bluuebunny/crossref_metadata_2025 huggingface dataset:
Cochlear implants for deaf children
Authors: Miyamoto Richard T. , Myres Wendy A. , Pope Molly L. , Carotta Catherine C.
Published: October 2006

Fifteen profoundly deaf patients under the age of 18 years have received a 3M/House cochlear implant. The surgical procedure employed is essentially the same as that used in adults with a few modifications to accommodate for the smaller dimensions of the mastoid process and the thinness of the scalp and temporal squama. Pediatric subjects.receive timing and intensity information at similar thresholds as adults implanted with this device which contributes to improvement in speech production to various degrees. All subject groups demonstrated significant language delays as a result of their profound hearing losses. Postimplantation, more growth was seen in receptive than in expressive language skills. However, the growth observed did not exceed that expected in profoundly deaf children as reported in the literature. Language growth as a result of the cochlear implant aloneis yet to be documented in our patients.
Endoscopic sizing: An attempt at uniformity
Authors: Stankiewicz James A. , Holinger Lauren D.
Published: October 2006

The inside and outside diameters of all endoscopes and tracheotomy tubes in the endoscopy suite were systematically measured. These measurements were correlated with the manufacturer's stated size and comparisons noted. A lack of uniformity was noted often among and between all product lines. In addition, endoscopes and tracheotomy tubes were not uniformly labeled with inside and outside diameters. As a result, the proper choice of a tracheotomy tube or endoscope for a patient's size and age may be confusing. A chart was developed and included in order to allow quick and accurate recognition of tracheotomy tube and endoscope sizes across product lines to aid in the proper selection of tracheotomy tubes and endoscopic equipment.
Tracheoesophageal speech failure in the laryngectomee: The role of constrictor myotomy
Authors: Henley Julian , Souliere Charles
Published: October 2006

Drs. Singer and Blom pioneered the development of a valved voice prosthesis and controlled fistula between the tracheal and esophagcal wall to generate fluent esophageal speech in laryngectomy patients. Since then numerous voice prostheses with different performance capacities have entered the marketplace. In spite of optimal choices and fitting of devices, there remains a population of patients refractory to this type of rehabilitation. It is our experience that a number of patients ultimately benefit from middle and inferior constrictor myotomy with marked improvement in their speech. Patient selection, evaluation, and operative techniques are discussed.

Five patients who were unable to speak even after introduction of various commercially available devices showed marked improvement after middle and inferior constrictor surgical myotomy. Minimal complications were encountered even in irradiated patients. These patients were preoperatively injected with Xylocaine to produce a partial blockade. Their speech improved dramatically for the duration of Xylocaine blockade. Esophageal video fluoroscopy of attempted speech with the voice prosthesis in place confirmed constrictor spasm that opposed air flow to the oropharynx.

Inferior and middle constrictor myotomy appears to be very beneficial in rehabilitation of failed alaryngeal speakers who demonstrate pharyngeal constrictor spasm.
Temporalis muscle flap: An alternative in oropharyngeal reconstruction
Authors: HÜttenbrink Karl‐Bernd
Published: October 2006

After resection of the ascending ramus of the mandible, the temporalis muscle is rendered functionless. It represents a viable and versatile bulk of tissue covered by stout fascia, which can be used in oral and oropharyngeal reconstruction after extensive excisional surgery. The surgical effort is reasonable, owing to the vicinity of the defect.

The fascia, which resists the saliva, is left uncovered; epithelization is completed after 2 to 3 weeks. The cosmetic result is acceptable. Skin incisions are invisible because they are covered by hair; the flattening of the temporal fossa will be smoothed out by scarring after several months. The postoperative course was uneventful in 11 patients but for minor problems. The flap remained viable in all subjects. The temporalis muscle flap seems to be a valuable alternative among the techniques of oral and oropharyngeal reconstruction.
Pulsatile tinnitus
Authors: Levine Steven B. , Snow James B.
Published: October 2006

Tinnitus is a frequent presenting symptom. Tinnitus that is rhythmic and synchronous with the patient's heartbeat is rare. Pulsatile tinnitus may be the only symptom of life‐threatening and treatable diseases. The presence of hearing loss or vertigo focuses the diagnostic evaluation. The cause of pulsatile tinnitus may be found on otoscopic examination. Audiologic assessment and enhanced computed tomography often contribute to the diagnosis. Increased intracranial pressure should be excluded with a fundoscopic examination. Arteriography is required to diagnose life‐threatening and treatable lesions in the presence of normal otoscopy, audiologic assessment, and enhanced computed tomography.
Distinctive immunohistochemical labeling of epithelial and mesenchymal elements in laryngeal pseudosarcoma
Authors: Ophir Dov , Marshak Gabriel , Czernobilsky Bernard
Published: October 2006

A laryngeal squamous cell carcinoma in situ with an underlying spindle cell nodule (pseudosarcoma) was immunohistochemically labeled with antibodies to tissue‐specific intermediate filament proteins, including desmin, vimentin, and cytokeratin. Two distinct populations of cells were found within the lesion: cytokeratin‐positive cells, corresponding to the carcinomatous component of the tumor, and vimentin‐positive spindle cells in the subepithelial nodule. In view of the strict specificity of antivimentin and anticytokeratin for cells of mesenchymal and epithelial origin, respectively, it is proposed that the two components of the pseudosarcoma in our case are not morphologic variants of the same tumor, and that the subepithelial nodule represents a mesenchymal lesion. These results can, however, not be extrapolated to other cases since in some the spindle cell component may represent metaplastic epithelial cells. In view of the difficulties encountered in reaching a correct diagnosis in these lesions, it is recommended to use intermediate filament typing to elucidate the nature of the spindle cells in this controversial tumor.
Endoscopic middle meatal antrostomy: Theory, technique, and patency
Authors: Kenned David W. , Zinreich S. James , Kuhn Frederick , Shaalan Hisham , Naclerio Robert , Loch Eric
Published: October 2006

Ostial obstruction is a major factor in the pathogenesis of sinusitis. Detailed diagnostic evaluation in patients with maxillary sinusitis demonstrates the prominence of disease in the ethmoidal infundibulum and in adjacent ethmoid cells. Surgical procedures performed to improve maxillary sinusitis by inferior meatal antrostomy leave residual disease in the ostiomeatal area and may result in persistent mucociliary obstruction.

Historically, the possibility of closure following ostial manipulation and the importance of dependent drainage of the maxillary sinus have been cited as arguments against the middle meatal approach. In this study of middle meatal antrostomies the patency rate was 98% between 4 and 32 months. The postoperative endoscopic findings and symptomatic improvement suggest that mucociliary clearance occurs through the surgically widened ostium. We conclude that endoscopic middle meatal antrostomy does not lead to ostial stenosis.
Obliteration Of Mastoid And Middle Ear For Severe Trauma To The Temporal Bone
Authors: Kveton John F.
Published: October 2006

A review of four cases of severe trauma to the temporal bone involving fracture of the external auditory canal indicates that adipose obliteration of the mastoid and middle‐ear cleft with closure of the external auditory canal is the optimal method of repair. In two of four patients, one‐stage repair was successful using this technique, and in the other two patients, obliteration was required as a revision operation after cholesteatoma developed from previous procedures.
Neodymium‐yag laser intranasal photocoagulation in hereditary hemorrhagic telangiectasia: An update report
Authors: Kluger Paul B. , Shapshay Stanley M. , Hybels Roger L. , Kirk Bohigian R.
Published: October 2006

Hereditary hemorrhagic telangiectasia is a challenging problem for the otolaryngologist since frequent, often severe epistaxis is the major symptom. Options for therapy in the past have included nasal packing, electrocautery, systemic estrogens, septal dermatoplasty, arterial embolization, and arterial ligation. Although successful treatment has been achieved with some of these methods, particularly septal dermatoplasty, other forms of therapy are needed prompting the use of laser photocoagulation.

The neodymium yttrium‐aluminum‐garnet (Nd‐YAG) laser was used to treat a group of 19 patients with hereditary hemorrhagic telangiectasia over a 4‐year period without complications. Endonasal laser photocoagulation was effective in decreasing epistaxis in patients not requiring frequent transfusions prior to laser therapy. Three patients with the most severe epistaxis received minimal or no benefit from Nd‐YAG laser photocoagulation. In most patients Nd‐YAG photocoagulation is successful in treating epistaxis associated with hereditary hemorrhagic telangiectasia and should be a therapeutic option for this chronic disease having no available cure.
Condylomatous lesions of the upper aerodigestive tract
Authors: Nash Michael , Lucente Frank E. , Gould Wilbur J. , Srinivasan Krishna
Published: October 2006

Condyloma acuminatum is one of four types of common human verrucous lesions that are of viral etiology. Also known as “moist wart,” condyloma acuminatum is most often seen on the mucosal surfaces of the anogenital area. However, occurrences in the mucosal lined areas of the head and neck region are quite rare.

Since 1901, 30 cases of condylomatous lesions have been reported in the upper aerodigestive tract, occurring mainly in the various regions of the oral cavity. Eighteen of the cases were confirmed by histopathologic documentation, while the remainder were anecdotal.

We have recently encountered six new cases of condyloma acuminatum, verified by histologic examination. One occurred on the tongue, another in the tonsillar fossa, one in the hypopharynx and three on the vocal cords. We present these cases and review the previously reported cases. In addition, we will discuss the differential diagnosis of these lesions, and their importance to the practicing otolaryngologist.
Compaeison of polysomnography and sonography for assessing regularity of respiration during sleep in adenotonsillar hypertrophy
Authors: Potsic William P.
Published: October 2006

Increasing awareness of the role of adenotonsillar hypertrophy in the etiology of chronic airway obstruction and disturbed respiration during sleep has created interest in the diagnostic methods available to assess the effects of obstruction. This study evaluates and compares simultaneously‐obtained recordings of polysomnography and sleep sonography in children obstructed by adenotonsillar hypertrophy. Four hundred sixty‐five 4‐minute samples obtained from 18 patients in a clinical studies unit were analyzed and rated as to severity. Agreement between polysomnography and sleep sonography was very high in scoring the respiratory pattern (r=0.79) and detecting apnea (r=0.89). These findings demonstrate that sleep sonography is a reliable method for evaluating patients with upper airway obstruction due to adenotonsillar hypertrophy.
Patency of the internal jugular vein after functional neck dissection
Authors: Fisher Cynthia B. , Mattox Douglas E. , Zinreich James S.
Published: October 2006

The objective of this study was to determine the immediate patency rate for internal jugular veins preserved in functional neck dissections. Thirteen patients had contrast‐enhanced CT scans 2 to 4 weeks postoperatively. Ten veins were patent and had a diameter comparable to that seen on the preoperative scan; one vein was narrowed but patent; two were occluded. Probable factors associated with occlusion include trauma of the vessel and extrinsic compression of the vein by the skin or myocutaneous flaps.
The anatomical basis for post‐tracheotomy innominate artery rupture
Authors: Oshinsky Alan E. , Rubin John S. , Gwozdz Christina S.
Published: October 2006

Classical teaching suggests that placement of a tracheostomy tube through the second or third tracheal rings will safeguard the innominate artery in the majority of patients.

A tracheotomy was performed on ten fresh, adult cadavers through a vertical incision in the second and third tracheal rings. A series of measurements was made evaluating the relationship of the innominate artery to the tracheostomy tube and to laryngotracheal structures.

In every dissection, some part of the tracheostomy tube cuff or tip was found to be adjacent to the innominate artery.

We conclude that, contrary to general belief, placement of the tracheotomy incision at the second and third tracheal rings will not in and of itself protect the innominate artery from rupture.
Comparative studies of speech processing strategies for cochlear implants
Authors: Wilson B. S. , Finley C. C. , Weber B. A. , White M. W. , Farmer J. C. , Wolford R. D. , Merzenich M. M. , Lawson D. T. , Kenan P. D. , Schindler R. A.
Published: October 2006

A wide variety of speech processing strategies for multichannel auditory prostheses were compared in studies of two patients implanted with the UCSF electrode array. Each strategy was evaluated using tests of vowel and consonant confusions, with and without lipreading. Included among the strategies were the compressed analog processor of the present UCSF/Storz prosthesis and a group of interleaved pulses processors in which the amplitudes of nonsimultaneous pulses code the spectral variations of speech. For these patients, each with indications of poor nerve survival, test scores were significantly higher with the interleaved pulses processors. We believe this superior performance was a result of 1. the substantial release from channel interactions provided by nonsimultaneous stimuli and 2. a fast enough rotation among the channels to support adequate temporal and spectral resolution of perceived speech sounds.
Mohs for head and neck mucosal cancer: Report on 111 patients
Authors: Davidson Terence M. , Haghighi Parviz , Astarita Robert , Baird Stephen , Seagren Stephen
Published: October 2006

Microscopically Oriented Histologic Surgery (MOHS) has been applied to primary epidermoid cancers of the mucosal tissues of the head and neck since 1979. In that time we have treated 170 patients and maintained excellent records, losing no patients to follow‐up. One hundred three patients have been followed for 2 years. Of this group, only nine patients have developed local recurrences; three were salvaged, six were not.

This presentation reviews the concept of MOHS and its application to head and neck mucosal lesions. The results are analyzed, and conclusions are drawn regarding what we have learned about the biologic behavior of head and neck tumors and the role of MOHS in treating these neoplasms.
The sternocleidomastoid myoperiosteal flap for esophagopharyngeal reconstruction and fistula repair: Clinical and experimental study
Authors: Friedman Michael , Toriumi Dean M. , Chilis Thomas , Strorigl Terri , Skolnik Emanuel
Published: October 2006

Despite advances in head and neck surgery, reconstruction of the pharynx and cervical esophagus continues to be troublesome. Classic pedicled flaps are often too bulky and difficult to position for repair of pharyngeal and esophageal fistulas. An ideal flap would be local, well‐vascularized, compact, and capable of being sutured into a tension‐free, watertight seal. In selected cases, the sternocleidomastoid myoperiosteal flap can meet these requirements in a single‐stage procedure for repair of fistulas as well as selected cases of primary pharyngeal reconstruction.

The use of this flap is described in five patients. Two patients underwent laryngectomy with partial pharyngectomy that left inadequate mucosa for primary closure. A sternocleidomastoid myoperiosteal flap was used to add width to the remaining mucosa. Both patients healed within 3 weeks and remained stricture free. Three other patients who underwent radiation followed by tumor resection and standard primary closure of the pharynx developed fistulas. Two fistulas were repaired successfully with the sternocleidomastoid myoperiosteal flap, and both patients were able to eat a general diet on the eighth postoperative day. Reconstruction was also performed in dogs to histologically evaluate the epithelialization capacity of the periosteum. There was total epithelialization of the flap at 4 weeks after reconstruction.
Bionic larynx: Electronic control of the reimplanted organ in the dog
Authors: Broniatowski Michael
Published: October 2006

Complete rehabilitation of paralyzed head and neck structures has been difficult, and attempts at reinnervation of striated muscles have not consistently succeeded. Recent studies have shown that disabled muscles can be electronically “paced.” This, together with recent developments in microelectronics, has led to the concept of the Bionic Larynx. The current experiments involve transposed nerve‐muscle pedicles used to selectively reinnervate larynges which were denervated, entirely detached from the animal except for their vascular supply, and then reimplanted. These pedicles were later stimulated using a potentially implantable “pacing unit.” It was possible to selectively control the critical functions of the larynx, using as stimuli physiological events that are preserved even when the vocal folds are paralyzed or uncoordinated. Although laryngeal transplantation in humans remains theoretical, these studies show that it could be feasible in the future.
Injection of fat for soft tissue augmentation
Authors: Wetmore Stephen J.
Published: October 2006

Perinephric rabbit fat was divided into small particles with scissors and razor blades and then injected subcutaneously into the donor rabbit. The injected fat was compared with surgically implanted fat. Subcutaneous augmentation with both types of fat resulted in similar findings. Grossly, 40% of injection and implantation sites were palpable after 16 to 36 weeks of observation. Histologically, fat was present at practically every site, but with a variable amount of fat cell destruction.

This study demonstrates that the author's method for dividing and injecting fat produces comparable results in terms of soft tissue augmentation to those obtained by surgically implanting fat. Although injected fat does not fulfill the criteria as the ideal substance for soft tissue augmentation, fat injection may prove to be a clinically useful means for improving body contour.
In Situ hybridization and immunohistochemical study of human papillomavirus infection in adult laryngeal papillomas
Authors: Tsutsumi Kouichiro , Nakajima Takashi , Gotoh Masahiro , Shimosato Yukio , Tsunokawa Youko , Terada Masaaki , Ebihara Satoshi , Ono Isamu
Published: October 2006

Routinely processed paraffin sections from 20 patients with adult laryngeal papillomas were examined for the presence of human papillomavirus type 11 (HPV‐11) DNA and its specific mRNA by in situ hybridization methods using 35S‐labeled RNA probes. Immunohistochemical techniques were also used to identify papillomavirus genus‐specific common antigen (pgsantigen). HPV‐11 DNA signals and/or papillomavirus genus‐specific common antigen were detected in all eight samples of multiple laryngeal papilloma. On the other hand, in 12 samples of single laryngeal papilloma, neither papillomavirus genus‐specific common antigen nor HPV‐11 DNA were detected. Four patients were positive for both HPV‐11 DNA and pgs‐antigen. In three of these four patients, HPV‐11 mRNA signals were also detected. These results provided direct evidence of the association of HPV and adult multiple laryngeal papilloma.
Remodeling and Vascular Spaces in Bone
Authors: Eriksen Erik Fink , Eghbali-Fatourechi Guiti Z , Khosla Sundeep
Published: October 2006

In recent years, we have come to appreciate that the close association between bone and vasculature plays a pivotal role in the regulation of bone remodeling and fracture repair. In 2001, Hauge et al. characterized a specialized vascular structure, the bone remodeling compartment (BRC), and showed that the outer lining of this compartment was made up of flattened cells, displaying all the characteristics of lining cells in bone. A decrease in bone turnover leads to a decrease in surfaces covered with remodeling compartments, whereas increased turnover causes an increase. Immunoreactivity for all major osteotropic growth factors and cytokines including osteoprotegerin (OPG) and RANKL has been shown in the cells lining the BRC, which makes the BRC the structure of choice for coupling between resorption and formation. The secretion of these factors inside a confined space separated from the bone marrow would facilitate local regulation of the remodeling process without interference from growth factors secreted by blood cells in the marrow space. The BRC creates an environment where cells inside the structure are exposed to denuded bone, which may enable direct cellular interactions with integrins and other matrix factors known to regulate osteoclast/osteoblast activity. However, the denuded bone surface inside the BRC also constitutes an ideal environment for the seeding of bone metastases, known to have high affinity for bone matrix. Reduction in BRC space brought about by antiresorptive therapies such as bisphosphonates reduce the number of skeletal events in advanced cancer, whereas an increase in BRC space induced by remodeling activators like PTH may increase the bone metastatic burden. The BRC has only been characterized in detail in trabecular bone; there is, however, evidence that a similar structure may exist in cortical bone, but further characterization is needed.
Recovery From Skeletal Fluorosis (an Enigmatic, American Case)
Authors: Kurland Etah S , Schulman Rifka C , Zerwekh Joseph E , Reinus William R , Dempster David W , Whyte Michael P
Published: October 2006

A 52-year-old man presented with severe neck immobility and radiographic osteosclerosis. Elevated fluoride levels in serum, urine, and iliac crest bone revealed skeletal fluorosis. Nearly a decade of detailed follow-up documented considerable correction of the disorder after removal of the putative source of fluoride (toothpaste).

Introduction: Skeletal fluorosis, a crippling bone disorder, is rare in the United States, but affects millions worldwide. There are no data regarding its reversibility.

Materials and Methods: A white man presented in 1996 with neck immobility and worsening joint pains of 7-year duration. Radiographs revealed axial osteosclerosis. Bone markers were distinctly elevated. DXA of lumbar spine (LS), femoral neck (FN), and distal one-third radius showed Z scores of +14.3, +6.6, and −0.6, respectively. Transiliac crest biopsy revealed cancellous volume 4.5 times the reference mean, cortical width 3.2 times the reference mean, osteoid thickness 25 times the reference mean, and wide and diffuse tetracycline uptake documenting osteomalacia. Fluoride (F) was elevated in serum (0.34 and 0.29 mg/liter [reference range: <0.20]), urine (26 mg/liter [reference range: 0.2–1.1 mg/liter]), and iliac crest (1.8% [reference range: <0.1%]). Tap and bottled water were negative for F. Surreptitious ingestion of toothpaste was the most plausible F source.

Results: Monitoring for a decade showed that within 3 months of removal of F toothpaste, urine F dropped from 26 to 16 mg/liter (reference range: 0.2–1.1 mg/liter), to 3.9 at 14 months, and was normal (1.2 mg/liter) after 9 years. Serum F normalized within 8 months. Markers corrected by 14 months. Serum creatinine increased gradually from 1.0 (1997) to 1.3 mg/dl (2006; reference range: 0.5–1.4 mg/dl). Radiographs, after 9 years, showed decreased sclerosis of trabeculae and some decrease of sacrospinous ligament ossification. DXA, after 9 years, revealed 23.6% and 15.1% reduction in LS and FN BMD with Z scores of +9.3 and +4.8, respectively. Iliac crest, after 8.5 years, had normal osteoid surface and thickness with distinct double labels. Bone F, after 8.5 years, was 1.15% (reference range, <0.1), which was a 36% reduction (still 10 times the reference value). All arthralgias resolved within 2 years, and he never fractured, but new-onset nephrolithiasis occurred within 9 months and became a chronic problem.

Conclusions: With removal of F exposure, skeletal fluorosis is reversible, but likely impacts for decades. Patients should be monitored for impending nephrolithiasis.
Achieved Versus Intended Pulse Oximeter Saturation in Infants Born Less Than 28 Weeks' Gestation: The AVIOx Study
Authors: Hagadorn James I. , Furey Anne M. , Nghiem Tuyet-Hang , Schmid Christopher H. , Phelps Dale L. , Pillers De-Ann M. , Cole Cynthia H. ,   and the AVIOx Study Group
Published: October 2006

OBJECTIVE. The objective of this study was to document pulse oximeter saturation levels achieved in the first 4 weeks of life in infants who were born at <28 weeks' gestation, compared with the levels that were targeted by local policy, and examine factors that are associated with compliance with the target range.

METHODS. Infants who were <28 weeks' gestation and ≤96 hours of age were enrolled in a prospective, multicenter cohort study. Oximetry data were collected with masked signal-extraction oximeters for a 72-hour period in each of the first 4 weeks of life. Data were compared with the pulse oximeter saturation target range prescribed by local institutional policy. Factors that were associated with intended range compliance were identified with hierarchical modeling.

RESULTS. Fourteen centers from 3 countries enrolled 84 infants with mean ± SD birth weight of 863 ± 208 g and gestational age of 26 ± 1.4 weeks. Oxygen saturation policy limits ranged between 83% and 92% for lower limits and 92% and 98% for upper limits. For infants who received respiratory support, median pulse oximeter saturation level achieved was 95%. Center-specific medial levels were within the intended range at 12 centers. Centers maintained infants within their intended range 16% to 64% of the time but were above range 20% to 73% of the time. In hierarchical modeling, wider target ranges, higher target range upper limits, presence of a policy of setting oximeter alarms close to the target range limits, and lower gestational age were associated with improved target range compliance.

CONCLUSIONS. Success with maintaining the intended pulse oximeter saturation range varied substantially among centers, among patients within centers, and for individual patients over time. Most noncompliance was above the intended range. Methods for improving compliance and the effect of improved compliance on neonatal outcomes require additional research.
A Delphi Approach to Reach Consensus on Primary Care Guidelines Regarding Youth Violence Prevention
Authors: De Vos Edward , Spivak Howard , Hatmaker-Flanigan Elizabeth , Sege Robert D.
Published: October 2006

OBJECTIVE. Anticipatory guidance is a cornerstone of modern pediatric practice. In recognition of its importance for child well being, injury prevention counseling is a standard element of that guidance. Over the last 20 years, there has been growing recognition that intentional injury or violence is one of the leading causes of morbidity and mortality among youth. The US Surgeon General identified youth violence as a major public health issue and a top priority. Yet, only recently has the scope of injury prevention counseling been expanded to include violence. Pediatric health care providers agree that youth violence–prevention counseling should be provided, yet the number of topics available, the already lengthy list of other anticipatory guidance topics to be covered, developmental considerations, and the evidence base make the selection of an agreed-on set a considerable challenge. The purpose of this study was to systematically identify and prioritize specific counseling topics in violence prevention that could be integrated into anticipatory guidance best practice.

DESIGN. A modified electronic Delphi process was used to gain consensus among 50 national multidisciplinary violence-prevention experts. Participants were unaware of other participants' identities.

METHODS. The process consisted of 4 serial rounds of inquiry beginning with a broad open-ended format for the generation of anticipatory guidance and screening topics across 5 age groups (infant, toddler, school age, adolescent, and all ages). Each subsequent round narrowed the list of topics toward the development of a manageable set of essential topics for screening and counseling about positive youth development and violence prevention.

RESULTS. Forty-seven unique topics were identified, spanning birth to age 21 years. Topics cover 4 broad categories (building blocks): physical safety, parent centered, child centered, and community connection. Participants placed topics into their developmentally appropriate visit-based schedule and made suggestions for an appropriate topic reinforcement schedule. The resulting schedule provides topics for introduction and reinforcement at each visit.

CONCLUSIONS. The Delphi technique proved a useful approach for accessing expert opinion, for analyzing and synthesizing results, for achieving consensus, and for setting priorities among the numerous anticipatory guidance and assessment topics relevant for raising resilient, violence-free youth.
The Influence of Head Growth in Fetal Life, Infancy, and Childhood on Intelligence at the Ages of 4 and 8 Years
Authors: Gale Catharine R. , O'Callaghan Finbar J. , Bredow Maria , Martyn Christopher N. ,   the Avon Longitudinal Study of Parents and Children Study Team
Published: October 2006

OBJECTIVE. We investigated the effects of head growth prenatally, during infancy, and during later periods of development on cognitive function at the ages of 4 and 8 years.

METHODS. We studied 633 term-born children from the Avon Longitudinal Study of Parents and Children cohort whose head circumference was measured at birth and at regular intervals thereafter. Their cognitive function was assessed with the Wechsler Preschool and Primary Scale of Intelligence at the age of 4 years and with the Wechsler Intelligence Scale for Children at the age of 8 years. Linear regression analysis was used to calculate postnatal head growth between successive time points, conditional on previous size, and to examine the relationship between head growth during different periods of development and later IQ.

RESULTS. When the influence of head growth was distinguished for different periods, only prenatal growth and growth during infancy were associated with subsequent IQ. At 4 years, after adjustment for parental characteristics, full-scale IQ increased an average of 2.41 points for each 1-SD increase in head circumference at birth and 1.97 points for each 1-SD increase in head growth during infancy, conditional on head size at birth. At 8 years, head circumference at birth was no longer associated with IQ, but head growth during infancy remained a significant predictor, with full-scale IQ increasing an average of 1.56 points for each 1-SD increase in growth.

CONCLUSION. The brain volume a child achieves by the age of 1 year helps determine later intelligence. Growth in brain volume after infancy may not compensate for poorer earlier growth.
Gestational Age and Birth Weight in Relation to School Performance of 10-Year-Old Children: A Follow-up Study of Children Born After 32 Completed Weeks
Authors: Kirkegaard Ida , Obel Carsten , Hedegaard Morten , Henriksen Tine Brink
Published: October 2006

BACKGROUND. Children born extremely premature (<28 weeks) or with a very low birth weight (<1500 g) have a poorer school performance than children born at term with a normal birth weight. Much less is known about children of higher gestational ages and birth weights. We studied gestational age after 32 completed weeks and birth weight in relation to the child's school performance at the age of 10 years.

METHODS. We performed a follow-up study of 5319 children born between January 1990 and June 1992. We got the information on birth weight and gestational age from birth registration forms; when the children were between 9 and 11 years of age, we gathered information about their school performance (reading, spelling, and arithmetic) from questionnaires completed by the parents and the children's primary school teachers.

RESULTS. The association between birth weight and reading, as well as spelling and arithmetic disabilities, showed a graded relationship, with children who weighed <2500 g having the highest risks. Even children who weighed between 3000 and 3499 g had an increased risk of all 3 learning disabilities compared with children who weighed between 3500 and 4000 g. This association persisted after adjustment for potential cofounders and when the analyses were restricted to children born at term (39–40 weeks of gestation), suggesting that the association could not be explained by a low gestational age. Compared with children born at term, reading and spelling difficulties were more often found among children born at gestational age 33 to 36 weeks and 37 to 38 weeks, whereas there was no relation between gestational age and arithmetic difficulties.

CONCLUSIONS. Gestational age and birth weight were associated with school performance in the 10-year-old child and the association extended into the reference range of both birth weight and gestational age.
Food-Related Advertising on Preschool Television: Building Brand Recognition in Young Viewers
Authors: Connor Susan M.
Published: October 2006

OBJECTIVES. This study used content analysis to explore how much and what type of advertising is present in television programming aimed at toddlers and preschool-aged children and what methods of persuasion are being used to sell products and to promote brands to the youngest viewers.

METHODS. Four randomly selected, 4-hour blocks (9 am to 1 pm) were recorded in spring 2005 from each of 3 stations airing programming aimed specifically at toddlers and preschool-aged children (Public Broadcasting Service, Disney, and Nickelodeon). All content that aired in the spaces between programs was examined. Data recorded for food-related advertisements included the primary appeals used to promote products or brands, whether advertisements were aimed at children or adults, whether advertisements used primarily animation or live action, whether advertisements showed food, and whether licensed characters were used.

RESULTS. In 96 half-hour blocks of preschool programming, the 3 stations had a total of 130 food-related advertisements (1.354 food advertisements per half-hour). More than one half of all food advertisements (76 of 130 advertisements) were aimed specifically at children, and the majority of those were for fast food chains (50 advertisements) or sweetened cereals (18 advertisements). The primary advertising appeals used associated products with fun and happiness and/or with excitement and energy. Fast food advertisements in particular seemed to focus on building brand recognition and positive associations, through the use of licensed characters, logos, and slogans.

CONCLUSIONS. The majority of child-oriented food advertisements viewed seemed to take a branding approach, focusing on creating lifelong customers rather than generating immediate sales. Promotional spots on advertisement-supported (Nickelodeon) and sponsor-supported (Public Broadcasting Service and Disney) networks took similar approaches and used similar appeals, seeming to promote the equation that food equals fun and happiness.
Association Between Television, Movie, and Video Game Exposure and School Performance
Authors: Sharif Iman , Sargent James D.
Published: October 2006

BACKGROUND. The relationship between media exposure and school performance has not been studied extensively in adolescents.

OBJECTIVE. The purpose of this work was to test the relative effects of television, movie, and video game screen time and content on adolescent school performance.

METHODS. We conducted a population-based cross-sectional survey of middle school students (grades 5–8) in the Northeastern United States. We looked at weekday television and video game screen time, weekend television and video game screen time, cable movie channel availability, parental R-rated movie restriction, and television content restriction. The main outcome was self-report of school performance (excellent, good, average, or below average). We used ordinal logistic-regression analysis to test the independent effects of each variable, adjusting for demographics, child personality, and parenting style.

RESULTS. There were 4508 students who participated in the study; gender was equally represented, and 95% were white. In multivariate analyses, after adjusting for other covariates, the odds of poorer school performance increased with increasing weekday television screen time and cable movie channel availability and decreased with parental restriction of television content restriction. As compared with children whose parents never allowed them to watch R-rated movies, children who watched R-rated movies once in a while, sometimes, or all of the time had significantly increased cumulative odds of poorer school performance. Weekend screen time and video game use were not associated with school performance.

CONCLUSIONS. We found that both content exposure and screen time had independent detrimental associations with school performance. These findings support parental enforcement of American Academy of Pediatrics guidelines for media time (particularly weekdays) and content limits to enhance school success.
Randomized, Controlled Trial Comparing Synchronized Intermittent Mandatory Ventilation and Synchronized Intermittent Mandatory Ventilation Plus Pressure Support in Preterm Infants
Authors: Reyes Zenaida C. , Claure Nelson , Tauscher Markus K. , D'Ugard Carmen , Vanbuskirk Silvia , Bancalari Eduardo
Published: October 2006

BACKGROUND. Prolonged mechanical ventilation is associated with lung injury in preterm infants. In these infants, weaning from synchronized intermittent mandatory ventilation may be delayed by their inability to cope with increased respiratory loads. The addition of pressure support to synchronized intermittent mandatory ventilation can offset these loads and may facilitate weaning.

OBJECTIVE. The purpose of this work was to compare synchronized intermittent mandatory ventilation and synchronized intermittent mandatory ventilation plus pressure support in weaning from mechanical ventilation and the duration of supplemental oxygen dependency in preterm infants with respiratory failure.

METHODS. Preterm infants weighing 500 to 1000 g at birth who required mechanical ventilation during the first postnatal week were randomly assigned to synchronized intermittent mandatory ventilation or synchronized intermittent mandatory ventilation plus pressure support. In both groups, weaning followed a set protocol during the first 28 days. Outcomes were assessed during the first 28 days and until discharge or death.

RESULTS. There were 107 infants enrolled (53 synchronized intermittent mandatory ventilation plus pressure support and 54 synchronized intermittent mandatory ventilation). Demographic and perinatal data, mortality, and morbidity did not differ between groups. During the first 28 days, infants in the synchronized intermittent mandatory ventilation plus pressure support group reached minimal ventilator settings and were extubated earlier than infants in the synchronized intermittent mandatory ventilation group. Total duration of mechanical ventilation, duration of oxygen dependency, and oxygen need at 36 weeks' postmenstrual age alone or combined with death did not differ between groups. However, infants in synchronized intermittent mandatory ventilation plus pressure support within the 700- to 1000-g birth weight strata had a shorter oxygen dependency.

CONCLUSIONS. The results of this study suggest that the addition of pressure support as a supplement to synchronized intermittent mandatory ventilation during the first 28 days may play a role in reducing the duration of mechanical ventilation in extremely low birth-weight infants, and it may lead to a reduced oxygen dependency in the 700- to 1000-g birth weight strata.
Comparative Prognostic Utilities of Early Quantitative Magnetic Resonance Imaging Spin-Spin Relaxometry and Proton Magnetic Resonance Spectroscopy in Neonatal Encephalopathy
Authors: Shanmugalingam Shanthi , Thornton John S. , Iwata Osuke , Bainbridge Alan , O'Brien Frances E. , Priest Andrew N. , Ordidge Roger J. , Cady Ernest B. , Wyatt John S. , Robertson Nicola J.
Published: October 2006

OBJECTIVE. We sought to compare the prognostic utilities of early MRI spin-spin relaxometry and proton magnetic resonance spectroscopy in neonatal encephalopathy.

METHODS. Twenty-one term infants with neonatal encephalopathy were studied at a mean age of 3.1 days (range: 1–5). Basal ganglia, thalamic and frontal, parietal, and occipital white matter spin-spin relaxation times were determined from images with echo times of 25 and 200 milliseconds. Metabolite ratios were determined from an 8-mL thalamic-region magnetic resonance spectroscopy voxel (1H point-resolved spectroscopy; echo time 270 milliseconds). Outcomes were assigned at age 1 year as follows: (1) normal, (2) moderate (neuromotor signs or Griffiths developmental quotient of 75–84), (3) severe (functional neuromotor deficit or developmental quotient <75 or died). Predictive efficacies for differentiation between normal and adverse (combined moderate and severe) outcomes were compared by receiver operating characteristic curve analysis and logistic regression.

RESULTS. Thalamic and basal ganglia spin-spin relaxation times correlated positively with outcome and predicted adversity. Although thalamic and basal ganglia spin-spin relaxation times were prognostic of adversity, magnetic resonance spectroscopy metabolite ratios were better predictors, and, of these, lactate/N-acetylaspartate was most accurate.

CONCLUSIONS. Deep gray matter spin-spin relaxation time was increased in the first few days after birth in infants with an adverse outcome. Proton magnetic resonance spectroscopy was more prognostic than spin-spin relaxation time, with lactate/N-acetylaspartate the best measure. Nevertheless, both techniques were useful for early prognosis, and the potential superior spatial resolution of spin-spin relaxometry may define better the precise anatomic pattern of injury in the early days after birth.
Determinants and Impact of Generalist–Specialist Communication About Pediatric Outpatient Referrals
Authors: Stille Christopher J. , McLaughlin Thomas J. , Primack William A. , Mazor Kathleen M. , Wasserman Richard C.
Published: October 2006

OBJECTIVE. Effective communication between primary care and specialty physicians is essential for comanagement when children are referred to specialty care. We sought to determine rates of physician-reported communication between primary care physicians and specialists, the clinical impact of communication or its absence, and patient- and practice system–level determinants of communication for a cohort of children referred to specialty care.

METHODS. We enrolled 179 patients newly referred from general pediatricians in 30 community practices to 15 pediatric medical specialists in 5 specialties. Primary care physicians and specialists completed questionnaires at the first specialty visit and 6 months later. Questions covered communication received by primary care physicians and specialists, its impact on care provision, system characteristics of practices, and roles of physicians in treatment. We used multivariate logistic regression to determine associations between practice system and patient characteristics and the dependent variable of reported primary care physician–specialist communication.

RESULTS. Specialists reported communication from referring primary care physicians for only 50% of initial referrals, whereas primary care physicians reported communication from specialists after 84% of initial consultations. Communication was strongly associated with physicians' reported ability to provide optimal care. System characteristics associated with reported primary care physician–specialist communication were computer access to chart notes and lack of delays in receipt of information. Associated patient characteristics included non-Medicaid insurance, no additional specialists seen, and specialty to which referred. Physicians favored comanagement of referred patients in more than two thirds of the cases.

CONCLUSIONS. Although a prerequisite for optimal care, communication from primary care physicians to specialists is frequently absent. Interventions should promote widely accessible clinical information systems and target children with complex needs and public insurance.
Risk Reduction for Adverse Drug Events Through Sequential Implementation of Patient Safety Initiatives in a Children's Hospital
Authors: Leonard Michael S. , Cimino Michael , Shaha Steven , McDougal Sandra , Pilliod Joanne , Brodsky Linda
Published: October 2006

BACKGROUND. Medication management is a complex, multifaceted system. Prescribing errors occur upstream in the process, and as such, their effects can be perpetuated, and sometimes even exacerbated, in subsequent steps. These errors place patients at risk of adverse drug events. Children, especially young infants, are at particular risk because of their size, unique physiology, and immature ability to metabolize drugs.

OBJECTIVE. The purpose of this study was to reduce the risk of harm to children resulting from prescribing errors.

METHODS. We sequentially implemented patient safety initiatives over a 1-year time frame at a pediatric tertiary care academic facility. The initiatives included an educational Web site with competency examination, distribution of a personal digital assistant-based standardized dosing reference, a zero-tolerance policy for incomplete or incorrect medication orders, prescriber performance feedback, and presentation of outcome data at citywide grand rounds. A total of 8718 orders were collected and analyzed to assess the impact of these initiatives.

RESULTS. The absolute risk reduction from prescribing errors was 38 per 100 orders, with a relative risk reduction of 49%. Web-based education with point-of-care drug references and a zero-tolerance policy for incomplete or incorrect orders were most effective in decreasing potential adverse drug events. Documentation of appropriate weight-based dosing and indication for therapy increased by 24% and 42%, respectively.

CONCLUSIONS. Process-improvement initiatives focusing on prescriber education and behavior modification can reduce the risk of harm to pediatric patients from prescribing errors.