bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Prolonged Bottle Feeding on Cow's Milk Intake and Iron Stores at 18 Months of Age
Authors: Lampe John B. , Velez Nilsa
Published: June 2007

Thirty-four toddlers were studied in a prospective, convenience sample comparison at their 18-month health supervision visit to examine the effect of prolonged (i.e., to 18 months of age) bottle feeding on both the daily volume of cow's milk intake and the toddler's iron stores (serum ferritin concentrations.) Seventeen toddlers had been weaned from the bottle by approximately 1 year of age, and 17 toddlers who remained on the bottle at 18 months of age were the compared group. The toddlers who remained on the bottle had significantly greater (P<0.001) cow's milk intake (mean 26.3 oz vs 16.1 oz). The mean ferritin concentrations were lower in the persistent bottle group (17.3 μg/L vs 23.4 μg/L), but not significantly so. Questioning parents about their toddlers' continued bottle use at 18 months can provide a marker for potentially excessive cow's milk intake.
Pediatric Morning Report: An Appraisal
Authors: Barton Leslie L. , Rice Sydney A. , Wells Susan J. , Friedman Allan D.
Published: June 2007

We examined and contrasted morning reports at two hospitals, university and community, that have a pediatric residency program. Patient diagnoses assigned at morning report were compared with final diagnoses to assess disease categories discussed and the value of including outpatient follow-up in this educational forum. Data were obtained during morning reports for 6 months by chief residents at university and private community hospitals. Pertinent history, physical examination, and laboratory and radiologic findings were recorded and were assigned a tentative morning report diagnosis based on morning report discussion. Cases were then reviewed at discharge and at 6 months to determine final diagnoses. At the university hospital, 58% of the cases were undiagnosed before presentation at morning report. Of those cases, 23% were assigned a diagnosis at morning report that differed from the final diagnosis. Similarly, at the private community hospital, 28% of cases were undiagnosed before presentation at morning report. Of those cases, 73% were assigned a diagnosis that differed from the final diagnosis. We conclude that the provision of follow-up at morning report is important for maximizing resident education.
An Analysis of Morning Report at a Pediatric Hospital
Authors: Gerard James M. , Friedman Allan D. , Barry Richard C. , Carney Michael J. , Barton Leslie L.
Published: June 2007

The purpose of this study was to determine the types of cases residents select for morning report discussion and the educational value of postdischarge follow-up of unknown cases. Between April and December of 1994, at Cardinal Glennon Children's Hospital in St. Louis, Missouri, random, resident, and group-selected patients listed at morning report were followed up throughout hospitalization. Patients were categorized based upon whether or not their morning report and discharge diagnoses were the same or different. Patients discharged without a diagnosis were followed up by chart review at 6 months to determine whether a diagnosis had been made. Data were analyzed by Chi-square analysis with Bonfferoni adjustment factor for multiple comparisons. Residents were more than two times more likely to select cases for discussion in which the diagnosis changed during hospitalization (P<O.O1). The 6-month follow-up yielded new diagnoses in only 21% of previously unknown cases. We concluded that residents do an exceptional job of selecting difficult diagnostic cases for discussion at morning report. Postdischarge follow up of unknown cases adds little new information for discussion at morning report.
The Web, Communication Trends, and Children's Health
Authors: Izenberg Neil , Lieberman Debra A.
Published: June 2007

The Internet and The World Wide Web are changing the way pediatricians find medical information and provide care. This article, the first in a four-part series on The Web, Communication Trends, and Children's Health, published in consecutive issues of this journal, describes how the Web was created and how its multimedia capabilities are affecting information exchange.
Lack of Evidence of Transmission of HIV-1 to Family Contacts of H1V-1 Infected Children
Authors: Courville Teresa M. , Caldwell Blake , Brunell Philip A.
Published: June 2007

Although a number of studies have documented that casual household contact does not result in the transmission of HIV, isolated cases of person-to-person transmission have been reported. We report a study of household transmission in which the families were unaware the children were infected with HIV and thus took no precautions to prevent transmission. Twenty-two family members of nine transfusion-associated HlV-infected children were studied for transmission of HIV in house-holds. There was a total of 174 person-years of household exposure; 76 of these exposure years were before the diagnosis of HIV infection in the index child. All family members tested negative for HIV by ELISA. Sharing household facilities, and interactions with the infected child including kissing, bathing, sleeping with, and helping to bathe, dress, and eat, did not result in transmission. Interactions that could theoretically result in person-to-person transmission occurred in these house-holds such as caring for nose bleeds, biting, and home health care procedures. The findings of this and other studies support the participation of HIV-infected infants and children in out-of-home care programs. It remains prudent, however, to observe current recommendations for prevention of HIV-1 for all individuals regardless of whether HIV status is known.
Clinical Characteristics of an Apparent Life-Threatening Event (ALTE) and the Subsequent Occurrence of Prolonged Apnea or Prolonged Bradycardia
Authors: Steinschneider Alfred , Richmond Cheryl , Ramaswamy Vandana , Curns Aaron
Published: June 2007

The objective of this study was to test the hypothesis that the characteristics of an apparent life-threatening event (ALTE) influence the risk for a subsequent episode of prolonged apnea or bradycardia. Data were obtained from 182 infants referred because of an apparent lifethreatening event who were followed up at home for 2 lunar months on an apnea/bradycardia monitor with recording capability. A prolonged episode was defined as apnea ≥20 sec long or an episode of bradycardia ≥10 sec in duration as validated and measured from the event recordings. Seventeen percent of infants had at least one episode of prolonged apnea or prolonged bradycardia. Change in skin color, degree of resuscitative intervention, and behavioral state were not statistically significant factors influencing the risk of a subsequent prolonged episode. Contrary to clinical expectation, a significantly greater percentage of infants subsequently had a prolonged episode whose muscle tone was described as normal during the ALTE (24.0%), when compared with those infants whose ALTE was associated with limpness or increased muscle tone (9.3%). The coexistence of gastroesophageal reflux did not influence the overall results. The observations in this study place in question the clinical approach of relying on the detailed characteristics of an ALTE in determining the need for follow-up studies and/or home monitoring.
Postdural Puncture Headache in Pediatric Oncology Patients
Authors: Ramamoorthy Chandra , Geiduschek Jeremy M. , Bratton Susan L. , Miser Angela W. , Miser James S.
Published: June 2007

This prospective cohort study determined the incidence and risk factors for development of postdural puncture headache (PDPH) in children after lumbar puncture (LP). Eighty-six children were enrolled. LPs were performed with use of 22-gauge spinal needles with the bevel oriented parallel to the long axis of the spine. Follow-up telephone interviews and patients' diary of symptoms were collected. Headache brought on by sitting up and relieved by lying down was defined as PDPH. Of the 80 who completed the study, six (8%) developed PDPH. Two (3%) were less than 6 years old and four (5%) were 6 to 12 years of age. Children with a history of headache following a previous LP were nine times as likely to experience PDPH. PDPH occurs not infrequently in children. A prior history of headache is a predisposing factor.
Colonic Polyps in Children: Frequently Multiple and Recurrent
Authors: Pillai R. B. , Tolia V.
Published: June 2007

A retrospective chart review on 77 children and adolescents (45 males and 32 females) with colorectal polyps seen over a 15-year period (1980-1994) was undertaken. Their presenting symptoms, demographic data, methods of diagnosis, pathologic diagnosis, and outcome were assessed. The age at presentation varied from 6 months to 19 years (mean age 77 months), 66.2% presenting under 6 years of age. The presenting symptoms were rectal bleeding in 71 patients, mass per rectum in 12, abdominal pain in nine, diarrhea in nine, vomiting in two, and one patient was asymptomatic. Air contrast barium enema was confirmatory in 41/54 patients (76%). Polyps were palpable in 16 patients during the rectal examination. A single polyp was present in 50 patients, whereas two to five polyps were present in 20 patients, and more than five in seven patients. Successful endoscopic removal was accomplished in 71/73 patients (97.3%). In 83.1% of patients polyps were located in the rectosigmoid area and in 32.5% polyps occurred proximal to the sigmoid colon. However, multiple polyps in the same location or at other locations were also present simultaneously. Recurrence was observed in five of 63 patients (7.9%) with juvenile polyps, in one patient with infantile polyposis, and in one with solitary adenomatous polyp. We conclude that a full colonoscopic evaluation should be performed in all patients with suspected polyps if feasible, for multiple polyps occurred in 35% of children without polyposis syndromes in this series. Parents of patients with more than three polyps and/or a family history of juvenile polyposis should be warned regarding the possibility of an increased risk of malignancy in future if polyps continue to recur.
The Web, Communication Trends, and Children's Health Part 3: The Web and Health Consumers
Authors: Izenberg Neil , Lieberman Debra A.
Published: June 2007

The World Wide Web has the potential to change significantly how medical care is both delivered and consumed. This, the third of a five-part series on The Web, Communication Trends, and Children's Health, considers how families can use the Internet to find consumer health information and to access care. This article also discusses some of the potential and limitations of Web-based health resources. Part 1 of this series described the development and technology of the Internet and the Web. Part 2 suggested how pediatricians can use the Web to gather medical information and how the increasing capabilities of the Web may affect clinical practice.
Neurofibromatosis Type 1 in Childhood: Evaluation of Clinical and Epidemiologic Features as Predictive Factors for Severity
Authors: Zvulunov A. , Weitz R. , Metzker A.
Published: June 2007

The authors evaluated clinical and epidemiologic features of neurofibromatosis type 1 (NF-1) as predictive factors of severity of the disease. The data were retrieved from medical records of 110 children with NF-1 followed up during the period 1974-1991 (mean duration of follow-up 6.7 years). Presence of macrocephaly correlated with higher grade of severity of the disease (P10.018). Familial NF-1 was more common in patients with grade 4 disease than in children with grade 1 severity (P<0.05; odds ratio 2.9, confidence limits 0.85-10.5). The specificity of positive family history and macrocephaly as predictive factors for the grade 4 disease was 90% and 89%, respectively, and sensitivity was 71% and 36%, correspondingly. Positive predictive value of familial NF-1 and macrocephaly was 24% and 31%, respectively. In conclusion, although patients with family history of NF-1 and with macrocephaly tend to have more severe disease, the clinical utility of these features as predictive factors for severity is limited.
Use of the Rectal Examination on Children with Acute Abdominal Pain
Authors: Scholer Seth J. , Pituch Ken , Orr Don P. , Dittus Robert S.
Published: June 2007

The purpose of this study was to determine the frequency with which general pediatricians perform a rectal examination on children with a complaint of acute abdominal pain and to determine factors associated with performing a rectal examination. Children were eligible for the study if they were 2 to 12 years of age and presented to the clinic or emergency department of a municipal teaching hospital with a complaint of abdominal pain of less than or equal to three days' duration. Measured variables included demographic characteristics and presenting signs and symptoms. For each patient, a clinical reviewer (1) assigned a final diagnosis, (2) determined whether a rectal examination had been performed, and (3) assessed the clinical contribution of the rectal examination findings. For 1,140 children presenting for a nonscheduled visit with acute abdominal pain, a rectal examination was performed on 4.9% (56/1,140). Using multiple logistic regression, children were more likely to have a rectal examination performed if they had abdominal tenderness (odds ratio [OR]=3.3 and 95% confidence interval [CI], 1.8 to 6.0), a history of constipation (OR=6.0 and 95% CI, 2.3 to 15.3), or a history of rectal bleeding (OR=9.1 and 95% CI, 2.9 to 29). Children were less likely to have had a rectal examination performed if they presented with associated symptoms of cough (OR=0.32 and 95% CI, 0.14 to 0.74), headache (OR=0.15 and 95% CI, 0.05 to 0.46), or sore throat (OR=0.28 and 95% CI, 0.08 to 0.91). The final diagnoses of 12 children who had clinically contributory findings on rectal examination included: constipation (5), gastroenteritis (3), appendicitis (2), abdominal adhesions (1), and abdominal pain of unclear etiology (1). General pediatricians infrequently perform a rectal examination on children who present with a complaint of acute abdominal pain. Clinical factors affect the likelihood of whether a rectal examination is performed.
The Intrapulmonary Percussive Ventilator and Flutter Device Compared to Standard Chest Physiotherapy in Patients wit Cystic Fibrosis
Authors: Newhouse Patricia A. , White Fred , Marks John H. , Homnick Douglas N.
Published: June 2007

Stasis of viscid secretions in cystic fibrosis (CF) leads to chronic infection, inflammation, and lung destruction. Chest physiotherapy (CPT) has been used for many years to assist in the removal of these secretions. However, the need for independently administered CPT exists, particularly for adolescents and the older CF patient. Two devices, the intrapulmonary percussive ventilator (IPV) and the Flutter device (Flutter) have been promoted for this purpose. This study compares these devices to standard, manual CPT. There was no difference in sputum quantity produced with any method studied. Transiently lower oxygen saturation was noted with standard CPT compared with the IPV and Flutter. Inconsistent but significant improvements in flow rates were noted with the two devices compared to standard CPT. Important trends to lower lung volumes, probably indicating decreased air trapping, were also noted with all three therapies at 1 and 4 hours after administration. There were no adverse effects with any treatment regimen. Larger and longer studies of these devices compared to standard CPT and with each other are warranted to assess their value for independent administration of CPT in CF patients and to determine long-term effects on maintenance of pulmonary function.
Munchausen Syndrome by Proxy
Authors: Souid Abdul-Kader , Keith David V. , Cunningham Allan S.
Published: June 2007

Munchausen syndrome by proxy is the most difficult form of child abuse. It carries substantial morbidity and mortality. The diagnosis relies on appropriate suspicion and careful investigation. The psychological illness/need of the perpetrator is the main clinical feature. Early recognition and appropriate intervention prevent further abuse and criminal actions.
Use of Bilevel Positive Airway Pressure (BIPAP) in End-Stage Patients with Cystic Fibrosis Awaiting Lung Transplantation
Authors: Caronia Catherine G. , Gorvoy Jack , Silver Peter , Quinn Carolyn , Nimkoff Laura , Sagy Mayer
Published: June 2007

Nine consecutive end-stage patients with cystic fibrosis (CF) awaiting lung transplantation were admitted to the pediatric intensive care unit (PICU) in respiratory decompensation. They all received noninvasive bilevel positive airway pressure (BIPAP) support and were evaluated to determine whether or not it improved their oxygenation and provided them with long-term respiratory stability. BIPAP was applied to all patients after a brief period of assessment of their respiratory status. Inspiratory and expiratory positive airway pressures (IPAP, EPAP) were initially set at 8 and 4 cm H2O respectively. IPAP was increased by increments of 2 cm H2O and EPAP was increased by 1 cm H2O increments until respiratory comfort was achieved and substantiated by noninvasive monitoring. Patients were observed in the PICU for 48 to 72 hours and then discharged to home with instructions to apply BIPAP during night sleep and whenever subjectively required. Regular follow-up visits were scheduled through the hospital-based CF clinic. The patients' final IPAP and EPAP settings ranged from 14 to 18 cm H2O and 4 to 8 cm H2O, respectively. All nine patients showed a marked improvement in their respiratory status with nocturnal use of BIPAP at the time of discharge from the PICU. Their oxygen requirement dropped from a mean of 4.6 ± 1.1 L/min to 2.3 ± 1.5 L/min (P<0.05). Their mean respiratory rate decreased from 34 ± 4 to 28 ± 5 breaths per minute (P<0.05). The oxygen saturation of hemoglobin measured by pulse oximetry, significantly increased from a mean of 80% ± 15% to 91% ± 5% (P<0.05). The patients have been followed up for a period of 2 to 43 months and have all tolerated the use of home nocturnal BIPAP without any reported discomfort. Six patients underwent successful lung transplantation after having utilized nocturnal BIPAP for 2, 6, 14, 15, 26, and 43 months, respectively. Three patients have utilized home BIPAP support for 2, 3, and 19 months, respectively, and continue to await lung transplantation. An acute development of refractory respiratory failure resulted in the demise of the remaining three patients after having utilized BIPAP for 3, 6, and 10 months, respectively. The authors conclude that BIPAP therapy improves the respiratory status of decompensating end-stage CF patients. It is well tolerated for long-term home use and provides an extended period of respiratory comfort and stability for CF patients awaiting lung transplantation.
Renal Stone Disease in Children
Authors: Santos-Victoriano Mylene , Brouhard Ben H. , Cunningham Robert J.
Published: June 2007

Renal stone disease has been regarded as an uncommon problem in children compared to adults. However, increased awareness of this problem in children may lead to early intervention preventing long-term consequences on the kidney and the urinary tract. This article reviews the epidemiology, pathogenesis, and the most common etiologies of renal stones in children. The clinical features and diagnostic and therapeutic modalities for the specific etiologies are also outlined. Using these guidelines may be helpful not only in the treatment but also in the prevention of renal stones.
First-Morning Urine Specific Gravity and Enuresis in Preschool Children
Authors: Salita Marc , Macknin Michael , Medendorp Sharon V. , Jahnke Diane
Published: June 2007

The object of the study was to determine whether a first-morning urine specific gravity of less than or equal to 1.015 was associated with enuresis in children 3 to 6 years old. Parents of preschool children seen at the Cleveland Clinic Foundation during a 5-month period completed a questionnaire concerning bed-wetting and voiding habits of their child and collected first-morning urine specimens for specific gravity analysis. Of 101 children, 12 had a urine specific gravity of less than or equal to 1.015 (11.9%), including seven of 73 (9.6%) nonbed-wetters, two of 19 (10.5%) bed-wetters by history (who did not wet their beds on the night of the study), and three of nine (33.3%) bed-wetters (who wet their beds on the night of the study). The 73 nonbed-wetters (72.3%) had a mean (±standard deviation) urine specific gravity of 1.022 (±0.006); 19 bed-wetters by history (18.9%) had a mean urine specific gravity of 1.024 (±0.006); and nine bed-wetters (8.9%) had a mean urine specific gravity of 1.019 (±0.005). The groups' mean urine specific gravities were not significantly different (p=O.lO) and the enuretic children were not more likely to have first-morningvoid urine specific gravity of less than or equal to 1.015 than nonenuretic children (p=0.14). Enuretic children who wet their beds on the night of the study had lower mean urine specific gravity than nonbed-wetters although the difference was not significant. Therefore, we do not recommend routine use of first warning void urine specific gravity analysis for predicting presence or absence of enuresis.
Fatal Carnitine Palmitoyltransferase II Deficiency in a Newborn: New Phenotpic Features
Authors: Pierce Maria R. , Pridjian Gabriella , Morrison Sarah , Pickoff Arthur S.
Published: June 2007

We describe the term male infant of asymptomatic, healthy nonconsanguineous parents presenting on the first day of life with nonketotic hypoglycemia, seizures, hepatomegaly, cardio-megaly with biventricular hypertrophy, and ventricular arrhythmias. Cranial ultrasound revealed cystic dysplasia with several foci of hyperechogenicity within the right basal ganglia. Free carnitine was markedly decreased in the urine and plasma with a pronounced elevation of plasma long-chain acylcarnitines. Fibroblast carnitine palmitoyltransferase II activity was reduced to 26% and 38% in the father and mother, respectively. The infant expired on day 5 of life from malignant ventricular tachy-arrhythmias. Diffuse lipid accumulation was evident at autopsy, including in the liver, heart, kidney, adrenal cortex, skeletal muscle, and lungs. This new case of infantile CPT-1I deficiency illustrates the severity of the early onset form of CPT-II deficiency.
Children's Illness Cognition: What Mothers Think
Authors: Rubovits David S. , Wolynn Todd H.
Published: June 2007

This study examined the relationships between children's conceptions of illness etiology, treatment, and prevention and parents' estimates of their children's conceptions. Semistructured interviews were conducted with 194 children and their mothers or guardians. Responses were coded for conceptual complexity and developmental sophistication. Relative levels of illness etiology, treatment, and prevention understanding as well as agreement between mothers and their children were calculated. Three quarters of mothers were on target with their children's responses in the etiology and treatment domains while approximately 10% underestimated and 15% overestimated. Within the prevention domain, 50% of mothers were on target with the remainder split evenly between underestimation and overestimation. Mothers who underestimated their children's understanding believed them to be much less sophisticated than how on target mothers viewed their children and overestimating mothers believed their children to be more sophisticated than on target mothers (Fs>13.25; p<0.001).
Early Ear Problems and Developmental Problems at School Age
Authors: Lindsay Ronald L. , Tomazic Terry , Whitman Barbara Y. , Accairdo Pasquale J.
Published: June 2007

Retrospective history of middle ear disease was compared with developmental diagnosis in 507 consecutively referred school-age children. History of major ear problems was positively associated with discrepancies between the performance and verbal IQ on the WISC-R. History of major ear problems was positively associated with the presence of articulation disorders for children in the low social class, hyperactivity in the middle social class, and language problems in the high social class. A history of significant middle ear disease in early childhood should raise concerns for articulation difficulties and possible language problems in children presenting to clinicians with school problems.
Pediatric Imported Malaria in New York: Delayed Diagnosis
Authors: Viani Rolando M. , Bromberg Kenneth
Published: June 2007

The records of 20 children with imported malaria admitted to Kings County Hospital between October 1987 and May 1995 were reviewed. All had a history of recent travel or immigration from a malaria endemic area (West-Africa [16], Central-America [three], and the Caribbean [one]). None of the 10 children with a travel history received appropriate malaria chemoprophylaxis. The most common symptoms and signs were daily fever, chills, and hepatomegaly. Diagnosis was delayed in seven children who were initially felt to have pharyngitis or viral syndrome. Common laboratory findings were anemia and thrombocytopenia. P falciparum was identified in 70% of the patients. Other species were P malariae and P vivax. Complications occurred in six children, hyponatremia in five, seizures in three, and cerebral malaria in one patient. The high incidence of chloroquine-resistant malaria makes chemoprophylaxis difficult in children. The clinical presentation of malaria is nonspecific, and diagnostic delays occur, so a high index of suspicion is needed in children with a travel history.
Ask, Advise, Assist: Pediatricians and Passive Smoke Exposure
Authors: Burnett Kara F. , Young Paul C.
Published: June 2007

The objectives of this study were to determine: (1) how frequently pediatricians obtain a history of passive smoke exposure (PSE), (2) what type of advice regarding PSE they offer and how frequently they offer it, and (3) what methods and what assistance they believe would be useful to reduce PSE. A random sample of 1,000 US members (GEN) of the American Academy of Pediatrics (AAP) and all 724 members of the AAP sections of pulmonology, otolaryngology, and allergy (SPECS) were sent a questionnaire. Seven hundred fifty-five usable questionnaires were returned. Ninety-six percent of 321 general pediatricians obtained a PSE history at least “sometimes” but were much more likely to “always” do so when seeing a patient with asthma (87%) or recurrent otitis media (56%) than during well-child visits (41%) (p<O.OO0l). Ninety-eight percent of pulmonologists and 95% of allergists “always” obtained a PSE history from parents of their asthmatic patients as compared with generalists who reported doing so 87% of the time (p=0.0004). Fifteen percent of GEN gave specific assistance to parents with smoking cessation such as referral to an internist or family practitioner or a community agency or initiating a smoking cessation program themselves, whereas 85% gave only nonspecific advice such as, “don't smoke around the child,“ or “quit smoking.“ Reasons for not initiating a cessation program included lack of skills (38%) or time (36%) or a belief that it was “not their responsibility” (13%). Pediatricians indicated that brochures for parents that describe the haz-L ards of PSE and contain specific information regarding how to refer to community smoking cessation programs would be of most use to them in helping parents reduce PSE to their children. Pediatricians frequently ask about PSE and advise reducing it but seldom assist parents with specific advice regarding effective methods to quit smoking.
Ovarian Masses in Children
Authors: Freud E. , Golinsky D. , Steinberg R. M. , Blumenfeld A. , Yaniv I. , Zer M.
Published: June 2007

We evaluated the outcome of children with ovarian mass operated on at our Center over an 8-year period. Thirty-four girls aged 1 day to 17 years were included in the study. Mean duration of follow-up was 39.5 months. Eighteen had a nonneoplastic mass and 16 a neoplastic mass, eight of which were malignant. Patients with a malignant tumor underwent adnexectomy of the affected side and appendectomy, without removal of the uterus or the other ovary and without partial omentectomy; only the one girl with bilateral malignant disease had bilateral adnexectomy. Five of the eight patients with malignant disease received chemotherapy. All patients are alive with no evidence of disease. Pediatric ovarian masses are rare but have a relatively high rate of malignancy. They differ from adult malignant tumors in many aspects. Conservative surgery should be applied to preserve fertility and combined, if necessary, with aggressive chemotherapy. A good prognosis may be expected in most cases, even with progressive disease.
School Psychologists: Strategic Allies in the Contemporary Practice of Primary Care Pediatrics
Authors: Wodrich David L. , Landau Steven
Published: June 2007

Immense changes in the developmental/behavioral aspects of primary care pediatrics have resulted from revisions in special education laws, introduction of managed care, widened dissemination of information about disabilities to parents, and the changing character of American society. Challenges associated with contemporary pediatric practice can be diminished by routine collaboration with school psychologists. An alliance with school-based psychologists permits pediatricians access to children in their natural environments and potential collaboration for preventing illness and emotional/behavior problems. Further, school psychologists can provide a partner for assessing and treating both common and low-incident disorders without the constraints imposed by managed care.
Observer Variability in Interpretation of Abdominal Radiographs of Infants with Suspected Necrotizing Enterocolitis
Authors: Rehan V. K. , Seshia M. M. K. , Johnston B. , Reed M. , Wilmot D. , Cook V.
Published: June 2007

We examined (1) the observer variability (both interobserver and intraobserver) in interpretation of abdominal radiographs of infants with suspected necrotizing enterocolitis (NEC), (2) the interobserver variability for individual radiologic signs used to diagnose NEC, and (3) the influence of experience in determining the extent of observer variability. Our hypotheses were (1) there would be considerable observer variability in interpretation of abdominal radiographs of infants with suspected NEC; (2) the extent of observer variability would differ for individual radiologic signs of NEC; and (3) the extent of observer variability would be determined by the observer's experience. The participants included 12 observers: two pediatric radiologists, four attending neonatologists, three neonatal fellows, and three pediatric residents. The participating observers under similar interpretation conditions, twice independently, interpreted the same 40 pairs of abdominal radiographs from infants with suspected NEC. The interval between the two interpretations was 3 to 6 months. Intraobserver and interobserver variability was assessed by applying the Kappa statistic to the radiologic signs of NEC for the two separate interpretations. The observers were blinded to patient's identity and the clinical course. Each observer recorded the absence, suspicion, or presence of (1) intestinal distention, (2) air fluid levels, (3) bowel wall thickening, (4) pneumatosis intestinalis, (5) portal venous gas, (6) pneumoperitoneum, and (7) NEC. We found low intraobserver and interobserver agreements. There was considerable variation in observer variability for individual radiologic signs. Trained observers performed better than intraining observers. We conclude that the radiologic signs in isolation should not be considered reliable. We recommend studies to formulate more objective criteria for many of the radiographic features of NEC. Standardization and periodic enforcement of these criteria among observers could reduce observer variability. We suggest that, to decrease both false-negative and falsepositive interpretation, an experienced observer should always review the radiographs of infants with suspected NEC.
Accuracy of Glucose Reflectance Testing for Detecting Hypoglycemia in Term Newborns
Authors: Meloy Linda , Miller Greg , Chandrasekaran M. H. , Summitt Carol , Gutcher Gary
Published: June 2007

Glucose concentrations of 248 newborns at 1 and 3 hours of age were determined at the bedside by means of the Accu-Chek III Reflectance® meter and in the laboratory by means of the Vitros 750® analyzer. Hypoglycemia being defined as a glucose concentration less than 40 mg/dL, the reflectance meter had a sensitivity of 0.757 and a specificity of 0.876 at 1 hour and 0.975 at 3 hours. The imprecision of the reflectance meter at 1 hour eliminated it as a routine testing method.
Public Plus Private in Recreation Development
Authors: Gunn Clare A.
Published: June 2007

Land use for state and national parks is con stantly growing to meet the recreational needs of Americans. The dearth of open land in many heavily populated areas emphasizes the need for wise development. Dr. Gunn feels that gov ernmental agencies should work closely with commercial developers and non-profit organiza tions in order to develop the type of recreational facilities people want and will use. When sepa rate approaches, often in opposing directions, are followed the best interests of the people are not served and the project can become sterile and stereotyped. This article is based on an ad dress delivered by Dr. Gunn on October 15, 1968, at the Seattle Congress for Recreation and Parks. — Ed.
A Prototype Design for a Convenience Food Service System
Authors: Kooser Ronald P.
Published: June 2007

This article is based on an address given by Mr. Kooser at the Eighth Annual Food Facilities Planning Seminar, held in October 1968 at Cor nell University.
Financial Management of Tomorrow's Food Systems
Authors: Lesure John D.
Published: June 2007

This article is based upon an address given at Stage VII — Exploring Food Systems of the Fu ture, held November 18—21, 1968, at the School of Hotel Administration, Cornell University.
Systems The Cure -All ?
Authors: Flambert Richard , Neibert Wid Omar
Published: June 2007

The "systems approach" and the use of computers are being advanced as the cure-all for low productivity in the food service industry. This article explores the meaning of "system" and the possibilities of com puters but points out flaws in buying a "total system."
Securities Regulation of Condominium Hotels
Authors: Gunnar Peter M.
Published: June 2007

This article is based on a report Peter M. Gunnar prepared for the Condominium Committee meet ing of the American Hotel & Motel Association at the 59th Annual Convention, held December 8-12 in Mexico City.

Mr. Gunnar, a lawyer and former trial court judge, is the chief executive officer of Condo minium Northwest, Inc. and of McMillan Inns, Inc., a company specializing in condominium resort hotels. His companies accomplished the first and second voluntary SEC registrations of condominium hotels — the Inn at Spanish Head and the Inn of the Seventh Mountain. Mr. Gun nar also acted as counsel for Sunriver Properties in registering Sunriver Lodge, the fourth such voluntary registration.
Hotel and Restaurant Lighting
Authors: Lampi Eino
Published: June 2007

The following article was written by the Finnish lighting designer, Eino Lampi, for distribution to participants of the International Hotel Con gress at their meeting in Helsinki in May 1972. The article was sponsored by, and includes il lustrations from, three Finnish lighting equip ment manufacturers — Oy Airam AB, Oy Nikia AB Finnish Cable Works, and OY Stromberg AB.

The neodymlite lamps (1 to 10 in the keyed illustration) are manufactured with neodymium gas, which gives the effect of a "black light," the popular term for ultraviolet energy near the visi ble spectrum. Black lights of a similar shape and also fluorescent tubes are readily available in the United States. The crystal lamps (19 to 27 on the chart) are uncommon but Mr. Lampi lists three American distributors. The contact rails, which permit great flexiblity in lighting layout, and the programmed units for lighting displays, are also readily available from American manu facturers.

A series of articles on light, color, and their ef fect on food appeared in the November 1965 issue of this magazine. — Professor Richard H. Penner, School of Hotel Administration, Cornell University.
Timesharing
Authors: Hart Christopher W.
Published: June 2007

Timesharing has been criticized in some circles, and heralded in others as a panacea for a range of developers' and hoteliers' ills. Despite the controversy, timeshare sales continue to double each year. How well the hotelier understands this recent phenomenon will determine whether timesharing represents a threat to his business or a vehicle for profitable growth
The Role of Today's Food- Service Manager
Authors: Pickworth James R. , Fletcher Edgerton L.
Published: June 2007

How autonomous is the food.service manager? To what extent does the authority accorded to man agers vary with company size? Can the manager of a table.service operation make more independent decisions than his fast- food counterpart can? A recent study provides some answers
Marketing to the International Visitor
Authors: O'Connor Thomas S.
Published: June 2007

The hospitality industry is the primary beneficiary of increasing tourist traffic from overseas. How well you understand the needs of the international traveler will determine your share of this growing market
A Glimpse of the Gold
Authors: Regan Gerry T.
Published: June 2007

A team of American chefs dominated the 1980 Culinary Olympics, * bringing home 21 gold medals and a silver medal. Gerry T. Regan, a member of the Cornell School of Hotel Administration faculty, attended the competition, where he took the accompanying full-color photographs and —in his own words —"spent seven days eating, drinking, and relishing the delights of this worldwide smorgasbord." Here are a few of his observations on that week in October.
Strategic Planning
Authors: Olsen Michael D. , DeNoble Alex R
Published: June 2007

Learn from the mistakes of other food-service firms -and capitalize on ideas that have worked for others
Marketing Intangible Products and Product Intangibles
Authors: Levitt Theodore
Published: June 2007

When you ask prospective customers to buy promises —as all service-oriented firms do - you must provide metaphorical reassurances of quality and "industrialize" the service-delivery process
The Divisive Issue of Comparable Worth
Authors: Greenlaw Paul S. , Grubb Barbara C.
Published: June 2007

The practice of segregating certain jobs by sex, a long-accepted tradition in many in dustries, has recently come under fire from civil-rights proponents who maintain that jobs should be compared across categories when wages are determined. Their cause was fueled by a 1981 Supreme Court ruling that opened the way for discrimination suits based on job comparability.

As more women seek to close the male-female wage gap through the courts, hospitality firms present a highly visible target for comparable-worth advocates
Experiencing Work: Values, Attitudes, and Moods
Authors: Georgel Jennifer M. , Jones Gareth R.
Published: June 2007

This paper describes a model (the VAM model) which integrates three of the most significant dimensions of the work experience, work values, attitudes, and moods, into one overarching framework. The VAM model proposes that a rich and more complete understanding of the experience of work necessitates the simultaneous consideration of work values, attitudes, and moods. After describing how work values, attitudes, and moods, each capture key aspects of experiencing work, we discuss three important dimensions along which they vary: time, dynamism, and focus. These dimensions underscore the need for the simultaneous consideration of values, attitudes, and moods for a fuller understanding of the work experience. We then describe how work values, attitudes, and moods have the potential to influence each other. Finally, we discuss the implications of the VAM model for understanding important organizational outcomes including extra-role behavior, job performance, social loafing, absenteeism, and turnover.
Congruence in Job-Performance Ratings: A Study of 360° Feedback Examining Self, Manager, Peers, and Consultant Ratings
Authors: Furnham Adrian , Stringfield Paul
Published: June 2007

Seven task-oriented teams worked together for between 4 and 6 months on a project. At the end of the task, members were each subject to four task-performance ratings: from self, superior, team-peers, and a consultant who was part of the team. There were fewer than chance differences between the different teams on the congruence measures so the data was combined. While the congruence between self and manager, self and peer, and self and consultant ratings were very low, the manager-peer, manager-consultant, and peer-consultant congruence was overall high. Observable behaviors like forward planning and communication showed overall highest congruence while less observable cognitive variables showed much lower congruence. These results are similar to previous studies in the area. Implications of the use of these ratings in management development are considered.
The Primary Risk
Authors: Hirschhorn Larry
Published: June 2007

In the Tavistock tradition, we understand an organization by first identifying its primary task. We ask, what is this organization set up to do, how is it organized to accomplish this objective, and what unconscious dynamics limit or distort its members' ability to do their work? This approach while powerful, does not help us understand organizations that live at strategic junctures in their life cycles. In these situations, the task is to choose a task. We need a conceptual framework to help us understand the psychodynamics of organizing and deciding in these situations. The following article develops the concept of the "primary risk' to explain how organizations behave in these situations. It links the primary risk to the psychoanalytic idea of ambivalence and the gestalt idea of the figure/ground relationship. It draws on case material to illuminate its concepts.
Mastery Frequency, and Interaction of Managerial Behaviors Relative to Subunit Effectiveness
Authors: Shipper Frank , White Charles S.
Published: June 2007

The relationships among mastery and frequency of managerial behaviors, and subunit effectiveness have frequently been confused. This study investigates both main and interactive effects. The results show that the interaction effect can often be the strongest effect and that increasing frequency without improving mastery can sometimes be detrimental. Furthermore, these results offer a possible explanation as to why research of managerial behavior has been so inconclusive. In addition, the results question popular advice given often to managers. Finally, some recommendations are made as to how management development could be made more effective based on the results of this study.
Comparing Group and Individual Level Assessments of Job Characteristics in Testing the Job Demand-Control Model: A Multilevel Approach
Authors: de Jonge Jan , van Breukelen Gerard J. P. , Landeweerd Jan A. , Nijhuis Frans J. N.
Published: June 2007

This article describes a test of Karasek's Job Demand-Control (JD-C) Model using both group and individual level assessments of job characteristics. By group assessments, we mean aggregated individual data. A random sample from general hospitals and nursing homes included 16 institutions, 64 units, and 1489 health care workers (82% response). Because of the hierarchically nested data structure (i.e., institutions, units, and individuals) the research questions and hypothesis were tested in multilevel regression analyses (VARCL). The results revealed both group level and individual level effects with regard to psychological outcomes, and stressed the usefulness of multilevel techniques. Karasek's JID-C Model was partly confirmed by finding two interaction effects at group level and at individual level with regard to job satisfaction and work motivation, respectively. The discussion focuses on theoretical, methodological, and practical implications of multilevel modeling with respect to the JD-C Model.
Fertility Desires and Sample Selection Bias: The Case of Senegal
Authors: Saila-Ngita Diafuka , Bravo-Ureta Boris E. , Pérez-Escamilla Rafael
Published: June 2007

The Heckman two-stage model for correcting selection bias was applied to analyze the determinants of fertility desire using DHS II (Demographic and Health Survey) data from Senegal. The study concludes that significant differences exist between women that report numeric answers and those who report non-numeric answers to a question relative to fertility desire. Therefore, excluding non-numeric answers from regression models produces biased parameter estimates. Furthermore, this study presents evidence that contraceptive methods in Senegal are primarily used to control undesired births as rural and urban residents share the desire for a large family size.
The Past and Present in Ghana’s Ethnic Conflicts: British Colonial Policy and Konkomba Agency, 1930-1951
Authors: Talton Benjamin A.
Published: June 2007

This article focuses on the events surrounding the 1940 Konkomba attack on the predominantly Dagomba village of Jagbel, in what is today Ghana’s Northern Region. This event demonstrates that the antagonism that became characteristic of the relationship between these two groups in the postcolonial period was a product of the political structure that the British colonial administration imposed. A central feature of this structure was indirect rule, which the British developed around “tribe” and “chieftaincy.” Groups whose system of authority satisfied British definitions of tribe and chieftaincy were recognized as politically legitimate. Those that did not were largely disenfranchised. As part of indirect rule, British officials forced the historically non-centralized Konkomba clans under the political jurisdiction of Dagomba nas, or chiefs, despite little historical precedent for such a relationship. By defining the political status of groups in strict terms, the British fostered the development of politicized ethnic identities and the use of symbols that came to be associated with these identities as resources as they competed for political and natural resources. This political inequality in local society and, therefore, conflict and tension between ethnic groups persisted under Ghana’s postcolonial regimes and led to more protracted violence between 1980 and 1994.
China’s Sustainable Development in Global Perspective
Authors: Chow Peter C.Y.
Published: June 2007

In addition to the boost from economic reform, China’s rapid economic growth in the past two decades resulted mainly from the disposition of its surplus agricultural labor and the massive inflow of foreign direct investment, both of which led to its rapid export expansion and high overall growth. This paper argues that the extensive use of foreign capital and the supply of cheap labor in China’s economy are the main driving forces for rapid economic growth in the post-reform period. Yet, sustainable development requires not just the existing supply of cheap labor, but also the necessary capital investment, which may not be forthcoming forever. It is argued that while the agricultural surplus labor is endogenous, the flow of foreign investment is exogenous because there is no guarantee that foreign direct investment will continue. Moreover, trade, which served as an engine of growth in the past, may become a stumbling block in the future. As China reaches the bottleneck of development, the nation will have to decide how to restructure its sociopolitical system to accommodate its sustainable development.