bluuebunny/crossref_metadata_2025_split huggingface dataset:
Earliest Appropriate Time for Administering Neurobehavioral Assessment in Newborn Infants
Authors: Xu Yingying , Yolton Kimberly , Khoury Jane 
Published: December 2010

OBJECTIVE:
To assess the effect of examination time on newborn neurobehavioral examinations administered within 48 hours of delivery and to identify the earliest appropriate time for performing the assessment.

METHODS:
We analyzed data from neurobehavioral examinations on 324 newborns using the NICU Network Neurobehavioral Scale (NNNS). Trends over examination time and cumulative percentage within published normal ranges were analyzed to identify the earliest appropriate time for administering the examination. Ordinal logistic regression and multivariate regression were used for testing and defining the earliest appropriate time for administering the examination without being influenced by acute effects of labor and delivery while controlling for several potential confounding factors.

RESULTS:
The arousal, excitability, lethargy, quality-of-movement, hypotonicity, and nonoptimal-reflexes scales were sensitive to timing of the examination. Results of ordinal logistic regression showed that 20 hours after delivery seemed to be the earliest appropriate time for administering newborn NNNS examinations. The proportion of NNNS scores within the normal range increased with time significantly when the examination was made less than 20 hours after delivery (n = 148) (odds ratio: 1.12 [95% confidence interval: 1.02–1.23]), but there was no longer significant association with time of examination after 20 hours (n = 176) (odds ratio: 1.04 [95% confidence interval: 0.99–1.09]). This result was confirmed by multivariate regression.

CONCLUSIONS:
We recommend 20 hours after delivery as the earliest appropriate time for administering newborn NNNS examinations to obtain results reflecting outcomes that are a representative assessment of newborn neurobehavior and not contaminated by acute effects of labor and delivery.
Enhanced Monitoring Improves Pediatric Transport Outcomes: A Randomized Controlled Trial
Authors: Stroud Michael H. , Prodhan Parthak , Moss Michele , Fiser Richard , Schexnayder Stephen , Anand Kanwaljeet 
Published: December 2010

BACKGROUND:
The “golden-hour” concept has led to emphasis on speed of patient delivery during pediatric interfacility transport. Timely intervention, in addition to enhanced monitoring during transport, is the key to improved outcomes in critically ill patients. Taking the ICU to the patient may be more beneficial than rapid delivery to a tertiary care center.

METHODS:
The Improved Monitoring During Pediatric Interfacility Transport trial was the first randomized controlled trial in the out-of-hospital pediatric transport environment. It was designed to determine the impact of improved blood pressure monitoring during pediatric interfacility transport and the effect on clinical outcomes in patients with systemic inflammatory response syndrome and moderate-to-severe head trauma. Patients in the control group had their blood pressure monitored intermittently with an oscillometric device; those in the intervention group had their blood pressure monitored every 12 to 15 cardiac contractions with a near-continuous, noninvasive device.

RESULTS:
Between May 2006 and June 2007, 1995, consecutive transport patients were screened, and 94 were enrolled (48 control, 46 intervention). Patients in the intervention group received more intravenous fluid (19.8 ± 22.2 vs 9.9 ± 9.9 mL/kg; P = .01), had a shorter hospital stay (6.8 ± 7.8 vs 10.9 ± 13.4 days; P = .04), and had less organ dysfunction (18 of 206 vs 32 of 202 PICU days; P = .03).

CONCLUSIONS:
Improved monitoring during pediatric transport has the potential to improve outcomes of critically ill children. Clinical trials, including randomized controlled trials, can be accomplished during pediatric transport. Future studies should evaluate optimal equipment, protocols, procedures, and interventions during pediatric transport, aimed at improving the clinical and functional outcomes of critically ill patients.
Diarrhea-Associated Hospitalizations Among US Children Over 2 Rotavirus Seasons After Vaccine Introduction
Authors: Yen Catherine , Tate Jacqueline E. , Wenk Joshua D. , Harris J. Mitchell , Parashar Umesh D. 
Published: December 2010

OBJECTIVE:
After implementation of rotavirus vaccination in 2006, large decreases in rates of severe diarrhea among US children occurred in 2007–2008. We ascertained whether these decreases were sustained in 2008–2009.

METHODS:
We examined hospital discharge data from a national network of pediatric hospitals and compared all-cause diarrhea-related and rotavirus-specific hospitalizations in 3 prevaccine rotavirus seasons (2003–2006) with those in 2 postvaccine seasons (2007–2008 and 2008–2009) among children &lt;5 years of age. We defined rotavirus seasons using data from a national laboratory surveillance network.

RESULTS:
At 62 consistently reporting hospitals, a median of 15 645 diarrhea-related hospitalizations (range: 14 881–16 884 hospitalizations) occurred each rotavirus season among children &lt;5 years of age in 2003–2006. Compared with this median, all-cause diarrhea-related hospitalizations decreased by 50% (n = 7760) in 2007–2008 and by 29% (n = 11 039) in 2008–2009. In 2007–2008, reductions of 47% to 55% were seen for all age groups, including vaccine-ineligible children ≥2 years of age (48%). In 2008–2009, these reductions decreased in magnitude, especially among children ≥2 years of age (17%). Decreases in 2007–2008 and 2008–2009 were similar in the Northeast and West, but decreases were smaller in 2008–2009, compared with 2007–2008, in the Midwest and South.

CONCLUSIONS:
Compared with prevaccine seasons, decreases in diarrhea- and rotavirus-associated hospitalizations seen in 2007–2008 were sustained in 2008–2009 but were somewhat smaller. Given the variability in diarrhea-related hospitalization trends over the 2 postvaccine seasons according to age group and region, continued surveillance is required for full assessment of the impact of rotavirus vaccination.
Contrasting Parents' and Pediatricians' Perspectives on Shared Decision-Making in ADHD
Authors: Fiks Alexander G. , Hughes Cayce C. , Gafen Angela , Guevara James P. , Barg Frances K. 
Published: December 2010

OBJECTIVE:
The goal was to compare how parents and clinicians understand shared decision-making (SDM) in attention-deficit/hyperactivity disorder (ADHD), a prototype for SDM in pediatrics.

METHODS:
We conducted semi-structured interviews with 60 parents of children 6 to 12 years of age with ADHD (50% black and 43% college educated) and 30 primary care clinicians with varying experience. Open-ended interviews explored how pediatric clinicians and parents understood SDM in ADHD. Interviews were taped, transcribed, and then coded. Data were analyzed by using a modified grounded theory approach.

RESULTS:
Parents and clinicians both viewed SDM favorably. However, parents described SDM as a partnership between equals, with physicians providing medical expertise and the family contributing in-depth knowledge of the child. In contrast, clinicians understood SDM as a means to encourage families to accept clinicians' preferred treatment. These findings affected care because parents mistrusted clinicians whose presentation they perceived as biased. Both groups discussed how real-world barriers limit the consideration of evidence-based options, and they emphasized the importance of engaging professionals, family members, and/or friends in SDM. Although primary themes did not differ according to race, white parents more commonly received support from medical professionals in their social networks.

CONCLUSIONS:
Despite national guidelines prioritizing SDM in ADHD, challenges to implementing the process persist. Results suggest that, to support SDM in ADHD, modifications are needed at the practice and policy levels, including clinician training, incorporation of decision aids and improved strategies to facilitate communication, and efforts to ensure that evidence-based treatment is accessible.
Effect of Defibrillation Energy Dose During In-Hospital Pediatric Cardiac Arrest
Authors: Meaney Peter A. , Nadkarni Vinay M. , Atkins Dianne L. , Berg Marc D. , Samson Ricardo A. , Hazinski Mary Fran , Berg Robert A. ,   for the American Heart Association National Registry of Cardiopulmonary Resuscitation Investigators
Published: December 2010

OBJECTIVE:To examine the effectiveness of initial defibrillation attempts. We hypothesized that (1) an initial shock dose of 2 ± 10 J/kg would be less effective for terminating fibrillation than suggested in published historical data and (2) a 4 J/kg shock dose would be more effective.PATIENTS AND METHODS:This was a National Registry of Cardiopulmonary Resuscitation prospective, multisite, observational study of in-hospital pediatric (aged ≤18 years) ventricular fibrillation or pulseless ventricular tachycardia cardiac arrests from 2000–2008. Termination of ventricular fibrillation or pulseless ventricular tachycardia and event survival after initial shocks of 2 J/kg were compared with historic controls and a 4 J/kg shock dose.RESULTS:Of 266 children with 285 events, 173 of 285 (61%) survived the event and 61 of 266 (23%) survived to discharge. Termination of fibrillation after initial shock was achieved for 152 of 285 (53%) events. Termination of fibrillation with 2 ± 10 J/kg was much less frequent than that seen among historic control subjects (56% vs 91%; P &lt; .001), but not different than 4 J/kg. Compared with 2 J/kg, an initial shock dose of 4 J/kg was associated with lower rates of return of spontaneous circulation (odds ratio: 0.41 [95% confidence interval: 0.21–0.81]) and event survival (odds ratio: 0.42 [95% confidence interval: 0.18–0.98]).CONCLUSIONS:The currently recommended 2 J/kg initial shock dose for in-hospital cardiac arrest was substantially less effective than previously published. A higher initial shock dose (4 J/kg) was not associated with superior termination of ventricular fibrillation or pulseless ventricular tachycardia or improved survival rates. The optimal pediatric defibrillation dose remains unknown.
A Prospective, Randomized, Double-Blind Comparison of 2% Mepivacaine With 1 : 20,000 Levonordefrin Versus 2% Lidocaine With 1 : 100,000 Epinephrine for Maxillary Infiltrations
Authors: Lawaty Ingrid , Drum Melissa , Reader Al , Nusstein John 
Published: December 2010

Abstract
The purpose of this prospective, randomized, double-blind crossover study was to compare the anesthetic efficacy of 2% mepivacaine with 1 : 20,000 levonordefrin versus 2% lidocaine with 1 : 100,000 epinephrine in maxillary central incisors and first molars. Sixty subjects randomly received, in a double-blind manner, maxillary central incisor and first molar infiltrations of 1.8 mL of 2% mepivacaine with 1 : 20,000 levonordefrin and 1.8 mL of 2% lidocaine with 1 : 100,000 epinephrine at 2 separate appointments spaced at least 1 week apart. The teeth were electric pulp tested in 2-minute cycles for a total of 60 minutes. Anesthetic success (obtaining 2 consecutive 80 readings with the electric pulp tester within 10 minutes) was not significantly different between 2% mepivacaine with 1 : 20,000 levonordefrin and 2% lidocaine with 1 : 100,000 epinephrine for the central incisor and first molar. However, neither anesthetic agent provided an hour of pulpal anesthesia.
Preventing Suicide in Young People: Systematic Review
Authors: Robinson Jo , Hetrick Sarah E. , Martin Cathy 
Published: December 2010

Objective: Risk of suicide attempt, suicidal ideation and deliberate self-harm is high among young people, yet limited evidence exists regarding effective interventions, particularly from randomized controlled trials. The aim of this study was to conduct a systematic review and meta-analysis of all randomized controlled trials testing interventions for adolescents and young adults who have presented to a clinical setting with any of these behaviours. Methods: The Cochrane Central Register of Controlled Trials, Medline, EMBASE and PsycINFO were searched for articles published from 1980 to June 2010. The following keywords formed the basis of the search strategy: ‘self-injurious behaviour’, ‘attempted suicide’, ‘suicide’, ‘suicidal behaviour’, ‘self-inflicted wounds’, ‘self-mutilation’, ‘self-harm’. We also hand searched conference abstracts from two major suicide prevention conferences and the reference lists of all retrieved articles and previous reviews. Results: There were 15 trials included in the review, with six ongoing trials also identified. In general, the reporting of the conduct of trials was poor, making it difficult to assess the risk of bias. The reporting of outcome data was inconsistent. No differences were found between treatment and control groups except in one study that found a difference between individual cognitive behavioural therapy and treatment as usual. Conclusion: The evidence regarding effective interventions for adolescents and young adults with suicide attempt, deliberate self-harm or suicidal ideation is extremely limited. Many more methodologically rigorous trials are required. However, in the meantime CBT shows some promise, but further investigation is required in order to determine its ability to reduce suicide risk among young people presenting to clinical services.
Cognitive Dysfunction in Post-Traumatic Obsessive–Compulsive Disorder
Authors: Borges Manuela C. , Braga Daniela T. , Iêgo Sandro , D'Alcante Carina C. , Sidrim Ilduara , Machado Maria Cristiana , Pinto Paula S. P. , Cordioli Aristides V. , do Rosário Maria Conceição , Petribú Kátia , Mendlowicz Mauro V. , Mari Jair J. , Miguel Eurípedes C. , Fontenelle Leonardo F. 
Published: December 2010

Objective: To investigate whether patients who develop obsessive–compulsive disorder (OCD) after posttraumatic stress disorder, i.e. post-traumatic OCD (PsT-OCD), display a distinctive neurocognitive pattern of dysfunction. Methods: Patients with PsT-OCD (n = 16), pre-traumatic OCD (PrT-OCD) (n = 18), non-traumatic OCD (NonT-OCD) (n = 67) and healthy controls (n = 17) had their performance compared on the following neuropsychological tests: the Wisconsin Card Sorting Test, the Iowa Gambling Task, the Wechsler Memory Scale Logical Memory, the Brief Visual Memory Test – Revised, and the Wechsler Abbreviated Scale for Intelligence. Results: Patients with OCD, as a group, were characterized by poor set-shifting abilities and impaired verbal and visuospatial memories. Impaired set-shifting abilities were found to correlate with the severity of obsessive–compulsive symptoms in all groups of patients with OCD, with the exception of PsT-OCD. Only patients with PsT-OCD were characterized by impaired visuospatial recognition, which was found to correlate with poor set-shifting abilities in this particular group of patients, but not in individuals with other types of OCD or in healthy controls. Conclusions: Our study suggests that PsT-OCD is associated with a distinctive pattern of neurocognitive dysfunction, thus providing support for a different subtype of OCD.
<i>Nitellopsis obtusa</i> (Desv.) J. Groves : A new charophytic record for Bangladesh
Authors: Naz Sabrina , Diba Nasrin Jahan , Zaman M. 
Published: December 2010

Not available. Keywords: Nitellopsis obtusa; Characeae; New record; Bangladesh.DOI: 10.3329/bjpt.v17i2.6701Bangladesh J. Plant Taxon. 17(2): 203-207, 2010 (December)
USING NEUROFUZZY NETWORKS TO MIMIC ANESTHESIOLOGIST KNOWLEDGE IN DECISION MAKING ON PROPOFOL ADMINISTRATION
Authors: Wu Hung-Shan , Hsu Huai-Yuan , Chang Chia-Chi , Hsiao Tzu-Chien 
Published: December 2010

The purpose of anesthesia is to maintain a steady state for specific clinical operations. In general, one anesthesiologist utilizes anesthetic drugs and anesthetic skills to make sure the depth of anesthesia (DOA) carefully in proper level such that a patient will not perceive pain during surgical procedure. It is complex to be treated as an art to reduce all sensations, whether it is the sense of pain, touch, temperature, or position. In this paper, utilizing the self-learning and the human-like reasoning ability of neurofuzzy networks, we design the virtual anesthesiologist to accommodate the knowledge and the experience of the real anesthesiologist in anesthetic drug administration. The heart rate and bispectral index are used as the input variables and the bispectral index target value (BIStarget) heart is treated as output variable. The anesthesia simulator is adopted to verify the virtual anesthesiologist's ability and to explore the patient status of the simulator. The pilot experiments and extended experiments have been carried out. The result showed that the virtual anesthesiologist was able to support the decision making on the maintenance of the patient DOA at BIStarget 60.
Plasmacytoid Dendritic Cell Dichotomy: Identification of IFN-α Producing Cells as a Phenotypically and Functionally Distinct Subset
Authors: Björck Pia , Leong H. Xianne , Engleman Edgar G. 
Published: December 2010

Abstract
Plasmacytoid dendritic cells (pDC) produce large amounts of type I IFN in response to invading pathogens, but can also suppress immune responses and promote tolerance. In this study, we show that in mice, these functions are attributable to two distinct pDC subsets, one of which gives rise to the other. CD9posSiglec-Hlow pDC secrete IFN-α when stimulated with TLR agonists, induce CTLs, and promote protective antitumor immunity. By contrast, CD9negSiglec-Hhigh pDC secrete negligible amounts of IFN-α, induce Foxp3+ CD4+ T cells, and fail to promote antitumor immunity. Although newly formed pDC in the bone marrow are CD9pos and are capable of producing IFN-α, after these cells traffic to peripheral tissues, they lose CD9 expression and the ability to produce IFN-α. We propose that newly generated pDC mobilized from the bone marrow, rather than tissue-resident pDC, are the major source of IFN-α in infected hosts.
IL-23–Mediated Psoriasis-Like Epidermal Hyperplasia Is Dependent on IL-17A
Authors: Rizzo Heather L. , Kagami Shinji , Phillips Kevin G. , Kurtz Stephen E. , Jacques Steven L. , Blauvelt Andrew 
Published: December 2010

Abstract
IL-23 and Th17 cells producing IL-17A and IL-22 are found in excess in skin affected by psoriasis. Previous studies showed that IL-22, but not IL-17A, mediates psoriasis-like epidermal hyperplasia following recombinant murine (rm)IL-23 injections into skin. To further investigate the role of IL-17A, ears of mice were injected with rmIL-23. Investigators blinded to treatment conditions and mouse genotypes measured ear swelling, epidermal thickness, and cytokine expression. In wild-type (WT) mice, rmIL-23 induced ear swelling (p &lt; 0.001, all p values versus saline), epidermal hyperplasia by histology (p &lt; 0.001) and confocal microscopy (p &lt; 0.004), and expression of both IL-17A and IL-22. As expected, rmIL-23 injections into IL-22−/− mice resulted in relatively little ear swelling (p &lt; 0.09) and epidermal hyperplasia (p &lt; 0.51 by histology and p &lt; 0.75 by confocal microscopy). Notably, rmIL-23 injections into IL-17A−/− mice produced little ear swelling (p &lt; 0.001, versus IL-23–injected WT mice) and epidermal hyperplasia (p &lt; 0.001 by histology and p &lt; 0.005 by confocal microscopy), even though IL-22 was readily induced in these mice. Furthermore, systemic delivery of blocking Abs directed against either IL-22 or IL-17A completely inhibited IL-23–induced epidermal hyperplasia in WT mice. These results demonstrate that IL-17A, like IL-22, is a downstream mediator for IL-23–induced changes in murine skin and that both of these Th17 cytokines are necessary to produce IL-23–mediated skin pathology. IL-17A may represent an attractive therapeutic target in individuals with psoriasis by blocking downstream effects of IL-23.
IL-17 Contributes to Cell-Mediated Defense against Pulmonary Yersinia pestis Infection
Authors: Lin Jr-Shiuan , Kummer Lawrence W. , Szaba Frank M. , Smiley Stephen T. 
Published: December 2010

Abstract
Pneumonic plague is one of the world’s most deadly infectious diseases. The causative bacterium, Yersinia pestis, has the potential to be exploited as a biological weapon, and no vaccine is available. Vaccinating B cell-deficient mice with D27-pLpxL, a live attenuated Y. pestis strain, induces cell-mediated protection against lethal pulmonary Y. pestis challenge. In this article, we demonstrate that prime/boost vaccination with D27-pLpxL confers better protection than prime-only vaccination. The improved survival does not result from enhanced bacterial clearance but is associated with increased levels of IL-17 mRNA and protein in the lungs of challenged mice. The boost also increases pulmonary numbers of IL-17–producing CD4 T cells. Interestingly, most of these cells simultaneously produce canonical type 1 and type 17 cytokines; most produce IL-17 and TNF-α, and many produce IL-17, TNF-α, and IFN-γ. Neutralizing IL-17 counteracts the improved survival associated with prime/boost vaccination without significantly impacting bacterial burden. Thus, IL-17 appears to mediate the enhanced protection conferred by booster immunization. Although neutralizing IL-17 significantly reduces neutrophil recruitment to the lungs of mice challenged with Y. pestis, this impact is equally evident in mice that receive one or two immunizations with D27-pLpxL, suggesting it cannot suffice to account for the improved survival that results from booster immunization. We conclude that IL-17 plays a yet to be identified role in host defense that enhances protection against pulmonary Y. pestis challenge, and we suggest that pneumonic plague vaccines should aim to induce mixed type 1 and type 17 cellular responses.
CD4 T Cells Promote Rather than Control Tuberculosis in the Absence of PD-1–Mediated Inhibition
Authors: Barber Daniel L. , Mayer-Barber Katrin D. , Feng Carl G. , Sharpe Arlene H. , Sher Alan 
Published: December 2010

Abstract
Although CD4 T cells are required for host resistance to Mycobacterium tuberculosis, they may also contribute to pathology. In this study, we examine the role of the inhibitory receptor PD-1 and its ligand PD-L1 during M. tuberculosis infection. After aerosol exposure, PD-1 knockout (KO) mice develop high numbers of M. tuberculosis-specific CD4 T cells but display markedly increased susceptibility to infection. Importantly, we show that CD4 T cells themselves drive the increased bacterial loads and pathology seen in infected PD-1 KO mice, and PD-1 deficiency in CD4 T cells is sufficient to trigger early mortality. PD-L1 KO mice also display enhanced albeit less severe susceptibility, indicating that T cells are regulated by multiple PD ligands during M. tuberculosis infection. M. tuberculosis-specific CD8 T cell responses were normal in PD-1 KO mice, and CD8 T cells only had a minor contribution to the exacerbated disease in the M. tuberculosis-infected PD-1 KO and PD-L1 KO mice. Thus, in the absence of the PD-1 pathway, M. tuberculosis benefits from CD4 T cell responses, and host resistance requires inhibition by PD-1 to prevent T cell-driven exacerbation of the infection.