bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of a Novel Bidirectional Canopy Reflectance Model for Row-Planted Rice and Wheat
Authors: Zhou Kai , Guo Yongjiu , Geng Yanan , Zhu Yan , Cao Weixing , Tian Yongchao
Published: August 2014

Rice and wheat are mainly planted in a row structure in China. Radiative transfer models have the potential to provide an accurate description of the bidirectional reflectance characteristics of the canopies of row-planted crops, but few of them have addressed the problem of row-planted structures. In this paper, a new 4SAIL-RowCrop model for row-planted rice and wheat canopies was developed by integrating the 4SAIL model and the Kimes geometric model. The Kimes model and the Kimes–Porous geometric optics (GO) module were used to simulate different scene component proportions. Spectral reflectance and transmittance were subsequently calculated using the 4SAIL model to determine the reflectance of crucial scene components: the illuminated canopy, illuminated background and shadowed background. The model was validated by measuring the reflectance of rice and wheat cultivars at different growth stages, planting densities and nitrogen fertilization rates. The directional and nadir reflectance simulated by the model agreed well with experimental data, with squared correlation coefficients of 0.69 and 0.98, root mean square errors of 0.013 and 0.009 and normalized root mean square errors of 15.8% and 12.4%, respectively. The results indicate that the 4SAIL-RowCrop model is suitable for simulating the spectral reflectance of the canopy of row-planted rice and wheat.
The Open Service Signal in Space Navigation Data Comparison of the Global Positioning System and the BeiDou Navigation Satellite System
Authors: Jan Shau-Shiun , Tao An-Lin
Published: August 2014

More and more Global Navigation Satellite Systems (GNSSs) have been developed and are in operation. Before integrating information on various GNSSs, the differences between the various systems must be studied first. This research focuses on analyzing the navigation data differences between the Chinese BeiDou Navigation Satellite System (BDS) and the United States’ Global Positioning System (GPS). In addition to explaining the impact caused by these two different coordinate and time systems, this research uses an actual open service signal in space (SIS) for both GPS and BDS to analyze their current system performance. Five data quality analysis (DQA) mechanisms are proposed in this research to validate both systems’ SIS navigation data. These five DQAs evaluate the differences in ephemeris and almanac messages from both systems for stability and accuracy. After all of the DQAs, the different issues related to GPS and BDS satellite information are presented. Finally, based on these DQA results, this research provides suggested resolutions for the combined use of GPS and BDS for navigation and guidance.
Optimization of a Cell Counting Algorithm for Mobile Point-of-Care Testing Platforms
Authors: Ahn DaeHan , Kim Nam , Moon SangJun , Park Taejoon , Son Sang
Published: August 2014

In a point-of-care (POC) setting, it is critically important to reliably count the number of specific cells in a blood sample. Software-based cell counting, which is far faster than manual counting, while much cheaper than hardware-based counting, has emerged as an attractive solution potentially applicable to mobile POC testing. However, the existing software-based algorithm based on the normalized cross-correlation (NCC) method is too time- and, thus, energy-consuming to be deployed for battery-powered mobile POC testing platforms. In this paper, we identify inefficiencies in the NCC-based algorithm and propose two synergistic optimization techniques that can considerably reduce the runtime and, thus, energy consumption of the original algorithm with negligible impact on counting accuracy. We demonstrate that an AndroidTM smart phone running the optimized algorithm consumes 11.5× less runtime than the original algorithm.
Particle Swarm Inspired Underwater Sensor Self-Deployment
Authors: Du Huazheng , Xia Na , Zheng Rong
Published: August 2014

Underwater sensor networks (UWSNs) can be applied in sea resource reconnaissance, pollution monitoring and assistant navigation, etc., and have become a hot research field in wireless sensor networks. In open and complicated underwater environments, targets (events) tend to be highly dynamic and uncertain. It is important to deploy sensors to cover potential events in an optimal manner. In this paper, the underwater sensor deployment problem and its performance evaluation metrics are introduced. Furthermore, a particle swarm inspired sensor self-deployment algorithm is presented. By simulating the flying behavior of particles and introducing crowd control, the proposed algorithm can drive sensors to cover almost all the events, and make the distribution of sensors match that of events. Through extensive simulations, we demonstrate that it can solve the underwater sensor deployment problem effectively, with fast convergence rate, and amiable to distributed implementation.
A Novel Approach for Weed Type Classification Based on Shape Descriptors and a Fuzzy Decision-Making Method
Authors: Herrera Pedro , Dorado José , Ribeiro Ángela
Published: August 2014

An important objective in weed management is the discrimination between grasses (monocots) and broad-leaved weeds (dicots), because these two weed groups can be appropriately controlled by specific herbicides. In fact, efficiency is higher if selective treatment is performed for each type of infestation instead of using a broadcast herbicide on the whole surface. This work proposes a strategy where weeds are characterised by a set of shape descriptors (the seven Hu moments and six geometric shape descriptors). Weeds appear in outdoor field images which display real situations obtained from a RGB camera. Thus, images present a mixture of both weed species under varying conditions of lighting. In the presented approach, four decision-making methods were adapted to use the best shape descriptors as attributes and a choice was taken. This proposal establishes a novel methodology with a high success rate in weed species discrimination.
Developing Child-Centered Social Policies: When Professionalism Takes Over
Authors: Hennum Nicole
Published: August 2014

No nation today can be understood as being fully child-centered, but many are pursuing social policies heavily favoring children. The emphasis on individual rights and the growth of scientific knowledge underpinning many of these policies have led to the improvement of the lives of a great many children. Paradoxically, these same knowledge bases informing social policies often produce representations and images of children and their parents that are detrimental for both of these groups. Using Norwegian child welfare policies and practices as examples, I will examine some of the possible pitfalls of child-centered praxis. The key question here is one asking whether the scientific frame central to child welfare professionalism has positioned children and parents as objects rather than subjects in their own lives and, in so doing, required them to live up to standards of life defined for them by experts. A central question will involve exploring the extent to which scientific knowledge has erased political and ethical considerations from the field when assessing social problems.
The Question of Sustainability of Green Electricity Policy Intervention
Authors: Bigerna Simona , Bollino Carlo , Polinori Paolo
Published: August 2014

In this paper, we analyse the financial viability and economic sustainability implications of government programs for the development of renewable energy sources, explicitly considering that consumers take environmental issues into account. We envisage a broad policy strategy for the future, which we label the “World Sustainable Scenario”, and we quantify the inter-temporal resource requirement in terms of investment necessary to achieve it. We perform an empirical meta-analysis to quantify the willingness to pay for green electricity worldwide. Subsequently, we compare the amount of resources required according to policy programs and the populations’ willingness to sacrifice current resources for future benefits (i.e., willingness to finance future investments) to assess the plausibility of current policies. The main empirical findings show that the population’s attitude toward green electricity will support, on average, 50% of the total investment required. We conclude that this is a positive result, which will make possible the success of the renewable energy sources development policy.
Immunological Cross-Reactivity and Neutralisation of European Viper Venoms with the Monospecific Vipera berus Antivenom ViperaTAb
Authors: Casewell Nicholas , Al-Abdulla Ibrahim , Smith David , Coxon Ruth , Landon John
Published: August 2014

Medically important cases of snakebite in Europe are predominately caused by European vipers of the genus Vipera. The mainstay of snakebite therapy is polyclonal antibody therapy, referred to as antivenom. Here we investigate the capability of the monospecific V. berus antivenom, ViperaTAb®, to cross-react with, and neutralise lethality induced by, a variety of European vipers. Using ELISA and immunoblotting, we find that ViperaTAb® antibodies recognise and bind to the majority of toxic components found in the venoms of the Vipera species tested at comparably high levels to those observed with V. berus. Using in vivo pre-clinical efficacy studies, we demonstrate that ViperaTAb® effectively neutralises lethality induced by V. berus, V. aspis, V. ammodytes and V. latastei venoms and at much higher levels than those outlined by regulatory pharmacopoeial guidelines. Notably, venom neutralisation was found to be superior to (V. berus, V. aspis and V. latastei), or as equally effective as (V. ammodytes), the monospecific V. ammodytes “Zagreb antivenom”, which has long been successfully used for treating European snake envenomings. This study suggests that ViperaTAb® may be a valuable therapeutic product for treating snakebite by a variety of European vipers found throughout the continent.
A neotropical Miocene pollen database employing image‐based search and semantic modeling
Authors: Han Jing Ginger , Cao Hongfei , Barb Adrian , Punyasena Surangi W. , Jaramillo Carlos , Shyu Chi‐Ren
Published: August 2014

• Premise of the study: Digital microscopic pollen images are being generated with increasing speed and volume, producing opportunities to develop new computational methods that increase the consistency and efficiency of pollen analysis and provide the palynological community a computational framework for information sharing and knowledge transfer.

• Methods: Mathematical methods were used to assign trait semantics (abstract morphological representations) of the images of neotropical Miocene pollen and spores. Advanced database‐indexing structures were built to compare and retrieve similar images based on their visual content. A Web‐based system was developed to provide novel tools for automatic trait semantic annotation and image retrieval by trait semantics and visual content.

• Results: Mathematical models that map visual features to trait semantics can be used to annotate images with morphology semantics and to search image databases with improved reliability and productivity. Images can also be searched by visual content, providing users with customized emphases on traits such as color, shape, and texture.

• Discussion: Content‐ and semantic‐based image searches provide a powerful computational platform for pollen and spore identification. The infrastructure outlined provides a framework for building a community‐wide palynological resource, streamlining the process of manual identification, analysis, and species discovery.
Separating morphologically similar pollen types using basic shape features from digital images: A preliminary study1
Authors: Holt Katherine A. , Bebbington Mark S.
Published: August 2014

• Premise of the study: One of the many advantages offered by automated palynology systems is the ability to vastly increase the number of observations made on a particular sample or samples. This is of particular benefit when attempting to fully quantify the degree of variation within or between closely related pollen types.

• Methods: An automated palynology system (Classifynder) has been used to further investigate the variation in pollen morphology between two New Zealand species of Myrtaceae (Leptospermum scoparium and Kunzea ericoides) that are of significance in the New Zealand honey industry. Seven geometric features extracted from automatically gathered digital images were used to characterize the range of shape and size of the two taxa, and to examine the extent of previously reported overlap in these variables.

• Results: Our results indicate a degree of overlap in all cases. The narrowest overlap was in measurements of maximum Feret diameter (MFD) in grains oriented in polar view. Multivariate statistical analysis using all seven factors provided the most robust discrimination between the two types.

• Discussion: Further work is required before this approach could be routinely applied to separating the two pollen types used in this study, most notably the development of comprehensive reference distributions for the types in question.
Facile synthesis of 1-alkoxy-1H-benzo- and 7-azabenzotriazoles from peptide coupling agents, mechanistic studies, and synthetic applications
Authors: Lakshman Mahesh K , Singh Manish K , Kumar Mukesh , Chamala Raghu Ram , Yedulla Vijayender R , Wagner Domenick , Leung Evan , Yang Lijia , Matin Asha , Ahmad Sadia
Published: August 2014

(1H-Benzo[d][1,2,3]triazol-1-yloxy)tris(dimethylamino)phosphonium hexafluorophosphate (BOP), 1H-benzo[d][1,2,3]triazol-1-yl 4-methylbenzenesulfonate (Bt-OTs), and 3H-[1,2,3]triazolo[4,5-b]pyridine-3-yl 4-methylbenzenesulfonate (At-OTs) are classically utilized in peptide synthesis for amide-bond formation. However, a previously undescribed reaction of these compounds with alcohols in the presence of a base, leads to 1-alkoxy-1H-benzo- (Bt-OR) and 7-azabenzotriazoles (At-OR). Although BOP undergoes reactions with alcohols to furnish 1-alkoxy-1H-benzotriazoles, Bt-OTs proved to be superior. Both, primary and secondary alcohols undergo reaction under generally mild reaction conditions. Correspondingly, 1-alkoxy-1H-7-azabenzotriazoles were synthesized from At-OTs. Mechanistically, there are three pathways by which these peptide-coupling agents can react with alcohols. From 31P{1H}, [18O]-labeling, and other chemical experiments, phosphonium and tosylate derivatives of alcohols seem to be intermediates. These then react with BtO− and AtO− produced in situ. In order to demonstrate broader utility, this novel reaction has been used to prepare a series of acyclic nucleoside-like compounds. Because BtO− is a nucleofuge, several Bt-OCH2Ar substrates have been evaluated in nucleophilic substitution reactions. Finally, the possible formation of Pd π–allyl complexes by departure of BtO− has been queried. Thus, alpha-allylation of three cyclic ketones was evaluated with 1-(cinnamyloxy)-1H-benzo[d][1,2,3]triazole, via in situ formation of pyrrolidine enamines and Pd catalysis.
Nematodes from terrestrial and freshwater habitats in the Arctic
Authors: Holovachov Oleksandr
Published: August 2014

We present an updated list of terrestrial and freshwater nematodes from all regions of the Arctic, for which records of properly identified nematode species are available: Svalbard, Jan Mayen, Iceland, Greenland, Nunavut, Northwest territories, Alaska, Lena River estuary, Taymyr and Severnaya Zemlya and Novaya Zemlya. The list includes 391 species belonging to 146 genera, 54 families and 10 orders of the phylum Nematoda.
Perspectives of Unlicensed Assistive Personnel on Career Development
Authors: Akaragian Salpy , Crooks Heidi , Pieters Huibrie C.
Published: August 2014

Background:

An equivalency program, Method 3, is a viable but underused option for unlicensed assistive personnel (UAP) who pursue licensure. This study describes the perceptions of UAP on opportunities for career development.

Methods:

Eighteen UAP participated in three focus groups. Thematic analysis was conducted with verbatim transcription.

Results:

Three major themes represented the lively discussions that occurred: core driving forces, processes of career development, and anticipated and desirable outcomes. Various subthemes described these major themes.

Conclusion:

Method 3 provides a realistic approach to help UAP persevere with career development. Collaboration with management and peers, encouragement, and effective communication contributed to the success of participants, despite obstacles and challenges. Camaraderie and flexible scheduling were critical elements in participants’ pursuit of first licensure. Taking small steps was described as an effective approach for UAP to persevere with career development. Support for informal career development is essential. Nursing leaders should consider an equivalency approach to accommodate individual preferences and learning needs for career development.

J Contin Educ Nurs
2013;44(9):415–423.
Revising Oxygen Targeting for Very Low Birth Weight Infants
Authors: Ferry Christine , Thibeau Shelley
Published: August 2014

Translating new knowledge into practice requires sufficient time, administrative support, and access to current information. A regional level III neonatal intensive care unit was tasked with updating a best practice that challenged the history of its well-recognized success in this field. Using strategies that can be applied in any setting, this interprofessional team drove the successful adoption of the updated best practice using a multidimensional implementation plan to promote patient safety.

J Contin Educ Nurs
2013;44(8):338–339.
Needs Assessment: Collecting the Evidence
Authors: Dickerson Pamela S.
Published: August 2014

How nurse planners collect needs assessment data has an impact on the success of educational activities. Instead of traditional approaches, such as an annual needs assessment, the focus needs to shift to the desired outcomes of the activity and the evidence that exists to demonstrate learner need.
J Contin Educ Nurs
. 2014;45(3):104–105.
Fostering Outcomes Through Education: A Systems Approach to Collaboration and Creativity
Authors: Smith Elaine L.
Published: August 2014

Across the country, integrated health care systems continue to emerge and expand. Large multifacility organizations can present both challenges and opportunities for nursing professional development and continuing education activities. This article will explore how one large multifacility system is addressing the varied learning needs of nursing staff across the enterprise.

J Contin Educ Nurs.
2014;45(4):155–157.
Coaching Touch Points
Authors: Serio Ingrid Johnson , Kowalski Karren
Published: August 2014

The ability to coach staff and learners is a critical skill for current staff development educators. Coaching includes setting your intention, creating a safe space, staying present, staying curious, withholding judgment, mirroring and modeling, avoiding a set agenda, and requiring accountability.
J Contin Educ Nurs.
2014;45(4):160–161.
Neurocognitive Decline in HIV Infection
Authors: Goodkin Karl , López Enrique , Hardy David J. , Hardy W. David
Published: August 2014

CME Educational Objectives

1.

Understand the impact of the diagnostic entities that comprise HIV-associated neurocognitive disorder (HAND) on cognitive function and on associated activities of daily living and to understand how to differentiate these entities.

2.

Understand the current clinical issues related to the changes in the incidence and prevalence of HAND, as well as the changes in its risk factors and actual clinical manifestations.

3.

Understand the advantages and disadvantages of the methods currently available to screen for the diagnostic entities that comprise HAND.

More than 34 million people worldwide are currently estimated to live with HIV infection. (Note: Although there are two types of HIV, only one is endemic in the United States — HIV type 1 [HIV-1], which is denoted throughout simply as “HIV.”) Nearly 7,000 people worldwide are newly infected with HIV on a daily basis, which is about 300 people per hour.
1
In the United States, there have been dramatic declines in the annual number of new HIV infections, from a peak of about 130,000 in the mid-1980s to a low of approximately 50,000 in the early 1990s. The rate of new infections increased in the late 1990s, followed by a leveling-off pattern since 2000 to about 55,000 new cases per year. The United States incidence figure had been previously estimated at 40,000 per year until a revision for those who were unknown to be seropositive was included.
2
This figure has remained stable for more than a decade despite the ongoing attempts of the Centers for Disease Control and Prevention (CDC) to reduce it.
A 50-Year-Old Male with Cirrhosis, HCV, Alcohol-Use Disorder, and Unexpected Decline While on DAA Therapy
Authors: Michel Ng , Patel Alkesh N. , Martel-Laferriere Valerie , Perumalswami Ponni
Published: August 2014

CME Educational Objectives

1.

Review concepts in the terminology, diagnosis, treatment, and prognosis of hepatitis C in the setting of alcohol-use disorder.

2.

Understand interactions between telaprevir, a US Food and Drug Administration–approved direct-acting antiviral for the treatment of hepatitis C virus, and commonly used psychotropic medications.

3.

Provide strategies for managing hepatitis C virus–infected patients with concurrent alcohol-use disorder.

The patient is a 50-year-old white man with a history of chronic hepatitis C virus (HCV) genotype 1b, depression, anxiety, hypertension, and alcohol-use disorder. His HCV infection was acquired 30 years ago. He has been followed at the liver medicine practice at Mount Sinai Hospital for the past 5 years. Despite recommendations from his hepatology team to abstain from alcohol and initiate a trial of treatment for HCV, the patient chose to defer currently available treatments, having heard of promising news about interferon-sparing regimens to be released in the near future.
Neuronal Mechanisms of Placebo Effects
Authors: Nayak Devdutt , Patel Pankaj
Published: August 2014

Placebo responses are complex and work through several neurobiological mechanisms. The neurotransmitters implicated thus far are dopamine (DA), gamma-aminobutyric acid (GABA), cholecystokinin (CCK), opioids, serotonin, and endocannabinoids. Both conscious expectations and unconscious conditioning can bring about molecular changes using the above neurotransmitters along the distributed biological systems, subserving cognition, emotions, pain control, reward, and learning.

Expectations can enhance DA secretion in the reward circuitry of the brain, which has a nucleus accumbens at its epicenter. The prefrontal cortex (PFC), which controls attention and emotional memories, negotiates the path to the reward. The nucleus accumbens (NAc), after capturing the sole attention of the PFC, is able to modulate arousal, emotional tone, and autonomic tone to make the brain seek reward of therapeutic benefit, even when no active treatment is offered. Both DA and endogenous opioids play a key role in modulation of placebo responsiveness. The negative expectations of the person regarding treatment or negative suggestions given by the treater can amplify anxiety and pain by activating several brain regions, such as the anterior cingulate cortex (ACC), PFC, and the insula. Thus, anticipatory anxiety generated acts on two independent pathways: the hypothalamic pituitary adrenal (HPA) axis and the CCKergic pro-nociceptive system.

By acting on anxiety, benzodiazepines can block both pathways and reduce pain. But CCK antagonists such as proglumide can only prevent nocebo hyperalgesia, and have no effect on HPA hyperactivity. The ebb and the flow of opioid/CCKergic systems produce the opposing effects of placebo/nocebo. The activation/deactivation between endogenous opioids/DA in NAc helps us understand both placebo and nocebo responses. There are parallels between the placebo response and classical conditioning. Endocrine, immune, and autonomic responses can be conditioned by placebos. Both the expectancy and conditioning mechanisms mediate placebo responses contingent upon previous experiences and social observational learning.
Use of Placebos Poses Ethical Dilemma
Authors: Nayak Devdutt , Chodha Vicky
Published: August 2014

The term “placebo” lives in infamy in the history of medicine and medical research because of its association with fraud, fakery, coercion, and abuse and has promulgated progressively stricter regulations and guidelines. Opposition to using placebo control in clinical trials is based on the principles of biomedical ethics: beneficence, non-maleficence, justice, and autonomy. Many psychiatric disorders affect thinking, ability to reason, and judgment to act in one’s best interests, and many patient volunteers are not aware that their participation does not ensure getting the desired treatment.

The Declaration of Helsinki requires that every patient in a clinical trial receive the best-proven diagnostic and therapeutic method for the condition under study — a concept that just about rules out using placebo control in clinical and investigational drug research.

The U.S. Food and Drug Administration does not require placebo control in randomized, controlled trials but points out non-superiority of active comparator trials in psychiatric disorders and suggests that placebos can be used when “risk of death or serious harm is not at stake,” as they are not in many psychiatric conditions.

Many physicians fail to recognize the potential harm of using negative language in their clinical dialogue with patients. In everyday practice, the catch-22 inherent in information disclosure must be minimized. Too little information is antithetical to obtain informed consent and harms patient’s autonomy for decision-making. Too much information, especially about side effects, increases the possibility of nocebo effects and resulting nonadherence to treatment. “Positive framing” of information and tactfulness are the great allies of the physician.
Enhancing Placebo Effects in Clinical Care
Authors: Nayak Devdutt , Patel Pankaj
Published: August 2014

Sound principles of clinical practice emphasize positive therapeutic relationships, good communication skills, and alleviation of pain and suffering. Psychiatrists use the healing power of both words and drugs. Unfortunately, many psychiatric drugs have failed to show a robust effectiveness in real-world practice and have only a marginal intra-class difference between psychotropics that often comes at the price of intolerable side effects. A significant part of the observed efficacy of many drug treatments is derived from non-specific treatment effects (ie, placebo response). Psychotherapy research suggests that all bona fide psychotherapies have equivalent efficacy, regardless of the claims of their specific technique touted by partisan practitioners. Jerome Frank asserted 50 years ago that there are “curative” features common to all psychotherapies, namely: a person in distress, an expert, a healing setting and a ritual, and explanation for the condition. Ego development psychology informs us that self-soothing is learned by an infant from a nurturing mother, and the healing power of this bond is later transferred to physicians as “culturally sanctioned parental figures.”

Placebo-enhancing practitioners tend to be sensitive, caring, empathic listeners; encourage the patient to participate in decision-making; adapt their goals to patients’ needs and values; optimistic and impart hope; and are perceived by their patients as warm, friendly, reliable, and trustworthy. Good psychiatrists validate their patients’ suffering, are advocates and “cheerleaders,” and strive to restore patients’ self-efficacy, decrease demoralization, and enhance coping skills.

Giving people the best effective treatment, along with positive expectations, realistic optimism, and hope, strengthens the healing relationship, maximizes the placebo effect, and increases patients’ chances of responding in the future.
Criminal Injustice
Authors: Eisler Robert L. , Silverman Joseph S.
Published: August 2014

Over-incarceration, the inability to manage prisoners who are seriously mentally ill, and unwavering belief in free will have contributed powerfully to what has been called the “collapse” of American criminal justice. That over-incarceration is a serious problem is now widely recognized, but eliminating it will require many and varied changes. Current treatment of seriously mentally ill inmates is inhumane and ineffective. The underlying premise of the criminal justice system is that lawbreakers simply misused their free will. Modern neuroscience contradicts that premise. Changes specified here would reconfigure the concepts and procedures of U.S. criminal justice. Mental health professionals are ideally positioned to understand the changes needed and foster their implementation.
Intimate Partner Violence and Military Women
Authors: Tinney Glenna
Published: August 2014

Intimate partner violence (IPV) is a significant issue that affects all women, including those who serve in the military. The myriad of issues faced by active-duty women who experience IPV is very similar to those of women who have never been in the military. However, active-duty women have an additional layer of challenges and concerns related to the military culture and the military’s response to IPV. Many women in the military have experienced individual trauma, including IPV, at some point in their lives, be it before, during, and/or after leaving the military.

This article provides data from the first survey that have ever compared military and civilian rates of IPV, sexual violence, and stalking. It also addresses the context in which the violence is embedded, the impact on risk and danger, the consequences of a trauma history, and a trauma-informed approach for a screening, assessment, and intervention.
Diagnosis of Food Allergy
Authors: Bégin Philippe , Nadeau Kari C.
Published: August 2014

CME Educational Objectives

1.

Discuss the pre-test clinical assessment of a patient with a suspected food allergy.

2.

Review the currently available diagnostic tests and their performance for frequent food allergens.

3.

Interpret allergy tests in light of the pre-test assessment to determine final probability of food allergy and indication for referral for food challenge.

Diagnosis of food allergy can be challenging. Given the limited specificity of available allergy tests, these need to be interpreted in light of pre-test probability that is determined by a careful history. Using likelihood ratios calculated from previous publication may allow a more individualized assessment. This approach is likely to be most useful in patients with low to moderate results, below the 95% positive predictive value for that food. This review covers the diagnostic approach of immunoglobulin E-mediated food allergy. We first focus on the pre-test clinical assessment of a patient with a suspected food allergy. We then compare currently available diagnostic tests and discuss their performance for frequent food allergens. Finally, we conclude with the interpretation of allergy tests in light of the pre-test assessment to determine final probability of food allergy and indications for referral to an allergy specialist for food challenge.
Vaccines in the Pipeline: The Path from Development to Use in the United States
Authors: Pickering Larry K. , Walton L. Reed
Published: August 2014

CME Educational Objectives

1.

Review the current US Food and Drug Administration licensure process for vaccines.

2.

Describe the mechanism followed for developing ACIP recommendations.

3.

Summarize the potential for future vaccine development.

New vaccines in the United States go through a complex process on their path from development to the domestic market involving an intricate partnership of public and private agencies and organizations. This process includes licensure by the US Food and Drug Administration, the development of recommendations by the Advisory Committee on Immunization Practices, and safety oversight post-licensure. This article examines the roles of the US Food and Drug Administration and the Centers for Disease Control and Prevention as well as certain professional organizations in governing the testing, marketing, and usage of new vaccines. Vaccines currently in development to treat numerous infectious and noninfectious diseases are also examined and compared with frameworks of domestic vaccine development prioritization, past and present, as assessed by the Institute of Medicine.
Prevention and Control of Influenza and Dengue Through Vaccine Development
Authors: Greenberg David P. , Robertson Corwin A. , Gordon Daniel M.
Published: August 2014

CME Educational Objectives

1.

Review the impact of influenza infection in the pediatric population.

2.

Discuss the importance of influenza B as a key cause of morbidity and review the progress on development and deployment of quadrivalent influenza vaccines.

3.

Articulate the epidemiology and impact of dengue worldwide and identify difficulties unique to developing a vaccine for this disease.

Influenza and dengue are viral illnesses of global public health importance, especially among children. Accordingly, these diseases have been the focus of efforts to improve their prevention and control. Influenza vaccination offers the best protection against clinical disease caused by strains contained within the specific year’s formulation. It is not uncommon for there to be a mismatch between vaccine strains and circulating strains, particularly with regards to the B lineages. For more than a decade, two distinct lineages of influenza B (Yamagata and Victoria) have co-circulated in the US with varying frequencies, but trivalent influenza vaccines contain only one B-lineage strain and do not offer adequate protection against the alternate B-lineage. Quadrivalent influenza vaccines (QIVs), containing two A strains (H1N1 and H3N2) and two B strains (one from each lineage) have been developed to help protect against the four strains predicted to be the most likely to be circulating. The QIV section of this article discusses epidemiology of pediatric influenza, importance of influenza B in children, potential benefits of QIV, and new quadrivalent vaccines.

In contrast to influenza, a vaccine against dengue is not yet available in spite of many decades of research and development. A global increase in reports of dengue fever (DF) and its more severe presentations, dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS), suggest that US physicians will increasingly encounter patients with this disease. Similarities of the early signs and symptoms of influenza and dengue and the differences in disease management necessitates a better understanding of the epidemiology, clinical presentation, management, and prevention of DF by US physicians, including pediatricians. The article also provides a brief overview of dengue and discusses dengue vaccine development.
Prader-Willi Syndrome and Sleep-Disordered Breathing
Authors: Miller Jennifer , Wagner Mary
Published: August 2014

CME Educational Objectives

1.

Identify commonly observed sleep abnormalities in patients with Prader-Willi Syndrome (PWS).

2.

Discuss the effects of growth-hormone therapy on sleep-disordered breathing in patients with PWS.

3.

Identify other sleep-related abnormalities encountered in patients with PWS.

Prader-Willi Syndrome is a complex neurogenetic disorder characterized by appetite dysregulation, obesity with decreased muscle mass and increased fat mass, behavioral problems, various endocrinopathies, and sleep and respiratory abnormalities. Respiratory issues include both central and obstructive sleep apnea, excessive daytime sleepiness, narcolepsy, and impaired ventilatory control. There is some controversy as to whether growth hormone treatment, which is the standard of care for patients with Prader-Willi Syndrome, exacerbates or ameliorates the sleep-disordered breathing issues associated with this syndrome. The natural history of sleep and breathing issues and the issues surrounding growth hormone treatment on sleep-disordered breathing are discussed.
Evaluation of Short Stature in Children
Authors: Ismail Heba , Ness Kathryn
Published: August 2014

CME Educational Objectives

1.

Distinguish normal growth from pathological short stature.

2.

Identify key components in the history and physical exam in the evaluation of short stature.

3.

Outline the diagnostic evaluation, indications for growth hormone therapy and indications for referral to a specialist.

Normal growth in children is a reflection of general health and is the result of a complex interaction between genetic, nutritional, and hormonal factors. From conception through infancy, growth is mostly driven by maternal nutrition and the in utero environment. Genetic factors, growth and thyroid hormones, ghrelin, and sex steroids have a more prominent influence later. Normal growth is not linear; it is marked by periods of growth spurts, particularly during puberty, separated by periods of slow or immeasurable growth. There is often a period of growth deceleration observed before the onset of puberty, with maximal pubertal growth spurts occurring at Tanner stage III for girls and Tanner stage IV for boys. This is caused primarily by the combined effect of the increased amplitude of growth hormone pulses and sex steroids.

Short stature (SS), which is the subject of this review, is defined as a length or height more than 2 standard deviations below the mean for age and gender, which corresponds to a percentile below 2.5%. Taking a thorough patient history and completing a comprehensive physical examination are some of the most important diagnostic tools for pediatricians to use in the diagnosis of SS, and in making appropriate referrals as needed.
Musculoskeletal Screening: Developmental Dysplasia of the Hip
Authors: Roof Amanda C. , Jinguji Thomas M. , White Klane K.
Published: August 2014

CME Educational Objectives

1.

Discover the proper techniques for identifying and diagnosing developmental dysplasia of the hip (DDH) on physical exam.

2.

Identify proper imaging modalities to use as an adjunct to the physical exam.

3.

Clearly delineate when a referral to a DDH specialist is necessary.

Developmental dysplasia of the hip (DDH) is common because it is present in 1 of 100 newborns. Failure to diagnose DDH and treat in infancy can result in significant long-term disability. Early diagnosis can be accomplished through a quick but careful physical examination of all newborns. Further selective screening by ultrasound is indicated for those children with risk factors for DDH, which include family history, breech presentation, and unstable hip examination at the initial newborn examination. Continued examination of the hip at all routine well-child checkups is mandatory through the first year of life because late presenting DDH may occur. Treatment with a Pavlik harness is not typically instituted in the neonate because many unstable hips stabilize without intervention, but it is indicated in children older than 2 weeks with hip instability. Ultrasound screening for infants with risk factors for DDH is recommended at age 6 weeks. Pavlik harness treatment for children with unstable hips or significant dysplasia on ultrasound is continued until the hips stabilize and show concentric reduction on imaging. With time, diagnosis and treatment evolve to accommodate the growing child. Infants who fail to respond to nonoperative management may require more extensive interventions. At any time when treatment is initiated, a DDH specialist should be involved in the patient’s care. If DDH is recognized early, treatment is less invasive, and long-term effects are minimized.
Initial Evaluation and Management of a First Seizure in Children
Authors: Chelse A.B. , Kelley Kent , Hageman Joseph R. , Koh Sookyong
Published: August 2014

CME Educational Objectives

1.

Understand the initial evaluation of a child presenting with first seizure.

2.

Discuss the risk factors for seizure recurrence.

3.

Discuss the value of electroencephalography (EEG) and neuroimaging in diagnosis and treatment.

The pediatrician is often the first health professional notified of a child’s first seizure. First seizures cause much anxiety for parents and practitioners. Parents are frightened as they witness a paroxysmal event that involves convulsions or altered mental status, and as a result, they seek answers, reassurance, and support.

Every pediatrician faces the challenge of determining whether a child who had a paroxysmal event had a seizure. Therefore, it is important for the general pediatrician to have a good understanding of the diagnosis and management of a child’s first seizure. This review will discuss the definition of seizures and epilepsy, the critical questions to answer during the initial evaluation of a child’s first seizure, guidance for initial management, risk factors for seizure recurrence, and the value of electroencephalography in diagnosis and treatment.
Pediatric IBS: An Overview on Pathophysiology, Diagnosis and Treatment
Authors: Chogle Ashish , Mintjens Stijn , Saps Miguel
Published: August 2014

Irritable bowel syndrome (IBS) is a common disorder in children and adults. The pathogenesis and pathophysiology of IBS remains incompletely understood. The biopsychosocial model, which conceptualizes chronic pain as a dysregulation of the gut-brain-homeostasis with peripheral and central factors mutually influencing each other, is the most accepted framework to explain IBS. Twin and family aggregation studies suggest a genetic component that does not exclusively explain the higher prevalence of IBS in certain families. Social learning (environmental factors) and maladaptive coping predispose children to develop IBS with greater disability and more frequent medical consultations. Early-life events constitute an additional risk factor for the development of IBS and other functional gastrointestinal disorders (FGIDs). Children with a history of cow’s milk protein hypersensitivity or abdominal surgeries have a higher prevalence of IBS and other FGIDs years later. IBS frequently follows an episode of acute gastrointestinal inflammation (infectious or non-infectious).

This article discusses the importance, known pathophysiological mechanisms, clinical approach, and evidence-based therapeutic options for the management of IBS in children and adolescents.
Functional Dyspepsia in Children
Authors: Ganesh Meenakshi , Nurko Samuel
Published: August 2014

Functional dyspepsia (FD) is a widely prevalent problem in pediatrics, reportedly occurring in 3% to 27% of children and accounting for considerable impact on quality of life and health care costs. FD is defined by the Rome III classification as persistent upper abdominal pain or discomfort, not related to bowel movements, and without an organic cause, that is present for at least 2 months prior to diagnosis. Abnormal sensory perception, motor dysfunction, and psychosocial factors have been implicated in the causation of FD. Hypersensitivity to gastric distension, delayed gastric emptying, antral hypomotility, and gastric dysrhythmia are some abnormalities that have been noted in FD.

Diagnosis of FD is based on a thorough history and examination, and an appropriate selection of tests based on clinical judgment, the presence of alarm signs, and response to treatment. A positive diagnosis of FD helps to shift focus from further testing to treatment of symptoms. The majority of children with dyspepsia do not have mucosal lesions on endoscopy; hence, endoscopy is not mandatory for the diagnosis of FD.
Helicobacter pylori
is an uncommon cause of dyspepsia in children, and test and treat strategy is discouraged. Delayed gastric emptying may be present in up to 70% of children with dyspepsia.

A biopsychosocial approach to treatment involving medications, psychological and social supports, and complementary therapies is advocated. Proton pump inhibitors (PPIs) and prokinetics are commonly used first-line medications. PPIs are preferred when epigastric pain is the predominant symptom, whereas prokinetics may be chosen when postprandial fullness or early satiety is the main symptom. PPIs may be more efficacious and cost-effective than H2 blockers according to adult data.
A 16-Year-Old Male with Dizziness, Parasthesias, and Ataxia
Authors: Tsien Margaret Z. , Brorson James R. , Lukas Rimas V. , Dawson Emily C.
Published: August 2014

A 16-year-old African-American male with no past medical history presented with gait instability and somnolence. He had intermittent neurological complaints during the prior 4 months, including dizziness, left arm paresthesias, decreased hearing, and inability to control his hands. After an initial diagnosis of vertigo, his symptoms progressed, leading to reevaluation and a second emergency department head computed tomography (CT) scan, which revealed a large area of hypodensity in the cerebellum. Repeat head CT on arrival to the intensive care unit showed a large, left cerebellar hemispheric stroke. This case study discusses the findings of the patient’s cerebral angiogram, the diagnosis of fibromuscular dysplasia, and the aggressive treatment that likely prevented further devastating strokes in the brainstem, thalamus, and occipital lobe. This case serves as a reminder that strokes are not just an adult disease and that classic presentations can occur even in unconventional patients.
Recognition and Treatment of Postmenopausal Osteoporosis
Authors: Hannafon Freda , Cadogan Mary P.
Published: August 2014

Osteoporosis is a common but often silent condition among older adults. The characteristic pathological changes associated with osteoporosis may go unnoticed until a fracture occurs or a bone density test is performed. Although osteoporosis occurs in men and among premenopausal women, it is most prevalent among postmenopausal women who are the focus of this article. Within the subpopulation of postmenopausal women, there are major differences in risk status, disease severity, and response to treatment. Two individual examples are presented to highlight these differences and to illustrate appropriate assessment and treatment strategies in each scenario. In addition, general nonpharmacological recommendations for postmenopausal women across risk status and disease severity are presented. [
Journal of Gerontological Nursing, 40
(3), 10–14.]
Nonpharmacological Interventions in Long-Term Care: Feasibility and Recent Trends
Authors: Fitzsimmons Suzanne , Barba Beth , Stump Maria , Bonner Alice
Published: August 2014

Numerous studies have found excessive or in appropriate use of antipsychotic drugs in nursing home patients with cognitive impairment or perceived behavioral issues. Inappropriately medicating this vulnerable population can lead to several negative outcomes, including failure to have needs met, injury, illness, and even death. In response to recent literature and government reports highlighting this issue, in 2012, the Centers for Medicare and Medicaid Services (CMS) launched an initiative called the
National Partnership to Improve Dementia Care
. This article discusses the CMS initiative, as well as the feasibility and recent trends in the use of nonpharmacological interventions that could be implemented when working with patients with cognitive impairment and behavioral and psychological symptoms associated with dementia. [
Journal of Gerontological Nursing, 40
(5), 10–14.]