitive task performance, which needed 2 ordinary sleep opportunities to recover to the baseline level, and the change of subjective mood states were also different for each mood.
Inhaled Fluorescent Magnetic Nanoparticles Induced Extramedullary Hematopoiesis in the Spleen of Mice
Authors: Kwon Jung‐Taek , Kim Dae‐Seong , Minai‐Tehrani Arash , Hwang Soon‐Kyung , Chang Seung‐Hee , Lee Eun‐Sun , Xu Cheng‐Xiong , Lim Hwang Tae , Kim Ji‐Eun , Yoon Byung‐Il , An Gil‐Hwan , Lee Kee‐Ho , Lee Jin‐Kyu , Cho Myung‐Haing
Published: October 2009

Inhaled Fluorescent Magnetic Nanoparticles Induced Extramedullary Hematopoiesis in the Spleen of Mice: Jung‐Taek Kwon, et al. Laboratory of Toxicology, College of Veterinary Medicine, Seoul National University, Korea

Objectives

Nanomaterials are used in a wide variety of industrial materials such as semiconductors, magnetic resonance imaging, gene delivery carriers for gene therapy and many others; thus, human seems to be frequently exposed to them. Such diverse applications of nanoparticles elicit the need to identify the positive aspects of nanomaterials while avoiding the potential toxic effects. In this study, inhalation toxicity of manufactured nanomaterials using fluorescent magnetic nanoparticles (FMNPs) was assessed to address the issue of potential nanoparticle toxicity.

Methods

Biological samples from a previous mouse FMNP exposure experiment were analyzed for potential FMNP toxicity. Mice inhaled FMNPs for 4 wk through a nose‐only exposure chamber developed by our group for 4 wk and the potential toxicity of FMNPs was analyzed.

Results

The nanoparticle distribution by scanning mobility particle sizer (SMPS) analysis showed that the mean values of number concentration (mass concentrations) in the nose‐only exposure chamber were maintained at 4.89×105/cm3(approximately 159.4 µg/m3) for the low concentration and 9.34×105/cm3(approximately 319.5 µg/m3) for the high concentration, respectively. Inhalation of FMNPs caused a decrease of body weight and significant changes of white blood cells (WBCs) levels in whole blood. The FMNPs induced extramedullary hematopoiesis in the spleen without having a pulmonary effect.

Conclusions

Our results support the proposition that extensive toxicity evaluation is needed for practical applications of anthropogenic nanomaterials and suggest that careful regulation of nanoparticle applications may be necessary to maintain a high quality of life as well as for facilitating the development of nanotechnology.
Occupational Stress and Burnout of Lawyers
Authors: Tsai Feng‐Jen , Huang Wei‐Lun , Chan Chang‐Chuan
Published: October 2009

Occupational Stress and Burnout of Lawyers: Feng‐Jen Tsai, et al. Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taiwan

Objective

The aim of this study was to explore the associations between burnout and occupational stress measured by demand‐control support (DCS) and effort‐reward imbalance (ERI) models among lawyers.

Methods

This cross‐sectional study included 180 lawyers from 26 law firms in the Taipei Bar. The Chinese version of Karasek's job content questionnaire (C‐JCQ) and the Chinese version of Siegrist's ERI questionnaire (C‐ERI) were used to measure occupational stress, and the Chinese version of the Copenhagen Burnout Inventory (C‐CBI) questionnaire was used to measure personal, work‐related and client‐related burnout. Logistic regression analysis was used to determine the associations between burnout and lawyers' occupational stress and job specialty adjusting for age, gender, marital status, work experience, working hours per day, firm size and the significant occupational stress of each model for the other.

Results

Lawyers reported relatively higher scores in job control, psychological demands and effort, and high prevalence of self‐perceived work stress. Litigious lawyers had higher decision authority and workplace social support, higher work‐related burnout and higher client‐related burnout than non‐litigious lawyers. Personal burnout and work‐related burnout were associated with high psychological demands, effort, and effort‐reward ratio.

Conclusions

High occupational stress was associated with high levels of personal and work‐related burnout among lawyers.
Short Nighttime Sleep-Duration and Hyperactivity Trajectories in Early Childhood
Authors: Touchette Evelyne , Côté Sylvana M. , Petit Dominique , Liu Xuecheng , Boivin Michel , Falissard Bruno , Tremblay Richard E. , Montplaisir Jacques Y.
Published: October 2009

OBJECTIVES: Our objectives were to investigate the developmental trajectories of nighttime sleep duration and hyperactivity over the preschool years and to identify the risk factors associated with short nighttime sleep duration and high hyperactivity scores.

DESIGN, SETTING, AND PARTICIPANTS: Nighttime sleep duration and hyperactivity were measured yearly by questionnaires administered to mothers of 2057 children from age 1.5 to 5 years. Developmental trajectories of nighttime sleep duration and hyperactivity throughout early childhood were analyzed to determine interassociations. A multinomial logistic regression was performed to determine which factors among selected child, maternal, and family characteristics and parental practices surrounding sleep periods in early childhood were associated with short nighttime sleep duration and high hyperactivity scores.

RESULTS: The trajectories of nighttime sleep duration and hyperactivity were significantly associated. The odds ratio (OR) of reporting short nighttime sleep duration was 5.1 for highly hyperactive children (confidence interval [CI]: 3.2–7.9), whereas the OR of reporting high hyperactivity scores was 4.2 for persistently short sleepers (CI: 2.7–6.6). The risk factors for reporting short nighttime sleep duration and high hyperactivity scores were (1) being a boy, (2) having insufficient household income, (3) having a mother with a low education, and (4) being comforted outside the bed after a nocturnal awakening at 1.5 years of age.

CONCLUSIONS: The risk of short nighttime sleep duration in highly hyperactive children is greater than the risk of high hyperactivity scores in short sleepers. Preventive interventions that target boys living in adverse familial conditions could be used to address these concomitant behavioral problems.
Acute Heart Failure Syndromes in the Pediatric Emergency Department
Authors: Macicek Scott M. , Macias Charles G. , Jefferies John L. , Kim Jeffrey J. , Price Jack F.
Published: October 2009

OBJECTIVE: The objectives of this study were to (1) describe the clinical presentation of acute heart failure syndromes (AHFS) in the pediatric emergency department (ED) and (2) determine the physician treatment regimens and outcomes in the same population.

METHODS: This was a cross-sectional study of patients who presented with AHFS to the ED at our institution from January 2003 to October 2006. We defined AHFS as “the gradual or rapid deterioration in heart failure signs and symptoms resulting in a need for urgent therapy.” Patients were included when they had documented signs or symptoms of HF attributable to ventricular dysfunction. Patients were excluded when they were older than 21 years or had HF symptoms that were attributable to left-to-right intracardiac shunting or left-sided obstructive lesions. All eligible ED patient visits were adjudicated by a pediatric HF specialist.

RESULTS: Fifty-seven patient visits to the ED met inclusion criteria. There was a significant difference in time from arrival to treatment with a diuretic when the therapy was started in the ED rather than in the inpatient units. Median time to initiation of a vasoactive agent was significantly less for patients whose infusions were started in the ED compared with the ICU. Two patients died in the ED, and overall mortality or need for mechanical circulatory support for hospitalized patients was 18% (n = 10).

CONCLUSIONS: These data yield important insight into the clinical features and initial treatment of children who present with AHFS in the ED and may allow for improved recognition and treatment of this clinical syndrome.
Exploring the Relationship Among Weight, Race, and Sexual Behaviors Among Girls
Authors: Akers Aletha Yvette , Lynch Cheryl P. , Gold Melanie A. , Chang Judy Chia-Chi , Doswell Willa , Wiesenfeld Harold C. , Feng Wentao , Bost James
Published: October 2009

OBJECTIVE: The relationship between weight and sexual behavior among adolescents is poorly understood. We examined this relationship in a nationally representative sample of high school girls.

METHODS: We performed a cross-sectional analysis of self-reported data from 7193 high school girls who completed the 2005 Youth Risk Behavior Surveillance survey. We used multivariate logistic regression to examine associations among 3 weight indices (BMI calculated from self-reported weight and height, perceived weight, and weight misperception) and 6 sexual behaviors (ever had vaginal sex; sex before age 13; ≥4 sexual partners; and alcohol, condom, and oral contraceptive use at last sex) adjusting for age, race/ethnicity, and a history of intimate partner violence.

RESULTS: There were no differences in the likelihood of ever having sex on the basis of BMI or weight perception accuracy; however, girls who perceived themselves as overweight were less likely to have ever had sex. Among sexually active girls, those who had low BMI and perceived themselves as overweight or had overweight misperceptions were less likely to report condom use at last sex. Sexually active girls who perceived themselves as overweight were also more likely to have had sex before age 13. Associations between the 3 weight indices and sexual risk behaviors varied across racial/ethnic groups.

CONCLUSIONS: Sexual risk behaviors may be more common among girls who are underweight or perceive themselves (accurately or not) to be overweight and vary by racial/ethnic group. This suggests that girls at weight extremes and those from different racial backgrounds may have unique sexual health education and prevention needs.
Economic Evaluation of Inhaled Nitric Oxide in Preterm Infants Undergoing Mechanical Ventilation
Authors: Zupancic John A. F. , Hibbs Anna Maria , Palermo Lisa , Truog William E. , Cnaan Avital , Black Dennis M. , Ballard Philip L. , Wadlinger Sandra R. , Ballard Roberta A. ,   and the NO CLD Trial Group
Published: October 2009

OBJECTIVE: In the previously reported Nitric Oxide for Chronic Lung Disease (NO CLD) trial, ventilated preterm infants who received a course of inhaled nitric oxide (iNO) between 7 and 21 days of life had a significant improvement in survival without bronchopulmonary dysplasia (BPD), as well as a shorter duration of admission and ventilation. However, the price for the drug may be a barrier to widespread use. We sought to estimate the incremental cost-effectiveness of iNO therapy to prevent BPD in infants of <1250 g birth weight.

METHODS: We used patient-level data from the NO CLD randomized trial. The study took a third-party payer perspective and measured costs and effects through hospital discharge. We applied previously reported hospital per-diem costs stratified according to intensity of ventilatory support, nitric oxide costs from standard market prices, and professional (physician) fees from the Medicare fee schedule. We compared log transformed costs by using multivariable modeling and performed incremental cost-effectiveness analysis with estimation of uncertainty through nonparametric bootstrapping.

RESULTS: The mean cost per infant was $193125 in the placebo group and $194702 in the iNO group (adjusted P = .17). The point estimate for the incremental cost per additional survivor without BPD was $21297. For infants in whom iNO was initiated between 7 and 14 days of life, the mean cost per infant was $187407 in the placebo group and $181525 in the iNO group (adjusted P = .46). In this group of early treated infants, there was a 71% probability that iNO actually decreased costs while improving outcomes.

CONCLUSIONS: Despite its higher price relative to many other neonatal therapies, iNO in this trial was not associated with higher costs of care, an effect that is likely due to its impact on length of stay and ventilation. Indeed, for infants who receive nitric oxide between 7 and 14 days of life, the therapy seemed to lower costs while improving outcomes.
The Health and Obesity: Prevention and Education (HOPE) Curriculum Project—Curriculum Development
Authors: Huang Jeannie , Pokala Parvathi , Hill Linda , Boutelle Kerri N. , Wood Christine , Becerra Karen , Calfas Karen
Published: October 2009

The Health and Obesity: Prevention and Education (HOPE) project is a multidisciplinary, healthy living counseling curriculum to educate pediatric clinicians in training on how to recognize children who are at risk for obesity and its comorbidities and how to promote healthy weight among children and their families. Curriculum topics were selected by experts of nutrition, medicine, dentistry, behavioral counseling, and education and incorporate the recent 2007 Expert Committee recommendations regarding the prevention, assessment, and treatment of childhood and adolescent obesity. The HOPE curriculum instructs medical and dental clinicians on the health consequences of childhood obesity and screening techniques to identify children and families at risk, reviews the current evidence for health intervention recommendations, and teaches trainees regarding the theoretical rationale and art of constructive and culturally sensitive weight counseling for behavioral change. Although designed and tailored specifically for and currently available medical and dental trainees, the HOPE curriculum is Web-based and will also be made available to currently practicing clinicians across the United States beginning in winter 2009. This educational tool, grounded in understanding of relevant sciences, literature, and research methods, provides clinicians with the skills necessary to identify and counsel patients who are at risk to promote healthy weight among youth. This article discusses the approach and methods used for curriculum development. Future publications will discuss HOPE project implementation and outcomes.
Prospective, Observational Study of Outcomes in Neonates With Severe Thrombocytopenia
Authors: Stanworth Simon J. , Clarke Paul , Watts Tim , Ballard Sally , Choo Louise , Morris Tim , Murphy Mike F. , Roberts Irene ,   for the Platelets and Neonatal Transfusion Study Group
Published: October 2009

OBJECTIVE: A cross-sectional, observational study of outcomes for neonates with severe neonatal thrombocytopenia (SNT; platelet count of <60 × 109 platelets per L) was performed to examine hemorrhage and use of platelet transfusions.

METHODS: Neonates who were admitted to 7 NICUs and developed SNT were enrolled for daily data collection.

RESULTS: Among 3652 neonatal admissions, 194 neonates (5%) developed SNT. The median gestational age of 169 enrolled neonates was 27 weeks (interquartile range [IQR]: 24–32 weeks), and the median birth weight was 822 g (IQR: 670–1300 g). Platelet count nadirs were <20 × 109, 20 to 39 × 109, and 40 to 59 × 109 platelets per L for 58 (34%), 64 (39%), and 47 (28%) of all enrolled infants, respectively. During the study, 31 infants (18%) had no recorded hemorrhage, 123 (73%) developed minor hemorrhage, and 15 (9%) developed major hemorrhage. Thirteen (87%) of 15 episodes of major hemorrhage occurred in neonates with gestational ages of <28 weeks. Platelet transfusions (n = 415) were administered to 116 infants (69%); for 338 (81%) transfusions, the main recorded reason was low platelet count. Transfusions increased the platelet count from a median of 27 × 109 platelets per L (IQR: 19–36 × 109 platelets per L) to 79 × 109 platelets per L (IQR: 47.5–127 × 109 platelets per L).

CONCLUSIONS: Although one third of neonates enrolled in this study developed thrombocytopenia of <20 × 109 platelets per L, 91% did not develop major hemorrhage. Most platelet transfusions were given to neonates with thrombocytopenia with no bleeding or minor bleeding only.
Impact of Music, Music Lyrics, and Music Videos on Children and Youth
Authors:   Council on Communications and Media
Published: October 2009

This Policy Statement was retired July 2017.

Music plays an important role in the socialization of children and adolescents. Popular music is present almost everywhere, and it is easily available through the radio, various recordings, the Internet, and new technologies, allowing adolescents to hear it in diverse settings and situations, alone or shared with friends. Parents often are unaware of the lyrics to which their children are listening because of the increasing use of downloaded music and headphones. Research on popular music has explored its effects on schoolwork, social interactions, mood and affect, and particularly behavior. The effect that popular music has on children's and adolescents' behavior and emotions is of paramount concern. Lyrics have become more explicit in their references to drugs, sex, and violence over the years, particularly in certain genres. A teenager's preference for certain types of music could be correlated or associated with certain behaviors. As with popular music, the perception and the effect of music-video messages are important, because research has reported that exposure to violence, sexual messages, sexual stereotypes, and use of substances of abuse in music videos might produce significant changes in behaviors and attitudes of young viewers. Pediatricians and parents should be aware of this information. Furthermore, with the evidence portrayed in these studies, it is essential for pediatricians and parents to take a stand regarding music lyrics.
Media Violence
Authors:   Council on Communications and Media
Published: October 2009

Exposure to violence in media, including television, movies, music, and video games, represents a significant risk to the health of children and adolescents. Extensive research evidence indicates that media violence can contribute to aggressive behavior, desensitization to violence, nightmares, and fear of being harmed. Pediatricians should assess their patients' level of media exposure and intervene on media-related health risks. Pediatricians and other child health care providers can advocate for a safer media environment for children by encouraging media literacy, more thoughtful and proactive use of media by children and their parents, more responsible portrayal of violence by media producers, and more useful and effective media ratings. Office counseling has been shown to be effective.
The formation of monosulphate from tetracalcium aluminoferrite and magnesium sulphate
Authors: Clark B. A. , Brown P. W.
Published: October 2009

The formation of monosulphate, by hydration of a tetracalcium aluminoferrite powder, was investigated by isothermal calorimetry and X-ray diffraction (XRD) analyses. Hydration reactions were carried out isothermally at temperatures ranging from 25 to 80°C in 0·25 M, 0·5 M, 1·0 M, 2·0 M, and 3·0 M magnesium sulphate solutions. Gypsum was the initial hydration product in all magnesium sulphate concentrations and was the only crystalline hydration product in 2·0 M and 3·0 M magnesium sulphate solutions. Monosulphate was the dominant crystalline phase produced over the entire temperature range when hydration was carried out in magnesium sulphate concentrations between 0·25 M and 1·0 M. XRD and calorimetry also demonstrated that small amounts of calcium aluminium hydroxide, calcium aluminate carbonate hydrate and magnesium aluminate hydrate phases formed at the lower temperatures and in low (0·25 M and 0·5 M) magnesium sulphate concentrations. No crystalline phases incorporating iron were observed regardless of magnesium sulphate concentration or temperature.