bluuebunny/crossref_metadata_2025 huggingface dataset:
A Microcosm of the Biomedical Research Experience for Upper-level Undergraduates
Authors: Hurd Daryl D.
Published: June 2008

The skill set required of biomedical researchers continues to grow and evolve as biology matures as a natural science. Science necessitates creative yet critical thinking, persuasive communication skills, purposeful use of time, and adeptness at the laboratory bench. Teaching these skills can be effectively accomplished in an inquiry-based, active-learning environment at a primarily undergraduate institution. Cell Biology Techniques, an upper-level cell biology laboratory course at St. John Fisher College, features two independent projects that take advantage of the biology of the nematode Caenorhabditis elegans, a premier yet simple model organism. First, students perform a miniature epigenetic screen for novel phenotypes using RNA interference. The results of this screen combined with literature research direct students toward a singe gene that they attempt to subclone in the second project. The biology of the chosen gene/protein also becomes an individualized focal point with respect to the content of the laboratory. Progress toward course goals is evaluated using written, oral, and group-produced assignments, including a concept map. Pre- and postassessment indicates a significant increase in the understanding of broad concepts in cell biological research.
Stable Halodilithiosilanes: Synthesis and Reactivity of TsiXSiLi2 (X = Br and Cl)
Authors: Lee Myong Euy , Lim Young Mook , Son Joo Young , Seo Won Guk
Published: June 2008

The stable bromodilithiosilane at room temperature was synthesized in 86% yield by the reduction of the corresponding tribromo[tris(trimethylsilyl)methyl]silane with lithium naphthalenide.
Synthesis and Electroluminescent Properties of New Amorphous Cyclohexyl- and Hexyl-substituted Ter(9,9-dialkylfluorene)s
Authors: Lim Eunhee , Jung Byung-Jun , Kim Sung Min , Kim Bong Ok , Shim Hong-Ku
Published: June 2008

A series of ter(9,9-dialkylfluorene)s (TFs) containing cyclohexyl and hexyl side groups has been synthesized via the Suzuki coupling reaction. Their chemical structures were characterized by 1H NMR and 13C NMR. All TFs were soluble in common organic solvents and showed good thermal stability up to 400 °C. In particular, T(CHC)F composed of two 9,9-bis(cyclohexylmethyl)fluorenes and one dihexylfluorene showed improved thermal stability over T(HHH)F and was found to be amorphous, unlikely with T(CCC)F. A light-emitting diode device fabricated with an ITO/2-TNATA/NPB/TFs/Alq3/Liq/Al configuration exhibited blue light emission with EL maxima at 450 nm and EL efficiency of 1.1 cd/A.
A Relationship between Molecular Orientation and Current–Voltage Characteristics in Poly(3-hexylthiophene) Thin Film
Authors: Komino Takeshi , Tajima Hiroyuki , Matsuda Masaki
Published: June 2008

Simultaneous measurement of molecular orientation and current as a function of voltage has been conducted. Molecular orientation was measured using the polarization dependence of intramolecular electronic transition. In ITO/poly(3-hexylthiophene)/Al structure, it was found that the molecular orientation change assists the hysteretic current–voltage (J–V) characteristics. The result indicates that this measuring method can be useful in investigating the effects of molecular orientation change on unusual J–V characteristics.
An Onium Salt-catalyzed Direct Polycondensation of Lactic Acid
Authors: Iwahashi Hisako , Oka Tatsuya , Abiko Atsushi
Published: June 2008

Poly(l-lactic acid) of Mw≈160000 (PDI = 1.6) was produced by direct polycondensation of water-containing lactic acid using triphenylphosphonium triflate as a catalyst.
Chiral Bead-like Trimer of Tris(2,4-pentanedionato)ruthenium(III)
Authors: Sato Hisako , Kameda Jun , Fukuda Yutaka , Haga Masa-aki , Yamagishi Akihiko
Published: June 2008

A chiral tri-nuclear metal complex, ΔΔΔ- or ΛΛΛ-[Ru(acac)2(taet)Ru(acac)(taet)Ru(acac)2] (acac = acetylacetonato and taet = tetraacetylethanato), was prepared and its monolayer behavior was investigated, leading to the conclusion that the bead-like character of the trimer was an essential factor in achieving stable two-dimensional molecular packing.
Maternal Psychological Adjustment and Knowledge of Infant Development as Predictors of Home Safety Practices in Rural Low-Income Communities
Authors: Zolotor Adam J. , Burchinal Margaret , Skinner Debra , Rosenthal Marjorie ,   and the Key Family Life Project Investigators
Published: June 2008

BACKGROUND. Unintentional injury is the leading cause of death among toddlers in the United States. Toddlers spend the majority of time at home, and the use of recommended safety practices can prevent many injuries.

OBJECTIVE. Maternal psychological adjustment and understanding of child development are thought to influence the implementation of safety practices; however, the extent to which either factor is related has been examined with small samples and without attention to potential confounding. We hypothesize that mothers' use of safety practices will be higher when mothers have more knowledge of development and better psychological adjustment.

METHODS. This study is part of the Family Life Project, a longitudinal birth cohort of children from poor rural communities (n = 1611) and an ethnographic sample (n = 36). Mothers in the birth cohort completed scales to measure knowledge of development, psychological adjustment, and home safety practices. Factor analysis of the safety scale resulted in 4 subscales. Each subscale was predicted from maternal knowledge and adjustment in multivariable regression. Mothers in the ethnographic study described sources of information about home safety, current practices, and barriers.

RESULTS. Analyses indicated that mothers with better psychological adjustment were more likely to implement all of the safety practices, and mothers with more knowledge about development were more likely to minimize subtle hazards and install safety devices. An interaction between maternal adjustment and knowledge suggested that mothers with psychological distress were more likely to install safety devices if they had greater knowledge of development. Mothers reported that health care providers were the primary source of safety information, and barriers to implementation included poverty and lack of stable housing.

CONCLUSIONS. Knowledge of development and better psychological adjustment are associated with improved home safety. Knowledge about development is especially important for mothers with poor mental health. Pediatricians and designers of injury-prevention programs should consider the role of maternal mental health in child safety.
Sleep Patterns and Problems Among Chinese Adolescents
Authors: Liu Xianchen , Zhao Zhongtang , Jia Cunxian , Buysse Daniel J.
Published: June 2008

OBJECTIVES. Little is known about sleep patterns and problems in Chinese adolescents. This study was designed to examine sleep/wake patterns and problems and their associations with parent sleep among adolescents in China.

METHODS. This report represents part of an epidemiological study of sleep and health in 6 high schools in Jinan city, China. A total of 1056 adolescents and 838 parents completed a questionnaire in March or April 2005. Participants consisted of 625 boys and 441 girls, 557 seventh-graders (mean age: 13.5 ± 0.6 years) and 509 tenth-graders (mean age: 16.4 ± 0.7 years), and 603 mothers and 235 fathers. Adolescents and parents reported their own sleep/wake patterns and problems.

RESULTS. Average morning rising time (5:56 am vs 8:13 am) and sleep duration (7.5 hours vs 9.4 hours) differed significantly between weekdays and weekends. Compared with seventh-graders, 10th-graders went to bed later and awoke earlier, resulting in ∼1 hour of sleep less. Of the adolescents, 18.8% reported their sleep quality as poor, 26.2% were not satisfied with their sleep, 16.1% had insomnia, and 17.9% had daytime sleepiness. Significant but low adolescent-parent correlations were observed for sleep/wake patterns and perceived sleep quality. Difficulty initiating sleep in adolescents was significantly associated with history of insomnia in mothers and fathers.

CONCLUSIONS. Sleep insufficiency, insomnia, and daytime sleepiness are prevalent in Chinese adolescents. Sleep insufficiency on weekdays may be attributable to earlier morning rising to meet school schedules. Parental history of insomnia is associated with elevated risk for insomnia symptoms in adolescent offspring, although adolescent-parent correlations in sleep/wake patterns are relatively low.
Improved Cognitive Development Among Preterm Infants Attributable to Early Supplementation of Human Milk With Docosahexaenoic Acid and Arachidonic Acid
Authors: Henriksen Christine , Haugholt Kristin , Lindgren Magnus , Aurvåg Anne Karin , Rønnestad Arild , Grønn Morten , Solberg Rønnaug , Moen Atle , Nakstad Britt , Berge Rolf Kristian , Smith Lars , Iversen Per Ole , Drevon Christian André
Published: June 2008

OBJECTIVE. The objective of our study was to evaluate the effect of supplementation with docosahexaenoic acid and arachidonic acid for human milk-fed preterm infants. The primary end point was cognitive development at 6 months of age.

METHODS. The study was a randomized, double-blind, placebo-controlled study among 141 infants with birth weights of <1500 g. The intervention with 32 mg of docosahexaenoic acid and 31 mg of arachidonic acid per 100 mL of human milk started 1 week after birth and lasted until discharge from the hospital (on average, 9 weeks). Cognitive development was evaluated at 6 months of age by using the Ages and Stages Questionnaire and event-related potentials, a measure of brain correlates related to recognition memory.

RESULTS. There was no difference in adverse events or growth between the 2 groups. At the 6-month follow-up evaluation, the intervention group performed better on the problem-solving subscore, compared with the control group (53.4 vs 49.5 points). There was also a nonsignificant higher total score (221 vs 215 points). The event-related potential data revealed that infants in the intervention group had significantly lower responses after the standard image, compared with the control group (8.6 vs 13.2). There was no difference in responses to novel images.

CONCLUSIONS. Supplementation with docosahexaenoic acid and arachidonic acid for very preterm infants fed human milk in the early neonatal period was associated with better recognition memory and higher problem-solving scores at 6 months.
Clinical Profile of Hospitalized Children Provided With Urgent Assistance From a Medical Emergency Team
Authors: Kinney Sharon , Tibballs James , Johnston Linda , Duke Trevor
Published: June 2008

OBJECTIVE. The purpose of this work was to describe the frequency, characteristics, and outcomes of critical events and hospitalized children requiring medical emergency team review.

PATIENTS AND METHODS. We conducted an audit of prospectively collected medical emergency team forms and a retrospective review of medical charts during an 18-month period at a tertiary pediatric hospital in Australia. Critical events were defined as cardiac arrest, endotracheal intubation on the ward, reversal of analgesia or sedation, fluid resuscitation at ≥40 mL/kg, hyponatremia (serum sodium level of ≤125 mmol/L), hypernatremia (serum sodium level of ≥155 mmol/L), hypoglycemia (glucose level of ≤2 mmol/L), or severe metabolic acidosis (pH ≤ 7.1).

RESULTS. A total of 172 children had 225 medical emergency team calls (10.6 calls per 1000 hospital admissions and 2.0 calls per 1000 patient-days). Forty-two percent of calls were for infants <1 year old. Preexisting chronic disease was common, with 20% having a chronic underlying neurologic disorder. Forty-four percent of the children were postoperative. The mortality rate of the 172 children was 7.6% in the hospital and 13.4% within 1 year. Thirty-three children had a critical event, with reversal of analgesia being the most common event (n = 11). Postoperative children were more frequently seen in the critical-event group (64% vs 40%). Hospital and 1-year mortality rates were higher for children who had a critical event (16.1% vs 22.6%, respectively) than those who did not (5.7% vs 11.3%).

CONCLUSIONS. Chronic and complex illnesses were prevalent among children provided with urgent medical assistance from the medical emergency team in a tertiary hospital. Children in the postoperative phase were overrepresented among those with a critical event. A critical event significantly increased the risk of hospital mortality. Greater knowledge of high-risk groups is required to further improve outcomes for hospitalized children.
Differential Gender Response to Respiratory Infections and to the Protective Effect of Breast Milk in Preterm Infants
Authors: Klein M. Inés , Bergel Eduardo , Gibbons Luz , Coviello Silvina , Bauer Gabriela , Benitez Alicia , Serra M. Elina , Delgado M. Florencia , Melendi Guillermina A. , Rodríguez Susana , Kleeberger Steven R. , Polack Fernando P.
Published: June 2008

OBJECTIVE. The protective role of breastfeeding against severe acute lung disease in infants is well established, but its mechanism is unclear. Most hypotheses assume that breastfeeding confers similar passive protection to every infant; however, a few observations have suggested that the benefits of breast milk against severe lung disease may differ according to gender. The objective of this study was to determine whether the effect of breastfeeding on susceptibility to severe acute lung disease among infants at high risk is different for girls and boys.

METHODS. A cohort was analyzed prospectively by use of 2 different strategies: (1) predictors of first episode of rehospitalization by univariate and multivariate analyses using robust Poisson regression and (2) mean number of rehospitalizations between groups using multiple regression negative binomial models.

RESULTS. A total of 119 high-risk, very low birth weight infants were enrolled. Breast milk protected girls but not boys against severe acute lung disease. The interaction between breastfeeding and gender was clinically and statistically significant, even after adjustment for variables that can affect severity of acute lung disease. Disease was most severe in formula-fed girls (versus formula-fed boys).

CONCLUSIONS. Breastfeeding decreased the risk for severe acute lung disease in girls but not in boys. These findings suggest that breast milk protection is not universally conferred by passive transfer of humoral immunity (which should be gender indifferent), show that respiratory symptoms may be amenable to nonspecific modulation, and identify nonbreastfed preterm infant girls as an at-risk group for severe acute lung disease.
Race Matters in the Prosecution of Perpetrators of Inflicted Traumatic Brain Injury
Authors: Keenan Heather T. , Nocera Maryalice , Runyan Desmond K.
Published: June 2008

OBJECTIVE. The goal was to examine the case flow of child physical abuse prosecutions through the judicial system and to examine determinants of charges and sentencing decisions.

METHODS. This prospective cohort study monitored all defendants in identified cases of inflicted traumatic brain injury in North Carolina in 2000 and 2001. Victims were identified prospectively through surveillance at all PICUs in North Carolina and the Office of the Chief Medical Examiner. Suspected perpetrators were identified through information from families, hospital records, newspaper clippings, the Department of Corrections, and Clerks of Superior Court. Judicial case flow from original charges through sentencing was mapped. The victims' injury characteristics and suspects' characteristics, including potential mitigating and aggravating factors, were examined. Suspected perpetrator and victim characteristics were entered into multivariate models for examination of associations with charges and sentencing decisions.

RESULTS. Original and final charges varied widely. The most frequent original and final charge was the lowest-class felony child abuse charge. The child's death was predictive of higher felony charges. Sentences ranged from probation to life in prison. Of the defendants who were found to be guilty, 63% were incarcerated for some period of time. Severe sentences were associated with perpetrator race.

CONCLUSIONS. Prosecutors frequently charged the lowest felony child abuse charge available unless the child died. Minority status was not important in the decision to bring charges against a suspect but was the most important measured factor in rendering a sentence. Although the most appropriate charges and sentences can be argued, there seems to be a statewide bias toward harsher sentences for minority perpetrators.
Attitudes of Neonatologists Toward Delivery Room Management of Confirmed Trisomy 18: Potential Factors Influencing a Changing Dynamic
Authors: McGraw Melanie P. , Perlman Jeffrey M.
Published: June 2008

OBJECTIVE. The objective of this study was to determine the attitude of neonatal providers toward delivery room resuscitation of an infant with confirmed trisomy 18 with known congenital heart disease at ≥36 weeks of gestation.

METHODS. A multiple-choice questionnaire listing this clinical scenario was completed by neonatologists and fellows staffing level III NICUs. Potential factors influencing the decision to initiate resuscitation included maternal preference, neonatal condition at birth, obstetric care, and legal concerns.

RESULTS. Fifty-four (76%) of 71 surveys were completed. Of respondents, 44% indicated that they would be willing to initiate resuscitation. Maternal preference (70%) was the primary reason to initiate resuscitation, with the appearance of the neonate in the delivery room (46%) and legal concerns (25%) as additional factors.

CONCLUSIONS. Until recently, there was universal consensus that trisomy 18 was a lethal anomaly for which resuscitation in the delivery room was not indicated. These data indicate that more providers (44%) than anticipated would consider initiation of resuscitation for an infant with trisomy 18 even with congenital heart disease. We speculate that support for the best-interest standard for neonates is diminishing in favor of ceding without question to parental autonomy. This shift may have profound implications for ethical decisions in the NICU.
Prevalence of and Risk Factors for Community-Acquired Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus Colonization in Children Seen in a Practice-Based Research Network
Authors: Fritz Stephanie A. , Garbutt Jane , Elward Alexis , Shannon William , Storch Gregory A.
Published: June 2008

OBJECTIVE. We sought to define the prevalence of and risk factors for methicillin-resistant Staphylococcus aureus nasal colonization in the St Louis pediatric population.

METHODS. Children from birth to 18 years of age presenting for sick and well visits were recruited from pediatric practices affiliated with a practice-based research network. Nasal swabs were obtained, and a questionnaire was administered.

RESULTS. We enrolled 1300 participants from 11 practices. The prevalence of methicillin-resistant S aureus nasal colonization varied according to practice, from 0% to 9% (mean: 2.6%). The estimated population prevalence of methicillin-resistant S aureus nasal colonization for the 2 main counties of the St Louis metropolitan area was 2.4%. Of the 32 methicillin-resistant S aureus isolates, 9 (28%) were health care-associated types and 21 (66%) were community-acquired types. A significantly greater number of children with community-acquired methicillin-resistant S aureus were black and were enrolled in Medicaid, in comparison with children colonized with health care-associated methicillin-resistant S aureus. Children with both types of methicillin-resistant S aureus colonization had increased contact with health care, compared with children without colonization. Methicillin-sensitive S aureus nasal colonization ranged from 9% to 31% among practices (mean: 24%). The estimated population prevalence of methicillin-sensitive S aureus was 24.6%. Risk factors associated with methicillin-sensitive S aureus colonization included pet ownership, fingernail biting, and sports participation.

CONCLUSIONS. Methicillin-resistant S aureus colonization is widespread among children in our community and includes strains associated with health care-associated and community-acquired infections.
Gluten Intake Interferes With the Humoral Immune Response to Recombinant Hepatitis B Vaccine in Patients With Celiac Disease
Authors: Nemes Éva , Lefler Éva , Szegedi László , Kapitány Anikó , Kovács Judit B. , Balogh Márta , Szabados Katalin , Tumpek Judit , Sipka Sándor , Korponay-Szabó Ilma R.
Published: June 2008

OBJECTIVE. Patients with celiac disease, who often carry human leukocyte antigen-DR3;DQ2, are prone to inadequate response to hepatitis B immunization. We evaluated vaccine response in relation to disease activity and whether previous treatment with a gluten-free diet influences the achievement of protective antibody titers.

PATIENTS AND METHODS. We studied 128 children and adolescents with celiac disease and 113 age-matched control subjects. Twenty-two patients with celiac disease were prospectively immunized after diagnosis during dietary treatment (group 1). A total of 106 (group 2) and the control subjects received vaccination by mass immunization in schools at 14 years of age regardless of diet status and when celiac disease was still undiagnosed in 27 of these children. Diet compliance and celiac disease activity were monitored by measurement of antibodies against transglutaminase and endomysium. Vaccine response was determined by measuring antihepatitis B antibodies from serum.

RESULTS. The seroconversion after hepatitis B vaccination was 95.5% in group 1. All of these patients carried human leukocyte antigen DQ2. The response rate in group 2 was 50.9% and correlated with gluten intake (untreated patients: 25.9%, non-strict diet: 44.4%, strict diet: 61.4%). Treated and compliant patients did not significantly differ from control subjects (75.2%). Thirty-seven antihepatitis B–negative patients with celiac disease received a booster during a controlled gluten-free diet, and 36 (97.3%) seroconverted, irrespective of the presence of human leukocyte antigen DQ2.

CONCLUSIONS. Nonresponse to recombinant hepatitis B surface antigen may be a sign of undiagnosed celiac disease. However, there is a good vaccine response in adequately treated patients. Human leukocyte antigen DQ alleles do not seem to have a primary role. Revaccination is recommended during a controlled gluten-free diet.
Continuity-Structured Clinical Observations: Assessing the Multiple-Observer Evaluation in a Pediatric Resident Continuity Clinic
Authors: Zimmer Karen P. , Solomon Barry S. , Siberry George K. , Serwint Janet R.
Published: June 2008

OBJECTIVES. The continuity-structured clinical observation tool was developed and used to conduct a multiple-observer evaluation to assess residents in the core competency areas of patient care, interpersonal and communication skills, and professionalism. The objectives were to assess pediatric resident performance in a continuity clinic by using direct observation and to compare evaluations among preceptors, residents, and parents.

METHODS. Pediatric residents in a large continuity clinic participated between August and December 2005. The continuity-structured clinical tool included items in the following domains: opening the interview, history taking, relationship skills, personal manner, negotiation or management, and physical examination. Each resident was directly observed during 1 entire patient encounter. Parents, preceptors, and residents completed evaluations by selecting 1 of 4 possible responses for performance of each item. We dichotomized responses as “yes” versus “no/partial” and analyzed aggregate scores for individual items and domains among the 3 evaluators by McNemar test, percentage agreement, and interoberserver agreement (κ).

RESULTS. Fifty-four of 57 eligible residents had all 3 evaluations completed. Parents rated residents the highest and showed least variability (only 2 items for which parents indicated the task was completed in <90% of the encounters). Residents rated themselves the lowest (35 items with <90%). In comparing the residents and preceptors, the domains that had the lowest percentage of agreement were history taking (range: 61%–91%) and negotiation or management (range: 51%–88%). All of the evaluators scored residents the lowest in the domain of negotiation or management, with the following lowest-score items: probe for decision-makers, assess willingness and barriers, and use of visual aids.

CONCLUSIONS. Compared with parents, residents and preceptors demonstrated greater variability in resident performance evaluations. All of the evaluators scored residents lowest in the domain of negotiation or management during continuity-clinic visits. Residency programs should strongly consider emphasizing skill development in this area.
Accurate Parental Classification of Overweight Adolescents' Weight Status: Does It Matter?
Authors: Neumark-Sztainer Dianne , Wall Melanie , Story Mary , van den Berg Patricia
Published: June 2008

OBJECTIVE. Our goal was to explore whether parents of overweight adolescents who recognize that their children are overweight engage in behaviors that are likely to help their adolescents with long-term weight management.

METHODS. The study population included overweight adolescents (BMI ≥ 85th percentile) who participated in Project EAT (Eating Among Teens) I (1999) and II (2004) and their parents who were interviewed by telephone in Project EAT I. Cross-sectional analyses were conducted with 314 adolescent-parent dyads, and longitudinal analyses were completed with 170 dyads.

RESULTS. Parents who correctly classified their children as overweight were no more likely than parents who did not correctly classify their children as overweight to engage in the following potentially helpful behaviors: having more fruits/vegetables and fewer soft drinks, salty snacks, candy, and fast food available at home; having more family meals; watching less television during dinner; and encouraging children to make healthful food choices and be more physically active. However, parents who recognized that their children were overweight were more likely to encourage them to diet. Parental encouragement to diet predicted poorer adolescent weight outcomes 5 years later, particularly for girls. Parental classification of their children's weight status did not predict child weight status 5 years later.

CONCLUSIONS. Accurate classification of child overweight status may not translate into helpful behaviors and may lead to unhealthy behaviors such as encouragement to diet. Instead of focusing on weight per se, it may be more helpful to direct efforts toward helping parents provide a home environment that supports healthful eating, physical activity, and well-being.
Head Growth in Preterm Infants: Correlation With Magnetic Resonance Imaging and Neurodevelopmental Outcome
Authors: Cheong Jeanie L. Y. , Hunt Rod W. , Anderson Peter J. , Howard Kelly , Thompson Deanne K. , Wang Hong X. , Bear Merilyn J. , Inder Terrie E. , Doyle Lex W.
Published: June 2008

OBJECTIVE. Extremely preterm birth is associated with adverse neurodevelopmental sequelae. Head circumference has been used as a measure of brain growth. There are limited data relating head circumference to MRI. The purpose of this work was to establish the relationship between head circumference with brain MRI at term-equivalent age and to relate head circumference with neurodevelopmental outcome at 2 years.

PATIENTS AND METHODS. Two hundred and twenty-seven preterm infants (birth weight of <1250 g or <30 weeks’ gestation) were recruited. Head circumference was measured at birth, term, and 2 years’ corrected age, and z scores were computed. Microcephaly was defined as a head circumference z score of less than −2 SDs for age and gender. MRI scans at term (n = 214) were graded for white and gray matter abnormalities, and segmented volumes were calculated for different tissue types. Outcome at 2 years’ corrected age (n = 202) included scores on the Bayley Scales of Infant Development II.

RESULTS. Microcephaly increased from 7.5% at term to 29.7% at 2 years. There was no significant relationship between head circumference and white or gray matter abnormalities on MRI. There was a strong correlation between head circumference and brain volume at term. At term, microcephalic infants had significantly decreased volumes for total brain tissue and most segmented volumes compared with infants with normal head circumference, but only deep nuclear gray matter volume remained significantly lower when adjusted for total intracranial volume. At 2 years, microcephaly was associated with poorer cognitive and motor development and an increased rate of cerebral palsy.

CONCLUSIONS. Brain volume is a determinant of head size at term. Microcephaly is associated with a reduction of brain tissue volumes, especially deep nuclear gray matter, which suggests a selective vulnerability. Poor postnatal head growth in preterm infants becomes more evident by 2 years and is strongly associated with poor neurodevelopmental outcome and cerebral palsy.
Charges and Lengths of Stay Attributable to Adverse Patient-Care Events Using Pediatric-Specific Quality Indicators: A Multicenter Study of Freestanding Children's Hospitals
Authors: Kronman Matthew P. , Hall Matthew , Slonim Anthony D. , Shah Samir S.
Published: June 2008

OBJECTIVE. The purpose of this work was to determine the excess charges, both overall and according to category, and lengths of stay attributable to adverse patient-care events during pediatric hospitalization.

METHODS. Agency for Healthcare Research and Quality pediatric-specific quality indicators were used to identify adverse events in 431524 discharges from 38 freestanding, academic, not-for-profit, tertiary care pediatric hospitals in the United States participating in the Pediatric Health Information System database in 2006. All of the discharges from any of the 38 hospitals participating in the Pediatric Health Information System between January 1 and December 31, 2006, were eligible for inclusion. The primary outcomes were excess lengths of stay and charges (both overall and according to pharmacy, laboratory, imaging, clinical, supply, and other categories) were attributable to adverse patient-safety events as determined by 12 pediatric-specific quality indicators.

RESULTS. Statistically significant excess lengths of stay attributable to pediatric-specific quality indicator events ranged from 2.8 days for accidental puncture and laceration to 23.5 days for postoperative sepsis, and statistically significant excess overall charges ranged from $34884 for accidental puncture and laceration to $337226 for in-hospital mortality after pediatric heart surgery. Each charge category had significant charge increases caused by pediatric-specific quality indicator events, with the largest being laboratory and other charges, ranging from $7622 to $78048 and $11094 to $97805, respectively.

CONCLUSIONS. Some adverse events experienced during pediatric hospitalization have the potential to increase lengths of stay and charges considerably, and pediatric-specific quality indicators are useful in calculating these effects.
Increasing Caloric Contribution From Sugar-Sweetened Beverages and 100% Fruit Juices Among US Children and Adolescents, 1988–2004
Authors: Wang Y. Claire , Bleich Sara N. , Gortmaker Steven L.
Published: June 2008

OBJECTIVE. We sought to document increases in caloric contributions from sugar-sweetened beverages and 100% fruit juice among US youth during 1988–2004.

PATIENTS AND METHODS. We analyzed 24-hour dietary recalls from children and adolescents (aged 2–19) in 2 nationally representative population surveys: National Health and Nutrition Examination Survey III (1988–1994, N = 9882) and National Health and Nutrition Examination Survey 1999–2004 (N = 10 962). We estimated trends in caloric contribution, type, and location of sugar-sweetened beverages and 100% fruit juice consumed.

RESULTS. Per-capita daily caloric contribution from sugar-sweetened beverages and 100% fruit juice increased from 242 kcal/day (1 kcal = 4.2 kJ) in 1988–1994 to 270 kcal/day in 1999–2004; sugar-sweetened beverage intake increased from 204 to 224 kcal/day and 100% fruit juice increased from 38 to 48 kcal/day. The largest increases occurred among children aged 6 to 11 years (∼20% increase). There was no change in per-capita consumption among white adolescents but significant increases among black and Mexican American youths. On average, respondents aged 2 to 5, 6 to 11, and 12 to 19 years who had sugar-sweetened beverages on the surveyed day in 1999–2004 consumed 176, 229, and 356 kcal/day, respectively. Soda contributed ∼67% of all sugar-sweetened beverage calories among the adolescents, whereas fruit drinks provided more than half of the sugar-sweetened beverage calories consumed by preschool-aged children. Fruit juice drinkers consumed, on average, 148 (ages 2–5), 136 (ages 6–11), and 184 (ages 12–19) kcal/day. On a typical weekday, 55% to 70% of all sugar-sweetened beverage calories were consumed in the home environment, and 7% to 15% occurred in schools.

CONCLUSIONS. Children and adolescents today derive 10% to 15% of total calories from sugar-sweetened beverages and 100% fruit juice. Our analysis indicates increasing consumption in all ages. Schools are a limited source for sugar-sweetened beverages, suggesting that initiatives to restrict sugar-sweetened beverage sales in schools may have an only marginal impact on overall consumption. Pediatricians’ awareness of these trends is critical for helping children and parents target suboptimal dietary patterns that may contribute to excess calories and obesity.
The Language Spoken at Home and Disparities in Medical and Dental Health, Access to Care, and Use of Services in US Children
Authors: Flores Glenn , Tomany-Korman Sandra C.
Published: June 2008

BACKGROUND AND OBJECTIVE. Fifty-five million Americans speak a non-English primary language at home, but little is known about health disparities for children in non-English-primary-language households. Our study objective was to examine whether disparities in medical and dental health, access to care, and use of services exist for children in non-English-primary-language households.

METHODS. The National Survey of Childhood Health was a telephone survey in 2003–2004 of a nationwide sample of parents of 102 353 children 0 to 17 years old. Disparities in medical and oral health and health care were examined for children in a non-English-primary-language household compared with children in English- primary-language households, both in bivariate analyses and in multivariable analyses that adjusted for 8 covariates (child's age, race/ethnicity, and medical or dental insurance coverage, caregiver's highest educational attainment and employment status, number of children and adults in the household, and poverty status).

RESULTS. Children in non-English-primary-language households were significantly more likely than children in English-primary-language households to be poor (42% vs 13%) and Latino or Asian/Pacific Islander. Significantly higher proportions of children in non-English-primary-language households were not in excellent/very good health (43% vs 12%), were overweight/at risk for overweight (48% vs 39%), had teeth in fair/poor condition (27% vs 7%), and were uninsured (27% vs 6%), sporadically insured (20% vs 10%), and lacked dental insurance (39% vs 20%). Children in non-English-primary-language households more often had no usual source of medical care (38% vs 13%), made no medical (27% vs 12%) or preventive dental (14% vs 6%) visits in the previous year, and had problems obtaining specialty care (40% vs 23%). Latino and Asian children in non-English-primary-language households had several unique disparities compared with white children in non-English-primary-language households. Almost all disparities persisted in multivariable analyses.

CONCLUSIONS. Compared with children in English-primary-language households, children in non-English-primary-language households experienced multiple disparities in medical and oral health, access to care, and use of services.
Cancer Incidence Among Children and Adolescents in the United States, 2001–2003
Authors: Li Jun , Thompson Trevor D. , Miller Jacqueline W. , Pollack Lori A. , Stewart Sherri L.
Published: June 2008

OBJECTIVE. Our goal was to describe current childhood cancer incidence in the United States and identify demographic and geographic variation among children and adolescents with cancer.

METHODS. We examined data from 39 National Program of Cancer Registries and 5 Surveillance, Epidemiology, and End Results statewide registries (representing >90% of the US population) to identify cancers diagnosed among persons aged 0 to 19 from 2001–2003. Diagnosed cancers were grouped by the third version of the International Childhood Cancer Classification. Analyses were stratified according to gender, age, race, ethnicity, and US census region. A multivariable negative binomial regression model was used to evaluate demographic and geographic differences in incidence for all cancers combined.

RESULTS. We identified 36446 cases of childhood cancer with an age-adjusted incidence rate of 165.92 per million. Stratified analyses showed that, for all cancers combined, boys had a significantly higher rate than girls; children (aged 0–14 years) had a significantly lower rate than adolescents (aged 15–19 years); and white children had the highest incidence rate among all races. Young people living in the Northeast had the highest incidence rate among all US census regions, which may be partially attributed to significantly higher incidence rates for central nervous system neoplasms and lymphomas in this region compared with other US census regions. Negative binomial regression analysis demonstrated that the childhood cancer-incidence rate varied significantly according to gender, age, race, ethnicity, and geography.

CONCLUSIONS. This study is the first to demonstrate substantial regional differences in the incidence of childhood cancer. It also shows that incidence varies according to gender, age, race, and ethnicity. Our research findings are useful for prioritizing future childhood cancer research needs.
Autism and the Environment: Challenges and Opportunities for Research
Authors: Altevogt Bruce M. , Hanson Sarah L. , Leshner Alan I.
Published: June 2008

Autism spectrum disorder is a complex developmental disorder that dramatically affects the lives of patients and their families and the broader community. The causes of autism are unknown; however, evidence increasingly suggests that a complex interplay among environmental stressors, genetic mutations, and other biological factors likely plays a significant role in the development and/or progression of autism spectrum disorder. On April 18 and 19, 2007, the Institute of Medicine's Forum on Neuroscience and Nervous System Disorders hosted a workshop to provide a venue to bring together scientists; major sponsors of autism-related research; and members of the autism patient, family, and advocacy community to discuss the most promising and urgent scientific questions and opportunities. Broad participation by the autism community enriched the meeting significantly by contributing a valuable and personal perspective that is often missing from scientific meetings. It also began a much improved public–private partnership in which all stakeholders are represented. On the basis of the presentations and the discussions that followed, an array of important scientific opportunities were identified in 5 general categories: (1) opportunities to advance clinical research; (2) opportunities to enhance epidemiologic studies; (3) opportunities to improve the understanding of autism's pathology and etiology; (4) tools and infrastructure needs; and (5) opportunities for public–private partnerships. This workshop demonstrated that full public engagement can greatly enhance activities such as this workshop and its outcomes. Furthermore, we expect that this listing of scientific challenges, needs, and opportunities will help to frame a more comprehensive research agenda.
Neonatal and Late-Onset Diabetes Mellitus Caused by Failure of Pancreatic Development: Report of 4 More Cases and a Review of the Literature
Authors: Chen Rongrong , Hussain Khalid , Al-Ali Maryam , Dattani Mehul T. , Hindmarsh Peter , Jones Peter M. , Marsh Phil
Published: June 2008

OBJECTIVE. Permanent neonatal diabetes mellitus caused by developmental failure of the pancreas is rare. Thus far, only a few genetic causes have been reported. We now report the clinical and genetic aspects of 4 more cases of permanent neonatal diabetes mellitus caused by pancreatic agenesis or hypoplasia.

PATIENTS AND METHODS. All 4 of the patients were from consanguineous kinships, and all presented with diabetes mellitus and pancreatic exocrine insufficiency. Three patients had pancreatic agenesis, and 1 had pancreatic hypoplasia on computed tomography scan. DNA was extracted from blood samples of patients and unaffected family members. Specific genes were amplified by polymerase chain reaction and characterized by DNA sequencing.

RESULTS. Several genes that encode transcription factors that have known roles in pancreas development were characterized in the affected children and unaffected family members. These genes include Pdx1, the master regulator of pancreas development and β-cell differentiation, and other transcription factors that are expressed early in pancreas development, namely, Ptf1a, Sox9, Sox17, Hnf6, and HlxB9. Several novel polymorphisms were found in our patients. However, these were also present in unaffected individuals. No disease-causing mutations were found in any of these genes.

CONCLUSIONS. These findings add to the 4 cases already in the literature in which the Pdx1 structural gene has been found to be normal in patients with pancreatic agenesis or hypoplasia. The analysis here has been extended to include the screening of 4 other candidate genes in addition to promoter elements upstream of the Pdx1. Two of the cases occurred in a sibling pair, and 2 were isolated, so there may be more than 1 etiology in the cases reported here.
Postlicensure Monitoring of Intussusception After RotaTeq Vaccination in the United States, February 1, 2006, to September 25, 2007
Authors: Haber Penina , Patel Manish , Izurieta Hector S. , Baggs James , Gargiullo Paul , Weintraub Eric , Cortese Margaret , Braun M. Miles , Belongia Edward A. , Miller Elaine , Ball Robert , Iskander John , Parashar Umesh D.
Published: June 2008

BACKGROUND. In 1999, a previous rotavirus vaccine (RotaShield; Wyeth Laboratories, Marietta, PA) was withdrawn from the US market after postlicensure monitoring identified an association with intussusception. Although the new rotavirus vaccine (RotaTeq; Merck, West Point, PA) introduced in 2006 was not associated with intussusception in prelicensure trials, additional monitoring is important to ensure a complete safety profile.

METHODS. We assessed intussusception reports after RotaTeq vaccination by using data from the Vaccine Adverse Event Reporting System and the Vaccine Safety Datalink, a cohort of children enrolled in managed care. Observed versus expected rate ratios were determined by using vaccine dose distribution data and Vaccine Safety Datalink background intussusception rates.

RESULTS. Between February 1, 2006, and September 25, 2007, the Vaccine Adverse Event Reporting System received 160 intussusception reports after RotaTeq vaccination. With the assumptions that reporting completeness was 75% and that 75% of the distributed doses of RotaTeq were administered, the observed versus expected rate ratios were 0.53 and 0.91 for the 1–21 and 1–7 day interval after vaccination, respectively. In the Vaccine Safety Datalink, 3 intussusception cases occurred within 30 days after 111521 RotaTeq vaccinations, compared with 6 cases after 186722 non–RotaTeq vaccinations during the same period. If, like RotaShield, RotaTeq had a 37-fold increased risk of intussusception within 3 to 7 days after vaccination, then 8 intussusception cases would be expected within 3 to 7 days among the ∼84000 infants vaccinated with the first dose of RotaTeq in the Vaccine Safety Datalink (N = 49902) and the prelicensure trial (N = 34035) combined, whereas no cases have been observed.

CONCLUSIONS. Available data do not indicate that RotaTeq is associated with intussusception. Although an intussusception risk similar in magnitude to that of RotaShield can be excluded, continued monitoring is necessary for complete assessment of the safety profile of RotaTeq.
Achieving Quality Health Services for Adolescents
Authors:   Committee on Adolescence
Published: June 2008

In recent years, there has been an increased national focus on assessing and improving the quality of health care. This statement provides recommendations and criteria for assessment of the quality of primary care delivered to adolescents in the United States. Consistent implementation of American Academy of Pediatrics recommendations (periodicity of visits and confidentiality issues), renewed attention to professional quality-improvement activities (access and immunizations) and public education, and modification of existing quality-measurement activities to ensure that quality is delivered are proposed as strategies that would lead to improved care for youth.
Prescribing Assistive-Technology Systems: Focus on Children With Impaired Communication
Authors: Desch Larry W. , Gaebler-Spira Deborah ,   and the Council on Children With Disabilities
Published: June 2008

This clinical report defines common terms of use and provides information on current practice, research, and limitations of assistive technology that can be used in systems for communication. The assessment process to determine the best devices for use with a particular child (ie, the best fit of a device) is also reviewed. The primary care pediatrician, as part of the medical home, plays an important role in the interdisciplinary effort to provide appropriate assistive technology and may be asked to make a referral for assessment or prescribe a particular device. This report provides resources to assist pediatricians in this role and reviews the interdisciplinary team functional evaluation using standardized assessments; the multiple funding opportunities available for obtaining devices and ways in which pediatricians can assist families with obtaining them; the training necessary to use these systems once the devices are procured; the follow-up evaluation to ensure that the systems are meeting their goals; and the leadership skills needed to advocate for this technology. The American Academy of Pediatrics acknowledges the need for key resources to be identified in the community and recognizes that these resources are a shared medical, educational, therapeutic, and family responsibility. Although this report primarily deals with assistive technology specific for communication impairments, many of the details in this report also can aid in the acquisition and use of other types of assistive technology.
Broad range adjustable emission of stacked SiNx/SiOy layers
Authors: Barreto J. , Perálvarez M. , Morales A. , Garrido B. , Montserrat J. , Domínguez C.
Published: June 2008

Structures containing stacked layers of silicon-rich silicon nitride (green-blue luminescence) and oxide (red luminescence) fabricated by ion implantation are reported, and it is shown how a Si-based material can be engineered to emit over a broad range. To study in depth the emission from implanted SiNx matrices, single nitride layers have been also fabricated by the first time. Si excess variation and the relative thickness of nitride and oxide provide the intensity and position variation of the peaks, and thus open the way to engineer a stack with desired emission properties over the whole visible spectrum.