bluuebunny/crossref_metadata_2025_split huggingface dataset:
A randomized controlled trial of azithromycin and amoxycillin/clavulanate in the management of subacute childhood rhinosinusitis
Authors: Ng Dkk , Chow P‐Y , Leung Lck , Chau K‐W , Chan E , Ho Jcs 
Published: March 2003

Objective: Subacute childhood rhinosinusitis is a disorder commonly seen in children with allergic rhinitis. Antibiotics have been recommended as a major component of the treatment regime. The objective of the present study was to compare the effectiveness of a 3‐day course of azithromycin and a 2‐week course of amoxycillin/clavulanate in the treatment of subacute childhood rhinosinusitis. Methodology: A randomized single‐blinded control study of subacute rhinosinusitis was conducted, comparing a 3‐day course of azithromycin and a 2‐week course of amoxycillin/clavulanate. Inclusion criteria were children aged between 5 and 16 years, duration of nasal blockage or discharge between 30 and 120 days, and abnormal sinus radiographs. All enrolled children were prescribed budesonide nasal spray (Rhinocort Aqua Nasal Spray, Astra Pharmaceuticals, Sodertalje, Sweden) as adjuvant treatment. Results: Forty‐two children were recruited into the study and one defaulted on follow‐up. Failure occurred in 6 of 20 for the azithromycin group and 5 of 21 for the amoxycillin/clavulanate group. The odds ratio was 1.46 (95%CI 0.37–5.80, P = 0.73). No relapse occurred in azithromycin group and 5 of 21 in amoxycillin/clavulanate group. The odds ratio was 0.16 (95%CI 0.017–1.51, P = 0.18). Both antibiotics were well tolerated, however, two children, one from each group, complained of mild transient epigastric discomfort. Conclusions: This small study did not provide evidence of a difference between 14 days of amoxycillin/clavulanate and 3 days of azithromycin. Larger studies will be needed to determine which, if any, antibiotic regimen should be used in treating subacute childhood rhinosinusitis.
Regional differences in outcome for very low‐birthweight infants: Do they persist at 7–8 years of age?
Authors: Darlow Ba , Horwood Lj , Mogridge N 
Published: March 2003

Objective: To determine whether regional differences in early neonatal morbidity in a national cohort of very low‐birthweight (VLBW) infants persisted at 7–8 years of age. Methods: Perinatal data collected prospectively from birth on all VLBW infants born in New Zealand in 1986 and admitted to a neonatal unit included the hospital principally caring for the infant: hospitals A–D being level III hospitals and ‘Other’ including the smallest level III and all level II hospitals. At 7–8 years of age, 298 surviving children (96% survivors living in New Zealand) were assessed at a home visit. Parents were given a comprehensive questionnaire to complete, the children underwent a visual examination and were tested with the Revised Wechsler Intelligence Scale for Children and the child’s teacher was sent a questionnaire to complete. Results: Neonatal survival was significantly greater in the two largest hospitals (A and B) and this difference in survival remained at 7–8 years of age after adjustment for perinatal factors (P < 0.05). There were no differences between hospitals in risks of long‐term sensorineural disability and behavioural or educational outcomes. There were interhospital differences in rates of visual problems and, after adjustment for confounding factors, there remained a marginally significant (P = 0.06) increased risk of myopia in hospital D. Conclusions: Despite differences in early morbidity favouring larger hospitals, there were no substantive differences in long‐term (7–8 years) outcomes across a range of measures in this national cohort of VLBW infants.
Acquired central diabetes insipidus in children: A 12‐year Brisbane experience
Authors: Al‐Agha AE , Thomsett MJ , Ratcliffe JF , Cotterill AM , Batch JA 
Published: March 2003

Objective: To study the clinical, endocrine and radiological features and progress of children presenting with acquired diabetes insipidus (CDI). Methodology: Chart review of children presenting because of CDI to Brisbane paediatric endocrine clinics between 1987 and 1999. Results: Thirty‐nine children (female/male ratio 21/18) aged 0.1–15.4 years (mean age 6.7 years) were identified. Aetiologies were head trauma or familial in eight cases (20.5%) each, central nervous system (CNS) tumours in five cases (12.8%), CNS malformations in four cases (10.2%), histiocytosis in three cases (7%) and hypoxia and infection in two cases (5.1%) each. Seven cases (17.9%) remain undiagnosed. Of the 32 (82%) cases with isolated anti‐diuretic hormone deficiency at presentation, 24 cases (61.5%) experienced no further endocrine deficit. Additional endocrine deficits occurred mainly in the tumour or undiagnosed groups. On follow‐up brain magnetic resonance imaging (MRI) scans in the seven undiagnosed cases, six patients had mild or no change and one patient had marked improvement of MRI findings. These changes occurred 10–48 months (mean 18 months) after presentation. Conclusions: Children without an aetiological diagnosis for the uncommon condition of acquired CDI require careful follow‐up. More intensive investigation at presentation (e.g. estimation of cerebrospinal fluid human chorionic gonadotrophin) promises to lessen the number of such cases. Pituitary stalk biopsies should be reserved for those patients with progressive MRI changes. If these changes do not occur early, our experience suggests that follow‐up MRI scans may need to be performed only yearly.
Specific dangers associated with infants sleeping on sofas
Authors: Byard RW , Beal S , Blackbourne B , Nadeau JM , Krous HF 
Published: March 2003

Aim: A study was undertaken to examine specific circumstances that may lead to accidental asphyxial deaths in infants on sofas. Methods: Coronial files in South Australia (Australia) from 1989 to 1998, and files at the Office of the Medical Examiner in San Diego County (USA) from 1991 to 1998 were searched for all cases of infant deaths occurring on sofas. Results: A total of 10 cases with complete death scene descriptions were found. Four deaths were attributed to sudden infant death syndrome and six deaths to accidental asphyxia, of which four involved shared sleeping with an adult. Lethal circumstances involved infants being overlayed by an adult (n = 2), wedged between an adult and the back of a sofa (n = 1), sleeping with an intoxicated/sedated adult (n = 2), wedged between pillows and the back of a sofa (n = 1), and wedged into the back of a sofa (n = 1). Conclusions: Although shared sleeping of an adult with an infant on a sofa may result in accidental asphyxia, there is also the potential for wedging and accidental asphyxia of infants sleeping alone on a sofa. For this reason the use of sofas for both shared and solitary infant sleeping is discouraged.
Hypocarbia in the ventilated preterm infant and its effect on intraventricular haemorrhage and bronchopulmonary dysplasia
Authors: Erickson SJ , Grauaug A , Gurrin L , Swaminathan M 
Published: March 2003

Objective:  To examine the relationship between PaCO2 levels in ventilated very preterm infants and (i) the incidence of severe intraventricular haemorrhage (IVH) and periventricular leukomalacia (PVL); and (ii) bronchopulmonary dysplasia (BPD).Methods:  A retrospective cohort analysis of preterm infants comparing PaCO2 levels with the incidence of severe IVH/PVL and BPD was carried out on patients born at less than 29 weeks gestation from 1992 to 1994 and admitted to the tertiary neonatal intensive care unit at the King Edward Memorial Hospital (314 infants). During the first 96 h, PaCO2 levels were examined including lowest and highest PaCO2 levels, mean PaCO2 levels and duration of hypocarbia both pre‐ and post‐surfactant administration.Results:  Of the 314 infants, there were 40 early neonatal deaths (less than 48 h) who were not included in the analysis. Of the 274 surviving infants, 72 (26%) infants had severe IVH. Infants whose PaCO2 fell below 30 mmHg at any stage in the first 48 h of life had an increased risk of severe IVH or PVL (odds ratio 2.38; 95% CI 1.27−4.49; P = 0.007). Of the 265 survivors to 36 weeks corrected gestational age, 134 (51%) had BPD. Infants with at least three PaCO2 values less than 30 mmHg in the first 24 h of life had an increased risk of BPD (odds ratio 2.21; 95% CI 1.05−4.57; P = 0.036).Conclusions:  The risk of severe IVH/PVL was significantly increased by hypocarbia. There was also an association between hypocarbia and BPD, particularly when hypocarbia was prolonged. These findings suggest that avoidance of hypocarbia may reduce the incidence of severe IVH/PVL and BPD in preterm infants.
Evaluation of a community intervention programme for preschool behaviour problems
Authors: Elliot J , Prior M , Merrigan C , Ballinger K 
Published: March 2003

Objectives: To evaluate an early intervention project focused on improving child prereading skills and parent behaviour‐management skills, for 4‐year‐old children in the western suburbs of Melbourne (Victoria, Australia). Methodology: Following screening of a large sample of preschoolers, four groups were constructed: (i) children receiving a phonological skills‐based prereading package in their normal preschool programme; (ii) children whose parents attended six sessions of child behaviour management skill training; (iii) children who received both interventions; and (iv) a control group. Pre‐, post‐, 1 and 2 year follow‐up measures were taken to assess effects on child behavioural and learning adjustment. Results and Conclusions: This community based intervention resulted in positive effects, despite being of low intensity, in achieving significantly less hyperactive/distractable behaviour in children from the combined intervention group at 2 years postintervention. Anxiety problems were also reduced at the post‐treatment phase. The prereading package did not demonstrate any effects on reading skills and was deemed to be insufficiently intensive to affect a population of disadvantaged preschoolers. This universal‐type of intervention was well accepted by the community, but there is need for further effort to increase recruitment of families of at‐risk children into such programmes.
Pseudomonas fluorescens pseudobacteraemia: A cautionary lesson
Authors: Smith J , Ashhurst‐Smith C , Norton R 
Published: March 2003

Objectives: To describe an outbreak of pseudobacteraemia caused by Pseudomonas
fluorescens in a paediatric population. To document and highlight the effect this outbreak had on clinical management and the steps taken to determine the source. Methods: A clinical and microbiological investigation was carried out into
a cluster of 38 pseudobacteraemias caused by Pseudomonas fluorescens in paediatric patients over a 10 month period. Results: The source of the outbreak of pseudobacteraemia was found to be
contaminated lithium heparin tubes, which were being filled prior to the filling
of the blood culture bottle. Cultures of the same tubes yielded Pseudomonas fluorescens. As a result of the initial positive blood cultures, clinical management was altered in 18 cases. A staff education programme was instituted and eventually resulted in a cessation of the pseudobacteraemia. Conclusions: Pseudobacteraemias are a major cause of potentially inappropriate therapy in febrile children. Attention to detail in the collection of blood cultures can help reduce this outcome. Staff involved in the collection of blood cultures need to be aware of this potential source of contamination.
Iatrogenic injury in childhood staphylococcal scalded skin syndrome
Authors: Holme SA , Davies JH , Mills CM 
Published: March 2003

Abstract: Staphylococcal scalded skin syndrome (SSSS) may cause significant morbidity in children. It is common practice for adhesive occlusive dressings to be used to apply topical local anaesthetic prior to venepuncture. We report two cases in which removal of these dressings from children with SSSS caused injury and discomfort in areas previously free from blistering. We recommend that an alternative method of topical anaesthetic application is used to minimize skin trauma in these patients.
Inle: A large Myanmar lake in transition
Authors: Su Myint , Jassby Alan D. 
Published: March 2003

AbstractInle Lake is situated in the southern part of Shan State in Myanmar. It is the country’s second‐largest lake, home to more than 120 000 people and a large bird sanctuary and a major source of hydroelectric power for southern Myanmar. Several distinct environmental problems have arisen in the lake basin. A long‐term decrease in lake area has taken place over the last 30 years, probably because of siltation and climate. The drought of the last 2 years in particular has caused a drop in hydroelectric power output, which is affecting southern Myanmar. Many marginal parts of the lake are occupied by elephant grass mats (Saccharum spotaneum L.), known locally as kaing. These mats mature to form solid, floating islands, which are used for a unique form of agriculture but are also an increasing source of pesticide and fertilizer runoff into the lake. Textile cottage industries also abound, and both natural and manufactured dyes are discharged into the lake. Households, including many houses built on stilts in the lake, are a source of garbage and sewage. Livestock breeding also is a source of sewage. Shifting (taungyar) cultivation and village expansion has greatly increased erosion. Dredging is now necessary in many places and water clarity has decreased. The Inle carp (Cyprinus carpio intha), known locally as nga‐phane, plays an important role in the food supply, as well as being a cultural symbol of the local Intha people. Nga‐phane population abundance is currently low, probably because of changes in water chemistry and decreased clarity in the lake water. Partially because of the perceived potential for tourism, many sectors are now involved in lake rehabilitation and management.
Lake Jabel restoration project: Phosphorus status and possibilities and limitations of diversion of its nutrient‐rich main inflow
Authors: Kleeberg Andreas , Nixdorf Brigitte , Mathes Jürgen 
Published: March 2003

AbstractExternal and internal phosphorus loading was studied in 1996 in the anthropogenically eutrophicated Lake Jabel, which is located in Mecklenburg (north‐eastern Germany). It has a dimictic 23‐m‐deep northern basin, a 19‐m‐deep middle basin and a 6‐m‐deep polymictic southern basin. The main tributary, Grabowhöfer Grenzgraben, which enters via a leaching field from a waste‐water treatment plant, has been identified as the major nutrient discharge (80% of total phosphorus loading) into the northern basin. The sediment is the second largest source of phosphorus for Lake Jabel, contributing 25.7%, 27.4% and 2.4% of the overall phosphorus load to the northern, middle and southern basins, respectively. Although the favoured diversion of the Grabowhöfer Grenzgraben would contribute to a reduction of 1.22 t P and 20.94 t NO3‐–‐N per year, it is mainly rejected for the following reasons. If the extreme monthly nitrate supply, between 4.84 and 189.6 mg N m‐2 day–1 ceased, the release of redox‐sensitive phosphorus in the northern basin would increase by a factor of 0.54, which is with 41.1% total phosphorus, twice as high as that in the middle basin. In addition, the nitrate supply can substantially lower the seasonal precipitation of stable iron sulphides, which would otherwise lower the concentration of redox‐sensitive phosphorus, but cannot change the phosphorus retention in the long term. Because of internal phosphorus sources, the diversion of the Grabowhöfer Grenzgraben would result in no substantial changes in the level of trophy.
Storage of ammonia in old sewer sediments
Authors: Dabrowski Wojciech 
Published: March 2003

AbstractNitrogen sources in combined sewers are briefly summarised. Some evidence of biodegradation including the ammonification of sewer sediment has been found from a new interpretation of field experimental data known from the literature. Gravel and sand sediments in combined sewers were found to be potential sources of ammonia, which is discharged through overflows.
Top‐down biological controls on tropical lake productivity
Authors: Hubble D. S. , Harper D. M. 
Published: March 2003

AbstractAlthough productivity is primarily controlled by bottom‐up factors (nutrient levels), there are secondary effects caused by biological factors such as zooplankton grazing and algal self‐shading. The measurement of grazing effects and determination of the contributions of different nutrient pools should elucidate the roles of nutrient levels and biotic effects and also infer the relative importance of classical and microbial food webs. To produce a series of grazing intensity, after initial screening to remove macrozooplankton, lake water was filtered to remove remaining zooplankton. This was used to dilute whole lake water in a filtered : unfiltered ratios from 0:1 to 1:0, which was then incubated with nutrient enrichment. Results show an increase of up to 20% in productivity for surface midlake waters. To investigate grazing by nutrient dilution/deletion, grazing dilutions were again prepared; however, nutrients were added to produce three different conditions,+N +P (all nutrients), –N (nitrogen omitted) and –P (phosphorus omitted). From productivity measurements, the contributions of internal, external and recycled nitrogen and phosphorus nutrient pools were calculated. Sites at Hippo Point (HP) (midlake) and Malewa River inflow (MR) (near the mouth of the River Malewa) show little difference in the contribution of external nutrients, but remaining productivity is mostly fuelled by recycled nutrients at the MR site. Little difference was found between nitrogen and phosphorus‐limited conditions.
Lakes and society: The contribution of lakes to sustainable societies
Authors: Klessig Lowell L. 
Published: March 2003

AbstractLake management is typically approached from a biophysical perspective. Lake managers ask how lakes can be managed to sustain their ecological functions. The social value of lakes is usually given less attention. The present paper begins the analysis at the other end of the lake and society connection by posing the question: what social needs must be met to sustain society? The primary social needs of sustainable societies are outlined and then the contribution of lakes to each need is discussed. Lakes can only provide optimal social benefits if management decisions recognize the full set of potential contributions lakes can make to society and those management decisions are integrated to provided balanced attention to all values that lakes provide. The present paper expands the domain of values beyond the traditional environmental and recreational contributions of lake management to also include aesthetics, education, economic opportunity, emotional security, cultural opportunity, individual freedom and spirituality. Citizen involvement is essential in broadening the conceptualization of the lake values and in implementing integrated management plans.
Lake Toba: Need for an integrated management system
Authors: Saragih Bungaran , Sunito Satyawan 
Published: March 2003

AbstractLake Toba is the largest year‐round lake in South‐East Asia and the largest volcanic lake in the world. The Lake Toba catchment area faces an environmental crisis characterized by widespread deforestation, drought, decline of the water level, water quality degradation, invasive species and loss of biological diversity. More than half of the Lake Toba catchment area is classified as land at high erosion risk. Widespread poverty gives people little room to think beyond day‐to‐day needs and is an instrument for unsustainable methods of fishing and growing food. The Lake Toba catchment area is not managed as an integrated whole, but rather as four separate districts. Guidelines and orders tend to come from the government in Jakarta rather than being developed locally with stakeholder involvement. Differences in approach between government and non‐governmental organizations (NGOs) have resulted in friction and mistrust between the two. Local, national and international NGOs have been the biggest contributors to increasing the awareness of the need for an integrated approach to managing the lake. Technical exchanges with Lake Champlain have facilitated an exchange of experience of managing a large lake watershed, the transfer of low‐cost alternative technologies for managing waste water in small communities and development of new approaches to pulp and paper mills on both lakes. The Lake Toba Heritage Foundation’s priorities include establishing a research and monitoring programme, creating a science and education centre, and developing better coordination among central, provincial and district levels of government.
Greek Lakes: Limnological overview
Authors: Zacharias Ierotheos , Bertachas Ilias , Skoulikidis Nikolaos , Koussouris Theodoros 
Published: March 2003

AbstractThe Institute of Inland Waters in Greece has investigated the physical, chemical and biological characteristics of major Greek lakes, with regard to water use, quality and trophic status. Based on this and other limnological investigations, Greek lakes can be divided into three categories: warm monomictic deep lakes, warm monomictic shallow lakes, and dimictic shallow lakes. The water quality of some Greek lakes demonstrates the presence of high concentrations of nutrients and heavy metals, with reduced concentrations of diluted oxygen. High concentrations of ammonia, nitrate and phosphate are found in many lakes, while anaerobic hypolimnia are usually found in shallow lakes. Phosphorus is the main nutrient responsible for eutrophication because it is the limiting factor in most of the lakes that were investigated.
Diabetic renal disease in transitional and disadvantaged populations
Authors: Nelson Robert G 
Published: March 2003

SUMMARY:Diabetes mellitus has reached epidemic proportions throughout much of the world, and people from developing countries and disadvantaged groups from developed countries are affected disproportionately. Not only is diabetes more common in these populations, but it develops at an earlier age. Accordingly, patients have more years of life in which to develop the chronic complications of diabetes and the risk of complications is often further enhanced by limited access to health care. Renal disease is a frequent consequence of diabetes in these populations, and a number of factors related to poverty, malnutrition and accelerated lifestyle changes may lead to even greater rates in the future.
Nursing on paper: therapeutic letters in nursing practice
Authors: Moules Nancy J. 
Published: March 2003

Nursing on paper: therapeutic letters in nursing practice This paper offers a selected piece of interpretive research extracted from the context of a larger research study. The hermeneutic research inquiry described in this paper involved the examination of the nursing and family therapy intervention of therapeutic letters. It incorporated the textual interpretation of 11 therapeutic letters, clinical sessions with three families, clinical team discussions, and research interviews with four family members and three nurse clinicians who participated in the writing of the letters. This particular paper extracts segments of the research related to the letters received by two participants, as well as some general findings, with a focus on the possibilities and influences of therapeutic letters in nursing practice. The findings of this research offer suggestions, not as a template, but as an inspiration and evocation to write therapeutic letters that address the obligation of meeting people experiencing illness at the point of their suffering, with words and questions that invite relationship, reflection, and are large enough to sustain a meeting.