bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of surface modification of beech wood flour on mechanical and thermal properties of poly (3-hydroxybutyrate)/wood flour composites
Authors: Gregorova Adriana , Wimmer Rupert , Hrabalova Marta , Koller Martin , Ters Thomas , Mundigler Norbert
Published: June 2009

Poly (3-hydroxybutyrate) (PHB), a biodegradable polymer from the polyhydroxyalkanoate biopolyester class, was filled with 20% beech wood flour (WF) to form completely biodegradable films. In the present study, the influence of surface modification of wood flour was investigated on the interfacial adhesion of PHB/WF composites. In addition to a hydrothermal pretreatment, sodium hydroxide and stearic acid were used as surface modifiers. Direct measurement of interfacial adhesion was carried out by mechanical testing and dynamic mechanical analysis. Thermal properties, degree of crystallinity of PHB/WF composites were determined by differential scanning calorimetry. Effects of sodium hydroxide and stearic acid treatment on the adhesion of PHB/WF interface were feeble when no hydrothermal pretreatment was applied. Nevertheless, surface modifiers applied on hydrothermally pretreated WF significantly improved the WF/PHB interface adhesion.
Primary and secondary decay fungi on exposed pine tree logs in the forest
Authors: Kim Gyu-Hyeok , Lim Young Woon , Choi Yong-Seok , Kim Min-Ji , Kim Jae-Jin
Published: June 2009

The successional diversity of basidiomycetous fungi was studied on Korean pine (Pinus koraiensis) and pitch pine (Pinus rigida) logs that were left exposed on the forest floor based on fungal surveys conducted after 18, 42, and 54 months of exposure. A total of 131 basidiomycetous isolates were recovered from the logs and grouped by their cultural morphology. Fungal identification was achieved by a BLAST search of partial nuclear large subunit ribosomal DNA sequences in GenBank. The results of the 18 month survey revealed that the isolation frequency and fungal diversity were higher for pitch pine than Korean pine. The dominant species found on Korean and pitch pine logs during the first survey were Hypochnicium karstenii and Phlebiopsis gigantea, respectively. In the 42 and 54 month surveys, the primary species were replaced by Hypochnicium eichleri, Phanerochaete
velutina, Phlebia radiata, Rhizochaete sp., and Trametes versicolor. These results showed that decay fungi have host preference for woody materials that vary according to the species of tree being colonized.
Microwave radar for detection of resin defects in Pinus elliottii Engelm var elliottii
Authors: Hislop Greg , Hellicar Andrew D. , Li Li , Greene Kieran , Lewis Chris , Meder Roger
Published: June 2009

Surface penetrating microwave radar is identified as a low-cost, reliable, portable, and safe means of detecting resin defects in plantation-grown pine logs. This new method of non-destructively testing logs has the potential to be applied at several intervention points in the value chain, including on standing trees, fallen stems, and merchandised logs either in the forest or in the mill. Results clearly distinguish resin-affected logs from unaffected logs, even in logs of high moisture content.
The Effect of Adjuvants, Pesticide Formulation, and Spray Nozzle Tips on Spray Droplet Size
Authors: Klein Robert N. , Golus Jeffrey A. , Nelms Kelli L.
Published: June 2009

Many factors, including adjuvants, pesticide formulations, and nozzle tips, affect spray droplet size. It is important to understand these factors as spray droplet size affects both drift and efficacy of pesticides, which is a main concern with pesticide application. A laser particle analyzer was used to determine the spray droplet size and distributions of a range of formulations sprayed through several types of nozzle tips. Nozzles included were extended range flat fan sizes 11003 and 11005 (Spraying Systems XR), air induction flat fan sizes 11005 and 11004 (AI), air induction extended range flat fan size 11005 (AIXR), preorifice flat fan size 11005 (TT), and a second preorifice flat fan size 2.5 (TF). Several deposition/retention adjuvants were studied, including Array, Interlock, In-Place, and Thrust. Another study looked at diflufenzopyr + dicamba (Status, BASF) in combination with several adjuvants. Also, three fungicides were evaluated at differing spray volumes. Results indicated that the droplet size of some nozzle tips is more affected than others by changes in the contents of the spray solution.
Modellgestützte Vorsteuerung für messbare StörungenModel Based Feed Forward Control for Measurable Disturbances
Authors: Wurmthaler Christoph , Kühnlein Alexander
Published: June 2009

Modellgestützte Vorsteuerungen wurden bisher nur zur Einstellung des Führungsverhaltens vorgeschlagen. Der Kurzbeitrag zeigt, dass diese Methode bei allen messbaren Eingangsgrößen, insbesondere bei messbaren Störgrößen anwendbar ist. Damit wird das Regelkreisverhalten für jede messbare Eingangsgröße unabhängig von den anderen einstellbar.
Gedanken zur Zukunft des Automobils
Authors: Guzzella Lino
Published: June 2009

Eine intensive individuelle Mobilität ist ein typisches Merkmal einer wohlhabenden Gesellschaft. Den vielen Vorteilen dieser Mobilität stehen jedoch leider auch relevante Nachteile gegenüber. In diesem Aufsatz werden zwei daraus erwachsende zentrale Probleme, nämlich der Verbrauch an fossilen Energieträgern und der CO2-Ausstoß, näher betrachtet. In allen Überlegungen wird versucht, ein möglichst ganzheitliches Bild zu skizzieren und technisch realistische Optionen für die Zukunft aufzuzeigen, wobei insbesondere die Rolle der Automatisierungstechnik hervorgehoben wird.
What first principles molecular dynamics can tell us about EXAFS spectroscopy of radioactive heavy metal cations in water
Authors: Duvail Magali , D'Angelo Paola , Gaigeot Marie-Pierre , Vitorge Pierre , Spezia Riccardo
Published: June 2009

In this paper we show how molecular dynamics simulation can improve comprehension of structure and dynamics of water solvent around heavy cations. In particular, metal-water radial distribution function obtained from molecular dynamics can be used into EXAFS equation to improve the experimental signal fitting. Here we show results on structure and dynamics of Co2+, that is a radiocontaminant cation in its isotopic form 60Co, and lanthanoids(III) that are the chemical analogues of actinides(III) in aqueous solution.
Speciation of protactinium(V) at tracer scale
Authors: Le Naour Claire , Di Giandomenico M. V. , Zhao Y. , Mendes M.
Published: June 2009

Solvent extraction in the conditions of tracer scale chemistry was used to study protactinium(V) complexation with sulphate, chloride, oxalate and diethylene-triamine-pentaacetate. Extraction experiments were conducted using the chelating agent thenoyltrifluoroacetone (TTA) in toluene at constant ionic strength and temperature. Information on the species involved in partition equilibria relative to protactinium(V) complexation were deduced from a systematic study of the variations of distribution coefficient of Pa(V) as function of ligands, protons and TTA concentration.
In vivo screening of proteins likely to bind uranium in exposed rat kidney
Authors: Frelon Sandrine , Guipaud Olivier , Mounicou Sandra , Lobinski Ryszard , Delissen Olivia , Paquet F.
Published: June 2009

Uranium is a naturally abundant element which has been used in several industries. Internal exposure could occur via three main pathways that are ingestion, inhalation and wounds. It has been recently shown that chronic ingestion of uranium in drinking water induces an important uranium accumulation in kidney with a perturbation of iron metabolism in this organ.

Whereas uranium speciation is a key parameter to elucidate the chemical reactivity and the mobility of an element, it remains poorly documented in most of environmental and biological media. A few examples of uranium complexation with biomolecules have been published recently but most of them are in vitro studies whereas in vivo experiments remain poorly investigated.

In order to better understand possible competition of uranium towards metals involved in the metal-protein binding, i.e. iron, copper, calcium, a study on uranium speciation was investigated by doing an in vivo screening of target proteins likely to bind it in kidneys of exposed rats. Rats were chronically exposed via contaminated drinking water at 40 mg L-1 and killed 9 months after the beginning of exposure. Kidneys were dissected out and protein extract was prepared. Then, separation of renal proteins by isoelectric focusing gel electrophoresis (IEF) and two-dimensional gel electrophoresis (2-DE) followed by LA-ICPMS analysis were performed.

IEF-LA-ICP MS showed that uranium could specifically bind few proteins in kidney whereas 2-DE-LA-ICP MS could indicate that uranium is not covalently bound to proteins in this organ. The results suggested that even at moderate concentrations of exposure, uranium can be observed chelated with some renal proteins that is very encouraging to understand the entry, storage and elimination of this element in kidneys.
Structure of early actinides(V) in acidic solutions
Authors: Di Giandomenico M. V. , Naour C. Le , Simoni E. , Guillaumont D. , Moisy Philippe , Hennig Christoph , Conradson Steven D. , Den Auwer C.
Published: June 2009

Protactinium occupies a key position in the actinide series between thorium and uranium. In aqueous acidic solution, it is stable at oxidation state (V), occurring either as an oxocation or as a naked ion, depending on the media. Very few structural information on the hydration sphere of Pa(V) in acidic medium is available, in particular in hydrofluoric acid. Combined EXAFS and theoretical calculations have been used in this work to characterize the protactinium coordination sphere at various HF concentrations. The correlation of the XAFS data with quantum chemical calculations provides complementary structural and electronic models from ab initio techniques. At HF concentrations from 0.5 to 0.05 M, both theoretical calculations and EXAFS data suggest that the protactinium coordination sphere is mainly composed of fluoride ions. At the lowest HF concentration, the occurrence of a monooxo bond is observed with EXAFS, in agreement with the literature. A comparison of these data with related neptunium(V) and plutonium(V) diooxocations in perchloric acid is also presented.
Assessment of uranium and selenium speciation in human and bacterial biological models to probe changes in their structural environment
Authors: Avoscan L. , Milgram Sarah , Untereiner Guillaume , Collins Richard , Khodja H. , Covès Jacques , Hazemann Jean-Louis , Carrière M. , Gouget B.
Published: June 2009

This study illustrates the potential of physicochemical techniques to speciate uranium (U) and selenium (Se) in biological samples. Speciation, defined here as the study of structural environment, of both toxic elements, was characterized at several levels in biological media and directly in human cells or bacteria once the metal(loid)s were internalized. External speciation that is extracellular speciation in culture media was predicted by thermodynamic equilibrium computer modelling using the JChess software and validated by spectroscopic measurements (XANES and EXAFS). Internal speciation that is intracellular speciation in eukaryotic and prokaryotic cells was studied in vitro with a soil bacterium Cupriavidus metallidurans CH34 and ROS 17/2.8 osteoblasts, human cells responsible for bone formation. XANES, EXAFS, HPLC-ICP-MS and SDS-PAGE coupled to particle induced X-ray emission (PIXE) permitted the identification and quantification of complexes formed with organic or inorganic molecules and/or larger proteins.
Jazz as Democracy? Dave Brubeck and Cold War Politics
Authors: Crist Stephen A.
Published: June 2009

The Dave Brubeck Quartet's 1958 tour on behalf of the U.S. State Department, part of the grand Cold War project of propagating American-style democracy in opposition to communism, did not advance in an orderly and self-evident manner. Rather it was an extremely contingent enterprise enacted through countless individual actions and statements by a motley assortment of bureaucrats and businessmen, and frequently teetered on the brink of chaos. The story of Brubeck's tour, including its evolution and impact, is complex and multifaceted, involving overlapping and conflicting agendas, governmental secrecy, high-minded idealism, and hard-nosed business. The narrative also raises issues of race and race relations in the context of the Cold War struggle against communism and brings into focus the increasing cultural prestige of jazz and other popular genres worldwide during the period when the ideological premises of the Cold War were being formulated.

Thirty years later—in 1988, as the Cold War was waning—the Quartet performed in Moscow at the reciprocal state dinner hosted by President Ronald Reagan for General Secretary Mikhail Gorbachev during their fourth summit meeting. The sequence of events leading up to this occasion, including the Quartet's long-anticipated tour of the Soviet Union during the previous year, reveals Brubeck to have been not only a talented musician but a canny entrepreneur as well. By the late 1980s the cultural and political landscape had shifted so dramatically as to be virtually unrecognizable to the Cold Warriors of the 1950s.

By all accounts, Brubeck's tours in the 1950s and 1980s were among the most successful of their kind. Though Brubeck attributes their efficacy primarily to the power of an influential idea that came into its own toward the beginning of the Cold War—namely, jazz as democracy—the documentary record makes clear that the impact of his travels involved a multifarious nexus of other factors as well, including reputation, personality, and marketability.
Birds, Beasts, and Bombs in Messiaen's Cold War Mass
Authors: Fallon Robert
Published: June 2009

Although Messiaen is commonly portrayed as having been disengaged from worldly affairs, his eyes fixed on heaven, many of his works can be shown to possess a subtext of political or social commentary that frames worldly issues in religious rhetoric. In a notable example, the Messe de la Pentecôte for organ (1950), Messiaen dramatizes the Cold War threat of nuclear apocalypse by contrasting a leitmotif he calls the Beast of the Apocalypse with evocations of birdsong that represent peace and freedom. Probably influenced by Picasso's use of birds as symbols of peace and by René Leibowitz's Sartrean calls for artistic commitment, the Mass ends with a chord he describes as an explosion. The work's subtext appears to warn against nuclear catastrophe and to advocate faith in the face of Cold War fear and anxiety.
Górecki's Scontri and Avant-Garde Music in Cold War Poland
Authors: Jakelski Lisa
Published: June 2009

Poland's post-1956 cultural liberalizations sat uneasily in the midst of a Cold War binary that equated avant-gardism with artistic freedom and socialist realism with aesthetic coercion. During 1960–61, Polish composers and critics debated the seeming paradox of official support in Poland for avant-garde aesthetics. Their disputes arose after the premiere of Henryk Mikołaj Górecki's Scontri (Collisions) for Orchestra, op. 17, at the 1960 Warsaw Autumn Festival; disrupted the General Assembly of the Polish Composers' Union in December 1960; and persisted in the journal Ruch Muzyczny (Musical Movement) during the early months of 1961.

Taken together, the successive stages of debate show how defenses of Polish avant-garde music intersected with competing cultural imperatives of the Cold War. Maneuvers by composers and critics formed a musical corollary to the “Polish road to socialism” that Władysław Gomułka had engineered with the Soviet Union, an agreement by which expanded internal freedoms would be tolerated as long as no serious steps were taken to abandon state socialism in Poland. The amenability of music to such critical moves, paired with the growing international prestige of Polish avant-garde composers and the Warsaw Autumn Festival, suggests why music was spared the reimposition of restrictive governmental oversight as Poland's Thaw came to a close.
Music at the Edge of the Construct
Authors: Ford Phil
Published: June 2009

Writers across a wide spectrum of cold war discourse voiced an anxiety that American minds could be made to see things as some alien will might want us to see them. Cold War popular culture drew on such notions to fashion a spectacle of mind control and depicted advertising, Hollywood, and politics as sites for the manufacture of illusions. Each site finds its critique in a film from the first postwar decades: A Star Is Born (1954) shows Hollywood myths overwhelming the lives of their creators; John Cassavetes's Shadows (1957/1959) voices the hip critique of commodified mass culture; and The Manchurian Candidate (1962) spins a paranoid scenario in which American politics, Communist brainwashing, and television conspire to create a counterfeit reality so total there may be no escape. These films picture their characters struggling to escape the construct of false images that besets them. The musical scoring of these films, though while radically different, defines the boundary of the construct and marks the distance between reality and image.
Incidence and Outcomes of Pediatric Acute Lung Injury
Authors: Zimmerman Jerry J. , Akhtar Saadia R. , Caldwell Ellen , Rubenfeld Gordon D.
Published: June 2009

OBJECTIVE: This population-based, prospective, cohort study was designed to determine the population incidence and outcomes of pediatric acute lung injury.

METHODS: Between 1999 and 2000, 1 year of screening was performed at all hospitals admitting critically ill children in King County, Washington. County residents 0.5 to 15 years of age who required invasive (through endotracheal tube or tracheostomy) or noninvasive (through full face mask) mechanical ventilation, regardless of the duration of mechanical ventilation, were screened. From this population, children meeting North American-European Consensus Conference acute lung injury criteria were eligible for enrollment. Postoperative patients who received mechanical ventilation for <24 hours were excluded. Data collected included the presence of predefined cardiac conditions, demographic and physiological data, duration of mechanical ventilation, and deaths. US Census population figures were used to estimate incidence. Associations between outcomes and subgroups identified a priori were assessed.

RESULTS: Thirty-nine children met the criteria for acute lung injury, resulting in a calculated incidence of 12.8 cases per 100000 person-years. Severe sepsis (with pneumonia as the infection focus) was the most common risk factor. The median 24-hour Pediatric Risk of Mortality III score was 9.0, and the mean ± SD was 11.7 ± 7.5. The hospital mortality rate was 18%, lower than that reported previously for pediatric acute lung injury. There were no statistically significant associations between age, gender, or risk factors and outcomes.

CONCLUSIONS: We present the first population-based estimate of pediatric acute lung injury incidence in the United States. Population incidence and mortality rates are lower than those for adult acute lung injury. Low mortality rates in pediatric acute lung injury may necessitate clinical trial outcome measures other than death.
Movie Character Smoking and Adolescent Smoking: Who Matters More, Good Guys or Bad Guys?
Authors: Tanski Susanne E. , Stoolmiller Mike , Cin Sonya Dal , Worth Keilah , Gibson Jennifer , Sargent James D.
Published: June 2009

OBJECTIVE: To assess the association between smoking onset and exposure to movie smoking according to character type.

METHODS: A longitudinal, random-digit-dial telephone survey of 6522 US adolescents was performed with movie exposure assessed at 4 time points over 24 months. Adolescents were asked whether they had seen a random subsample of recently released movies, for which we identified smoking by major characters and type of portrayal (divided into negative, positive, and mixed/neutral categories). Multivariate hazard regression analysis was used to assess the independent effects of these exposures on the odds of trying smoking.

RESULTS: By the 24-month follow-up survey, 15.9% of baseline never-smokers had tried smoking. Within the sample of movies, 3848 major characters were identified, of whom 69% were male. Smokers represented 22.8% of 518 negative characters, 13.7% of 2486 positive characters, and 21.1% of 844 mixed/neutral characters. Analysis of the crude relationship showed that episodes of negative character smoking exposure had the strongest influence on smoking initiation. However, because most characters were portrayed as positive, exposure to this category was greatest. When the full population effect of each exposure was modeled, each type of character smoking independently affected smoking onset. There was an interaction between negative character smoking and sensation-seeking with stronger response for adolescents lower in sensation-seeking.

CONCLUSIONS: Character smoking predicts adolescent smoking initiation regardless of character type, which demonstrates the importance of limiting exposure to all movie smoking. Negative character portrayals of smoking have stronger impact on low risk-taking adolescents, undercutting the argument that greater exposure is a marker for adolescent risk-taking behavior.
Child Protection Outcomes for Infants of Substance-Using Mothers: A Matched-Cohort Study
Authors: McGlade Andrea , Ware Robert , Crawford Maree
Published: June 2009

OBJECTIVE: Parental drug use is a critical public health issue; it is estimated to be present in up to 80% of referrals to Australian child protection agencies. However, no data regarding the child protection outcomes of infants of substance-using parents exist in Australia, and no comparisons have been made with infants of non–substance-using parents. We assessed differences in substantiated abuse between 2 groups of mothers in Brisbane to quantify this risk.

METHODS: Mothers who disclosed opiate, amphetamine, or methadone use between 2000 and 2003 were identified and compared with non–substance-using mothers who were matched for gender and gestational age. All infants were linked to the Department of Child Safety Child Protection Information System database. Child protection outcomes, such as substantiated notifications and entry into foster care, were compared between groups.

RESULTS: We studied 119 infants of substance-using mothers and 238 matched infants. Infants of substance-using mothers were more likely to suffer substantiated harm (hazard ratio 13.3 [95% confidence interval 4.6–38.3]) and to enter foster care (hazard ratio 13.3 [95% confidence interval 5.1–34.3]). Infants of mothers using illicit drugs were more likely to suffer substantiated harm and more likely to enter foster care than infants of mothers who were compliant with a methadone program.

CONCLUSIONS: Infants of substance-using mothers have much poorer child protection outcomes than infants of non–substance-using mothers. This study adds substantial evidence toward a real association between maternal drug use and child abuse. Greater interagency collaboration is urgently required to reduce this risk.
Treatment of Kawasaki Disease: Analysis of 27 US Pediatric Hospitals From 2001 to 2006
Authors: Son Mary Beth F. , Gauvreau Kimberlee , Ma Lin , Baker Annette L. , Sundel Robert P. , Fulton David R. , Newburger Jane W.
Published: June 2009

OBJECTIVES: We sought to analyze trends in admissions and to describe therapies used for acute Kawasaki disease over a 6-year period.

METHODS: The Pediatric Health Information System provides patient data including demographic variables, International Classification of Diseases, Ninth Revision codes, and services billed to patients. Patient identifiers enable tracking of medication use in and across multiple admissions within a center. We analyzed data for patients with (1) a diagnosis code for Kawasaki disease, (2) intravenously administered immunoglobulin treatment during hospitalization, and (3) discharge between January 1, 2001, and December 30, 2006, from 27 hospitals contributing complete data over the study period.

RESULTS: During the study period, 5197 Kawasaki disease admissions were identified for 4811 patients; numbers increased 32.6% from 2001 (n = 678) to 2006 (n = 899). Retreatment with intravenous immunoglobulin was administered to 712 patients (14.8%) over the study period. Other antiinflammatory therapies included intravenously administered methylprednisolone (5.8%), orally administered prednisone (2.8%), and infliximab (1%). Use of infliximab steadily increased from 0.0% (0 of 678 patients) in 2001 to 2.3% (21 of 899 patients) in 2006. Coronary artery aneurysms were coded for 3.3% of patients. Male patients, patients <1 year of age, and Hispanic patients were significantly more likely to have coding for coronary artery aneurysms.

CONCLUSIONS: Our report provides the first large multicenter description of agents used in the treatment of intravenously administered immunoglobulin-resistant Kawasaki disease in the United States. Trends include increased numbers of admissions attributable to Kawasaki disease and increased usage of infliximab.
Intravenous Lipid and Bilirubin-Albumin Binding Variables in Premature Infants
Authors: Amin Sanjiv B. , Harte Theresa , Scholer Lori , Wang Hongyue
Published: June 2009

BACKGROUND: The lipid intake at which a significant bilirubin-displacing effect occurs as a function of gestational age (GA) is unclear.

OBJECTIVE: To determine the effect of gradual increase in IL intake from 1.5 to 3 g/kg per day on bilirubin-albumin binding variables as a function of GA in premature infants with indirect hyperbilirubinemia.

METHODS: Infants of 24 to 33 weeks' gestation at birth who received IL (20% Intralipid [Fresenius Kabi, Uppsala, Sweden]) doses of 1.5, 2, 2.5, and 3 g/kg per day over 4 consecutive days were prospectively evaluated. The blood samples were drawn twice at least 8 hours apart on each IL intake to measure total serum bilirubin and free bilirubin by the peroxidase test. The highest free bilirubin on each IL intake, the corresponding total serum bilirubin, and serum albumin were used to calculate the bilirubin/albumin binding constant or binding affinity.

RESULTS: Sixty-two infants (median GA: 28 weeks) were studied during the first 10 days of life. None of the subjects had culture-proven sepsis, had triglyceride levels of >2.05 mmol/L, or were receiving steroids. Infants were grouped in 2-week GA intervals. The cumulative frequency of elevated free bilirubin concentration (≥90th percentile or Bf ≥ 32 nmol/L) as a function of IL intake was inversely related to GA and was significantly different among 2-week GA groups. There was significant decrease in binding affinity and increase in free bilirubin concentration with higher IL intake for ≤28 week but not for >28 week GA groups.

CONCLUSIONS: The IL intake may be associated with a significant fall in the binding affinity of bilirubin for plasma protein and a concomitant increase in free bilirubin concentration in premature infants. The lipid intake at which this occurs depends on GA.
Convalescent Care of Infants in the Neonatal Intensive Care Unit in Community Hospitals: Risk or Benefit?
Authors: Donohue Pamela K. , Hussey-Gardner Brenda , Sulpar Leslie J. , Fox Renee , Aucott Susan W.
Published: June 2009

OBJECTIVE: To compare very low birth weight (VLBW) infants transported to a community hospital (CH) before discharge with infants who received convalescent care in a regional-referral NICU (RR-NICU) on 4 parameters: health indicators at the time of hospital discharge, health care use during the 4 months after discharge to home, parent satisfaction with hospital care, and cost of hospitalization.

PATIENTS AND METHODS: VLBW infants cared for in 2 RR-NICUs during 2004–2006 were enrolled in the study. One RR-NICU transfers infants to a CH for convalescent care and the other discharges infants directly home. Infants were followed prospectively. Information was gathered from medical charts, parent interviews, and hospital business offices.

RESULTS: A total of 255 VLBW infants were enrolled in the study, and 148 were transferred to 15 CHs. Nineteen percent of transferred infants were readmitted to a higher level of care before discharge from the hospital. Preventative health measures and screening examinations were more frequently missed, readmission within 2 weeks of discharge from the hospital was more frequent, parents were less satisfied with hospital care, and duration of hospitalization was 12 days longer, although not statistically different, if infants were transferred to a CH for convalescence rather than discharged from the RR-NICU. Total hospital charges did not differ significantly between the groups.

CONCLUSION: Transfer of infants to a CH from an RR-NICU for convalescent care has become routine but may place infants at risk. Our study indicates room for improvement by both CHs and RR-NICUs in the care of transferred VLBW infants.
Early Resuscitation of Children With Moderate-to-Severe Traumatic Brain Injury
Authors: Zebrack Michelle , Dandoy Christopher , Hansen Kristine , Scaife Eric , Mann N. Clay , Bratton Susan L.
Published: June 2009

OBJECTIVES: Traumatic brain injury is a leading cause of death and disability in children. Guidelines have been established to prevent secondary brain injury caused by hypotension or hypoxia. The purpose of this study was to identify the prevalence, monitoring, and treatment of hypotension and hypoxia during “early” (prehospital and emergency department) care and to evaluate their relationship to vital status and neurologic outcomes at hospital discharge.

METHODS: This was a retrospective study of 299 children with moderate-to-severe traumatic brain injury presenting to a level 1 pediatric trauma center. We recorded vital signs and medical provider response to hypotension and/or hypoxia during all portions of early care.

RESULTS: Blood pressure (31%) and oxygenation (34%) were not recorded during some portion of “early care.” Documented hypotension occurred in 118 children (39%). An attempt to treat documented hypotension was made in 48% (57 of 118 children). After adjusting for severity of illness, children who did not receive an attempt to treat hypotension had an increased odds of death of 3.4 and were 3.7 times more likely to suffer disability compared with treated hypotensive children. Documented hypoxia occurred in 131 children (44%). An attempt to treat hypoxia was made in 92% (121 of 131 children). Untreated hypoxia was not significantly associated with death or disability, except in the setting of hypotension.

CONCLUSIONS: Hypotension and hypoxia are common events in pediatric traumatic brain injury. Approximately one third of children are not properly monitored in the early phases of their management. Attempts to treat hypotension and hypoxia significantly improved outcomes.
Age-Related Renal Parenchymal Lesions in Children With First Febrile Urinary Tract Infections
Authors: Pecile Paolo , Miorin Elisabetta , Romanello Carla , Vidal Enrico , Contardo Marzia , Valent Francesca , Tenore Alfred
Published: June 2009

OBJECTIVE: The aim of this study was to define the association between age and the occurrence of acute pyelonephritis and renal scars.

METHODS: Between 1999 and 2002, all children 0 to 14 years of age consecutively seen with a first febrile urinary tract infection were enrolled in the study. 99mTc-Dimercaptosuccinic acid renal scintigraphy was performed within 5 days after admission for the detection of renal parenchymal involvement. The presence of vesicoureteral reflux was assessed by using cystography performed 1 month after the infection. If the acute scan results were abnormal, then follow-up 99mTc-dimercaptosuccinic acid scanning was performed after 6 months, to assess the frequency of scars.

RESULTS: A total of 316 children were enrolled in the study (190 children <1 year, 99 children 1–4 years, and 27 children 5–14 years of age). 99mTc-Dimercaptosuccinic acid scintigraphy revealed that 59% of the children had renal involvement in the acute phase of infection. The frequency of kidney involvement in infants <1 year of age (49%) was significantly lower than that in children 1 to 4 years of age (73%) and >5 years of age (81%). Of the 187 children with positive acute 99mTc-dimercaptosuccinic acid scan results, 123 underwent repeat scintigraphy after 6 months. Renal scars were found for 28% of children <1 year, 37% of children 1 to 4 years, and 53% of children 5 to 14 years of age. No significant differences in the frequency of scars and the presence or absence of vesicoureteral reflux were noted.

CONCLUSIONS: Our findings confirm that acute pyelonephritis and subsequent renal scarring occur only in some children with first febrile urinary tract infections. Children <1 year of age with febrile urinary tract infections have a lower risk of parenchymal localization of infection and renal scarring.
Risk Factors for Persistent Fatigue With Significant School Absence in Children and Adolescents
Authors: Bakker Robert J. , van de Putte Elise M. , Kuis Wietse , Sinnema Gerben
Published: June 2009

OBJECTIVE: To assess children and adolescents with severe fatigue who are referred to pediatricians and to examine whether factors can be identified at their first visit that predict worse outcomes at 1 year.

METHODS: Ninety-one patients, aged 8 to 18 years completed questionnaires about sleep, somatic symptoms, physical activity, and fatigue. They were reassessed 12 months later. Measurements at baseline and outcome were analyzed by using univariable logistic regression with persistent, severe fatigue (yes/no) and persistent school absence (yes/no) as dependent variables and baseline scores as independent variables.

RESULTS: After 12 months, 50.6% of the children and adolescents showed improvement; 29.1% had persistent fatigue, and 20.3% had persistent fatigue with significant school absence. Factors associated with the poorest outcome were sleep problems (odds ratio [OR]: 1.4 [95% confidence interval (CI): 1.1–1.8]), initial fatigue score (OR: 1.1 [95% CI: 1.0–1.2]), somatic complaints such as hot and cold spells (OR: 1.9 [95% CI: 1.2–3.0]), blurred vision (OR: 2.1 [95% CI: 1.1–4.0]), pain in arms and legs (OR: 2.0 [95% CI: 1.0–3.2]), back pain (OR: 1.8 [95% CI: 1.0–3.2]), constipation (OR: 1.7 [95% CI: 1.0–2.7]), and memory deficits (OR: 1.8 [95% CI: 1.0–3.2]). Resolved fatigue was associated with male gender (OR: 5.0 [95% CI: 1.6–15.5]) and a physically active lifestyle (OR: 1.3 [95% CI: 1.1–1.5]).

CONCLUSIONS: Assessment of predictive factors at the first visit enables the pediatrician to identify those patients with severe fatigue who are at risk of a poor outcome. Female gender, poor sleep quality, physically inactive lifestyle, and specific somatic complaints were important predictive factors.
The Association of Lung Disease With Cerebral White Matter Abnormalities in Preterm Infants
Authors: Anjari Mustafa , Counsell Serena J. , Srinivasan Latha , Allsop Joanna M. , Hajnal Joseph V. , Rutherford Mary A. , Edwards A. David
Published: June 2009

OBJECTIVE: Preterm infants have a high incidence of neurodevelopmental impairment associated with diffuse cerebral white matter abnormalities and also a high incidence of serious respiratory disease. However, it is unclear if lung disease and brain injury are related, and previous research has been impeded by confounding effects, including prematurity and infection. Using a new approach that permits multivariate statistical analysis, we tested the hypothesis that lung disease is associated with specific white matter abnormalities, detected as reduced fractional anisotropy (FA) in diffusion tensor imaging data.

METHODS: Fifty-three preterm infants with no evidence of focal abnormality on conventional MRI were studied at term-equivalent age by using tract-based spatial statistics, an automated observer-independent method for voxelwise analysis of major white matter pathways.

RESULTS: In several white matter tracts, FA decreased with a linear relation to the gestational age at birth. Independent of the confounding effects of prematurity and age at scan, respiratory disease was associated with specific white matter abnormalities in preterm infants; those infants receiving mechanical ventilation for >2 days in the perinatal period (n = 10) showed reduced FA in the genu of the corpus callosum, whereas subjects with chronic lung disease (n = 15) displayed a reduction in FA in the left inferior longitudinal fasciculus.

CONCLUSION: Independent of the degree of prematurity, respiratory disease is associated with cerebral white matter abnormalities.
Morbidities and Hospital Resource Use During the First 3 Years of Life Among Very Preterm Infants
Authors: Korvenranta Emmi , Lehtonen Liisa , Peltola Mikko , Häkkinen Unto , Andersson Sture , Gissler Mika , Hallman Mikko , Leipälä Jaana , Rautava Liisi , Tammela Outi , Linna Miika
Published: June 2009

OBJECTIVE: The objective of this study was to determine how the use of hospital resources during the first 3 years of life was associated with prematurity-related morbidity in very preterm infants (gestational age of <32 weeks or birth weight of <1501 g).

METHODS: The study was a retrospective, national register study including all very preterm infants born alive in Finland between 2000 and 2003 (N = 2148). Infants who died before the age of 3 years (n = 264) or who had missing register data (n = 88) were excluded from the study. The relationship between 6 morbidity groups and the need for hospital care during the first 3 years of life was studied by using a negative binomial model.

RESULTS: A total of 66.2% of the infants did not have any of the morbidities studied. Infants who were subsequently diagnosed as having cerebral palsy (6.1% of the study group), later obstructive airway disease (20.0%), hearing loss (2.5%), visual disturbances or blindness (3.8%), or other ophthalmologic problems (13.4%) had initial hospital stays that were a mean of 7, 8, 12, 17, and 3 days longer, respectively, than those for infants without these conditions. All morbidity groups were associated with increased numbers of hospital visits during either the second or third year of life, compared with infants without these morbidities. The need for hospitalizations and outpatient hospital care decreased with postnatal age for infants with later morbidities and for infants without later morbidities.

CONCLUSIONS: Most very preterm infants born in Finland survived without severe morbidities and required relatively little hospital care after the initial discharge. However, those with later morbidities had a long initial length of stay and more readmissions and outpatient visits during the 3-year follow-up period.
Triplets Across the First 5 Years: The Discordant Infant at Birth Remains at Developmental Risk
Authors: Feldman Ruth , Eidelman Arthur Isaac
Published: June 2009

OBJECTIVES: To examine whether the risk posed to infant development by triplet birth persists into childhood and whether growth-discordant triplets are at a particularly high developmental risk.

METHODS: Twenty-one sets of triplets were matched with 21 sets of twins and 21 singletons (N = 126) for medical and demographic conditions and were followed from birth to 5 years. At 6, 12, and 24 months, cognitive development was assessed and mother-infant interactions were coded for maternal sensitivity and child social engagement. At 5 years, the children's cognitive development and neuropsychological skills were tested, social engagement was coded from mother-child interactions, and behavior problems were examined. Maternal adjustment was assessed during interviews at 1 and 5 years.

RESULTS: Although triplets showed lower cognitive performance at 6, 12, and 24 months as compared with singletons and twins, differences were attenuated by 5 years in both global IQ and executive functions. Similarly, the lower social engagement observed across infancy and the higher internalizing symptoms reported at 2 years for those in the triplet group were no longer found at 5 years. Difficulties in maternal adjustment among mothers of triplets decreased from 1 to 5 years. However, in 65.2% of the initial sample there was a weight discordance of >15% at birth, and the discordant triplets showed poorer cognitive and social development as compared with their siblings across infancy. At 5 years, the discordant children demonstrated lower cognitive and executive functions performance, decreased social engagement, and higher internalizing symptoms as compared with both siblings and peers.

CONCLUSIONS: Whereas most triplets catch up after an early developmental delay, the risk for discordant triplets seems to persist into childhood. Such infants, who are at both biological and environmental risk, should receive special and consistent professional care.
Prenatal Growth and Early Postnatal Influences on Adult Motor Cortical Excitability
Authors: Pitcher Julia B. , Robertson Alexandra L. , Cockington Richard A. , Moore Vivienne M.
Published: June 2009

OBJECTIVE: Suboptimal prenatal growth may adversely influence motor neurophysiologic development and predispose the individual to greater risk of neurodegenerative disorders in later life. We investigated the influences of prenatal growth and the postnatal environment on motor cortical function in young adults.

METHODS: Transcranial magnetic stimulation was used to construct corticospinal stimulus-response curves for 35 young adults (mean age: 28 ± 0.5 years; 19 males) born ≥37weeks' gestation. Birth weight centile was calculated relative to maternal size, parity, ethnicity, gender, and gestation. Handgrip strength and dexterity were measured separately. Regression analyses assessed the influence of prenatal (birth weight centile and gestation) and postnatal (socioeconomic indices and maternal education) factors on corticospinal parameters, strength, and dexterity scores.

RESULTS: Lower birth weight was associated with increased interhemispheric asymmetry in motor threshold and increased cortical stimulus-response curve slope. A shorter gestation predicted a larger area under this curve in the right hand. High motor threshold was predicted by greater environmental adversity in early postnatal life, but not by prenatal factors. Higher birth weight centile and lower motor threshold were associated with greater educational achievement.

CONCLUSIONS: Poor in utero growth and mild prematurity are associated with altered corticospinal excitability in adulthood. An early postnatal environment with less early postnatal socioeconomic disadvantage and having a mother with a completed high school education partly ameliorates this. While altered cortical development has some functional consequences already evident in early adulthood, it may have a later, additional adverse impact on aging-related changes in motor function.
Risk Factors Affecting School Readiness in Premature Infants With Respiratory Distress Syndrome
Authors: Patrianakos-Hoobler Athena I. , Msall Michael E. , Marks Jeremy D. , Huo Dezheng , Schreiber Michael D.
Published: June 2009

OBJECTIVE: With advances in neonatal care, more children born prematurely are successfully reaching school age. It is unknown how many will be ready for school and what factors affect school readiness. Our objective was to assess readiness of children born prematurely for entry into public school, and determine risk factors associated with lack of school readiness in this population.

METHODS: This was a single-center prospective cohort study. Follow- up data were collected for 135 of 167 (81%) surviving premature infants with RDS requiring surfactant-replacement therapy. The children were seen between July 2005 and September 2006 (average age: 5.7 ± 1.0 years) and underwent standardized neurodevelopmental and health assessments and socioeconomic status classification. A 4-level school-readiness score was constructed by using each child's standardized scores on assessments of basic concepts (Bracken School-Readiness Assessment), perceptual skills (Visual-Motor Integration Test), receptive vocabulary (Peabody Picture Vocabulary Test, Third Edition), daily living functional skills (Pediatric Functional Independence Measure), and presence of sensory impairments or autism. Proportional odds models were used to identify risk factors predicting lower school-readiness levels.

RESULTS: Mean birth weight was 1016 ± 391 g, and mean gestational age was 27.5 ± 2.6 weeks. Ninety-one (67%) children were school-ready. Using multivariate analysis, male gender, chronic lung disease, and severe intraventricular hemorrhage or periventricular leukomalacia were associated with lower school-readiness levels. However, the most powerful factor determining school-readiness level was low socioeconomic status.

CONCLUSION: Interventions targeting neonatal morbidities may be much less effective at improving overall performance at school age compared with the effect of the impoverished social environment.
Conflicts About End-of-Life Decisions in NICUs in the Netherlands
Authors: Verhagen A. A. Eduard , de Vos Mirjam , Dorscheidt Jozef H. H. M. , Engels Bernadette , Hubben Joep H. , Sauer Pieter J.
Published: June 2009

OBJECTIVE: To determine the frequency and background of conflicts about neonatal end-of-life (EoL) decisions.

METHODS: We reviewed the medical files of 359 newborns who had died during 1 year in the 10 Dutch NICUs and identified 150 deaths that were preceded by an EoL decision on the basis of the child's poor prognosis. The attending neonatologists of 147 of the 150 newborns were interviewed to obtain details about the decision-making process.

RESULTS: EoL decisions about infants with a poor prognosis were initiated mainly by the physician, who subsequently involved the parents. Conflicts between parents and the medical team occurred in 18 of 147 cases and were mostly about the child's poor neurologic prognosis. Conflicts within the team occurred in 6 of 147 cases and concerned the uncertainty of the prognosis. In the event of conflict, the EoL decision was postponed. Consensus was reached by calling additional meetings, performing additional diagnostic tests, or obtaining a second opinion. The chief causes of conflict encountered by the physicians were religious convictions that forbade withdrawal of life-sustaining treatment and poor communication between the parents and the team.

CONCLUSIONS: The parents were involved in all EoL decision-making processes, and consensus was ultimately reached in all cases. Conflicts within the team occurred in 4% of the cases and between the team and the parents in 12% of the cases. The conflicts were resolved by postponing the EoL decision until consensus was achieved.