bluuebunny/crossref_metadata_2025 huggingface dataset:
Randomized, Double-Blind, Placebo-Controlled Study to Evaluate the Efficacy and Safety of Topiramate for Migraine Prevention in Pediatric Subjects 12 to 17 Years of Age
Authors: Lewis Donald , Winner Paul , Saper Joel , Ness Seth , Polverejan Elena , Wang Steven , Kurland Caryn L. , Nye Jeff , Yuen Eric , Eerdekens Marielle , Ford Lisa
Published: March 2009

OBJECTIVE. Currently, no drugs are Food and Drug Administration-approved for migraine prophylaxis in pediatric patients. The objective of this study was to evaluate the efficacy and safety of topiramate for migraine prevention in adolescents.

METHODS. Adolescents (12–17 years of age) with a ≥6-month history of migraine were assigned randomly to receive 16 weeks of daily treatment with topiramate (50 or 100 mg/day) or placebo. The primary efficacy measure was the percent reduction in monthly migraine attacks, with the use of the 48-hour rule, from the prospective baseline period to the last 12 weeks of the double-blind phase. The 48-hour rule defined a single migraine episode as all recurrences of migraine symptoms within 48 hours after onset. Several secondary efficacy measures were evaluated, including the reduction from baseline in the monthly migraine day rate and the 50% responder rate. Safety and tolerability were also assessed.

RESULTS. A total of 29 (83%) of 35 subjects treated with topiramate at 50 mg/day, 30 (86%) of 35 subjects treated with topiramate at 100 mg/day, and 26 (79.0%) of 33 placebo-treated subjects completed double-blind treatment. Topiramate at 100 mg/day, but not 50 mg/day, resulted in a statistically significant reduction in the monthly migraine attack rate from baseline versus placebo (median: 72.2% vs 44.4%) during the last 12 weeks of double-blind treatment. Topiramate at 100 mg/day, but not 50 mg/day, also resulted in a statistically significant reduction in the monthly migraine day rate from baseline versus placebo. The responder rate favored topiramate at 100 mg/day (83% vs 45% for placebo). Upper respiratory tract infection, paresthesia, and dizziness occurred more commonly in the topiramate groups than in the placebo group.

CONCLUSIONS. The 100 mg/day topiramate group demonstrated efficacy in the prevention of migraine in pediatric subjects. Overall, topiramate treatment was safe and well tolerated.
Distinct Genetic Risk Based on Association of MET in Families With Co-occurring Autism and Gastrointestinal Conditions
Authors: Campbell Daniel B. , Buie Timothy M. , Winter Harland , Bauman Margaret , Sutcliffe James S. , Perrin James M. , Levitt Pat
Published: March 2009

OBJECTIVE. In addition to the core behavioral symptoms of autism spectrum disorder, many patients present with complex medical conditions including gastrointestinal dysfunction. A functional variant in the promoter of the gene encoding the MET receptor tyrosine kinase is associated with autism spectrum disorder, and MET protein expression is decreased in the temporal cortex of subjects with autism spectrum disorder. MET is a pleiotropic receptor that functions in both brain development and gastrointestinal repair. On the basis of these functions, we hypothesized that association of the autism spectrum disorder–associated MET promoter variant may be enriched in a subset of individuals with co-occurring autism spectrum disorder and gastrointestinal conditions.

PATIENTS AND METHODS. Subjects were 918 individuals from 214 Autism Genetics Resource Exchange families with a complete medical history including gastrointestinal condition report. Genotypes at the autism spectrum disorder–associated MET promoter variant rs1858830 were determined. Family-based association test and χ2 analyses were used to determine the association of MET rs1858830 alleles with autism spectrum disorder and the presence of gastrointestinal conditions.

RESULTS. In the entire 214-family sample, the MET rs1858830 C allele was associated with both autism spectrum disorder and gastrointestinal conditions. Stratification by the presence of gastrointestinal conditions revealed that the MET C allele was associated with both autism spectrum disorder and gastrointestinal conditions in 118 families containing at least 1 child with co-occurring autism spectrum disorder and gastrointestinal conditions. In contrast, there was no association of the MET polymorphism with autism spectrum disorder in the 96 families lacking a child with co-occurring autism spectrum disorder and gastrointestinal conditions. χ2 analyses of MET rs1858830 genotypes indicated over-representation of the C allele in individuals with co-occurring autism spectrum disorder and gastrointestinal conditions compared with non-autism spectrum disorder siblings, parents, and unrelated controls.

CONCLUSION. These results suggest that disrupted MET signaling may contribute to increased risk for autism spectrum disorder that includes familial gastrointestinal dysfunction.
Readmission and Late Mortality After Pediatric Severe Sepsis
Authors: Czaja Angela S. , Zimmerman Jerry J. , Nathens Avery B.
Published: March 2009

OBJECTIVE. Pediatric severe sepsis remains a significant health problem with hospital mortality up to 10%. However, there is little information about later health outcomes or needs of survivors. Therefore, our goal was to evaluate the rates of and risk factors for rehospitalization and late mortality among survivors of pediatric severe sepsis.

PATIENTS AND METHODS. This was a population-based retrospective cohort study of survivors of pediatric severe sepsis (age 1 month to 18 years) in Washington State over the years 1990–2004. The sentinel admission was linked to subsequent death or episodes of hospitalization. The main outcome measures were readmission and/or late death after surviving an initial hospitalization with severe sepsis. Risk factors for readmission or death were identified by using a multivariate extended Cox model.

RESULTS. Overall, 7183 children were admitted with severe sepsis, 6.8% of whom died during the sentinel admission or within 28 days of discharge, whereas an additional 6.5% died subsequently. Almost half (47%) of the survivors were readmitted at least once (median: 3) after a median of 3 months, and the majority of these readmissions were emergent. Sentinel admission factors independently associated with both adverse outcomes were neurologic or hematologic organ dysfunction, government-based insurance, as well as several coexisting health conditions. In addition, age less than 1 year at the time of sepsis and bloodstream and cardiovascular infections were highly associated with subsequent readmission.

CONCLUSIONS. Late death occurred with similar frequency as early death associated with hospitalization with severe sepsis. Almost half of the pediatric patients suffering from an episode of severe sepsis had at least 1 subsequent hospitalization, two thirds of which were emergent or urgent. These data suggest that late outcomes after an episode of severe sepsis are poor and call for the evaluation of interventions designed to reduce later morbidity and mortality.
Less Air Pollution Leads to Rapid Reduction of Airway Inflammation and Improved Airway Function in Asthmatic Children
Authors: Renzetti Gabriele , Silvestre Gaetano , D'Amario Claudio , Bottini Egidio , Gloria-Bottini Fulvia , Bottini Nunzio , Auais Alexander , Perez Miriam K. , Piedimonte Giovanni
Published: March 2009

OBJECTIVE. Air pollution can promote airway inflammation, posing significant health risks for children with chronic respiratory problems. However, it is unknown whether this process is reversible, so that limiting pollution will benefit these children. We measured the short-term response of allergic asthmatic children exposed to a real-life reduction in outdoor air pollution by using noninvasive biomarkers of airway inflammation and function.

PATIENTS AND METHODS. Thirty-seven untreated allergic children with mild persistent asthma were recruited from a highly polluted urban environment and relocated to a less polluted rural environment. Air pollution, pollen counts, and meteorological conditions were carefully monitored at both sites. Nasal eosinophils, fractional exhaled nitric oxide, peak expiratory flow, and urinary leukotriene E4 were measured first in the urban environment and then again 7 days after relocation to the rural environment.

RESULTS. One week after relocation to the rural environment, we measured, on average, a fourfold decrease in nasal eosinophils and significant decrease in fractional exhaled nitric oxide. We also noted an improvement in lower airway function, reflected by highly significant increase in peak expiratory flow. In contrast, mean urinary leukotriene E4 concentration remained unchanged after 1 week of exposure to the rural environment.

CONCLUSIONS. Better air quality is associated with a rapid reduction of airway inflammation in allergic asthmatic children. Nasal eosinophils and fractional exhaled nitric oxide are sensitive indicators of this effect, and their rapid decline is paralleled by improved airway function measured by peak expiratory flow. Leukotriene synthesis has a more variable response to environmental modifications.
Burden of Acute Gastroenteritis Hospitalizations and Emergency Department Visits in US Children That Is Potentially Preventable by Rotavirus Vaccination: A Probe Study Using the Now-Withdrawn RotaShield Vaccine
Authors: Tate Jacqueline E. , Curns Aaron T. , Cortese Margaret M. , Weintraub Eric S. , Hambidge Simon , Zangwill Kenneth M. , Patel Manish M. , Baggs James M. , Parashar Umesh D.
Published: March 2009

BACKGROUND. With the implementation of a new rotavirus immunization program in the United States in 2006, determining the potential health benefits of rotavirus vaccination is important. We estimated the burden of acute gastroenteritis hospitalizations and emergency department visits in US children that are potentially preventable by rotavirus vaccination.

METHODS. We conducted a retrospective cohort analysis of children who in 1998–1999 were eligible to receive a now-withdrawn rotavirus vaccine (RotaShield) and were continuously enrolled in 1 of 6 managed care organizations in the Vaccine Safety Datalink. Estimates of vaccine effectiveness against all-cause gastroenteritis hospitalizations and emergency department visits adjusted according to month of birth, gender, and managed care organizations were calculated as 1 minus the risk ratio of outcomes among children in different dose groups. The burden of acute gastroenteritis prevented by vaccination was compared with the rotavirus burden estimated by 2 previously used indirect methods.

RESULTS. The effectiveness of a full 3-dose RotaShield series over a 1-year follow-up period was 83% against all-cause gastroenteritis hospitalizations and 43% against all-cause gastroenteritis emergency department visits. An increasing number of doses improved the effectiveness in preventing gastroenteritis hospitalizations, but no clear trend was observed between number of doses and effectiveness in prevention of gastroenteritis emergency department visits. The proportion of gastroenteritis hospitalizations and emergency department visits prevented by vaccination was substantially greater than the 48% to 53% of year-round hospitalizations and 33% of emergency department visits estimated to result from rotavirus by indirect methods.

CONCLUSIONS. The withdrawn rotavirus vaccine was highly effective in preventing hospitalizations and emergency department visits for all-cause acute gastroenteritis and the health benefits of vaccination against rotavirus may be greater than previously estimated.
Association Between Bullying and Psychosomatic Problems: A Meta-analysis
Authors: Gini Gianluca , Pozzoli Tiziana
Published: March 2009

CONTEXT. In the last few years, there has been an increasing amount of research showing the concurrent and long-term consequences of bullying and being bullied by peers.

OBJECTIVE. We performed a meta-analysis to quantify the association between involvement in bullying and psychosomatic complaints in the school-aged population.

METHODS. We searched online databases (Embase, Medline, PsychInfo, Scopus) up to March 2008, bibliographies of existing studies, and qualitative reviews for studies that examined the association between involvement in bullying and psychosomatic complaints in children and adolescents. The original search identified 19 studies, of which 11 satisfied prestated inclusion criteria.

RESULTS. Three random-effects meta-analyses were performed for the following 3 groups of children aged between 7 and 16 years: victims, bullies, and bully-victims. Bully-victims, victims, and bullies had a significantly higher risk for psychosomatic problems compared with uninvolved peers.

CONCLUSIONS. The association between involvement in bullying and psychosomatic problems was demonstrated. Given that school bullying is a widespread phenomenon in many countries around the world, the present results suggest that bullying be considered a significant international public health issue.
Risk Factors and Adult Body Mass Index Among Overweight Children: The Bogalusa Heart Study
Authors: Freedman David S. , Dietz William H. , Srinivasan Sathanur R. , Berenson Gerald S.
Published: March 2009

OBJECTIVE. Compared with thinner children, overweight children (BMI for age between the 85th and 94th Centers for Disease Control and Prevention percentiles) have moderately elevated levels of lipids and blood pressure and are at increased risk for becoming obese adults. We examined the ability of BMI for age, the skinfold sum (subscapular + triceps), and the waist/height ratio to identify which overweight children are at greatest risk.

METHODS. Cross-sectional (n = 2501) and longitudinal (n = 2124) analyses were performed among subjects who participated in the Bogalusa Heart Study.

RESULTS. Levels of risk factors and adult BMI (median: 32 kg/m2) among overweight children were midway between those of thinner children and obese children (BMI for age ≥ 95th percentile). Although there was a wide range of skinfold sums among the overweight children, levels of BMI for age and the skinfold sum provided relatively little information on adverse risk-factor levels and adult BMI. Overweight children with a relatively high (upper tertile) waist/height ratio, however, were ∼2 to 3 times more likely to have adverse levels of most risk factors than were those with a low waist/height ratio.

CONCLUSIONS. Overweight children vary substantially in terms of body fatness and risk-factor levels. Among these overweight children, levels of waist/height ratio are more strongly associated with adverse risk-factor levels than are levels of BMI for age or skinfold thickness. Additional information is needed on the relation of childhood waist/height ratio to adult complications.
Longitudinal Study of Exposure to Entertainment Media and Alcohol Use Among German Adolescents
Authors: Hanewinkel Reiner , Sargent James D.
Published: March 2009

BACKGROUND. Entertainment media exposure may predict teenager alcohol use, but few longitudinal studies have been reported.

METHODS. A longitudinal study was conducted of 2708 German adolescents aged 10 to 16 years who had never drunk alcohol. Each adolescent was surveyed at school about daily television use, whether they had a television in their bedroom, and their exposure to movie alcohol depictions. Adolescents were resurveyed 12 to 13 months later (retention rate: 85%) to determine onset of drinking alcohol without parental knowledge and binge drinking (≥5 consecutive drinks).

RESULTS. Overall, 885 (33%) students initiated alcohol use without parental knowledge (17% in quartile 1 movie alcohol exposure), and 387 (14%) initiated binge drinking during follow-up. After controlling for baseline covariates, exposure to movie alcohol use significantly increased percent initiating alcohol use (to 24% in exposure quartile 2, 33% in quartile 3 and 34% in quartile 4) and percent initiating binge drinking (to 8.6% in exposure quartile 2, 12% in quartile 3 and 13% in quartile 4). Having a television in the bedroom also predicted both outcomes, but daily television use did not.

CONCLUSIONS. Movie exposure and having a television in the bedroom are both independent predictors of onset of problematic alcohol use among German teenagers. Media restrictions could play a role in prevention.
Acute Pediatric Monoarticular Arthritis: Distinguishing Lyme Arthritis From Other Etiologies
Authors: Thompson Amy , Mannix Rebekah , Bachur Richard
Published: March 2009

OBJECTIVE. Identify clinical predictors of Lyme arthritis among patients with acute monoarticular arthritis.

METHODS. A medical chart review was conducted of children ≤18 years of age with monoarticular arthritis who underwent arthrocentesis in a pediatric emergency department located in the northeast United States. Patients were classified into 3 categories of arthritis: septic, Lyme, or nonseptic non-Lyme arthritis. Historical, clinical, and laboratory data were compared to identify distinguishing features of Lyme arthritis.

RESULTS. One hundred seventy-nine patients were studied: 46 (26%) patients with septic arthritis, 55 (31%) patients with Lyme arthritis, and 78 (43%) patients with nonseptic non-Lyme arthritis. Compared with those with septic arthritis, patients with Lyme disease were more likely to have a tick-bite history, knee involvement, and less likely to have a history of fever or elevated temperature at triage. Erythrocyte sedimentation rate, C-reactive protein, joint white blood cell count, and joint neutrophil percentage were also statistically lower. In comparison to nonseptic non-Lyme arthritis, knee involvement and tick-bite history were predictors of Lyme. Erythrocyte sedimentation rate, joint white blood cell count, and joint neutrophil percentage were also statistically different. Multivariate analysis comparing Lyme to septic arthritis demonstrated fever history and elevated C-reactive protein level to be negative predictors of Lyme arthritis and knee involvement to be a positive predictor (model sensitivity: 88%; specificity: 82%).

CONCLUSIONS. Lyme arthritis shares features with both septic and nonseptic non-Lyme arthritis. This overlap prevents the creation of a clinically useful predictive model for Lyme arthritis. In endemic areas, Lyme testing should be performed on all patients presenting with acute monoarticular arthritis.
Validity and Stability of Self-reported Health Among Adolescents in a Longitudinal, Nationally Representative Survey
Authors: Fosse Nathan E. , Haas Steven A.
Published: March 2009

OBJECTIVES. The goals of this study to assess (1) the stability of self-reported health among a nationally representative sample of youth in adolescence over a period of 6 years, (2) the concordance of self-reported health between parents and children, and (3) the validity of self-reported health across a range of physical and emotional indicators of adolescent well-being.

METHODS. This study uses data from rounds 1 to 7 (1997–2003) of the National Longitudinal Survey of Youth, 1997 Cohort (NLSY97). The sample consists of 6748 youth born between January 1, 1980, and December 31, 1984. Data on one of the youths’ parents were also included in the baseline of the survey. Analyses were conducted using polychoric correlations and ordinal logistic regression.

RESULTS. Self-reported health of adolescents over a 7-year period indicated moderate stability (40% agreement after 7 years for girls and 41% for boys). Concordance was also present between parents and their children, although the association was higher among same-gender pairings (mother-daughter and father-son concordances). Adolescents’ self-reported health was also linked with the presence or absence of chronic health conditions, emotional problems, and with being overweight or obese but not with sensory conditions or physical deformity.

CONCLUSIONS. Self-reported health is stable from early and middle adolescence to young adulthood. Self-reported health is also a valid measure of a variety of physical and emotional dimensions of adolescent well-being. The stability and validity of self-reported health do not differ by the gender of the child, although there is slightly greater concordance when the reporting parent is the same gender as the child.
Does Head Cooling With Mild Systemic Hypothermia Affect Requirement for Blood Pressure Support?
Authors: Battin Malcolm R. , Thoresen Marianne , Robinson Elizabeth , Polin Richard A. , Edwards A. David , Gunn Alistair Jan ,   on behalf of the Cool Cap Trial Group
Published: March 2009

OBJECTIVE. Our goal was to evaluate whether head cooling with mild systemic hypothermia for neonatal encephalopathy is associated with greater requirement for volume or inotrope support.

PATIENTS AND METHODS. We studied term infants (≥36 weeks) with moderate-to-severe neonatal encephalopathy plus abnormal amplitude integrated electroencephalography, randomly assigned to head cooling for 72 hours starting within 6 hours of birth, with the rectal temperature maintained at 34.5°C ± 0.5°C (n = 112), or conventional care (n = 118).

DESIGN. This was a multicenter randomized, controlled study (the CoolCap trial). The primary outcome was the time relationship between mean arterial blood pressure and subsequent administration of inotropes or volume administration.

RESULTS. Pooled data from 0 to 76 hours after randomization revealed no difference in mean arterial blood pressure between groups and significantly lower mean heart rate during cooling. The use of inotropes or volume was related to preceding mean arterial blood pressure and not to treatment group in the first 24 hours. In contrast, from 24 to 76 hours, there was no effect of mean arterial blood pressure, but there was an overall reduction in pressure support over time and significantly more frequent pressure support in the cooled group than in controls.

CONCLUSIONS. Mild systemic hypothermia did not affect arterial blood pressure or initial treatment with inotropes or volume in infants with moderate-to-severe encephalopathy but was associated with an apparent change in physician behavior, with slower withdrawal of therapy in cooled infants.
The Effects of Varying Periods of Uninsurance on Children's Access to Health Care
Authors: Cummings Janet R. , Lavarreda Shana Alex , Rice Thomas , Brown E. Richard
Published: March 2009

OBJECTIVE. Many studies have documented the adverse consequences of uninsurance for children, but less is known about the differential effects of varying periods of uninsurance. This study examines the relative effects of varying periods of uninsurance (uninsured for 1–4 months, 5–11 months, or all year) on children's access to care.

METHODS. Using data from the 2005 California Health Interview Survey Children's File (ages 0–11), we estimated logistic regressions to examine the effect of insurance status on 6 measures of health care access, controlling for child demographics, child health status, family characteristics, and urban residence. Indicators for insurance status included the following categories: (1) privately insured all year (reference); (2) Medicaid all year; (3) State Children's Health Insurance Program all year; (4) uninsured for 1 to 4 months; (5) uninsured for 5 to 11 months; (6) uninsured all year; and (7) other insurance all year.

RESULTS. We found that children who experience short spells of uninsurance (1–4 months) are less likely to have a usual source of care and are more likely to experience delays in needed care than those with continuous private or public insurance. The consequences are even worse for children who experience more substantial periods of uninsurance, because they are also less likely to receive preventive care (well-child visits and flu shots) or visit the doctor during the year and are more likely to experience delays in receiving needed medical care and prescriptions than those with continuous coverage. The Medicaid program and State Children's Health Insurance Program in California both seem to have ensured levels of health care access similar to that obtained by children with year-round private coverage.

CONCLUSIONS. These findings highlight the benefits gained through continuous health insurance, whether public or private. Public policies should be adopted to ensure continuity of coverage and retention in public insurance programs.
Hospital-Based Surveillance to Estimate the Burden of Rotavirus Gastroenteritis Among European Children Younger Than 5 Years of Age
Authors: Forster Johannes , Guarino Alfredo , Parez Nathalie , Moraga Fernando , Román Enriqueta , Mory Olivier , Tozzi Alberto E. , de Aguileta Ana López , Wahn Ulrich , Graham Clive , Berner Reinhard , Ninan Titus , Barberousse Celia , Meyer Nadia , Soriano-Gabarró Montse ,   and the Rotavirus Study Group
Published: March 2009

OBJECTIVES. Rotavirus is the leading cause of acute gastroenteritis requiring hospitalization in young children. Data on the burden of rotavirus gastroenteritis are needed to guide recommendations for rotavirus vaccine use. This study was undertaken to estimate the burden of rotavirus gastroenteritis in European children <5 years of age.

METHODS. This prospective, study was conducted in 12 hospitals in France, Germany, Italy, Spain, and the United Kingdom. A sample of all children aged <5 years presenting to emergency departments or hospitalized because of community-acquired acute gastroenteritis was enrolled for parental interview and stool collection. Acute gastroenteritis was defined as diarrhea (≥3 loose stools per 24 hours) for <14 days. Rotavirus was detected by enzyme-linked immunosorbent assay and typed by reverse-transcriptase polymerase chain reaction.

RESULTS. Between February 2005 and August 2006, 3734 children with community-acquired acute gastroenteritis were recruited and retained for analysis (55.9% via the emergency department, 41.8% hospitalized). Of the 2928 community-acquired acute gastroenteritis cases for which stool samples were available, 43.4% were rotavirus-positive by enzyme-linked immunosorbent assay (32.8% emergency department, 56.2% hospitalized). Of these rotavirus gastroenteritis cases 80.9% occurred in children aged <2 years and 15.9% among infants aged <6 months. Acute gastroenteritis was more severe in rotavirus-positive subjects (Vesikari score ≥ 11 in 53.3% compared with 31.0% of rotavirus-negative subjects). All 1271 rotavirus-positive strains were genotyped (G1P[8]: 40.3%; G9P[8]: 31.2%; G4P[8]: 13.5%; G3P[8]: 7.1%).

CONCLUSIONS. Rotavirus gastroenteritis places high demands on European health care systems, accounting for 56.2% of hospitalizations and 32.8% of emergency department visits because of community-acquired acute gastroenteritis in children aged <5 years. Most community-acquired rotavirus gastroenteritis occurs in children aged <2 years, and a high proportion occurs in infants aged <6 months. Cases were also observed among very young infants <2 months of age. Rotavirus vaccination is expected to have a major impact in reducing morbidity and the pressure on hospital services in Europe.
Efficacy of Inhaled Corticosteroids in Infants and Preschoolers With Recurrent Wheezing and Asthma: A Systematic Review With Meta-analysis
Authors: Castro-Rodriguez Jose A. , Rodrigo Gustavo J.
Published: March 2009

OBJECTIVE. To compare the efficacy of inhaled corticosteroids in infants and preschoolers with recurrent wheezing or asthma.

METHODS. Randomized, prospective, controlled trials published January 1996 to March 2008 with a minimum of 4 weeks of inhaled corticosteroids versus placebo were retrieved through Medline, Embase, and Central databases. The primary outcome was wheezing/asthma exacerbations; secondary outcomes were withdrawal caused by wheezing/asthma exacerbations, changes in symptoms score, pulmonary function (peak expiratory flow and forced expiratory volume in 1 second), or albuterol use.

RESULTS. Of eighty-nine studies identified, 29 (N = 3592 subjects) met the criteria for inclusion. Patients who received inhaled corticosteroids had significantly less wheezing/asthma exacerbations than those on placebo (18.0% vs 32.1%); posthoc subgroup analysis suggests that this effect was higher in those with a diagnosis of asthma than wheeze but was independent of age (infants versus preschoolers), atopic condition, type of inhaled corticosteroid (budesonide metered-dose inhaler versus fluticasone metered-dose inhaler), mode of delivery (metered-dose inhaler versus nebulizer), and study quality (Jadad score: <4 vs ≥4) and duration (<12 vs ≥12 weeks). In addition, children treated with inhaled corticosteroids had significantly fewer withdrawals caused by wheezing/asthma exacerbations, less albuterol use, and more clinical and functional improvement than those on placebo.

CONCLUSIONS. Infants and preschoolers with recurrent wheezing or asthma had less wheezing/asthma exacerbations and improve their symptoms and lung function during treatment with inhaled corticosteroids.
Maturation of Little Skate and Winter Skate in the Western Atlantic from Cape Hatteras to Georges Bank
Authors: Frisk Michael G. , Miller Thomas J.
Published: March 2009

We estimated the length and age of maturation in little skate Leucoraja erinacea and winter skate L. ocellata based on samples of 1,884 little skate and 1,153 winter skate ovaries collected from Cape Hatteras, North Carolina, to Georges Bank. Two levels of maturity were recognized: onset maturity, which marks the onset of the allocation of energy from somatic growth to reproduction; and “functional” maturity, which marks the point when mature oocytes are released. Size at maturation increased with latitude in little skate, 50% onset maturity occurring at 42.5, 43.0, and 46.5 cm (total length) and 50% functional maturity at 43, 44, and 46 cm for the mid-Atlantic, southern New England–Georges Bank, and Gulf of Maine regions, respectively. Based on age estimates from previously published work, the age at which little skate achieve functional maturation ranged between 7.0 and 7.5 years for the U.S. northeast coast. In winter skate, no statistically significant regional differences in maturation rates were found. Size at 50% onset maturity was estimated to be 66 cm and at 50% functional maturity 76 cm for the U.S. northeast coast. In winter skate, onset maturity occurred at 9.5 years and functional maturity at 12.5 years. Thus, functional maturity in this species occurred 3 years after the onset of maturation, indicating that the species has a long adolescence before contributing offspring to the population.
Relationships between Larval and Juvenile Abundance of Winter-Spawned Fishes in North Carolina, USA
Authors: Taylor J. Christopher , Mitchell Warren A. , Buckel Jeffrey A. , Walsh Harvey J. , Shertzer Kyle W. , Martin Gretchen Bath , Hare Jonathan A.
Published: March 2009

We analyzed the relationships between the larval and juvenile abundances of selected estuarine-dependent fishes that spawn during the winter in continental shelf waters of the U.S. Atlantic coast. Six species were included in the analysis based on their ecological and economic importance and relative abundance in available surveys: spot Leiostomus xanthurus, pinfish Lagodon rhomboides, southern flounder Paralichthys lethostigma, summer flounder Paralichthys dentatus, Atlantic croaker Micropogonias undulatus, and Atlantic menhaden Brevoortia tyrannus. Cross-correlation analysis was used to examine the relationships between the larval and juvenile abundances within species. Tests of synchrony across species were used to find similarities in recruitment dynamics for species with similar winter shelf-spawning life-history strategies. Positive correlations were found between the larval and juvenile abundances for three of the six selected species (spot, pinfish, and southern flounder). These three species have similar geographic ranges that primarily lie south of Cape Hatteras. There were no significant correlations between the larval and juvenile abundances for the other three species (summer flounder, Atlantic croaker, and Atlantic menhaden); we suggest several factors that could account for the lack of a relationship. Synchrony was found among the three southern species within both the larval and juvenile abundance time series. These results provide support for using larval ingress measures as indices of abundance for these and other species with similar geographic ranges and winter shelf-spawning life-history strategies.
Geometric Morphological Differences Distinguish Populations of Scup in the Northwestern Atlantic Ocean
Authors: Love Joseph W. , Chase Peter D.
Published: March 2009

Scup Stenotomus chrysops, a commercially important marine species, are distributed from Nova Scotia to south Florida, and may represent morphologically distinct populations across their range. It was determined whether there were morphological differences between a North Atlantic Bight (NAB) population (41°N) and two South Atlantic Bight (SAB) populations (30°N and 32°N) of this species from April 2005 to July 2005, when the populations had formed spawning groups. Morphology was compared among populations by means of a geometric, landmark-based analysis of morphological and meristic traits for 180 individuals that were sexed and staged to maturity. A backward, stepwise discriminant functions analysis (DFA) produced a model that generated DFA scores that differed significantly between the NAB and SAB populations. Forehead and body depth dimensions differed among populations but not sexes. The DFA model predicted similar scores for 32 new NAB individuals and 31 new SAB individuals; however, scores were consistently underpredicted for the NAB individuals and overpredicted for the SAB individuals. We concluded that distinct northern and southern populations support a two-stock or two-species hypothesis; however, it is unclear whether this stock structure is related to reproductive or other life history traits. Either phenotypic plasticity or divergent selection may explain the morphological dissimilarities among these populations, but their influence on individual fitness remains unknown.
Diagnostic Potential of 3D-Data–Based Reconstruction Software: An Analysis of the Rare Disease Pattern of Cherubism
Authors: Holst Alexandra Ioana , Hirschfelder Ursula , Holst Stefan
Published: March 2009

Cherubism is an autosomal-dominant syndrome characterized by bilateral maxillomandibular bony degeneration, fibrous connective tissue hyperplasia, and displacement of permanent tooth germs. Reossification of the cystic lumen occurs spontaneously, but dislocated teeth must be realigned orthodontically. Advancements in virtual 3D reconstruction of anatomic structures based on computed tomography (CT) or cone beam CT data have provided for more predictable individual treatment planning. We evaluated two software programs for making densitometry and volume measurements of cystic areas in the mandibles, and for 3D visualization of permanent tooth germs within the cystic lumen, in two siblings with cherubism.
Bupivacaine Administration and Postoperative Pain following Anterior Iliac Crest Bone Graft for Alveolar Cleft Repair
Authors: Dashow Jason E. , Lewis Charlotte W. , Hopper Richard A. , Gruss Joseph S. , Egbert Mark A.
Published: March 2009

Objective:

To determine whether placement of a bupivacaine-soaked absorbable sponge (BAS) in addition to bupivacaine infiltration at the anterior iliac crest (AIC) donor site alters postoperative pain for children undergoing alveolar bone grafting (ABG) for cleft lip with or without cleft palate (CL±P). The comparison group received only bupivacaine infiltration (NO BAS) at the AIC.

Design:

Retrospective cohort. Medical records were abstracted by one investigator, blinded to BAS versus NO BAS use.

Setting and Patients:

Consecutive patients with CL±P who underwent ABG between 2000 and 2006 at one large U.S. craniofacial center.

Intervention:

BAS was used in 118 procedures and NO BAS in 89.

Outcome Measures:

Postoperative pain score, total and opioid pain medication requirement, length of hospital stay (LOS), and time to initial ambulation.

Results:

One hundred eighty-two patients underwent 207 ABG procedures. Mean pain scores were significantly lower when BAS was used compared with NO BAS (1.3 versus 1.8; p  =  .01). Patients who received BAS required significantly less pain medication than NO BAS patients: opioids (0.14 versus 0.20 mg/kg; p  =  .01) and total (0.60 versus 0.71 mg/kg; p  =  .02). Relative to the NO BAS group, those who received BAS had a shorter LOS (30.9 versus 42.4 hours; p < .0001) and less time to initial ambulation following surgery (14.4 versus 20.6 hours; p < .0001).

Conclusion:

Use of BAS at the AIC donor site significantly reduced postoperative pain score, pain medication requirement, LOS, and time to ambulation relative to children who did not receive BAS following ABG.
Psychosocial Functioning and Sleep Patterns in Children and Adolescents with Cleft Lip and Palate (CLP) Compared with Healthy Controls
Authors: Brand Serge , Blechschmidt Anja , Müller Andreas , Sader Robert , Schwenzer-Zimmerer Katja , Zeilhofer Hans-Florian , Holsboer-Trachsler Edith
Published: March 2009

Objective:

The aim of this study was twofold: to assess psychological functioning, interactional competencies, and sleep patterns in children and adolescents with cleft lip and palate (CLP), and to compare these results with those from age- and gender-matched controls. It was hypothesized that participants with CLP would exhibit greater difficulties in psychological functioning, more interactional difficulties, and poorer sleep patterns than those without CLP.

Participants:

Thirty-two children and adolescents with CLP and 34 controls were recruited. Ages ranged from 6 to 16 years.

Main Outcome Measures:

For psychosocial assessment, the Strength and Difficulties Questionnaire (SDQ) and a questionnaire on interactional competencies (PIELCQ) were completed; for sleep assessment, a sleep log was completed for seven consecutive nights.

Results:

Participants with and without CLP did not differ with respect to emotional problems, conduct problems, or hyperactivity. With respect to interactional competencies, participants with CLP were six times more likely to report difficulties. Unfavorable sleep patterns were associated with psychosocial strain but not with the presence of CLP.

Conclusions:

Results indicate that children and adolescents with CLP may report that they have sleep irregularities as often as those without CLP. In adolescence, the presence of CLP may be associated with increased difficulties. Consequently, skill training to improve context-related social competencies may be appropriate.
Dynamic Analysis of the Effects of Upper Lip Pressure on the Asymmetry of the Facial Skeleton in Patients with Unilateral Complete Cleft Lip and Palate
Authors: Nagasao Tomohisa , Miyamoto Junpei , Konno Eri , Ogata Hisao , Nakajima Tatsuo , Isshiki Yasushige
Published: March 2009

Objective:

Our purpose was to assess quantitatively the effect of increased upper-lip pressure on asymmetry of the facial bones in patients with unilateral complete lip-alveolar-palatal clefts.

Methods:

We collected computed tomographic images from 16 patients with unilateral complete lip-alveolar-palatal clefts and classified them into two groups based on absence/presence of alveolar bone grafting. We categorized eight patients (9.6 ± 2.0 years old) who had not been treated with alveolar bone grafting as the ABG(−) group and the other eight patients (9.3 ± 1.6 years old) who had received alveolar bone grafting as the ABG(+) group. After producing a computer-aided design model for each patient, we applied a uniform load on the anterior aspects of the maxilla, alveolus, and teeth of the model to simulate the upper-lip pressure. Then we calculated the degree of distortion each model presented using the finite element method. We compared the distortion pattern between the ABG(−) and ABG(+) groups.

Results:

In the ABG(−) patients, asymmetry of distortion between the cleft and noncleft sides was present in wide areas involving the orbit, nasal bone, piriform margin, and anterior wall of the maxillary sinus. In the ABG(+) patients, asymmetry of distortion was limited to rather small areas.

Conclusions:

In unilateral complete lip-alveolar-palatal clefts patients, the upper-lip pressure works to dislocate the cleft-side segment to a more posterior position than the noncleft-side segment. This finding implies that the increased lip pressure exacerbates facial asymmetry of these patients. The exacerbating effect on facial asymmetry is alleviated by alveolar bone grafting.
The Tessier Number 5 Facial Cleft: Surgical Strategies and Outcomes in Six Patients
Authors: da Silva Freitas Renato , Alonso Nivaldo , Shin Joseph H. , Busato Luciano , Dall'Oglio Tolazzi AndréRicardo , de Oliveria e Cruz Gilvani Azor
Published: March 2009

The Tessier no. 5 facial cleft is an extremely rare congenital malformation. Only 26 cases have been described in the English-language literature. The cleft begins in the upper lip just medial to the oral commissure, extending across the cheek as a groove ending at the junction of the middle and lateral thirds of the lower eyelid. The bone involvement usually includes an alveolar cleft in the premolar region, extends across the maxilla lateral to the infraorbital nerve, up to the infraorbital rim and orbital floor. The goals of the surgical procedure include reconstructing the lower eyelid, repositioning the lateral canthus, closure of the labiomaxillary cleft, and restoration of the skeletal continuity (including the orbital floor defect) with bone grafts. We present six patients with the Tessier no. 5 facial cleft who have been treated in our combined centers and discuss the surgical options and difficulties faced in the reconstruction of this rare and challenging craniofacial malformation. To date, we have treated six patients (two with bilateral and four with unilateral clefts). Three of the patients with unilateral clefting had an associated no. 4 cleft and one patient with a bilateral cleft had an associated no. 3 cleft. This paper represents the largest series to date documenting surgery for patients with the Tessier no. 5 facial cleft.
Are Teeth Close to the Cleft More Susceptible to Periodontal Disease?
Authors: de Almeida Ana Lúcia Pompéia Fraga , Gonzalez Marly Kimie Sonohara , Greghi Sebastião Luiz Aguiar , Conti Paulo César Rodrigues , Pegoraro Luiz Fernando
Published: March 2009

Objective:

To evaluate whether teeth close to the cleft area present higher prevalence and severity of periodontal disease than teeth in other regions.

Design:

Cross-sectional.

Setting:

Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo.

Patients:

There were 400 individuals with complete unilateral or bilateral cleft lip and palate, aged 15 to 49 years, without any previous periodontal treatment.

Main Outcome Measures:

All clinical parameters were evaluated in six sites for each tooth. The arithmetic means were calculated for each sextant.

Results:

Of the sextants, 86.75% presented means of probing depth smaller than or equal to 3 mm. No sextant exhibited means of probing depth greater than or equal to 6 mm. There was a statistically significant difference (p < .001) in probing depth according to age, types of cleft, and sextant; 95.87% of sextants presented mean attachment levels smaller than or equal to 3 mm. The sextant with cleft did not present higher means of probing depth, clinical attachment level, plaque index, and gingival index. There was gingival bleeding in 99.08% of the sample and plaque in 97.40%. The type of cleft was not an important factor influencing the prevalence of periodontal disease. Age seems to be an important factor influencing the prevalence and severity of periodontal disease for all aspects investigated.

Conclusions:

Periodontal disease in individuals with clefts occurred in a similar manner as observed in other populations. The presence of the cleft does not seem to increase the prevalence of the disease.
Treatment of Dental Anomalies in Children with Complete Unilateral Cleft Lip and Palate at Sickkids Hospital, Toronto
Authors: Cassolato Sandra F. , Ross Bruce , Daskalogiannakis John , Noble James , Tompson Bryan
Published: March 2009

Objective:

To quantify dental anomalies in permanent dentition associated with complete unilateral cleft lip and palate and to survey treatment modalities used to address these problems.

Method:

Retrospective study of 116 children with complete unilateral cleft lip and palate treated at SickKids since birth. Presence and morphology of lateral incisors and second premolars were determined. Orthodontic, surgical, and/or prosthetic procedures were analyzed.

Results:

The cleft-side lateral incisor was absent in 93.1% of finished cases. The lateral incisor mesial to the cleft was present in 4.3%, absent due to agenesis in 75.9%, and extracted in 19.8% of cases. The lateral distal to the cleft was present in 2.6%, absent due to agenesis in 33.6%, and extracted in 63.8% of cases. Of 105 lateral incisors, only one had normal morphology. Noncleft-side lateral incisors were absent in 16% of finished cases. Absence was due to agenesis in 12.1% of cases and extraction in 4.3%. When the lateral incisor was missing, closure of the dental space occurred by orthodontic tooth movement after alveolar bone grafting (45%); surgical closure with simultaneous alveolar bone grafting (35%); prosthetic closure (17%); and 3% were failures. Agenesis of premolars occurred in 12.1% of cleft-side and 10.3% of noncleft-side maxillary second premolars.

Conclusions:

The cleft-side lateral incisor is rarely present at the conclusion of orthodontic and surgical treatment of complete unilateral cleft lip and palate. Often absent due to agenesis, when present it is typically abnormal in size and bone support and is commonly extracted in favor of canine substitution.
PROGRESSING TOWARD DATA INTIMACY: A REVIEW OF WITHIN‐SESSION DATA ANALYSIS
Authors: Fahmie Tara A. , Hanley Gregory P.
Published: March 2009

Visual inspection of data is a common method for understanding, responding to, and communicating important behavior‐environment relations in single‐subject research. In a field that was once dominated by cumulative, moment‐to‐moment records of behavior, a number of graphic forms currently exist that aggregate data into larger units. In this paper, we describe the continuum of aggregation that ranges from distant to intimate displays of behavioral data. To aid in an understanding of the conditions under which a more intimate analysis is warranted (i.e., one that provides a richer analysis than that provided by condition or session aggregates), we review a sample of research articles for which within‐session data depiction has enhanced the visual analysis of applied behavioral research.
AN EXPLORATORY ANALYSIS OF TASK‐INTERSPERSAL PROCEDURES WHILE TEACHING OBJECT LABELS TO CHILDREN WITH AUTISM
Authors: Volkert Valerie M. , Lerman Dorothea C. , Trosclair Nicole , Addison Laura , Kodak Tiffany
Published: March 2009

Research has demonstrated that interspersing mastered tasks with new tasks facilitates learning under certain conditions; however, little is known about factors that influence the effectiveness of this treatment strategy. The initial purpose of the current investigation was to evaluate the effects of similar versus dissimilar interspersed tasks while teaching object labels to children diagnosed with autism or developmental delays. We then conducted a series of exploratory analyses involving the type of reinforcer delivered for correct responses on trials with unknown or known object labels. Performance was enhanced under the interspersal condition only when either brief praise was delivered for all correct responses or presumably more preferred reinforcers were provided for performance on known trials rather than on unknown trials.