bluuebunny/crossref_metadata_2025 huggingface dataset:
Dimensions of Career Indecision Among Puerto Rican College Students
Authors: Corkin Danya , Arbona Consuelo , Coleman Nicole , Ramirez Romilia
Published: March 2008

The purpose of this study was (a) to explore the factor structure of a Spanish version of the Career Decision Scale (CDS; Osipow, Carney, Winer, Yanico, & Koschier, 1976) with Puerto Rican college students, (b) to examine the relation of trait anxiety to the identified dimensions of career indecision, and (c) to explore differences in anxiety and career indecision dimensions between career undecided students and subgroups of career decided students. Participants were 337 undergraduate students enrolled at a major private university in Puerto Rico. An exploratory factor analysis with the items of the Spanish CDS yielded four factors similar to those identified with the original CDS. In addition, results indicated that the identified dimensions of career indecision were positively associated with anxiety and that college students who presented as career decided were a heterogeneous group. The findings suggested that the Spanish version of the CDS may be a valid instrument to assess antecedents of career indecision among Hispanic college students and that some college students who identify themselves as career decided may benefit from career counseling interventions.
A "Commercial View of This Unfortunate War": Economic Roots of an American National State in the Ohio Valley, 1775–1795
Authors: Bergmann William H.
Published: March 2008

This article argues that the roots of an American national state were forged in the wars with Native Americans for control of the Ohio Valley between 1775 and 1795. It examines how the new national government's use of its fiscal-military powers shifted and accelerated an economic transformation in the region by encouraging commercial husbandry and merchant-based exchange. An expanded commercial economy, in turn, supported the federally funded military. The result was that local western economies and communities became more tightly bound to an expansionist national government.
"Friends of the Negro! Fly with me, The path is open to the sea": Remembering the Haitian Revolution in the History, Music, and Culture of the African American People
Authors: Jackson Maurice
Published: March 2008

This essay explores how the images, representations, and ideals of the Haitian Revolution and its leader, Toussaint Louverture, have been replicated in the history, music, art, and culture of African American people in the United States over the past two centuries.
Benjamin Franklin's Interiors
Authors: Cahill Edward
Published: March 2008

This essay investigates the problem of articulating psychological interiority in eighteenth-century American writing by considering Franklin's ideologically divided relationship to the architectural interiors of his 1764 Market Street town house and his rhetorical strategies for managing and representing his upward mobility.
The Hateful Self: Substitution and the Ethics of Representing War
Authors: Bartley Aryn
Published: March 2008

This essay reads the works of war journalists Michael Herr and Joe Sacco alongside Emmanuel Levinas's concepts of substitution, responsibility, and the "hatefulness" of the self in order to draw out the political possibilities of Levinas's thought.  Where Herr and Sacco posit responsibility and hatefulness as pre-existing, they grapple with the political practice of substitution. Most importantly, their writings draw out the limit case of the practice of substitution. The marking of their inevitable failure to substitute, however, poses a necessary critique of political, economic, and social structures that privilege some lives over others.
Regarding the Other: Postcolonial Violations and Ethical Resistance in Margaret Atwood's Bodily Harm
Authors: Drichel Simone
Published: March 2008

To observe that postcolonial studies as a field appears to be plagued by a guilty conscience—a persistent anxiety over its potential complicity with colonialism—is to state the obvious. Drawing on Emmanuel Levinas's philosophy, this essay exploits and extends this observation to argue that this guilty conscience reveals a largely overlooked ethical dimension in a field that derives its raison d'être from political, not ethical, concerns. Focusing on the concept of le regard, the essay suggests that Margaret Atwood's Bodily Harm offers an exemplary dramatization of such a guilty conscience, simultaneously revealing le regard's complicity with colonial violence and its ethical interruption.
Hup! Hup! We Must Tumble: Toward an Ethical Reading of the Schlemiel
Authors: Feuer Menachem , Schmitz Andrew
Published: March 2008

The schlemiel is a central character in the tradition of Yiddish and Jewish-American literature. Oftentimes, the schlemiel is read as a comic character that has political and ethical content. In our essay, we take another look at the ethical character of the schlemiel by way of a close reading of Levinas's notion of the self, aesthetics, and ethics, coupled with Hommi Bhabba's reading of Levinas in terms of history and Adam Newton's reading of Levinas in terms of narrative. This nuanced reading is used in the analysis of schlemiels in selected stories and parables of Franz Kafka, I. B. Singer and Nathan Englander.
The Point of the Story: Levinas, Blanchot and "The Madness of the Day"
Authors: Sheaffer-Jones Caroline
Published: March 2008

The focus of this article is Levinas's "Exercises on 'The Madness of the Day'" in Proper Names and Blanchot's story, which is the subject of Levinas's reading. With reference to some of the writings by each of the authors, the problem of testimony and its limits is posed, in particular in relation to testifying to death or madness. What are Levinas's reading and Blanchot's story about? What differences in perspective can be emphasized? In what sense, in both approaches, is the point of the story elusive?
Writing and the Paradox of the Self: Machiavelli’s Literary Vocation*
Authors: Bernard John
Published: March 2008

The respective roles ofvirtùandfortuna, never resolved in his political writings, are critical to understanding Machiavelli’s literary evolution. As his letters suggest, in the years between the fall of the Soderini republic and his reentry into public life withMandragola, Machiavelli came to understand the power of language to impose order on the anarchy of events. The fragmentaryL’Asinorecords his discovery that writing can achieve an agency denied to princes.Mandragola’s dialectic between the author and his protagonist demonstrates that the inventive plasticity of the writer is grounded in the inherent stability of the creative self.
Homer in the French Renaissance*
Authors: Ford Philip
Published: March 2008

Although the works of Homer remained unknown in Western Europe for much of the Middle Ages, their reappearance was welcomed enthusiastically in France toward the end of the fifteenth century by the small band of scholars capable of reading Greek. The founding of the Collège des lecteurs royaux in 1530 gave a fillip to Homeric studies, and partial editions of Homer were printed in Paris, aimed at a student audience. French translations also helped to bring the poems to a wider audience. However, the question of the interpretation of Homer was central to the reception of the two epics, and, after examining the publishing history, this paper sets out to assess how succeeding generations of scholars set about reading and teaching the prince of poets.
“A wonderfull tryumfe, for the wynnyng of a pryse”: Guilds, Ritual, Theater, and the Urban Network in the Southern Low Countries, ca. 1450–1650*
Authors: Van Bruaene Anne-Laure
Published: March 2008

This essay discusses the role of the Chambers of Rhetoric (literary guilds or confraternities) in the construction of urban culture in the Southern Low Countries. The Chambers of Rhetoric not only contributed to the forging of urban identity through their associational practices, but also played an important role in the molding of public space through theatrical representations and the staging of civic ritual. In particular, the Chambers’ participation in large-scale regional and interregional theater and poetry competitions is crucial for our understanding of sixteenth-century urban culture in the Low Countries.
Homer for the Court of François I
Authors: Rothstein Marian
Published: March 2008

Hugues Salel’s translation of theIliadwas intended for noble, warrior readers, a conclusion based largely on internal evidence, both from the physical book (including its woodcuts) and from the French rendering of Homer’s epic. This article looks at the book’s verbal and visual texts to understand how Salel’s translation of theIliadis shaped in anticipation of its contemporary reception. It examines a translation into the vernacular of one of antiquity’s masterpieces, as well as what noble readers knew and wanted to know, and questions the purposes and processes of the production of illustrations and marginalia in the period.
“Plain Broad Narratives of Substantial Facts”: Credibility, Narrative, and Hakluyt’sPrincipall Navigations*
Authors: Schleck Julia
Published: March 2008

This article compares voyage narratives printed in Richard Hakluyt’s 1589 Principall Navigations to contemporaneous travel histories in an effort to contextualize the epistemological status of each group of texts and debunk the former’s reputation for greater factuality. It critiques the use commonly made of Hakluyt’s narratives in literary studies, arguing that the privileging of these texts over other sources results in postcolonial studies that ironically valorize a type of writing which promoted the colonial mindset these studies seek to expose.
Hercules and Albrecht Dürer’s Das Meerwunder in a Chantbook from Renaissance
Spain *
Authors: Candelaria Lorenzo
Published: March 2008

This article centers on two images from the life of Hercules and a
border painting modeled after Albrecht Dürer’s engraving Das
Meerwunder (ca. 1498) in a Kyriale produced ca. 1500 for a Dominican
convent in Toledo, Spain. It discusses the cultural significance of Hercules in
Spain, and Toledo in particular, then presents a contextually sensitive reading
of the image derived from Dürer’s enigmatic engraving, whose subject has yet to
be identified. The image in the Kyriale appears to represent Hercules’
once-famous rescue of the Trojan princess Hesione from a sea
monster.
Principles and Practice in the Civic Government of Fifteenth-Century Genoa*
Authors: Shaw Christine
Published: March 2008

This paper is an examination of the civic government of Genoa from 1435 to 1464, and of the principles that underlay how it was conducted. Despite the political instability caused by contenders for the dogeship, and the division of offices between Guelfs and Ghibellines and between nobles andpopolari,the civic government generally operated on a consensual basis. The principles and practices of the civic government restricted the power of the doges and prevented them from turning their position into an effectivesignoria.
Thomas Wyatt in Italy
Authors: Brigden Susan , Woolfson Jonathan
Published: March 2008

This article follows a young Thomas Wyatt (ca. 1503–42) — the Henrician poet and courtier —on his journeys to France and especially to Italy in 1526–27. It finds him at the greatest courts of Europe at a climacteric in European affairs, during which, by default, he had a part to play. It discovers the dramatic circumstances of his kidnap, ransom, and release. The article conjectures upon the ways in which Wyatt's Italian journey was formative for his political and poetic career, and upon the brilliance with which he transmuted the events of a life lived so intensely, so restlessly, into art.
For “Honor and Profit”: Benvenuto Cellini’s Medal of Clement VII and His Competition with Giovanni Bernardi
Authors: Holman Beth L.
Published: March 2008

This article examines the frameworks of artistic competition embodied in a 1534 contract for a contest of medalmaking between Benvenuto Cellini and Giovanni Bernardi, and in descriptions of other competitions, especially in Cellini’s autobiography. Strategies, decorum, and rhetoric of such competitions were embedded in notions of honor. In addition to personal and professional honor, court status and patronage were also at stake. By means of his competition with Bernardi and his medal of Pope Clement VII, Cellini hoped to recoup lost standing and favor, along with concomitant commissions and emoluments at the papal court — specifically, it is argued, an appointment at the Roman mint, where Cellini had been replaced by Bernardi in 1534. Cellini, however, was never rehabilitated at Clement’s court, and within days of the death of his patron, he murdered Pompeo de’ Capitaneis, the rival goldsmith whom he blamed for his loss of honor and profit.
Visualizing Imperium:The Virgin of the Seafarersand Spain’s Self-Image in the Early Sixteenth Century*
Authors: Carla Rahn Phillips
Published: March 2008

The Virgin of the Seafarers(1531–36) by Alejo Fernández was designed as the central panel of an altarpiece for the chapel in the House of Trade’s Hall of Audiences in Seville. Little attention has been paid to the central panel and almost none to the four side panels, yet they are crucial to our understanding of how the Spanish monarchy defined its mission overseas. The iconography of the altarpiece as a whole made visible Spain’s self-image as the creator and guarantor of a militant, evangelical Christian empire, dedicated to spreading the Gospel as well as fomenting trade and colonization.
Maximilian I as Archeologist*
Authors: Wood Christopher S.
Published: March 2008

Emperor Maximilian I was intensely engaged with material relics of the ancient Roman and medieval German past. Maximilian’s historical imagination, creative and participatory rather than objective and distancing, guided his own monumental projects. This essay analyzes, among other episodes, the quest for the bones of the historical Siegfried in Worms and an apparently archeological drawing by Albrecht Dürer.
The Poetry of a Minority Community: The Deaf Poet Pierre Pélissier and the Formation of a Deaf Identity in the 1850s
Authors: Quartararo Anne T. (Anne Therese)
Published: March 2008

This study investigates the cultural and educational ideas of the French deaf poet-teacher Pierre Pélissier (1814-1863) who was an instructor at the Paris Deaf Institute from the early 1840s until his death in 1863. As a young man, Pélissier became interested in composing poetry and through his verse, captured many of the social frustrations facing deaf people who had to manage in a hearing world. Once he became a teacher, Pélissier devoted his energies to developing the best methods to educate deaf youth. In the mid-nineteenth-century, he found himself defending natural sign language against proponents of spoken language. Pélissier responded with a his own book (published in 1856) on how sign language could be used in the French primary schools to educate deaf children. He advocated a type of bilingual educational environment for primary schools that relied on hearing and deaf students using the manual alphabet and sign language in a shared classroom setting. Pélissier's analysis of sign language as a pedagogical method clearly challenged the prevailing social view that deaf teachers were somehow less capable educators of deaf children than those who were hearing.
The Complexities of Caroline Pichler: Conflicting Role Models, Patriotic Commitment, and The Swedes in Prague (1827)
Authors: Robertson Ritchie
Published: March 2008

The active commitment to Austrian nationalism by the novelist Caroline Pichler contrasts strikingly with her declared view that women should avoid politics and remain in the domestic sphere. Drawing on her memoirs, this article argues that this contradiction results from her ambivalence toward two female role models: her mother and the Empress Maria Theresia, known as "Mother of Her Peoples." This ambivalence also underlies the portrayal of women engaged in a national cause in Pichler's novel The Swedes in Prague (Die Schweden in Prag , 1827). (RR)
Creating a Maidservant Community through Newspapers: The Berliner Dienstboten-Zeitung , 1898–1900
Authors: Karolle-Berg Julia
Published: March 2008

While the Berliner Dienstboten-Zeitung (Berlin Servants' Newspaper) has been cited frequently in research on maidservice in Berlin at the turn of the century, the development of the paper between 1898 and 1900 and its role in organizing female domestics have been largely overlooked. This essay analyzes how the editor of the BDZ created a feeling of community among his readers and ultimately inspired them to organize. Unlike other publications for and about servants around 1900 that tended to preserve traditional bourgeois values and interests without reference to servants' own issues and concerns, the BDZ was unique in that it revised its representation of maidservice in response to its readers. Though the BDZ and its community of readers were never able to effect significant social or political change, the newspaper nevertheless played a crucial role in raising social and scholarly awareness of maidservants' issues. (JKB)
"The most famous Jewish pacifist was Jesus of Nazareth": German-Jewish Pacifist Clementine Krämer's Stories of War and Visions for Peace
Authors: Loentz Elizabeth
Published: March 2008

This essay reintroduces the undeservedly forgotten literary oeuvre of the German-Jewish writer, feminist, social worker, and pacifist Clementine Krämer, focusing on her pacifist writings. These texts, published between 1915 and 1927, are read in the context of Krämer's dual commitment to the German women's movement and the Jewish community, probing how she negotiated in her writing and activism the multi-faceted identity of a German, Jewish, and feminist pacifist. The essay identifies two distinct periods in Krämer's pacifist writing. During the war years, Krämer published in the mainstream press stories and poems that were subtly subversive and studiously devoid of Jewish issues and characters. With the notable exception of her Bavarian-dialect pacifist novella Die Rauferei (The Fight, 1927), Krämer's postwar texts, which appeared almost exclusively in the Jewish press, were overtly and uncompromisingly pacifist, positing an inherent affinity between pacifism, Judaism, and feminism. (EL)
Can Trade-Ins Hurt You? Exploring the Effect of a Trade-In on Consumers' Willingness to Pay for a New Product
Authors: Zhu Rui (Juliet) , Chen Xinlei (Jack) , Dasgupta Srabana
Published: April 2008

When consumers decide to upgrade to a new or better product, they often trade in their currently owned or used product for the new one. The authors examine whether such trade-in behavior, in which consumers must negotiate the price for both the new and the used product, affects their willingness-to-pay price for the new good. Drawing on research on mental accounting, the authors reason that when consumers engage in a transaction involving a trade-in (i.e., when they act as both buyer and seller simultaneously), they place more importance on getting a good value for the used product than on getting a good price for the new product. As a result, such consumers exhibit a higher willingness-to-pay price for the new product than consumers who just buy the new product alone. The results from a series of laboratory experiments provide systematic support for this hypothesis. Finally, the authors lend external validity to their results by confirming the hypothesis using real-world transaction data from the automobile market.
Incorporating Subjective Characteristics in Product Design and Evaluations
Authors: Luo Lan , Kannan P.K. , Ratchford Brian T.
Published: April 2008

Consumers often use both objective and subjective criteria to evaluate a product. For example, power tool users may evaluate a power tool on the basis of not only its objective attributes, such as price and switch type, but also its subjective characteristics, such as ease of use and feel of the tool. This research emphasizes incorporating subjective characteristics in new product design. The authors propose a model in which consumers' purchase intentions can be affected by both the objective attributes and the subjective characteristics. This model has the form of a hierarchical Bayesian structural equation model, in which the subjective characteristics are treated as latent constructs. The authors also propose a Bayesian forecasting procedure in which the estimated relationships are used to improve the out-of-sample prediction. They illustrate the proposed approach in two empirical studies. The results indicate that by collecting additional information about consumers' perceptions of the subjective characteristics, the proposed model provides the product designer with a better understanding and a more accurate prediction of consumers' product preferences than the traditional conjoint models.
A Conjoint Approach to Multipart Pricing
Authors: Iyengar Raghuram , Jedidi Kamel , Kohli Rajeev
Published: April 2008

Multipart pricing is commonly used by service providers such as car rentals, prescription drug plans, health maintenance organizations, and wireless telephony. The general structure of these pricing schemes is a fixed access fee, which sometimes entitles users to a certain level of product use; a variable fee for additional use; and still another fee for add-on features that are priced individually and/or as bundles. The authors propose a method using conjoint analysis for multipart pricing. The method reflects the two-way dependence between prices and consumption and incorporates consumers' uncertainty about their use of a service. The proposed method estimates both choice probabilities and usage levels for each consumer as functions of the product features and the different price components. The authors then use these estimates to evaluate the expected revenues and profits of alternative plans and pricing schemes. They illustrate this method using data from a conjoint study of cell phone services. They compare the results with those obtained from using several competing models. Finally, they use the proposed procedure to identify the optimal set of features in a base plan and the pricing of optional features for a provider of cell phone services.
Bleeding Disorders in the Neonate
Authors: Manco-Johnson Marilyn J.
Published: April 2008

Bleeding syndromes in the newborn are rare, but they may be life-threatening and demand immediate attention. Results of an initial coagulation evaluation often can direct the clinician toward diagnostic possibilities, as can the degree of illness manifested by the infant. Among the potential causes of neonatal bleeding are platelet disorders, neonatal hemophilia and other congenital clotting factor deficiencies, vitamin K deficiency syndromes, liver failure, and disseminated intravascular coagulation. Depending on the cause, platelet or protein concentrates may be used for transfusion therapy.
Just, in Time: Ethical Implications of Serial Predictions of Death and Morbidity for Ventilated Premature Infants
Authors: Meadow William , Lagatta Joanne , Andrews Bree , Caldarelli Leslie , Keiser Amaris , Laporte Johanna , Plesha-Troyke Susan , Subramanian Madhu , Wong Sam , Hron Jon , Golchin Nima , Schreiber Michael
Published: April 2008

OBJECTIVES. For a cohort of extremely premature, ventilated, newborn infants, we determined the power of either serial caretaker intuitions of “die before discharge” or serial illness severity scores to predict the outcomes of death in the NICU or neurologic performance at corrected age of 2 years.

METHODS. We identified 268 premature infants who were admitted to our NICU in 1999–2004 and required mechanical ventilation. For each infant on each day of mechanical ventilation, we asked nurses, residents, fellows, and attending physicians the following question: “Do you think this child is going to live to go home or die before hospital discharge?” In addition, we calculated illness severity scores until either death or extubation.

RESULTS. A total of 17066 intuition profiles were obtained on 5609 days of mechanical ventilation in the NICU. One hundred (37%) of 268 profiled infants had ≥1 intuition of die before discharge. Only 33 infants (33%) with an intuition of die actually died in the NICU. Of 48 infants with even 1 day of corroborated intuition of die in the NICU, only 7 (14%) were alive with both Mental Developmental Index and Psychomotor Developmental Index scores of >69, and only 2 (4%) were alive with both Mental Developmental Index and Psychomotor Developmental Index Scores of >79 at corrected age of 2 years. On day of life 1, the Score for Neonatal Acute Physiology II value for nonsurvivors (38.2 ± 18.1) was significantly higher than that for survivors (26.3 ± 12.7). However, this difference decreased steadily over time as scores improved for both groups.

CONCLUSIONS. Illness severity scores become progressively less helpful over time in distinguishing infants who will either die in the NICU or survive with low Mental Developmental Index/Psychomotor Developmental Index scores. Serial caretaker intuitions of die before discharge also fail to identify prospective nonsurviving infants. However, corroborated intuitions of die before discharge identify a subset of infants whose likelihood of surviving to 2 years with both MDI and PDI >80 is approximately 4%.
Impact of Admission-Day Crowding on the Length of Stay of Pediatric Hospitalizations
Authors: Lorch Scott A. , Millman Andrea M. , Zhang Xuemei , Even-Shoshan Orit , Silber Jeffrey H.
Published: April 2008

OBJECTIVE. Increased crowding may affect the care that is delivered to hospitalized patients, particularly around the time of admission. There is little information about the impact of admission-day crowding on the outcome of children who are hospitalized with common pediatric conditions.

METHODS. A population cohort was constructed of children who were aged 1 to 17 years and were hospitalized in Pennsylvania and New York between April 1, 1996, and June 30, 1998, with 1 of 19 common pediatric conditions (N = 116235). Condition-specific Cox regression and logit models were developed to estimate the effect of admission-day occupancy on 4 outcome measures after controlling for illness severity and site of care: length of stay; 21-day readmission; prolonged stay or a stay longer than the typical, uncomplicated stay for that condition as a measure of care delivered to patients with uncomplicated courses; and conditional length of stay as a measure of care delivered to patients whose stays are prolonged.

RESULTS. For children who were admitted with respiratory disease, increasing admission-day occupancy from 60% to 100% was associated with a 0.25-day increase in the average length of stay. Increased admission-day occupancy above 60% was also associated with higher odds of a prolonged stay but not with a change in 21-day readmission rates or conditional length of stay. For children who were admitted with nonrespiratory conditions, increased admission-day occupancy was not associated with changes to any length-of-stay outcome.

CONCLUSIONS. Increased admission-day occupancy was associated with longer lengths of stay for less complicated respiratory admissions but not for children who were admitted with the most serious conditions. These results suggest that medical professionals, during times of increased workload, first focus their attention on more acutely ill children with a complicated course and thus delay treatment of children who have less complicated courses but require time-consuming management and treatment.
Global Initiatives for Improving Hospital Care for Children: State of the Art and Future Prospects
Authors: Campbell Harry , Duke Trevor , Weber Martin , English Mike , Carai Susanne , Tamburlini Giorgio ,   Pediatric Hospital Improvement Group
Published: April 2008

Deficiencies in the quality of health care are major limiting factors to the achievement of the Millennium Development Goals for child and maternal health. Quality of patient care in hospitals is firmly on the agendas of Western countries but has been slower to gain traction in developing countries, despite evidence that there is substantial scope for improvement, that hospitals have a major role in child survival, and that inequities in quality may be as important as inequities in access. There is now substantial global experience of strategies and interventions that improve the quality of care for children in hospitals with limited resources. The World Health Organization has developed a toolkit that contains adaptable instruments, including a framework for quality improvement, evidence-based clinical guidelines in the form of the Pocket Book of Hospital Care for Children, teaching material, assessment, and mortality audit tools. These tools have been field-tested by doctors, nurses, and other child health workers in many developing countries. This collective experience was brought together in a global World Health Organization meeting in Bali in 2007. This article describes how many countries are achieving improvements in quality of pediatric care, despite limited resources and other major obstacles, and how the evidence has progressed in recent years from documenting the nature and scope of the problems to describing the effectiveness of innovative interventions. The challenges remain to bring these and other strategies to scale and to support research into their use, impact, and sustainability in different environments.
Volumetric MRI Study of Brain in Children With Intrauterine Exposure to Cocaine, Alcohol, Tobacco, and Marijuana
Authors: Rivkin Michael J. , Davis Peter E. , Lemaster Jennifer L. , Cabral Howard J. , Warfield Simon K. , Mulkern Robert V. , Robson Caroline D. , Rose-Jacobs Ruth , Frank Deborah A.
Published: April 2008

OBJECTIVE. The objective of this study was to use volumetric MRI to study brain volumes in 10- to 14-year-old children with and without intrauterine exposure to cocaine, alcohol, cigarettes, or marijuana.

METHODS. Volumetric MRI was performed on 35 children (mean age: 12.3 years; 14 with intrauterine exposure to cocaine, 21 with no intrauterine exposure to cocaine) to determine the effect of prenatal drug exposure on volumes of cortical gray matter; white matter; subcortical gray matter; cerebrospinal fluid; and total parenchymal volume. Head circumference was also obtained. Analyses of each individual substance were adjusted for demographic characteristics and the remaining 3 prenatal substance exposures.

RESULTS. Regression analyses adjusted for demographic characteristics showed that children with intrauterine exposure to cocaine had lower mean cortical gray matter and total parenchymal volumes and smaller mean head circumference than comparison children. After adjustment for other prenatal exposures, these volumes remained smaller but lost statistical significance. Similar analyses conducted for prenatal ethanol exposure adjusted for demographics showed significant reduction in mean cortical gray matter; total parenchymal volumes; and head circumference, which remained smaller but lost statistical significance after adjustment for the remaining 3 exposures. Notably, prenatal cigarette exposure was associated with significant reductions in cortical gray matter and total parenchymal volumes and head circumference after adjustment for demographics that retained marginal significance after adjustment for the other 3 exposures. Finally, as the number of exposures to prenatal substances grew, cortical gray matter and total parenchymal volumes and head circumference declined significantly with smallest measures found among children exposed to all 4.

CONCLUSIONS. These data suggest that intrauterine exposures to cocaine, alcohol, and cigarettes are individually related to reduced head circumference; cortical gray matter; and total parenchymal volumes as measured by MRI at school age. Adjustment for other substance exposures precludes determination of statistically significant individual substance effect on brain volume in this small sample; however, these substances may act cumulatively during gestation to exert lasting effects on brain size and volume.
Association Between Living With Children and Adherence to Highly Active Antiretroviral Therapy in the Women's Interagency HIV Study
Authors: Merenstein Daniel J. , Schneider Michael F. , Cox Christopher , Schwartz Rebecca , Weber Kathleen , Robison Esther , Gandhi Monica , Richardson Jean , Plankey Michael W.
Published: April 2008

OBJECTIVE. The purpose of this work was to evaluate whether living with children adversely affects adherence to highly active antiretroviral therapy in HIV-infected women.

PARTICIPANTS AND METHODS. We conducted a prospective cohort study between October 1998 and September 2005. The study outcome was ≥95% adherence to highly active antiretroviral therapy evaluated at 5832 semiannual visits among 1366 HIV-infected women in the Women's Interagency HIV Study. The primary exposure defined at the visit immediately before outcome ascertainment was the number of children ≤18 years of age reported living in the household.

RESULTS. The percentage of women who reported ≥2 children in the household who also reported ≥95% adherence ranged from 68% to 75% compared with adherence when either 1 child or no children were reported. Each additional child reported living in the household was associated with a 6% decrease in the odds of ≥95% adherence.

CONCLUSION. The impact of living with a child on the ability to take medications by HIV-infected women has not been examined thoroughly. Our data suggest that adherence to highly active antiretroviral therapy is inversely associated with the number of children living in the household.
Differences in Rates and Short-term Outcome of Live Births Before 32 Weeks of Gestation in Europe in 2003: Results From the MOSAIC Cohort
Authors: Zeitlin Jennifer , Draper Elizabeth S. , Kollée Louis , Milligan David , Boerch Klaus , Agostino Rocco , Gortner Ludwig , Van Reempts Patrick , Chabernaud Jean-Louis , Gadzinowski Janusz , Bréart Gérard , Papiernik Emile ,   and the MOSAIC research group
Published: April 2008

OBJECTIVES. Advances in perinatal medicine increased survival after very preterm birth in all countries, but comparative population-based data on these births are not readily available. This analysis contrasts the rates and short-term outcome of live births before 32 weeks of gestation in 10 European regions.

METHODS. The Models of Organizing Access to Intensive Care for Very Preterm Births (MOSAIC) study collected prospective data on all very preterm births in 10 European regions covering 494463 total live births in 2003. The analysis sample was live births between 24 and 31 weeks of gestation without lethal congenital anomalies (N = 4908). Outcomes were rates of preterm birth, in-hospital mortality, intraventricular hemorrhage grades III and IV or cystic periventricular leukomalacia and bronchopulmonary dysplasia. Mortality and morbidity rates were standardized for gestational age and gender.

RESULTS. Live births between 24 and 31 weeks of gestation were 9.9 per 1000 total live births with a range from 7.6 to 13.0 in the MOSAIC regions. Standardized mortality was doubled in high versus low mortality regions (18%–20% vs 7%–9%) and differed for infants ≤28 weeks of gestation as well as 28 to 31 weeks of gestation. Morbidity among survivors also varied (intraventricular hemorrhage/periventricular leukomalacia ranged from 2.6% to ≤10% and bronchopulmonary dysplasia from 10.5% to 21.5%) but differed from mortality rankings. A total of 85.2 very preterm infants per 10000 total live births were discharged from the hospital alive with a range from 64.1 to 117.1; the range was 10 to 31 per 10000 live births for infants discharged with a diagnosis of neurologic or respiratory morbidity.

CONCLUSIONS. Very preterm mortality and morbidity differed between European regions, raising questions about variability in treatment provided to these infants. Comparative follow-up studies are necessary to evaluate the impact of these differences on rates of cerebral palsy and other disabilities associated with preterm birth.
Media Coverage of the Measles-Mumps-Rubella Vaccine and Autism Controversy and Its Relationship to MMR Immunization Rates in the United States
Authors: Smith Michael J. , Ellenberg Susan S. , Bell Louis M. , Rubin David M.
Published: April 2008

OBJECTIVE. The purpose of this work was to assess the association between media coverage of the MMR-autism controversy and MMR immunization in the United States.

METHODS. The public-use files of the National Immunization Survey were used to estimate annual MMR coverage from 1995 to 2004. The primary outcome was selective measles-mumps-rubella nonreceipt, that is, those children who received all childhood immunizations except MMR. Media coverage was measured by using LexisNexis, a comprehensive database of national and local news media. Factors associated with MMR nonreceipt were identified by using a logistic regression model.

RESULTS. Selective MMR nonreceipt, occurring in as few as 0.77% of children in the 1995 cohort, rose to 2.1% in the 2000 National Immunization Survey. Children included in the 2000 National Immunization Survey were born when the putative link between MMR and autism surfaced in the medical literature but before any significant media attention occurred. Selective nonreceipt was more prevalent in private practices and unrelated to family characteristics. MMR nonreceipt returned to baseline before sustained media coverage of the MMR-autism story began.

CONCLUSIONS. There was a significant increase in selective MMR nonreceipt that was temporally associated with the publication of the original scientific literature, suggesting a link between MMR and autism, which preceded media coverage of the MMR-autism controversy. This finding suggests a limited influence of mainstream media on MMR immunization in the United States.
Development, Testing, and Findings of a Pediatric-Focused Trigger Tool to Identify Medication-Related Harm in US Children's Hospitals
Authors: Takata Glenn S. , Mason Wilbert , Taketomo Carol , Logsdon Tina , Sharek Paul J.
Published: April 2008

OBJECTIVES. The purposes of this study were to develop a pediatric-focused tool for adverse drug event detection and describe the incidence and characteristics of adverse drug events in children's hospitals identified by this tool.

METHODS. A pediatric-specific trigger tool for adverse drug event detection was developed and tested. Eighty patients from each site were randomly selected for retrospective chart review. All adverse drug events identified using the trigger tool were evaluated for severity, preventability, ability to mitigate, ability to identify the event earlier, and presence of associated occurrence report. Each trigger and the entire tool were evaluated for positive predictive value.

RESULTS. Review of 960 randomly selected charts from 12 children's hospitals revealed 2388 triggers (2.49 per patient) and 107 unique adverse drug events. Mean adverse drug event rates were 11.1 per 100 patients, 15.7 per 1000 patient-days, and 1.23 per 1000 medication doses. The positive predictive value of the trigger tool was 3.7%. Twenty-two percent of all adverse drug events were deemed preventable, 17.8% could have been identified earlier, and 16.8% could have been mitigated more effectively. Ninety-seven percent of the identified adverse drug events resulted in mild, temporary harm. Only 3.7% of adverse drug events were identified in existing hospital-based occurrence reports. The most common adverse drug events identified were pruritis and nausea, the most common medication classes causing adverse drug events were opioid analgesics and antibiotics, and the most common stages of the medication management process associated with preventable adverse drug events were monitoring and prescribing/ordering.

CONCLUSIONS. Adverse drug event rates in hospitalized children are substantially higher than previously described. Most adverse drug events resulted in temporary harm, and 22% were classified as preventable. Only 3.7% were identified by using traditional voluntary reporting methods. Our pediatric-focused trigger tool is effective at identifying adverse drug events in inpatient pediatric populations.
Prevention of Vitamin K Deficiency Bleeding in Breastfed Infants: Lessons From the Dutch and Danish Biliary Atresia Registries
Authors: van Hasselt Peter M. , de Koning Tom J. , Kvist Nina , de Vries Elsemieke , Lundin Christina Rydahl , Berger Ruud , Kimpen Jan L. L. , Houwen Roderick H. J. , Jorgensen Marianne Horby , Verkade Henkjan J. ,   and the Netherlands Study Group for Biliary Atresia Registry
Published: April 2008

OBJECTIVE. Newborns routinely receive vitamin K to prevent vitamin K deficiency bleeding. The efficacy of oral vitamin K administration may be compromised in infants with unrecognized cholestasis. We aimed to compare the risk of vitamin K deficiency bleeding under different propylactic regimens in infants with biliary atresia.

PATIENTS AND METHODS. From Dutch and Danish national biliary atresia registries, we retrieved infants who were either breastfed and received 1 mg of oral vitamin K at birth followed by 25 μg of daily oral vitamin K prophylaxis (Netherlands, 1991–2003), 2 mg of oral vitamin K at birth followed by 1 mg of weekly oral prophylaxis (Denmark, 1994 to May 2000), or 2 mg of intramuscular prophylaxis at birth (Denmark, June 2000–2005) or were fed by formula. We determined the absolute and relative risk of severe vitamin K deficiency and vitamin K deficiency bleeding on diagnosis in breastfed infants on each prophylactic regimen and in formula-fed infants.

RESULTS. Vitamin K deficiency bleeding was noted in 25 of 30 of breastfed infants on 25 μg of daily oral prophylaxis, in 1 of 13 on 1 mg of weekly oral prophylaxis, in 1 of 10 receiving 2 mg of intramuscular prophylaxis at birth, and in 1 of 98 formula-fed infants (P < .001). The relative risk of a bleeding in breastfed compared with formula-fed infants was 77.5 for 25 μg of daily oral prophylaxis, 7.2 for 1 mg of weekly oral prophylaxis, and 9.3 for 2 mg of intramuscular prophylaxis at birth.

CONCLUSIONS. A daily dose of 25 μg of vitamin K fails to prevent bleedings in apparently healthy infants with unrecognized cholestasis because of biliary atresia. One milligram of weekly oral prophylaxis offers significantly higher protection to these infants and is of similar efficacy as 2 mg of intramuscular prophylaxis at birth. Our data underline the fact that event analysis in specific populations at risk can help to evaluate and improve nationwide prophylactic regimens.
Preventive Interventions Addressing Underage Drinking: State of the Evidence and Steps Toward Public Health Impact
Authors: Spoth Richard , Greenberg Mark , Turrisi Robert
Published: April 2008

The epidemiological features of underage drinking and evidence of its social, health, and economic consequences suggest compelling reasons for the development and dissemination of effective preventive interventions. To clarify the nature and extent of the current evidence base on preventive interventions addressing underage drinking, a review of the literature was conducted through extensive searches of the research literature on outcome evaluations, existing reviews of this body of outcome research (N = 25), and summary reports of evidence on specific interventions. More than 400 interventions were identified and screened, and the evidence for 127 was reviewed. Criteria for the evaluation of evidence were established for intervention studies with alcohol-specific outcome measures for 3 developmental periods (<10, 10–15, and 16 to ≥20 years of age). Ultimately, 12 interventions met criteria for “most promising” evidence and 29 met criteria for “mixed or emerging” evidence. Conducting this review revealed clear advances in the number of evidence-based interventions available and the quality of outcome research; however, much work remains to achieve greater public health impact through evidence-based interventions. This work should consider (1) the great need for intervention research related to understudied developmental phases, intervention domains (eg, family, school, community, and media), and populations (eg, early tweens, late teens, young adults not attending college, and nonmajority populations); (2) the critical importance of addressing key issues in research design and methods (eg, limited longitudinal studies, replication studies, and dissemination research); and (3) the need for improved consistency in application of evidence and reporting standards. Finally, we recommend the application of emerging consumer-oriented and community-participatory models for intervention development and research, designed to increase the likelihood of “real-world” public health impact through improved translation of intervention science into practice.
Developmentally Informed Research on the Effectiveness of Clinical Trials: A Primer for Assessing How Developmental Issues May Influence Treatment Responses Among Adolescents With Alcohol Use Problems
Authors: Wagner Eric F.
Published: April 2008

The goal of this article is to familiarize readers with the adolescent developmental issues and processes most likely to affect responses to treatment for alcohol use problems. Although the need for research that blends developmental science and treatment outcome research is widely acknowledged, scant information exists about developmentally informed approaches to treatment research with alcohol-abusing teens. Exactly how developmental issues may influence treatment responses among adolescents with alcohol use problems remains an open question. In the hope of moving developmentally informed research forward, this article reports findings from a literature review regarding the degree to which developmental issues and processes have been considered in adolescent alcohol treatment research. Moreover, promising concepts and methods from applied developmental science are discussed, as are various developmental processes and transitions that may influence adolescent risk behavior. Finally, guidance is provided regarding how applied developmental science conceptualizations and methods may be incorporated successfully into randomized, clinical trials with adolescents with alcohol use problems.
Evidence-Based Treatments for Alcohol Use Disorders in Adolescents
Authors: Deas Deborah
Published: April 2008

The prevalence of adolescent alcohol use and its related consequences underscore the need for evidenced-based treatments in this population. During the past decade, much progress has been made in treating adolescent alcohol use disorders with evidenced-based modalities developed specifically for adolescents. Controlled treatment outcome studies that compared ≥1 modality, used random assignment to treatment conditions, and were published between 1990 and 2004 are discussed in this review. Psychosocial treatments such as family-based interventions, motivational enhancement therapy (motivational interviewing), behavioral therapy, and cognitive-behavioral therapy, as well as the limited pharmacotherapy studies, are discussed. All of the studies used assessment tools validated for use in adolescent populations. Overall, great strides have been made in the area of adolescent alcohol treatment, and the treatment modalities presented have more than adequate potential for replication.