bluuebunny/crossref_metadata_2025 huggingface dataset:
Biologically active polymeric materials based on water polyurethane dispersions as the agent for increase of agricultural plants productivity
Authors:   Institute of Macromolecular Chemistry National Academy of Sciences of Ukraine, Kyiv, Ukraine, Savelyev Yuri V. , Iutynska Galyna O. ,   Zabolotny Institute of Microbiology and Virology National Academy of Scences of Ukraine, Kyiv, Ukraine, Robota Lyudmyla P. ,   Institute of Macromolecular Chemistry National Academy of Sciences of Ukraine, Kyiv, Ukraine, Biliavska Liudmyla O. ,   Zabolotny Institute of Microbiology and Virology National Academy of Scences of Ukraine, Kyiv, Ukraine, Travinska Tamara V. ,   Institute of Macromolecular Chemistry National Academy of Sciences of Ukraine, Kyiv, Ukraine, Brykova Olexandra M. ,   Institute of Macromolecular Chemistry National Academy of Sciences of Ukraine, Kyiv, Ukraine, Lytviakov Vladyslav I. ,   Institute of Macromolecular Chemistry National Academy of Sciences of Ukraine, Kyiv, Ukraine
Published: December 2021

Biologically active polymeric materials (BAPM) with prolonged activity have been created on the basis of ecologically safe, economically expedient water xanthan (XA)- and castor (CO)/xanthan-comprising ionomer polyurethanes (IPU) which are aggregatively stable, capable of water dilution, with the size of micelles 250-270 nm and water absorption up to 220%. IPUs of amorphous-crystalline structure (Xa- and CO/Xa-comprising) are characterized by increased degradability as compared to amorphous (CO- comprising) IPUs. After the 12 months of incubation the weight loss of IPU / CO12 / Xa20 due to the synergistic effect of the components is 71%, while the additive contribution of the components and their total content are equaled 43.6%, 32.0%, respectively. Changing the polyether nature and/or introduction of Xa into the IPU structure allow to reduce of adhesive effects from 1.43 to 0.20 MPa, sufficient for "sticking" of BAPM on the plant surface and to reduce the surface tension, and for formation of a non-monolithic film on plant surface, and, thus, will not interfere with the activity of the plant photosynthetic apparatus. 170 BAPM with prolonged action was obtained by chemical and physical immobilization into the IPU macrochain of the domestic polyfunctional biological product Averkom-N. After pre-sowing treatment of seeds of grain and vegetable crops with BAPM, their growth-stimulating activity was established: an increase in biomass up to 60% compared to 40% after treatment with Averkom-N; an increase of: tomatoes productivity (24%), average weight of fruits (30%), and a decrease of: plants’ damage by diseases in 5-8 times and the level of nitrates in comparison with Averkom-N. BAPM increase the productivity of agrophytocenoses, the resistibility of agricultural crops to abiotic and biotic stresses, yield, improve the quality of products, and improve the ecological state of the environment.
Palladium carbene complexes – efficient catalysts for hydrodehalogenation of haloarenes
Authors:   L.M. Litvinenko Institute of Physical Organic and Coal Chemistry of the National Academy of Sciences of Ukraine, Kyiv, Ukraine, Korotkikh Nikolai I. ,   Institute of Organic Chemistry of the National Academy of Sciences of Ukraine , Kyiv, Ukraine, Saberov Vahiz Sh. ,   Institute of Organic Chemistry of the National Academy of Sciences of Ukraine , Kyiv, Ukraine, Rayenko Gennady F. ,   L.M. Litvinenko Institute of Physical Organic and Coal Chemistry of the National Academy of Sciences of Ukraine, Kyiv, Ukraine, Avksentiev Alexandr S. ,   Institute of Organic Chemistry of the National Academy of Sciences of Ukraine , Kyiv, Ukraine, Yenya Vasyl I. ,   Institute of Organic Chemistry of the National Academy of Sciences of Ukraine , Kyiv, Ukraine, Glinyanaya Nataliya V. ,   L.M. Litvinenko Institute of Physical Organic and Coal Chemistry of the National Academy of Sciences of Ukraine, Kyiv, Ukraine, Shvaika Oles P. ,   L.M. Litvinenko Institute of Physical Organic and Coal Chemistry of the National Academy of Sciences of Ukraine, Kyiv, Ukraine
Published: December 2021

The work is aimed at solving the problem of neutralization of persistent organic pollutants by catalytic methods. In order to identify the relationship between electronic and steric factors of carbenes with catalytic efficiency in the reaction of hydrodehalogenation of haloarenes, the parameters for estimating the ligand influences are proposed (electronic - Ie indices, Ph philicities, ED electron donicities, and EA electron acceptabilities, steric - dimerization energies) using theoretical methods (DFT, B3LYP5, RHF). Synthesis of new heteroaromatic carbenes of the series of sterically shielded 1,3-diarylphenanthro-[9,10-d]imidazol-2-ylidene, 1,3-diaryl-2-methy­lene­phenan­thro-[9,10-d]imidazoline, tetrahydropyrimidin-2-ylidene, 1,3-diaryl­imidazol-2-ylidene, 1,3,4-triaryl-1,2,4-triazol-5-ylidenes, their carbene complexes with palladium iodide, as well as the carbene complex of the superbasic anionic carbene 1,3-bis-(4-oxidophenyl)-imidazol-2-ylidene with nickel(II) ion. 1H and 13C NMR spectroscopy, mass spectrometry and X-ray diffraction study methods were used to establish the structures of the synthesized compounds. A high catalytic effect of a number of sterically shielded carbene complexes (2.4b, 3.5, 4.6a) in the reaction of hydrodehalogenation of p-dichlorobenzene haloarenes with sodium methoxide in isopropanol at 80 °С (TON 98000–110000) was revealed that can be applied to solve the problem of neutralization of persistent organic pollutants. The efficiency of catalysis by sterically open compounds 4.6b and 6.7 appeared to be low (TON 74, 128). The high catalytic effect of sterically shielded compounds is explained by the increased stability of the complexes under the conditions of an alkaline medium caused by metal alkoxides.
Catalytic properties of nanocarbon materials in reaction of selective hydrogenation of acetylene
Authors:   L.V. Pisarzhevskii Institute of Physical Chemistry of the National Academy of Sciences of Ukraine, Kyiv, Ukraine, Bychko Igor B. , Abakumov Alexander A. ,   L.V. Pisarzhevskii Institute of Physical Chemistry of the National Academy of Sciences of Ukraine, Kyiv, Ukraine, Trypolskyi Andrii I. ,   L.V. Pisarzhevskii Institute of Physical Chemistry of the National Academy of Sciences of Ukraine, Kyiv, Ukraine, Strizhak Peter E. ,   L.V. Pisarzhevskii Institute of Physical Chemistry of the National Academy of Sciences of Ukraine, Kyiv, Ukraine
Published: December 2021

The chapter presents the results of studies of the catalytic properties of nanocarbon materials based on carbon nanotubes and reduced graphene oxide in the hydrogenation of ethylene, acetylene and ethylene-acetylene mixture by molecular hydrogen at atmosphere pressure. The current state of scientific approaches to the creation of nanocarbon metal-free catalysts for the hydrogenation reactions in both liquid and gas phases is presented. A possible nature of active center of the hydrogenation reaction located on the surface of the nanocarbon material is discussed. It is shown that the catalytic activity of the nanocarbon materials is not associated with metal impurities. The correlation between the structural characteristics of carbon nanomaterials and their catalytic properties in the hydrogenation reactions of unsaturated hydrocarbons is demonstrated. A comparative analysis of the catalytic activity of nanocarbon materials and catalysts that contain noble metals in the hydrogenation reaction of acetylene is presented. Finally, the fundamental possibility of creating a nanocarbon catalyst for selective hydrogenation of acetylene in excess ethylene is shown.
Математичне моделювання екологічного стану природних об'єктів навколишнього середовища
Authors: Каленчук-Порханова Анжеліна Олексіївна , Тульчинський Вадим Григорович
Published: December 2021

Статтю присвячено фундаментальним і прикладним напрямам робіт Інституту кібернетики ім. В.М. Глушкова НАН України, пов'язаним з вирішенням проблем аналізу ризиків виникнення надзвичайних ситуацій, забезпечення безпеки функціонування екологічних систем, дослідженням та прогнозуванням складних динамічних процесів у неоднорідних середовищах, розробленням методів математичного моделювання і комплексів їх чисельної реалізації, створенням високонадійних систем захисту інформації та автоматизованих систем математичного моделювання станів об'єктів навколишнього середовища. Наявність в Інституті кібернетики фахівців високої кваліфікації та потужного обчислювального ресурсу дозволяє гарантувати достовірність результатів при вирішенні складних наукових проблем. У статті також згадуються деякі пов'язані з Чорнобильською катастрофою події, які мають безпосередній зв'язок з обговорюваними напрямами робіт.
Radiation Exposure of Premature Infants Beyond the Perinatal Period
Authors: Hogan Alexander H. , Bellin Eran , Douglas Lindsey , Levin Terry L. , Esteban-Cruciani Nora
Published: December 2021

OBJECTIVES:

To determine the odds of premature compared with term infants exceeding the recommended radiation exposure threshold in the first year after discharge from birth hospitalization.

METHODS:

In this observational retrospective cohort study, we compared the radiation exposure of premature and term infants between 2008 and 2015 in an urban hospital system. The primary outcome was crossing the radiation exposure threshold of 1 millisievert. We assessed prematurity’s effect on this outcome with multivariable logistic regression.

RESULTS:

In our study, 20 049 term and 2047 preterm infants met inclusion criteria. The population was approximately one-half female, predominantly multiracial or people of color (40% African American and 44% multiracial), and of low socioeconomic status. Premature infants had 2.25 times greater odds of crossing the threshold compared with term infants after adjustment for demographics (95% confidence interval [CI]: 1.66–3.05). Adjustment for complex chronic conditions, which are validated metrics of pediatric chronic illness, attenuated this association; however, premature infants still had 1.58 times greater odds of crossing the threshold (95% CI: 1.16–2.15). When the final model was analyzed by degree of prematurity, very preterm and extremely preterm infants were significantly more likely to cross the threshold (1.85 [95% CI: 1.03–3.32] and 2.53 [95% CI: 1.53–4.21], respectively), whereas late preterm infants were not (1.14 [95% CI: 0.73–1.78]).

CONCLUSIONS:

Premature infants crossed the recommended radiation threshold more often than term infants in the year after discharge from birth hospitalization.
Standardizing Pediatric Somatic Symptom and Related Disorders Care: Clinical Pathway Reduces Health Care Cost and Use
Authors: Kullgren Kristin A. , Klein Edwin J. , Sturza Julie , Hutton David , Monroe Kimberly , Pardon Alicia , Sroufe Nicole , Malas Nasuh
Published: December 2021

BACKGROUND:

Pediatric somatic symptom and related disorders (SSRDs) are common with high health care costs and use because of lack of standardized, evidence-based practice. Our hospital implemented a clinical pathway (CP) for SSRD evaluation and management. Our study objective was to evaluate health care cost and use associated with the organization’s SSRD CP in the emergency department (ED) and inpatient settings hypothesizing lower cost and use in the CP group relative to controls.

METHODS:

We conducted a retrospective analysis of costs and use before and after implementation of the SSRD CP. Data were collected from the hospital’s electronic health record and the Pediatric Health Information System database. Participants included pediatric patients on the CP (“P” group) and control groups with an SSRD diagnosis and mental health consultation either the year before the CP (“C” group) or during the CP study period (“T” group). Primary outcomes included costs, length of stay, diagnostic testing, imaging, subspecialty consultation, and readmission rates.

RESULTS:

The ED P group had more lower-cost imaging, whereas the inpatient T group greater higher-cost imaging than other groups. The inpatient P group had significantly shorter length of stay, fewer subspecialty consults, and lower costs. There were no significant group differences in readmission rates. The CP reduced median total costs per patient encounter by $51 433 for the inpatient group and $6075 for the ED group.

CONCLUSIONS:

The CP group showed significant reductions in health care cost and use after implementation of a CP for SSRD care. In future work, researchers should explore patient and practitioner experience with the SSRD CP and long-term outcomes.
Improving Youth Suicide Risk Screening and Assessment in a Pediatric Hospital Setting by Using The Joint Commission Guidelines
Authors: Latif Finza , Patel Shilpa , Badolato Gia , McKinley Kenneth , Chan-Salcedo Clarissa , Bannerman Reginald , Schultz Theresa Ryan , Newton Jacqueline , Schott Meghan Marie , Tyson Colby M. , Wavra Theresa , Robb Adelaide S.
Published: December 2021

OBJECTIVES:

Hospitals accredited by The Joint Commission (TJC) are now required to use a validated screening tool and a standardized method for assessment of suicide risk in all behavioral health patients. Our aims for this study were (1) to implement a TJC-compliant process of suicide risk screening and assessment in the pediatric emergency department (ED) and outpatient behavioral health clinic in a large tertiary care children’s hospital, (2) to describe characteristics of this population related to suicide risk, and (3) to report the impact of this new process on ED length of stay (LOS).

METHODS:

A workflow using the Columbia Suicide Severity Rating Scale was developed and implemented. Monthly reviews of compliance with screening and assessment were conducted. Descriptive statistics were used to define the study population, and multivariable regression was used to model factors associated with high suicide risk and discharge from the ED. ED LOS of behavioral health patients was compared before and after implementation.

RESULTS:

Average compliance rates for screening was 83% in the ED and 65% in the outpatient clinics. Compliance with standardized assessments in the ED went from 0% before implementation to 88% after implementation. The analysis revealed that 72% of behavioral health patients in the ED and 18% of patients in behavioral health outpatient clinics had a positive suicide risk. ED LOS did not increase. The majority of patients screening at risk was discharged from the hospital after assessment.

CONCLUSIONS:

A TJC-compliant process for suicide risk screening and assessment was implemented in the ED and outpatient behavioral health clinic for behavioral health patients without increasing ED LOS.
Providing Inpatient Medical Care to Children With Autism Spectrum Disorder
Authors: Thom Robyn P. , Hazen Melissa M. , McDougle Christopher J. , Hazen Eric P.
Published: December 2021

Autism spectrum disorder (ASD) is a common neurodevelopmental disorder, affecting an estimated 1 in 40 children. Children with ASD have high rates of medical comorbidity and often experience high levels of distress during medical admissions, increasing the risk of agitation. Pediatric hospitalists receive minimal formal training on the inpatient care of children with ASD. In this article, we review strategies that pediatric hospitalists can use to optimize the care of children with ASD during inpatient admissions. These include gathering an ASD-related history early in the admission to understand the child’s baseline core ASD symptoms, including social and communication ability, sensory needs, and restricted or repetitive behaviors. This information can be used to tailor the hospitalist’s approach in each of these 3 domains. We conclude by reviewing procedure-related considerations, an approach to managing agitation, and quality improvement interventions.
SOME PEDIATRICIANS' VIEWS CONCERNING PROBLEMS OF HANDICAPPED CHILDREN
Authors: MCPEAK WILLIAM
Published: December 2021

MANY obstacles must be overcome before the health agencies and professions can successfully rehabilitate handicapped persons or adequately protect others from similar disablement, according to outstanding American pediatricians.

A survey of pediatricians' attitudes toward physical and mental crippling, recently completed by the Association for the Aid of Crippled Children, New York City, revealed a universal awareness that many important needs of the handicapped are still unmet and a determination that greater, more imaginative efforts must be made to meet them.

The biggest obstacle to full relief for the handicapped, as viewed by many survey respondents, is the lack of basic scientific knowledge concerning the cause of their diseases. Another obstacle of comparable seriousness is the lagging dissemination, among practicing physicians and other health workers who treat the handicapped, of the scientific knowledge which does exist and of the latest developments in techniques.

Although pediatricians realize that serious shortages exist in health facilities, personnel and other resources for direct care and treatment of handicapped individuals, they show relatively greater concern over deficiencies in the relevant knowledge and ineffectiveness of the technics now available. One reason for this view lies in the feeling that some diseases—for example, cerebral palsy—can never be treated with full success, once they exist; and that the necessary alternative is to prevent onset by further study of their causes.
INFANTILE CORTICAL HYPEROSTOSES
Authors: GIPSON AMOS C. , CLARK BENJAMIN P.
Published: December 2021

The case history is presented of a child with multiple cortical hyperostoses (the eleventh case to be reported), accompanied by fever, low grade leucocytosis and chronic course which falls into Caffey's group of Infantile Cortical Hyperostoses.
Atlas of Cardiovascular Diseases
Authors: GOODFRIEND JAMES
Published: December 2021

This book represents an ambitious attempt to portray briefly typical clinical, roentgenographic, electrocardiographic and pathological findings in various types of cardiac disease. The attempt is not altogether successful because of occasional oversimplification and omission of important data. For example, although the author stresses the importance of oblique views of the heart in the roentgenogram, these are presented in only three instances; and, although the electrocardiographic findings in pericarditis are discussed in the text and in the summary, no tracings are presented. Other similar deficiencies are present in the book even though space is sometimes devoted to other material which seems extraneous.
New Concepts of the Etiology, Diagnosis, and Treatment of Congenital Megacolon (Hirschsprung's Disease), by Orvar Swenson, MD, et al,Pediatrics, 1949;4:201–209
Authors: Fitzgerald Joseph F.
Published: December 2021

The clinical syndrome known as Hirschsprung disease (HD), or congenital megacolon, had been recognized for more than a century. The pathogenesis of the dilation/hypertrophy of the colon without mechanical obstruction was puzzling, and the subject of great debate. Virtually all infants and children affected with this disorder died.

The authors studied 26 patients with congenital megacolon admitted to Boston Children's Hospital during a 5-year period, from 1943 through 1947. Careful contrast radiographic study of the distal colon in all 26 revealed a functional obstruction produced by a dyskinesia of the rectum. This was detected by running a small amount of barium slowly into the rectum with the patient in an oblique position. A portion of the rectum/rectosigmoid was consistently subnormal in caliber. Barium then was allowed to run through this narrowed area into the dilated colon. The authors interpreted the radiographic findings as evidence of a physiologic partial obstruction of the rectum/rectosigmoid.

Colostomies were performed in the dilated portion of the colon in 3 early patients, and all symptoms/signs of HD disappeared in each instance. These returned, however, with closure of the colostomies and persisted until the ostomy was reestablished. Colostomies then were performed in an additional 12 patients, and each was relieved of symptoms with restoration of a normal-caliber colon. The authors recognized that the distal obstructing segment would have to be removed before the colostomy could be closed.

They devised a special “pull-through” form of resection and tested it in the laboratory. The operation was performed subsequently on 23 patients, with no fatalities. Closure of the colostomy was possible in all but 2. The authors outlined the operation in detail in the article. Three infants, the youngest being 2 months old, tolerated a one-stage operation. The authors indicated that all patients subsequently demonstrated the urge to defecate and had normal bowel control.

Patients with HD have a physiologic obstruction in the nondilated segment of colon. Early colostomy relieves the symptoms/signs of obstruction, and removal of the narrowed segment results in cure.
The Maintenance Need for Water in Parenteral Fluid Therapy, by Malcolm A. Holliday, MD, and William E. Segar, MD,Pediatrics, 1957;19:823–832
Authors: Chesney Russell W.
Published: December 2021

One of the major objectives of parenteral fluid therapy is provision of water to meet physiologic losses. These losses, the insensible and urinary losses, have been extensively studied and defined for infants and adults. It is established from these studies that both insensible loss of water and urinary water loss roughly parallel energy metabolism and do not parallel body mass (weight). Therefore, any values that are applicable to all ages must be derived from some function of energy metabolism.

Initially, and to a large extent even today, needs for water have been determined on the basis of weight in infants and on the basis of total amounts in adults. Although this serves well for infants and adults, the hapless individual between these two groups receives, at best, a rough estimate of his requirement for water.

Crawford and his associates have referred needs for water, and a variety of drug dosages as well, to a unit of surface area (SA) because SA closely parallels basal energy metabolism. In this system SA is computed from a height-weight nomogram.

It is generally agreed that the maintenance requirements for water of individuals is determined by their caloric expenditure. By means of the following formulae, the caloric expenditure of hospitalized patients can be determined from weight alone. For weights ranging from 0 to 10 kg, the caloric expenditure is 100 cal/kg/day; for weights ranging from 10 to 20 kg the caloric expenditure is 1000 cal plus 50 cal/kg for each kilogram of body weight >10; for weight >20 kg the caloric expenditure is 1500 cal plus 20 cal/kg for each kilogram >20.

Maintenance requirements for water depend on insensible loss of water and renal loss. An allowance of 50 mL/100 cal/day will replace insensible loss of water, and 66.7 mL/100 cal/day will replace renal losses. As water of oxidation will supply approximately 16.7 mL/100 cal/day, the remaining 100 mL/100 cal/day must be supplied to meet the remaining water losses of patients on parenteral fluid therapy. Possible exceptions to this figure are discussed.

Maintenance requirements of sodium, chloride, and potassium are 3.0, 2.0, and 2.0 mEq/100/cal/day, respectively.
Isolation of the Respiratory Syncytial Virus From a Patient With Pneumonia, by Daniel S. Rowe, MD, and Richard H. Michaels, MD,Pediatrics, 1960;26:623–629
Authors: Glezen W. Paul
Published: December 2021

A virus with the characteristics of the respiratory syncytial virus was isolated from the throat of a 6-month-old infant with pneumonia. The illness was accompanied by an eightfold increase in complement-fixation antibody to the Long strain of the respiratory syncytial virus identified by Chanock and colleagues1 and a 16-fold rise in the homologous neutralizing antibody, indicating that the pneumonia was accompanied by infection with this virus. The virus was labile to freezing at −15 to −20°C; isolation was possible from the original unfrozen specimen inoculated immediately or from passage virus pools sealed in glass ampules and stored in the dry ice chest.
A Simple Phenylalanine Method for Detecting Phenylketonuria in Large Populations of Newborn Infants, by Robert Guthrie and Ada Susi, Pediatrics, 1963;32:318–343
Authors: Scriver Charles R.
Published: December 2021

The article describes a “microbial inhibition assay” for rapid and economical measurement of phenylalanine levels in whole blood. Capillary blood, from a heel prick, is collected from the newborn infant onto Schleicher and Schuell no. 903 filter paper; a disk of the sample is then transferred to an Agar plate containing a heavy inoculum of Bacillus subtilisATCC 6051; an inhibitor of bacterial growth (β-2-thienylalanine) is counteracted by any significant excess of phenylalanine in the blood sample; and semiquantitative positive tests (hyperphenylalaninemia) are recorded by size of the bacterial growth zone in the Agar around the filter paper disc. The method permits mass screening for hyperphenylalaninemia.
Aerosol Beclomethasone Dipropionate Compared With Theophylline as Primary Treatment of Chronic, Mild to Moderately Severe Asthma in Children, by David G. Tinkelman, MD, et al,Pediatrics, 1993;92:64–77
Authors: Furukawa Clifton T.
Published: December 2021

Objective. To compare the benefits and adverse reactions of theophylline and beclomethasone (BDP) in the long-term control of mild to moderate chronic asthma in children.

Design. Multicentered, double-blind, double-placebo, randomized, controlled trial.

Patients. One hundred ninety-five children between the ages of 6 and 16 years with mild to moderate asthma.

Intervention. Treatment with either BDP, 84 μg four times a day, or sustained-release theophylline administered twice daily I doses adjusted for optimum control of symptoms.

Main Outcome Measures. Daily diary record of symptoms, peak flow rates, supplemental bronchodilator and glucocorticoid treatment, doctor and hospital visits, absence from work and school, and side effects.

Results. Aerosol BDP and sustained-release theophylline were effective primary treatments for mild to moderate chronic asthma. BDP resulted in comparable symptom control with less bronchodilator use and fewer courses of systemic steroids than did theophylline. Side effects were observed significantly more frequently with theophylline than with BDP. Growth velocity suppression was noted with BDP and was more pronounced in boys. Suppression was not associated with alterations in cortisol measurements either at baseline or following stimulation.

Conclusions. Both theophylline and BDP are effective therapy for mild to moderate asthma. Caution must be used with the administration of BDP in children because of possible growth velocity suppression.
Turner Syndrome and Osteoporosis: Mechanisms and Prognosis
Authors: Rubin Karen
Published: December 2021

Despite only limited reports of a greater number of fractures during childhood or adulthood, osteoporosis historically has been described as a feature in Turner syndrome, because of the frequent observation of radiographic osteopenia and the coarse trabecular pattern of the carpal bones on radiographs. The pathogenesis of the skeletal demineralization remains unclear, but the data support the concept of an intrinsic bone defect that is then exacerbated by a number of hormonal factors, including the growth-regulating hormones, the gonadal steroids, and possibly the calcium-regulating hormones. The advent of more refined methods, such as single- and dual-photon absorptiometry and dual energy x-ray absorptiometry, has led to improved insights into bone mineral density (BMD) status in Turner syndrome (TS). A major limitation of these projection methods is that they report areal and not true volumetric BMD, resulting in an underestimation of the true BMD in smaller subjects. In assessing BMD in TS, various methods have been used to eliminate the confounding effect of bone size. Some consistent patterns do emerge in persons with TS who are not treated with long-term growth hormone (GH) or estrogen therapy. A significant deficit in cortical bone commonly appears in childhood and usually is associated with a low bone-turnover state. Significant osteopenia at predominantly trabecular sites develops during mid- to late adolescence and persists into adulthood, when it is associated with increased bone turnover.

Preliminary BMD data on patients after long-term GH therapy show an absence of osteopenia. With respect to the impact of long-term estrogen therapy, the BMD deficit in adults with TS who have been treated adequately with estrogen, but who have not been treated with GH, is less than it is in those who have been insufficiently treated or not treated at all with estrogen. The available data indicate that long-term GH treatment during the prepubertal and early to midpubertal years optimizes BMD and improves the prognosis for adequate peak bone mass being achieved after a puberty that, most often, has been induced with exogenous estrogen. Long-term treatment with estrogen and progestin that is initiated during mid- to late adolescence and is continued throughout adulthood appears necessary for a normal peak bone mass to be achieved and the BMD to be preserved well beyond the time of peak bone mass.

Additional measures to prevent osteoporosis must be used, such as ensuring adequate calcium intake and ample weight-bearing activities, focusing on preventing injuries and avoiding overtreatment with thyroid hormones. Long-term surveillance with measurement of BMD and of bone turnover in a large TS population into their later adult years is necessary before it can be concluded that the osteopenia observed in TS is a nonprogressive asymptomatic bone defect of no clinical consequences.
The Psychological Consequences of Turner Syndrome and Review of the National Cooperative Growth Study Psychological Substudy
Authors: Siegel Patricia T. , Clopper Richard , Stabler Brian
Published: December 2021

Objective. To present longitudinal data on the psychological profile of a cohort of girls with and without Turner syndrome (TS) treated for 3 years with growth hormone (GH).

Methods. Among a sample of 283 children with short stature, 37 girls with TS were recruited at 27 US medical centers. Of the original cohort, 22 girls with TS, 13 girls with isolated growth hormone deficiency (GHD), and 12 girls with idiopathic short stature were followed through 3 years of GH therapy. All were school-age, were below the 3rd percentile for height, had low growth rates, and were naive to GH therapy. Psychological tests (the Wide Range Achievement Test and the Slosson Intelligence Test) were administered to the clinical groups within 24 hours of their first GH injection and yearly thereafter. Control subjects were 25 girls with normal stature matched for age and socioeconomic status, who were tested only at baseline. One parent of each subject also completed the Child Behavior Checklist for that subject.

Results. At baseline, the clinical groups had more internalizing behavioral problems, had fewer friends, and participated in fewer activities than did the control subjects. The groups did not differ in mean IQ or academic achievement, but the TS group did have more problems in mathematics achievement. Height and growth rate significantly increased in the clinical groups over the 3 years of GH therapy, but IQ and achievement scores did not. Significant linear reductions were noted in both Internalizing and Externalizing Behavior Problems after GH treatment, with the TS group having fewer behavior problems before and after GH treatment than did the GHD–idiopathic short stature group. Decreases in specific Child Behavior Checklist subscales, including attention, social problems, and withdrawal, also were seen in the clinical groups after GH therapy.

Conclusions. The comprehensive treatment of girls with TS should include educational and behavioral interventions in addition to traditional medical therapies.
Mothers' Sensitivity to Infant Signals
Authors: Leavitt Lewis A.
Published: December 2021

Of all of the infant's signals, the cry is particularly influential in the developing pattern of mother–infant interaction. If a mother terminates crying successfully, she may gain confidence; if unsuccessful, she may begin to focus on her perceived ineffectiveness. Pediatricians and nurses who work with mothers of young infants need to carefully evaluate what mothers “think” about their successes and failures in managing daily child care. Helping mothers “reframe” perceptions of their infant may be a simple but powerful intervention to optimize their interactions.
Teaching Parents About Infant Temperament
Authors: Carey William B.
Published: December 2021

Parents need to understand temperament because it has an impact on their daily interactions with their children. The essential messages for parents should be that temperament traits are real; they are important for both child and parent, and they are best managed by accommodation, not confrontation or attempts to change them. Parents can be reached at all levels of professional contact throughout childhood, including the newborn nursery at well-child visits, and in preschool or day care.
Health Care Costs of Formula-feeding in the First Year of Life
Authors: Ball Thomas M. , Wright Anne L.
Published: December 2021

Objective.

To determine the excess cost of health care services for three illnesses in formula-fed infants in the first year of life, after adjusting for potential confounders.

Methods.

Frequency of health service utilization for three illnesses (lower respiratory tract illnesses, otitis media, and gastrointestinal illness) in the first year of life was assessed in relation to duration of exclusive breastfeeding in the Tucson Children's Respiratory Study (n = 944) and the Dundee Community Study (Scottish study, n = 644). Infants in both studies were healthy at birth and represented nonselected, population-based samples. Children were classified as never breastfed, partially breastfed, or exclusively breastfed, based on their feeding status during the first 3 months of life. Frequency of office visits and hospitalizations for the three illnesses was adjusted for maternal education and maternal smoking, using analysis of variance. Cost estimates, from the perspective of the health care provider/payer, were based on the direct medical costs during 1995 within a large managed care health care system.

Results.

In the first year of life, after adjusting for confounders, there were 2033 excess office visits, 212 excess days of hospitalization, and 609 excess prescriptions for these three illnesses per 1000 never-breastfed infants compared with 1000 infants exclusively breastfed for at least 3 months. These additional health care services cost the managed care health system between $331 and $475 per never-breastfed infant during the first year of life.

Conclusions.

In addition to having more illnesses, formula-fed infants cost the health care system money. Health care plans will likely realize substantial savings, as well as providing improved care, by supporting and promoting exclusive breastfeeding.
Screening, Early Identification, and Office-based Intervention With Children and Youth Living in Substance-abusing Families
Authors: Werner Mark J. , Joffe Alain , Graham Antonnette V.
Published: December 2021

All health care professionals with clinical responsibility for the care of children and adolescents must be able to recognize, as early as possible, associated health problems or concerns in children of substance-abusing parents, and to be able to assist these children and families in seeking treatment and promoting health. Health care providers can have a tremendous influence on families of substance-abusing parents because of their understanding of family dynamics and their close long-standing relationship with the family. Information about family alcohol and other drug use should be obtained as part of routine history-taking and when there are indications of family dysfunction, child behavior or emotional problems, school difficulties, and recurring episodes of apparent accidental trauma, and in the setting of recurrent or multiple vague somatic complaints by the child or adolescent. In many instances, family problems with alcohol or drug use are not blatant; rather, their identification requires a deliberate and skilled screening effort.

Combining the principles of anticipatory guidance, screening, and early identification, with the acknowledgment that families should be included in the process, leads to a clear conclusion that screening for children affected by parental substance abuse must occur at all ages across infancy, childhood, and adolescence. Health care providers need to be trained in the identification and management of children and youth exposed to parental addiction. Such training must begin during undergraduate education in the health professions and be reinforced by role-modeling among health professions faculty as well as practicing providers.
Prevention and Intervention Strategies With Children of Alcoholics
Authors: Emshoff James G. , Price Ann W.
Published: December 2021

Objective.

This article was designed to give pediatricians a basic knowledge of the needs of children who live in families with alcoholism. It briefly presents issues involved in the identification and screening of such individuals and provides primary attention to a variety of preventive and treatment strategies that have been used with school children of alcoholics (COAs), along with evidence of their effectiveness.

Methodology.

A literature search including both published and unpublished descriptions and evaluations of interventions with COAs.

Results.

The scope and nature of the problems of growing up in an alcoholic home are presented. The risk and protective factors associated with this population have been used as a foundation for preventive and treatment interventions. The most common modality of prevention and intervention programs is the short-term small group format. Programs for COAs should include the basic components of information, problem- and emotion-focused coping skills, and social and emotional support. Physicians are in a unique position to identify and provide basic services and referrals for COAs. School settings are the most common intervention sites, but family and broad-based community programs also have shown promise in alcohol and other drug prevention.

Conclusions.

Several COA interventions have demonstrated positive results with respect to a variety of measures including knowledge of program content, social support, coping skills, and emotional functioning. Rigorous studies are needed to understand better the complex ways children deal with parental alcoholism. A need remains for empirically sound evaluations and for the delineation of research findings.
Evidence-Based Guidelines and Critical Pathways for Quality Improvement
Authors: Bergman David A.
Published: December 2021

Clinical practice guidelines have a long and distinguished tradition in pediatrics. Currently, the American Academy of Pediatrics has developed more than 15 practice guidelines and more than 250 clinical policy statements. In the past, practice guidelines have been used to improve care through the dissemination of evidence-based, clinically effective practices to pediatric practitioners. In the current environment this purpose has been broadened to include cost reduction, standardization of practice, and reduction of medical liability. This has led to both confusion and distrust on the part of the pediatrician. Practice guidelines are best understood as a tool to insure that children receive evidence-based care. They are best used in association with a set of outcome and performance measures that provide feedback to clinicians and allow for modification of the guidelines to meet the needs of the local patient population. The quality of practice guidelines is directly dependent on the quality of the medical evidence supporting the recommendation. Unfortunately only a small percentage of the evidence supporting practice guidelines comes from randomized clinical trials with the majority of the evidence coming from expert clinical panels. The success of practice guidelines in improving care for children has yet to be convincingly demonstrated. Currently, there is a dearth of well designed studies that document the effectiveness of practice guidelines. Their ultimate effectiveness will depend on both an improved evidence base and effective strategies for rapid dissemination of the recommendations. The development of evidence-based practice guidelines does not insure that it will have a major impact on physician practice. In the past, effective dissemination of new knowledge has been a long process, often taking years. This cycle time can be dramatically shortened through the development of networks of practice sites that share knowledge and experience in the implementation of practice guidelines and the use of strategies that take advantage of key groups in the dissemination process. When used appropriately, practice guidelines can provide an important adjunct to clinical research by facilitating the dissemination of new clinical findings and can provide an important platform for encouraging innovations in patient care.
Risk Adjustment for Quality Improvement
Authors: Richardson Douglas , Tarnow-Mordi William O. , Lee Shoo K.
Published: December 2021

We can learn what is achievable with current technologies by comparing our neonatal intensive care unit outcomes with others. Because neonatal intensive care units may vary with respect to their case-mix, risk adjustment is essential to making fair comparisons in any research that does not equalize risks through randomization. Risk adjustment first requires strict definition of each specific outcome. Then each risk factor is measured and weighted accordingly. Severity of illness scores are a special form of risk adjustment. The leading newborn illness severity scores rely on physiology-based items from bedside vital signs and laboratory tests. The mechanics of score development are discussed including item selection, definition, collection, and potential biases. The process of weighting risk factors usually involves building multivariate models. Issues of derivation, validation, discrimination, calibration, and reliability affect the utility of all scores. Once a comparison is appropriately risk-adjusted, there are important cautions about interpretation, including the source of the reference (benchmark) population, sample size, and biases from incomplete risk adjustment. Nonetheless, these findings can spur quality improvement efforts that can lead to dramatic, system-wide improvements in outcomes.
Perinatal Information Systems for Quality Improvement: Visions for Today
Authors: Slagle Terri A.
Published: December 2021

Today clinical information is used for a multitude of purposes beyond patient care documentation including quality review and improvement processes, allocation of resources, budgetary and long-term planning, productivity measurement, and justification to payers for services provided. Providers in perinatal medicine are faced with the challenge of finding methods to meet these information needs. Case examples of the different approaches to collecting and using obstetric and neonatal information are described. The role of computer-based patient records is outlined and solutions available to perinatal medicine are reviewed.
Consideration of the Use of Health Status, Functional Outcome, and Quality-of-Life to Monitor Neonatal Intensive Care Practice
Authors: Hack Maureen
Published: December 2021

Measures of health status, functional abilities, and quality-of-life are being used increasingly to evaluate health care practice, and to measure outcomes from the patient's perspective. There is thus a need to reassess the use of growth and neurodevelopmental status that have traditionally been used as measures of outcome after neonatal intensive care.

The quality of neonatal intensive care constitutes only one factor among many that determine the functional health and quality-of-life of survivors of neonatal intensive care. These include genetic disposition, intrauterine events, the effects of sociodemographic factors on the health and development of the child, and on the parents' assessment of their child's functioning. To obtain health status, functional and quality-of-life measures, parents need to act as proxy for the child during infancy and childhood. The parents' cultural, social, and educational background and the specific experience of the parent with children may influence their responses. Furthermore, their perspective may differ from that of the child.

Measures that have been used or have the potential to measure health status, functioning, and quality-of-life include the National Health Interview Survey, the National Health Insurance Study, the Functional Status II, the Multi-Attribute Health System, the Functional Independence Measure for Children, the Vineland Adaptive Behavior Scales, the Adolescent Child Health and Illness Profile, and the Child Health Questionnaire for children, infants, and toddlers. Knowledge of the validity of the use of these measures among survivors of neonatal intensive care is, however, sparse.

Studies have shown that the collection of a standard core of data from various national sources with specific criteria for defining severe disability at 2 years of age is feasible in Great Britain. However, questionnaires or available national databases provide global and epidemiologic information on outcomes rather than identifying the specific pathogenesis or rates of impairments.

To determine the possible deleterious effects of new therapies, specific diseases or impairments will need to be identified rather than the global effect on functioning or health related quality-of-life. Examination of the proximal neonatal impairments that predispose to later disability, such as rates of periventricular hemorrhage or retinopathy of prematurity, are probably better measures for evaluating quality of neonatal care rather than distal impairments such as cerebral palsy, growth impairments, or reactive airway disease.

The ultimate goal of neonatal intensive care is to provide survival without impairment. Objective measures of specific impairments and their residual disability are thus better measures of the quality of neonatal intensive care than subjective assessments of children and their families.
Improving Care Through Collaboration
Authors: Kilo Charles M.
Published: December 2021

The opportunity to improve health care using existing scientific knowledge is immense. Much is known that is not being used in routine care, leading to a large gap between knowledge and practice. Collaborative improvement models bring health care professionals together to focus on this gap and to accelerate the pace of improvement in their organizations. This article describes one such model, the Institute for Healthcare Improvement's Breakthrough Series Collaborative model. Lessons are drawn to help inform future collaborative efforts that focus on the improvement of care.
The Role of Parents in Children's Psychological Development
Authors: Kagan Jerome
Published: December 2021

This article reviews the three major ways parents influence children: direct interaction, identification, and transmission of family stories. This essay summarizes some of the relevant empiric data in support of this claim and describes the operation of other mechanisms that also contribute to the child's development.