bluuebunny/crossref_metadata_2025 huggingface dataset:
Possible Indirect Detection of rHuEPO Administration in Human Urine by High-Performance Liquid Chromatography Tandem Mass Spectrometry
Authors: Appolonova Svetlana A. , Dikunets Marina A. , Rodchenkov Grigory M.
Published: August 2008

The present study is based on the assumption that changes in an ADMA–DDAH–NOS (ADMA—asymmetrical dimethylarginine; DDAH—dimethyl-arginine dimethylaminohydrolase; NOS—nitric oxide synthase) system could be employed as indirect markers for recombinant human erythropoietin (rHuEPO) administration in doping control. We assessed a predictive value of four proposed new markers for rHuEPO abuse. Preliminary data showed that concentrations of ADMA, symmetrical dimethylarginine (SDMA), citrulline and arginine in human urine were increased after administration of a single intravenous erythropoietin injection (2000 U day−1, Epocrine, St-Petersburg, Russia). The study of variations of ADMA, SDMA, arginine and citrulline levels before and after rHuEPO administration was performed with two healthy male volunteers. Urine samples were collected before rHuEPO administration and urinary concentrations of ADMA and SDMA were determined at 10.0–40 μg mL−1 and of arginine and citrulline at 0.5–10 μg mL−1. A single dose injection of rHuEPO caused an increase in ADMA, SDMA, arginine and citrulline concentrations up to 40–270 μg mL−1, 40–240 μg mL−1, 10–60 μg mL−1 and 12–140 μg mL−1, respectively. These preliminary results indicated that an indirect approach could be used as a pre-screening of urine samples in order to decrease the number of samples with a low probability of rHuEPO abuse and, thus, save costs and human workload.
Use of an Electrochemically Synthesised Metabolite of a Selective Androgen Receptor Modulator for Mass Spectrometry-Based Sports Drug Testing
Authors: Thevis Mario , Lohmann Wiebke , Schrader Yvonne , Kohler Maxie , Bornatsch Wolfgang , Karst Uwe , Schänzer Wilhelm
Published: August 2008

The elucidation of the metabolism of new therapeutics is a major task for pharmaceutical companies and of great interest for drug testing laboratories. The latter in particular need to determine the presence or absence of drugs or their metabolic products in urine to test for a misuse of these compounds. Commonly, in vitro or animal models are used to mimic the human metabolism and produce potential targets in amounts allowing for method development. An alternative route based on electrochemical reactions of drugs was reported to allow for the generation of selected metabolites. The utility of this approach for doping control purposes was demonstrated with a novel class of anabolic agents termed selective androgen receptor modulators (SARMs). An arylpropionamide-derived drug candidate was subjected to electrochemical “metabolism” and a major phase-I-metabolite, resulting from the elimination of a substituted phenol residue as identified in in vitro experiments, was generated and characterised using liquid chromatography/nuclear magnetic resonance spectroscopy and high resolution/high accuracy mass spectrometry. The metabolite was included in routine doping control procedures based on liquid chromatography/tandem mass spectrometry and has served as a reference compound for 5000 doping control specimens.
Doping Control Analysis of Methoxyphenamine Using Liquid Chromatography-Tandem Mass Spectrometry
Authors: Thevis Mario , Sigmund Gerd , Koch Anja , Guddat Sven , Maurer Hans H. , Schänzer Wilhelm
Published: August 2008

Methoxyphenamine ( o-methoxy- N,α-dimethylphenethylamine, Orthoxine) used in earlier times as a bronchodilator is prohibited in sports according to the regulations of the World Anti-Doping Agency (WADA). The drug and several of its metabolites are commonly analysed in doping control screening assays using gas chromatography-mass spectrometry requiring extraction from urine specimens. A complementary method employing liquid chromatography-atmospheric pressure chemical ionisation-tandem mass spectrometry and direct injection of urine aliquots was developed, which provided a fast and sensitive alternative to confirm the presence of the prohibited compound and degradation products in sports drug testing samples. In particular, the chromatographic separation of the active drug from isomeric compounds such as the designer drug p-methoxymetamphetamine (PMMA) was of particular interest to unambiguously identify the applied substance and was accomplished using a C6–phenyl reverse-phase column with isocratic elution. The established procedure was validated for methoxyphenamine with regard to specificity, limit of detection (0.7 ng mL−1), intraday- and interday precision (2.5–5.8% and 10.8–16.2%, respectively) and its applicability was demonstrated with an authentic doping control sample which tested positive for the prohibited compound early in 2008.
The Relationship Between Perfect and Imperfect Information in a Two-Action Risk-Sensitive Problem
Authors: Bickel J. Eric
Published: August 2008

The ability to value information is a central feature of decision analysis and one of its most interesting areas of application. Unfortunately, general assertions regarding the drivers of information value or its properties have been difficult to formulate or have been disproved by counterexample. In this paper, we investigate the value of imperfect information relative to perfect information (RVOI). Within the context of a two-action decision problem with normal priors and exponential utility, we derive a closed-form solution for the value of information and demonstrate that the RVOI is maximal when the decision maker is indifferent between the two alternatives. In addition, we determine when the value of an information system providing a normally distributed signal with correlation coefficient ρ is equal to ρ × 100% or ρ2 × 100% of the value of perfect information. These results deepen our understanding of information value and enable practitioners to estimate the value of imperfect information in particular settings.
Aggregating Probabilistic Forecasts from Incoherent and Abstaining Experts
Authors: Predd Joel B. , Osherson Daniel N. , Kulkarni Sanjeev R. , Poor H. Vincent
Published: August 2008

Decision makers often rely on expert opinion when making forecasts under uncertainty. In doing so, they confront two methodological challenges: the elicitation problem, which requires them to extract meaningful information from experts; and the aggregation problem, which requires them to combine expert opinion by resolving disagreements. Linear averaging is a justifiably popular method for addressing aggregation, but its robust simplicity makes two requirements on elicitation. First, each expert must offer probabilistically coherent forecasts; second, each expert must respond to all our queries. In practice, human judges (even experts) may be incoherent, and may prefer to assess only the subset of events about which they are comfortable offering an opinion. In this paper, a new methodology is developed for combining expert assessment of chance. The method retains the conceptual and computational simplicity of linear averaging, but generalizes the standard approach by relaxing the requirements on expert elicitation. The method also enjoys provable performance guarantees, and in experiments with real-world forecasting data is shown to offer both computational efficiency and competitive forecasting gains as compared to rival aggregation methods. This paper is relevant to the practice of decision analysis, for it enables an elicitation methodology in which judges have freedom to choose the events they assess.
Valuing Future Information Under Uncertainty Using Polynomial Chaos
Authors: Prange Michael , Bailey William J. , Couët Benoit , Djikpesse Hugues , Armstrong Margaret , Galli Alain , Wilkinson David
Published: August 2008

This paper estimates the value of information for highly uncertain projects whose decisions have long-term impacts. We present a mathematically consistent framework using decision trees, Bayesian updating, and Monte Carlo simulation to value future information today, even when that future information is imperfect. One drawback of Monte Carlo methods in multivariate cases is the large number of samples required, which may result in prohibitive run times when considerable computer time is required to obtain each sample, as it is in our example. A polynomial chaos approach suitable for black-box functions is used to reduce these computations to manageable proportions. To our knowledge, this is the first exposition of polynomial chaos in the valuation literature. In our example it provides a speed-up of more than two orders of magnitude.

We demonstrate the approach with an oilfield example involving a future decision on where to place a new injection well relative to a fault. The example considers the value to the asset holder of a measurement, to be made in the future, that reveals the degree of reservoir compartmentalization caused by this fault. In conditions of high demand for rigs and other scarce capital-intensive oilfield equipment, it may be appropriate for the asset holder to agree to a forward contract for this critical measurement to be taken at a future date at some specified price. The service provider would be contractually bound to provide this measurement at this pre-agreed price within a specified time window, regardless of the prevailing price and availability of rigs and equipment. Despite the presence of financial uncertainty on future oil price and private uncertainty on reservoir variables that are largely unresolved by the measurement, our methodology provides a computationally efficient valuation framework, possibly leading to novel ways of setting up contract terms.
Self-Selection and Information Role of Online Product Reviews
Authors: Li Xinxin , Hitt Lorin M.
Published: August 2008

Online product reviews may be subject to self-selection biases that impact consumer purchase behavior, online ratings' time series, and consumer surplus. This occurs if early buyers hold different preferences than do later consumers about the quality of a given product. Readers of early product reviews may not successfully correct for these preference differences when interpreting ratings and making purchases. In this study, we develop a model that examines how idiosyncratic preferences of early buyers can affect long-term consumer purchase behavior as well as the social welfare created by review systems. Our model provides an explanation for the structure of product ratings over time, which we empirically test using online book reviews posted on Amazon.com. Our analysis suggests that firms could benefit from altering their marketing strategies such as pricing, advertising, or product design to encourage consumers likely to yield positive reports to self-select into the market early and generate positive word-of-mouth for new products. On the other hand, self-selection bias, if not corrected, decreases consumer surplus.
A Price Discrimination Model of Trade Promotions
Authors: Cui Tony Haitao , Raju Jagmohan S. , Zhang Z. John
Published: August 2008

Critics have long faulted the wide-spread practice of trade promotions as wasteful. It has been estimated that this practice adds up to $100 billion worth of inventory to the distribution system. Yet, the practice continues. In this paper, we propose a price discrimination model of trade promotions. We show that in a distribution channel characterized by a dominant retailer, a manufacturer has incentives to price discriminate between the dominant retailer and smaller independents. While offering all retailers the same pricing policy, price discrimination can be implemented through trade promotions because they induce different inventory-ordering behaviors on the part of retailers.

Differences in inventory holding costs have been shown to be an important determinant of consumer promotions. Our analysis suggests that differences in holding costs are also potentially an important driver for the use of trade promotions. The implications from our model explain a number of anecdotal and/or empirically observed puzzles about how trade promotions are practiced. For example, our analysis explains why chain stores welcome trade promotions but independents do not. Our analysis outlines implications for managing trade promotions.
Modeling DVD Preorder and Sales: An Optimal Stopping Approach
Authors: Hui Sam K. , Eliashberg Jehoshua , George Edward I.
Published: August 2008

When a DVD title is announced prior to actual distribution, consumers can often preorder the title and receive it as soon as it is released. Alternatively, once a title becomes available (i.e., formally released), consumers can obtain it upon purchase with minimal delay. We propose an individual-level behavioral model that captures the aggregate preorder/postrelease sales of motion picture DVDs. Our model is based on an optimal stopping framework. Starting with the utility function of a forward-looking consumer, and allowing for consumer heterogeneity, we derive the aggregate preorder/postrelease sales distribution. Even under a parsimonious specification for the heterogeneity distribution, our model recovers the typically observed temporal pattern of DVD preorder and sales, a pattern which exhibits an exponentially increasing number of preorder units before the release, peaks at release, and drops exponentially afterward. Using data provided by a major Internet DVD retailer, we demonstrate a number of important managerial implications stemming from our model. We investigate the role of preorder timing through a policy experiment, estimate residual sales, and forecast post-release sales based only on preorder information. We show that our model has substantially better predictive validity than benchmark models.
The Make-or-Buy Decision in the Presence of a Rival: Strategic Outsourcing to a Common Supplier
Authors: Arya Anil , Mittendorf Brian , Sappington David E. M.
Published: August 2008

Firms routinely decide whether to make essential inputs themselves or buy the inputs from independent suppliers. Conventional wisdom suggests that a firm will not buy an input for a price above its in-house cost of production. We show that this is not necessarily the case when a monopolistic input supplier also serves the firm's retail rival. In this case, the decision to buy the input (and thus become one of the supplier's customers) can limit the incentive the supplier would otherwise have to provide the input on particularly favorable terms to the retail rival. Thus, a retail competitor may pay a premium to outsource production to a common supplier in order to raise its rivals' costs.
Models and Tabu Search Metaheuristics for Service Network Design with Asset-Balance Requirements
Authors: Pedersen Michael Berliner , Crainic Teodor Gabriel , Madsen Oli B. G.
Published: August 2008

This paper focuses on a generic model for service network design, which includes asset positioning and utilization through constraints on asset availability at terminals. We denote these relations as “design-balance constraints” and focus on the design-balanced capacitated multicommodity network design model, a generalization of the capacitated multicommodity network design model generally used in service network design applications. Both arc- and cycle-based formulations for the new model are presented. The paper also proposes a tabu search metaheuristic framework for the arc-based formulation. Results on a wide range of network design problem instances from the literature indicate the proposed method behaves very well in terms of computational efficiency and solution quality.
Family, friend, and neighbour child care providers and maternal well‐being in low‐income systems: An ecological social perspective
Authors: Kossek Ellen E. , Pichler Shaun M. , Meece Darrell , Barratt Marguerite E.
Published: August 2008

Integrating theory from the family ecological systems and social support literatures with findings from child care research, in this study we develop and test a model relating family, friend, and neighbour (FFN) child care provider characteristics to perceived child care quality (provider reports of caregiving behaviours, mother‐provider caregiving relationship) and maternal well‐being (work‐family conflict, depressive symptoms). Results from phone interviews with 187 FFN providers receiving public subsidies indicated that even after controlling for familial status or household income, caregiver perceptions of higher quality care were associated with higher education levels, greater attachment to child care as a job; and lower provider depressive symptoms. After controlling for familial status, data analysed from a subset of 51 mother‐provider pairs, indicated that mothers using care from providers who reported higher quality parent‐caregiver social relationships reported lower work‐family conflict and depressive symptoms. This study suggests mothers who have providers with whom they have good caregiving interactions may experience positive social support and psychological crossover dynamics associated with mother well‐being.
Use of Colorimetric Test Strips for Monitoring the Effect of Hemodialysis on Salivary Nitrite and Uric Acid in Patients with End-Stage Renal Disease: A Proof of Principle
Authors: Blicharz Timothy M , Rissin David M , Bowden Michaela , Hayman Ryan B , DiCesare Christopher , Bhatia Jasvinder S , Grand-Pierre Nerline , Siqueira Walter L , Helmerhorst Eva J , Loscalzo Joseph , Oppenheim Frank G , Walt David R
Published: August 2008

Background: Initial screening of potential biomarkers for monitoring dialysis was performed with saliva samples collected from patients with end-stage renal disease (ESRD). A more thorough analysis of the most promising markers identified in the initial screening was conducted with saliva samples acquired at hourly intervals throughout dialysis to monitor analyte concentrations as dialysis progressed. We observed that salivary nitrite (NO2−) and uric acid (UA) concentrations consistently decreased as dialysis proceeded.

Methods: Solution-based colorimetric-detection chemistries for NO2− and UA were converted to a test strip format to produce a simple method for semiquantitatively measuring NO2− and UA concentrations in the clinic or at the patient’s home. We assessed the test strips with saliva samples collected from both ESRD patients undergoing dialysis and healthy control volunteers to qualitatively monitor the effect of dialysis on salivary NO2− and UA. We used computer software to analyze digital images of the resulting test strip color intensities.

Results: Test strip measurements showed that mean salivary concentrations of NO2− and UA were decreased in ESRD patients by 86% and 39%, respectively, compared with 15% and 9% for time-matched controls. Comparison of test strip results with calibrated solution-based assays suggests that the test strips can semiquantitatively measure salivary concentrations of NO2− and UA.

Conclusions: The colorimetric test strips monitored changes in salivary NO2− and UA concentrations that occurred in ESRD patients during dialysis. The test strips may prove useful for noninvasively evaluating dialysis progress and may also be useful for monitoring renal disease status.
Maternology
Authors: Díaz-Rossello José Luis , Ferreira-Castro Annabel
Published: August 2008

Neonates are potent incentive stimuli who regulate the mother's ability and motivation to engage in costly care-taking activities during a most vulnerable period of their early life. Laboratory animal studies as well as functional neuroimaging in human mothers have shown that the medial preoptic area of the hypothalamus and its projections to the mesocorticolimbic dopaminergic system regulate the motivational aspects of maternal behavior. Peripartum hormonal changes acting in these brain areas enhance the reinforcing value of the newborns and promote in the mother the highly motivated behavior observed immediately after parturition. A better understanding of the neural mechanisms that regulate the motivational aspects of maternal behavior can help to increase awareness of the importance of the early maternal/parental-infant interaction as well as to identify possible biological factors that underlie anomalies in human maternal behavior.
Cell-free Fetal DNA in Maternal Plasma
Authors: Smith James F. , Blumenfeld Yair
Published: August 2008

Since the discovery of cell-free fetal DNA (cffDNA) in peripheral maternal blood a decade ago, advances have been made in the identification and clinical application of these segments. Most studies of cffDNA have focused on using the segments for sex determination and fetal Rh genotyping, employing differences in genomic DNA between mother and fetus. Research has shifted toward targeting cffDNA for noninvasive aneuploidy detection. Over the last decade, a tremendous volume of research has focused on advancing the understanding of cffDNA structure, function, and detection. Despite this growing body of evidence, gaps in understanding of the biology of cffDNA and challenges in its isolation, enrichment, and processing have limited clinical applications in noninvasive prenatal diagnosis.
When Tenderness Should Replace Technology
Authors: Marron-Corwin Mary-Joan , Corwin Andrew D.
Published: August 2008

Increasing use of antenatal screening and genetic testing has created the circumstance of a woman who finds herself pregnant with a fetus that is known to be unsound. Some practitioners have become so concerned about the prospect of the less-than-perfect fetus that they have projected their personal desires into the care that they provide, thereby eliminating the possibility of following the natural history of the pregnancy. To serve the needs of these patients, a perinatal hospice service has been created.
Who is at Risk for Special Health Care Needs: Findings From the National Survey of Children's Health
Authors: Newacheck Paul W. , Kim Sue E. , Blumberg Stephen J. , Rising Joshua P.
Published: August 2008

OBJECTIVE. A conceptual model of risk factors for special health care needs in childhood was presented previously. This article uses that conceptual model to identify candidate variables for an exploratory empirical examination of the effects of factors that may increase or decrease the risk of developing a special health care need.

METHODS. The National Survey of Children's Health was used for our analysis (N = 102 353). We used multilevel and multivariate analysis methods. We examined risk factors for special health care needs generally and for specific physical, developmental, behavioral, and emotional conditions cooccurring with special health care needs. Risk factors were grouped into 6 major domains, namely, predisposing characteristics, genetic endowment, physical environment, social environment, health-influencing behavior, and health care system characteristics. We examined preschool-aged and school-aged children separately.

RESULTS. Significant associations were found in 5 of 6 domains studied (no variables in the health care systems characteristics were significant). Individual variables found to decrease or to increase significantly the odds of experiencing special health care needs were expressed at the child level (eg, age and gender), family level (eg, family structure and family conflict), and neighborhood level (eg, perception of supportiveness of the neighborhood).

CONCLUSIONS. This analysis is the first to consider empirically a range of risk factors for special health care needs, using a population health model. Although provisional, the results of our analysis can help us to begin thinking about which characteristics of the child, family, and community are worthy of further exploration. Some of the variables we found to be significantly associated with special health care needs, such as age and ethnicity, are immutable. However, we found a number of significant correlates (ie, possible risk factors) that may be amenable to public health interventions, including breastfeeding practices, exposure to secondhand smoke, family closeness, and neighborhood cohesion.
Infant and Childhood Growth Patterns, Insulin Sensitivity, and Blood Pressure in Prematurely Born Young Adults
Authors: Rotteveel Joost , van Weissenbruch Mirjam M. , Twisk Jos W. R. , Delemarre-Van de Waal Henriette A.
Published: August 2008

OBJECTIVE. Preterm infants are at increased risk to develop insulin resistance and high blood pressure. The influence of growth during childhood is not well established.

METHODS. We investigated childhood growth patterns in relation to blood pressure and insulin sensitivity, measured by the hyperinsulinemic euglycemic clamp, in young adults. We compared 29 subjects born preterm appropriate for gestational age, 28 subjects born preterm small for gestational age, and 30 subjects born at term with a normal birth weight.

RESULTS. Insulin sensitivity expressed as Mi value (glucose disposal mg/kg/min (insulin levels pmol/l) × 100) was lower in infants in the POPS-AGA (18.2) and POPS-SGA (15.2) groups than in the CON group (24.7). Systolic and diastolic blood pressure (mmHg) were higher in infants in the POPS-AGA (132/72) and POPS-SGA (127/71) groups than in the CON group (118/65). The preterm-born subjects, in lowest insulin sensitivity quartile had a higher height standard deviation score at ages 1, 2, and 5 years and a higher weight SD score at ages 2, 5, 10, 19, and 21 years than did those in the lowest insulin sensitivity quartile. The infants in the highest systolic blood pressure quartile had a higher height SD score at 3 months of age and at ages 2, 5, 10, 19, and 21 years and a higher weight SD score at ages 1, 2, 5, 10, 19, and 21 years than those in the lowest systolic blood pressure quartile.

CONCLUSIONS. Young adults born preterm have lower insulin sensitivity and higher blood pressure than controls. Increments in height and weight during childhood are associated with lower insulin sensitivity and higher blood pressure in adulthood.
CD4+/CD8+ T Cell Ratio for Diagnosis of HIV-1 Infection in Infants: Women and Infants Transmission Study
Authors: Pahwa Savita , Read Jennifer S. , Yin Wanrong , Matthews Yvonne , Shearer William , Diaz Clemente , Rich Kenneth , Mendez Hermann , Thompson Bruce ,   for the Women and Infants Transmission Study
Published: August 2008

OBJECTIVE. In this study, we tested the hypothesis that the CD4+/CD8+ T cell ratio could predict HIV infection status in HIV-exposed infants.

METHODS. CD4+/CD8+ T cell ratios were determined from data for live-born singleton infants who had been prospectively enrolled in the Women and Infants Transmission Study. Data for 2208 infants with known HIV infection status (179 HIV-infected and 2029 uninfected infants) were analyzed.

RESULTS. Receiver operating characteristic curves indicated that the CD4+/CD8+ T cell ratio performed better than the proportion of CD4+ T cells for diagnosis of HIV infection as early as 2 months of age, and this relationship was unaffected by adjustment for maternal race/ethnicity, infant birth weight, gestational age, and gender. At 4 months of age, 90% specificity for HIV diagnosis was associated with 60% sensitivity. For ease of use, graphical estimates based on cubic splines for the time-dependent parameters in a Box-Cox transformation (L), the median (M), and the coefficient of variation (S) were used to create LMS centile curves to show the sensitivity and specificity of CD4+/CD8+ T cell ratios in HIV-infected and uninfected infants until 12 months of age. At 6 months of age, a simplified equation that incorporated sequential CD4+/CD8+ T cell ratios and hematocrit values resulted in improved receiver operating characteristic curves, with 94% positive predictive value and 98% negative predictive value. The positive and negative predictive values remained above 90% in simulated infant populations over a wide range of HIV infection prevalence values.

CONCLUSIONS. In the absence of virological diagnosis, a presumptive diagnosis of HIV infection status can be made on the basis of CD4+/CD8+ T cell ratios in HIV-1-exposed infants after 2 months of age; sensitivity and specificity can be improved at 6 months by using a discriminant analysis equation.
Clinicians’ Description of Factors Influencing Their Reporting of Suspected Child Abuse: Report of the Child Abuse Reporting Experience Study Research Group
Authors: Jones Risé , Flaherty Emalee G. , Binns Helen J. , Price Lori Lyn , Slora Eric , Abney Dianna , Harris Donna L. , Christoffel Katherine Kaufer , Sege Robert D.
Published: August 2008

OBJECTIVES. Primary care clinicians participating in the Child Abuse Reporting Experience Study did not report all suspected physical child abuse to child protective services. This evaluation of study data seeks (1) to identify factors clinicians weighed when deciding whether to report injuries they suspected might have been caused by child abuse; (2) to describe clinicians’ management strategies for children with injuries from suspected child abuse that were not reported; and (3) to describe how clinicians explained not reporting high-suspicion injuries.

METHODS. From the 434 pediatric primary care clinicians who participated in the Child Abuse Reporting Experience Study and who indicated they had provided care for a child with an injury they perceived as suspicious, a subsample of 75 of 81 clinicians completed a telephone interview. Interviewees included 36 clinicians who suspected child abuse but did not report the injury to child protective services (12 with high suspicion and 24 with some suspicion) and 39 who reported the suspicious injury. Interviews were analyzed for major themes and subthemes, including decision-making regarding reporting of suspected physical child abuse to child protective services and alternative management strategies.

RESULTS. Four major themes emerged regarding the clinicians’ reporting decisions, that is, familiarity with the family, reference to elements of the case history, use of available resources, and perception of expected outcomes of reporting to child protective services. When they did not report, clinicians planned alternative management strategies, including active or informal case follow-up management. When interviewed, some clinicians modified their original opinion that an injury was likely or very likely caused by abuse, to explain why they did not report to child protective services.

CONCLUSIONS. Decisions about reporting to child protective services are guided by injury circumstances and history, knowledge of and experiences with the family, consultation with others, and previous experiences with child protective services.
Growth of Children on Classical and Medium-Chain Triglyceride Ketogenic Diets
Authors: Neal Elizabeth G. , Chaffe Hannah M. , Edwards Nicole , Lawson Margaret S. , Schwartz Ruby H. , Cross J. Helen
Published: August 2008

OBJECTIVE. The objectives of this study were to examine growth in children on classical and medium-chain triglyceride ketogenic diets and to investigate any association between growth and calorie or protein intake.

METHODS. Weight, height, and BMI z scores were recorded for children who were initiated on 1 of 2 ketogenic diets at baseline and after 3, 6, and 12 months, if continued. Mean calorie and protein intakes during treatment were calculated for children who completed 12 months on the diet. Changes in growth were compared between the 2 diets, and the association between growth and dietary intake was examined.

RESULTS. Seventy-five children provided growth data. Weight z scores decreased significantly between baseline and 3, 6, and 12 months; height z scores showed no change at 3 months but decreased significantly by 6 and 12 months. This was more significant in the younger and ambulatory children. Subdivision according to diet type showed weight z scores to decrease significantly in the medium-chain triglyceride group only at 3 and 6 months and in both groups at 12 months. Height z scores decreased significantly in both groups by 6 and 12 months. Forty children completed 12 months of treatment; in this group, the slopes of best-fit regression lines of serial z-score measures were used to represent growth trend. There were no significant differences in mean slope between classical and medium-chain triglyceride diet groups for weight, height, or BMI. There was no significant difference in mean calorie intake during the 12 months between the 2 diets, but the medium-chain triglyceride group had significantly higher protein intake. There was no significant correlation between calorie or protein intakes and the slope of the best-fit line for weight, height, or BMI.

CONCLUSIONS. Both weight and height z scores decreased during diet treatment. By 12 months, there was no difference in outcome between classical and medium-chain triglyceride protocols despite the increased protein in the latter diet.
Preliminary Assessment of Pediatric Health Care Quality and Patient Safety in the United States Using Readily Available Administrative Data
Authors: McDonald Kathryn M. , Davies Sheryl M. , Haberland Corinna A. , Geppert Jeffrey J. , Ku Amy , Romano Patrick S.
Published: August 2008

OBJECTIVES. With >6 million hospital stays, costing almost $50 billion annually, hospitalized children represent an important population for which most inpatient quality indicators are not applicable. Our aim was to develop indicators using inpatient administrative data to assess aspects of the quality of inpatient pediatric care and access to quality outpatient care.

METHODS. We adapted the Agency for Healthcare Research and Quality quality indicators, a publicly available set of measurement tools refined previously by our team, for a pediatric population. We systematically reviewed the literature for evidence regarding coding and construct validity specific to children. We then convened 4 expert panels to review and discuss the evidence and asked them to rate each indicator through a 2-stage modified Delphi process. From the 2000 and 2003 Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project Kids' Inpatient Database, we generated national estimates for provider level indicators and for area level indicators.

RESULTS. Panelists recommended 18 indicators for inclusion in the pediatric quality indicator set based on overall usefulness for quality improvement efforts. The indicators included 13 hospital-level indicators, including 11 based on complications, 1 based on mortality, and 1 based on volume, as well as 5 area-level potentially preventable hospitalization indicators. National rates for all 18 of the indicators varied minimally between years. Rates in high-risk strata are notably higher than in the overall groups: in 2003 the decubitus ulcer pediatric quality indicator rate was 3.12 per 1000, whereas patients with limited mobility experienced a rate of 22.83. Trends in rates by age varied across pediatric quality indicators: short-term complications of diabetes increased with age, whereas admissions for gastroenteritis decreased with age.

CONCLUSIONS. Tracking potentially preventable complications and hospitalizations has the potential to help prioritize quality improvement efforts at both local and national levels, although additional validation research is needed to confirm the accuracy of coding.
An Approach to Using Recombinant Erythropoietin for Neuroprotection in Very Preterm Infants
Authors: Fauchère Jean-Claude , Dame Christof , Vonthein Reinhard , Koller Brigitte , Arri Sandra , Wolf Martin , Bucher Hans Ulrich
Published: August 2008

OBJECTIVE. Erythropoietin has been shown to be protective against hypoxic-ischemic and inflammatory injuries in cell culture, animal models of brain injury, and clinical trials of adult humans. The rationale for our study was that early administration of high-dose recombinant human erythropoietin may reduce perinatal brain injury (intraventricular hemorrhage and periventricular leukomalacia) in very preterm infants and improve neurodevelopmental outcome. We investigated whether administration of high-dose recombinant human erythropoietin to very preterm infants shortly after birth and subsequently during the first 2 days is safe in terms of short-term outcome.

METHODS. This was a randomized, double-masked, single-center trial with a 2:1 allocation in favor of recombinant human erythropoietin. Preterm infants (gestational age: 24 to 31 weeks) were given recombinant human erythropoietin or NaCl 0.9% intravenously 3, 12 to 18, and 36 to 42 hours after birth.

RESULTS. The percentage of infants who survived without brain injury or retinopathy was 53% in the recombinant human erythropoietin group and 60% in the placebo group. There were no relevant differences regarding short-term outcomes such as intraventricular hemorrhage, retinopathy, sepsis, necrotizing enterocolitis, and bronchopulmonary dysplasia. For 5 infants who were in the recombinant human erythropoietin group and had a gestational age of <26 weeks, withdrawal of intensive care was decided (3 of 5 with severe bilateral intraventricular hemorrhage, 2 of 5 with pulmonary insufficiency); no infant of the control group died. Recombinant human erythropoietin treatment did not result in significant differences in blood pressure, cerebral oxygenation, hemoglobin, leukocyte, and platelet count.

CONCLUSIONS. No significant adverse effects of early high-dose recombinant human erythropoietin treatment in very preterm infants were identified. These results enable us to embark on a large multicenter trial with the aim of determining whether early high-dose administration of recombinant human erythropoietin to very preterm infants improves neurodevelopmental outcome at 24 months' and 5 years' corrected age.
Impact of Cesarean Section on Neonatal Mortality Rates Among Very Preterm Infants in the United States, 2000–2003
Authors: Malloy Michael H.
Published: August 2008

OBJECTIVE. The objective of this analysis was to compare the neonatal mortality rates for infants delivered through primary cesarean section versus vaginal delivery, taking into consideration a number of potentially risk-modifying conditions.

METHODS. US linked birth and infant death certificate files for 2000–2003 were used. Demographic, medical, and labor and delivery complications were abstracted from the files with infant information. The primary outcome examined was neonatal death (death at 0–27 days of age). Because of concern regarding misclassification of gestational age, a procedure was used to trim away births for which the birth weight for a specific gestational age was incongruous. Adjusted odds ratios were calculated for the risk of neonatal death relative to the mode of delivery (primary cesarean section versus vaginal delivery), using logistic regression analysis.

RESULTS. There were data for 13 733 neonatal deaths and 106 809 survivors available from the trimmed data set for analysis for the 4-year period. More than 80% of pregnancies with delivery between 22 and 31 weeks of gestation experienced ≥1 risk factor. Adjusted odds ratios demonstrated significantly reduced risk of neonatal death for infants delivered through cesarean section at 22 to 25 weeks of gestation (adjusted odds ratios of 0.58, 0.52, 0.72, and 0.81 for 22, 23, 24, and 25 weeks, respectively).

CONCLUSION. Cesarean section does seem to provide survival advantages for the most immature infants delivered at 22 to 25 weeks of gestation, independent of maternal risk factors for cesarean section.
Effect of Supplementing Pregnant and Lactating Mothers Withn-3 Very-Long-Chain Fatty Acids on Children's IQ and Body Mass Index at 7 Years of Age
Authors: Helland Ingrid B. , Smith Lars , Blomén Birgitta , Saarem Kristin , Saugstad Ola D. , Drevon Christian A.
Published: August 2008

OBJECTIVES. Arachidonic acid (20:4n-6) and docosahexaenoic acid (22:6n-3) are essential for brain growth and cognitive development. We have reported that supplementing pregnant and lactating women with n-3 very-long-chain polyunsaturated fatty acids promotes higher IQ scores at 4 years of age as compared with maternal supplementation with n-6 polyunsaturated fatty acids. In our present study, the children were examined at 7 years of age with the same cognitive tests as at 4 years of age. We also examined the relation between plasma fatty acid pattern and BMI in children, because an association between arachidonic acid and adipose tissue size has been suggested.

METHODS. The study was randomized and double-blinded. The mothers took 10 mL of cod liver oil or corn oil from week 18 of pregnancy until 3 months after delivery. Their children were tested with the Kaufman Assessment Battery for Children at 7 years of age, and their height and weight were measured.

RESULTS. We did not find any significant differences in scores on the Kaufman Assessment Battery for Children test at 7 years of age between children whose mothers had taken cod liver oil (n = 82) or corn oil (n = 61). We observed, however, that maternal plasma phospholipid concentrations of α-linolenic acid (18:3n-3) and docosahexaenoic acid during pregnancy were correlated to sequential processing at 7 years of age. We observed no correlation between fatty acid status at birth or during the first 3 months of life and BMI at 7 years of age.

CONCLUSION. This study suggests that maternal concentration of n-3 very-long-chain polyunsaturated fatty acids during pregnancy might be of importance for later cognitive function, such as sequential processing, although we observed no significant effect of n-3 fatty acid intervention on global IQs. Neonatal fatty acid status had no influence on BMI at 7 years of age.
Does Connection to Primary Care Matter for Children With Attention-Deficit/Hyperactivity Disorder?
Authors: Toomey Sara L. , Finkelstein Jonathan , Kuhlthau Karen
Published: August 2008

OBJECTIVE. Whether high-quality primary care in the form of a medical home effectively meets the health care needs of children with attention-deficit/hyperactivity disorder is unknown. The objectives of this study were to (1) describe the percentage who report unmet health care need, (2) evaluate whether having a medical home is associated with lower risk for having unmet needs, and (3) compare the impact of having a medical home on unmet need for children with attention-deficit/hyperactivity disorder with those with asthma.

METHODS. Cross-sectional analysis was conducted of the National Survey of Children's Health, 2003, a nationally representative sample. The primary outcome variable was parent-reported unmet health care need. Multivariate logistic regression tested the impact of having a medical home on unmet needs for children with attention-deficit/hyperactivity disorder and asthma.

RESULTS. The National Survey of Children's Health interviewed parents of 6030 children who had attention-deficit/hyperactivity disorder and 6133 children who had asthma and were between the ages of 6 and 17 years. A total of 16.8% of children with attention-deficit/hyperactivity disorder had at least 1 unmet need compared with 6.7% of children with asthma. Although the proportion of children with a medical home was comparable, children with attention-deficit/hyperactivity disorder were 3.5 times more likely to have an unmet need than were children with asthma. Children with asthma who have a medical home have less than half the likelihood of reporting an unmet need in comparison with those without a medical home; however, among children with attention-deficit/hyperactivity disorder, having a medical home was not associated with decreased likelihood of reporting an unmet need.

CONCLUSIONS. Having a medical home is not associated with fewer unmet needs for children with attention-deficit/hyperactivity disorder. Our results suggest that high-quality primary care may not be as successful at meeting the needs of children with behavioral health conditions compared with those with physical conditions.
Perceptions of Oral Health Training and Attitudes Toward Performing Oral Health Screenings Among Graduating Pediatric Residents
Authors: Caspary Gretchen , Krol David M. , Boulter Suzanne , Keels Martha Ann , Romano-Clarke Giusy
Published: August 2008

BACKGROUND. There is a lack of access to oral health services for American children. Some propose that pediatricians be trained to deliver preventive screening and education to families until they access a dental home. However, little is known about the current oral health training provided during pediatric residency.

OBJECTIVE. The purpose of this work was to evaluate the oral health training that pediatricians receive during residency and their attitudes toward performing basic oral health screenings.

METHODS. The American Academy of Pediatrics Survey of Graduating Residents is an annual, randomly sampled national survey of graduating pediatric residents. The 2006 Survey of Graduating Residents surveyed 611 residents and examined their perception of their oral health training and their attitudes about performing oral health screenings.

RESULTS. Thirty-five percent of residents received no oral health training during residency. Of those who did, 73% had <3 hours of training, and only 14% had clinical observation time with a dentist. Seventy-one percent felt that they had too little oral health training, and only 21% felt that their residency was very good or excellent in preparing them to perform oral health-risk assessments. Residents felt confident in their ability to offer anticipatory guidance but not to do the more technical oral health screenings. The majority of residents believed that pediatricians should conduct basic oral health screenings. Multiple regression analysis indicated that residents who received ≥3 hours of oral health training, who applied for jobs in the inner city, and whose career goal was to work in primary practice are those most likely to support this idea.

CONCLUSIONS. Pediatric residents currently receive little training in oral health, and the majority wish for more. This study shows that oral health training during residency can increase pediatrician confidence in participating in important oral health promotion tasks, including anticipatory guidance, oral screenings, and oral health-risk assessment.