bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical pathway using rapid rehydration for children with gastroenteritis
Authors: Phin SJ , McCaskill ME , Browne GJ , Lam LT 
Published: July 2003

Objective: To determine in the Emergency Department (ED) the efficacy of a clinical pathway using rapid rehydration for children moderately dehydrated as a result of acute gastroenteritis.Methods: This was a prospective study using historical controls, set in the ED of the Children's Hospital at Westmead, NSW, Australia. Subjects were aged from 6 months to 16 years presenting with vomiting and diarrhoea for <48 h who were mildly or moderately dehydrated. The intervention was a clinical pathway involving rapid rehydration using N/2 saline + 2.5% dextrose intravenously at 20 mL/kg per h for 2 h, or Gastrolyte R (Aventis Pharma, Lane Cove, NSW, Australia) via nasogastric tube at the same rate. There were 145 children in the prospective intervention group and 170 in the historical control group. The outcome measures were admission rate, percentage of patients discharged from the ED in 8 h or less, rate of re‐presentations within 48 h requiring admission, and rate of procedures with intravenous cannula or nasogastric tube.Results: In the moderately dehydrated children, significant reductions were observed in the admission rate and the number discharged in 8 h or less in the intervention group compared with the control group, with no significant difference in the rate of re‐presentation and the rate of procedures. In the moderately dehydrated children in the intervention group, the admission rate was 29 of 52 (55.8%) compared with the controls 26 of 27 (96.3%) (P < 0.001) and the number discharged in 8 h or less was 23 of 52 (44.2%) compared with 1 of 27 (3.7%) in the controls (P < 0.01).Conclusion: The clinical pathway utilizing rapid rehydration in children moderately dehydrated from gastroenteritis is effective in reducing admission rates and lengths of stay in the ED.
EpiPen epidemic: Suggestions for rational prescribing in childhood food allergy
Authors: Kemp AS 
Published: July 2003

Abstract:There has been a marked increase in community concerns of the risk of food induced anaphylaxis in children and a consequent increase in the provision of the self or carer injectable epinephrine (EpiPen) (CSL Ltd, Parkville, Victoria, Australia)). The Australian use of EpiPens in children under 10 years has increased by 300% over 5 years with a crude rate of EpiPen provision of 1 per 544 Australian children aged under 10 years. However, the risk of a fatal reaction to food, particularly in preschool children, is remote (in Australia, an estimated one fatality in 30 years in the under 5‐year‐old population and two deaths in 10 years in the entire child population). It is therefore important to provide a perspective on the risk of death from food induced anaphylactic to parents and carers in view of the anxiety generated on this issue. The indications for provision of an EpiPen to children are not well defined. Six risk factors, which can be considered in evaluating the risk of a life‐threatening reaction (age over 5 years; a history of respiratory tract involvement with the initial or subsequent reactions; a history of asthma requiring preventer medication; peanut or tree nut sensitivity; reactions induced by traces or small amounts of allergen; a strongly positive skin prick test) are proposed. It is suggested that the greater the number that are positive, the lower the threshold for provision of an EpiPen. In addition, instruction in EpiPen administration and the provision of both a clear and simple anaphylaxis action plan and a rational perspective on the remote risk of death is just as important as the provision of the device itself.
Carbohydrate intolerance and kidney stones in children in the Goldfields
Authors: Baldwin DN , Spencer JL , Jeffries‐Stokes CA 
Published: July 2003

Abstract Renal stones have been reported as a common finding in Australian Aboriginal children. The stones are predominantly urate in composition. We report on five children with nephrolithiasis from the Goldfields region of Western Australia. All were diagnosed when under 5 years of age, the majority being under 3 years. All five children also had lactose intolerance, and we postulate that carbohydrate malabsorption, together with the ensuing chronic diarrhoea and intraluminal breakdown of sugars by enteric bacteria may result in a situation of chronic metabolic acidosis. Chronic metabolic acidosis can lead to protein catabolism, increased urate excretion and the formation of renal stones. Carbohydrate intolerance may be an aetiological factor in the development of renal stones and possibly chronic renal disease, particularly in Aboriginal Australians. Renal disease represents one of the most significant factors affecting the health of Australian Aboriginal people. The incidence of end stage renal failure in this population exceeds that of non‐Aboriginals by a factor of 13:1, and this disproportionate figure is increasing. It is likely that chronic renal damage is multifactorial; however, it is probable that at least some aetiological factors have their onset during childhood.
Parenteral nutrition solution retrieved by lumbar puncture following left saphenous vein catheterization
Authors: Clarke P , Wadhawan R , Smyth J , Emmerson AJ 
Published: July 2003

Abstract Two extremely preterm infants had silastic lines inserted via the left great saphenous vein for intravenous feeding. Clinical deterioration approximately 10 days later led to lumbar puncture as part of a sepsis screen. Parenteral nutrition solution was recovered in the cerebrospinal fluid and heralded potentially life‐threatening catheter malposition. The cases illustrate another percutaneous central line‐associated morbidity, which is avoidable by careful verification of line position. All previously reported cases of this unusual complication are reviewed and we describe its likely mechanism. We postulate that the phenomenon is a complication peculiar to percutaneous catheterization of the left lower limb.
Red eyes as the initial presentation of systemic meningococcal infection
Authors: Yeung WL , Yam KL , Chan WM , Hui J 
Published: July 2003

AbstractThe present paper is a report of a 14‐month‐old boy who presented with fever, coryzal symptoms and red eyes. The patient developed a generalized tonic clonic convulsion on day 2 of his illness. Ophthalmological assessment demonstrated bilateral hypopyon and vitreous opacity resulting from endophthalmitis. Cerebrospinal fluid was positive for Neisseria meningitidis (A, C, Y, W 135) by latex agglutination. He was treated with high dose intravenous cefotaxime and intravitreal ceftazidime. He made good recovery and his vision was preserved. In view of the potential morbidity and mortality associated with systemic meningococcal infection, the presence of red eye and hypopyon provides important diagnostic clues indicating the need to investigate beyond superficial conjunctivitis. It should prompt the clinician to recognize endopthalmitis early and accurately diagnose this serious disease.
Neonatal plantar response revisited
Authors: Gupta A , Gupta Piyush 
Published: July 2003

Objective:  To evaluate plantar response in the early neonatal period in normal, term, healthy newborn infants. This was a prospective study set in the postnatal ward of a tertiary care hospital.Methods:  The plantar response was elicited in 256 healthy, term, appropriate‐for‐gestational‐age neonates during their first 7 days of life, utilizing the thumb‐nail‐drag method. The response was tested daily at intervals of 24 h, until the neonate was discharged. A total of 597 observations were made, and the responses were classified as extensor, flexor or equivocal.Results:  The overall plantar response was found to be predominantly extensor (73.8%), followed by equivocal (17.3%) and, finally, flexor (8.9%). The plantar response was bilaterally extensor in 72.5%, bilaterally equivocal in 14.2%, and bilaterally flexor in 7.7% of observations, respectively. Asymmetrical plantar response was elicited in 5.4% of observations. No difference was observed in individual categories based on age (<12 h, 12.1−24 h, 24.1−72 h, 72.1 h−7 days) and site of response (right/left foot).Conclusion:  The plantar response in healthy, term neonates is predominantly extensor. Further, the relatively high frequency of asymmetrical and symmetrical flexor responses limits its clinical usefulness in the early neonatal period.
Correlation among academic performance, recurrent abdominal pain and other factors in Year‐6 urban primary‐school children in Malaysia
Authors: Boey CCM , Omar A , Arul Phillips J 
Published: July 2003

Objective:  The present study aimed to investigate the extent to which recurrent abdominal pain and other factors were associated with academic achievement among Year‐6 (12 years of age) schoolchildren.Methods:  The present study was a cross‐sectional survey conducted from September to November 2001. Schoolchildren were recruited from primary schools that were selected randomly from a list of all primary schools in Petaling Jaya, Malaysia, using random sampling numbers. Information concerning recurrent abdominal pain, socio‐economic status, life events, demographic and other details was obtained using a combination of questionnaires and interviews. Academic achievement was assessed using a score based on the Malaysian Primary School Achievement Examination. An overall score at or above the mean was taken to indicate high academic achievement while a score below the mean indicated poor academic achievement.Results:  A total of 1971 children were studied (958 boys and 1013 girls: 1047 Malays, 513 Chinese and 411 Indians). Of these children, 456 (23.1%) fulfilled the criteria for recurrent abdominal pain. Using the method of binary logistic regression analysis, the following factors were found to be independently associated with poor academic performance: a low socio‐economic status (odds ratio (OR) 1.30; 95% confidence interval (CI) 1.25−1.35); male sex (OR 1.61; 95% CI 1.26−2.05); the death of a close relative (OR 2.22; 95% CI 1.73−2.85); the divorce or separation of parents (OR 3.05; 95% CI 1.73−5.40); the commencement of work by the mother (OR 1.34; 95% CI 1.02−1.76); hospitalization of the child in the 12 months prior to the study (OR 1.83; 95% CI 1.12−3.01); lack of health‐care consultation (OR 1.80; 95% CI 1.36−2.36); missing breakfast (OR 1.47; 95% CI 1.07−2.02); and lack of kindergarten education (OR 1.35; 95% CI 1.04−1.75).Conclusions:  Many factors, such as socio‐economic status and recent life events, were associated with poor academic performance. Recurrent abdominal pain did not correlate directly to academic performance. Stress may be a means by which various factors cause children to struggle academically.
Maternal phenylketonuria in Western Australia: Pregnancy outcomes and developmental outcomes in offspring
Authors: Ng T‐W , Rae A , Wright H , Gurry D , Wray J 
Published: July 2003

Objective:  To examine the outcomes of phenylketonuric (PKU) pregnancies in Western Australia including birth characteristics and cognitive and behavioural outcomes in offspring.Methods:  A cross‐sectional study of women and their offspring who were identified from the Western Australian Maternal PKU Program (WAMPKUP) from 1991 to 2000 was carried out. Cognitive assessments (K‐BIT or Griffiths scales) were conducted on women and their children, and behavioural assessments (CBCL) were conducted on the children.Results:  Thirty pregnancies by nine women were registered on the WAMPKUP between 1991 and 2000. There were 16 live births, with one preterm delivery at 32 weeks. There were no congenital abnormalities. Five of the nine mothers and their nine children (aged 18 months−10 years) participated in developmental assessments. A linear relationship was shown between lower maternal IQ scores and later attainment of metabolic control in pregnancy (rs = −0.828; P = 0.01). There was significant correlation between lower offspring IQ scores and later attainment of metabolic control in pregnancy (rs = −0.734; P = 0.02). Correlation between maternal and offspring cognitive scores was not significant. Four of nine (44%) children rated in the clinical range for behavioural problems. Compared to children with no behavioural difficulties, these children had lower cognitive abilities (P = 0.05) and maternal metabolic control during pregnancy was poor (P = 0.05).Conclusions:  Poor metabolic control in pregnancy is associated with poorer cognitive outcomes and increased behavioural difficulties in offspring of mothers with PKU. The results have implications for the implementation of appropriate dietary measures before conception in PKU pregnancies, and indicate a need for the establishment of multidisciplinary teams to follow up individuals with PKU to communicate the importance of pregnancy planning, to manage PKU pregnancies, and to follow up the offspring.
Audit of a paediatric directed donation programme
Authors: Knuckey MI , Wood EM , Savoia HF 
Published: July 2003

Objective:  A paediatric directed donation programme (DDP) was instituted by Women's and Children's Health in conjunction with the Australian Red Cross Blood Service, Melbourne, Victoria, Australia, in response to public demand following a case of transfusion‐transmitted HIV. This audit assesses the first 18 months of the programme.Methods:  Retrospective analysis, from February 2000 to July 2001, examining the number of units of blood requested, donated, and transfused, as well as the use of allogeneic (non‐directed) blood.Results:  The DDP received 125 referrals. Most (78%) were for elective surgery. Of the 89 eligible children, 76% (68) had blood donated for them by an ABO/Rhesus‐compatible parent, 81% of whom were first‐time blood‐donors. No donor tested positive for infectious markers. In total, 221 units of blood were requested and 116 units were collected. Non‐collection was mainly a result of parent−child ABO incompatibility or medical ineligibility of the proposed donor. Of the children for whom blood was collected, 28 (41%) received no transfusion and eight (12%) received non‐directed components in addition to DDP blood; thus, 32 (47%) received solely the blood from their directed donor. Of the units collected, 53 (46%) were transfused and 63 (54%) were discarded.Conclusions:  While the paediatric DDP serves a community need, the programme has a high wastage rate, is time‐consuming, labour‐intensive and an expensive alternative when compared with the provision of non‐directed volunteer blood. In continuing the programme, appropriateness of referral needs to be refined to reduce wastage rates.
Barriers to immunization: Attitudes of general practitioners to varicella, the disease and its vaccine
Authors: Milledge JT , Cooper CD , Woolfenden SR 
Published: July 2003

Objectives:  To investigate the attitudes of general practitioners (GPs) to varicella disease and varicella vaccine.Methods:  A cross‐sectional questionnaire was mailed to GPs in Fairfield (located in the south‐western suburbs of Sydney, NSW, Australia) to identify attitudes about varicella vaccine, previous experience with varicella disease and the likelihood of prescribing varicella vaccine.Results:  Of 239 questionnaires issued, 160 were returned (67%). The majority (72%) of respondents agreed that varicella vaccine should become part of the immunization schedule. However 12% of GPs did not support vaccination for varicella as they considered it to be a benign self‐limiting disease. Respondents who had experience with varicella complications were significantly more likely to recommend universal vaccination (OR 3.36; 95% confidence interval (CI) 1.38−8.19) whereas those respondents who were concerned about side effects of the vaccine were less likely to recommend universal vaccination (OR 0.31; CI 0.15−0.63).Conclusions:  The majority of GPs are receptive to varicella vaccination becoming part of the immunization schedule. Experience with varicella complications is associated with recommending universal varicella vaccination. General practitioners in this cohort do not consider varicella to be a benign disease, but they are concerned about possible unknown side effects of the vaccine. Public health measures for introducing universal vaccination need to address these concerns.
From delegation to specialization: nurses and clinical trial co‐ordination
Authors: Mueller Mary‐Rose 
Published: July 2003

From delegation to specialization: nurses and clinical trial co‐ordinationThis paper considers an area of clinical research that has been delegated by physician‐researchers to nurses and others in the United States, that of clinical trials co‐ordination. It uses interviews with nurse trial co‐ordinators to explore the occupational processes by which the boundaries of work enactment and the definition of work have been established by nurses and others. It then discusses the occupational processes that have been established to formalize a role for nurses in clinical research. It raises the question of (and offers speculation on) whether specialization alone will distinguish nursing from other occupational groups engaged in clinical research work.
Discourses of the body in euthanasia: symptomatic, dependent, shameful and temporal
Authors: Street Annette F , Kissane David W 
Published: July 2003

Discourses of the body in euthanasia: symptomatic, dependent, shameful and temporalThis theoretical paper is derived from a discourse analysis of the textual material from a study of the seven deaths associated with legalised euthanasia in the Northern Territory, Australia. The textual analysis utilises evidence from interviews, letters written by people seeking euthanasia, medical reports, coroner's records and media reports concerning the social experiment of legalised euthanasia in Australia. The paper does not discuss the euthanasia debate. It argues that the body is a neglected concern in the debates and offers a construction of the discourses of the body as symptomatic, dependent, shameful and temporal. Medical discourses frame the body as symptomatic but these people were also concerned with the loss of autonomy associated with dependence, with shame connected with loss of bodily functions and the embodied experience of determining a ‘time to die’.
Bending stiffness calculation for nanosize structures
Authors: IVANOVA E. A. , KRIVTSOV A. M. , MOROZOV N. F. 
Published: July 2003

ABSTRACTAdvances in high technologies using nanometer‐size structures, such as carbon nanotubes, require calculation of mechanical properties for the objects of the nanosize scale level. Majority of the theoretical mechanical models for nanoobjects is based on the macroscopic equations of theory of elasticity. This gives the questions about applicability of the quantities obtained from the macroscopic experiments to the nanoscale objects or about necessity of corrections taking into account the scale effects. The presented paper is devoted to theoretical investigation of the influence of the scale effects on the bending stiffness of a nanocrystal, which is extended in one direction and has a limited number of atomic layers in another direction. Ambiguity of the bending stiffness due to the ambiguity of the size definition for the nanosize object is discussed. It is shown that appropriate definition of the crystal thickness allows using conventional formula for the bending stiffness, which is known from continuum theory of elasticity.
Direct evaluation of accurate coefficients of the linear elastic crack tip asymptotic field
Authors: XIAO Q. Z. , KARIHALOO B. L. 
Published: July 2003

ABSTRACTAn improvement to the extended finite element method (XFEM) and generalised finite element method (GFEM) is introduced. It enriches the finite element approximation of the crack tip node as well as its surrounding nodes with not only the first term but also the higher order terms of the linear elastic crack tip asymptotic field using a partition of unity method (PUM). Numerical results show that together with a reduced quadrature rule to the enriched elements, this approach predicts accurate stress intensity factors (SIFs) directly (i.e. without extra post‐processing) after constraining the enriched nodes properly. However, it does not predict accurately the coefficients of the higher order terms. For that a hybrid crack element (HCE) is introduced which is powerful and convenient not only for directly determining the SIF but also the coefficients of higher order terms in the plane linear elastic crack tip asymptotic field. Finally, the general expressions for the coefficients of the second to fifth terms of the linear elastic crack tip asymptotic field of three‐point bend single edge notched beams (TPBs) with span to depth ratios widely used in testing are extended to very deep cracks with the use of the HCE.
Integrity of pressurized components with localized corrosion under internal pressure and transient thermal loading
Authors: GOLDSTEIN R. V. , ZHITNIKOV YU. V. , KADOCHNIKOV I. V. 
Published: July 2003

ABSTRACTThis paper is devoted to the modelling and analysis of the problem of the safety and residual lifetime of pressurized components (e.g. pressure vessels, apparatus, pipelines) with zones of local corrosion damage. Corrosion damage is the most common form of structural material degradation in service conditions, in particular, in the chemical and gas, and oil industries. Attention is paid to nonstationary regimes of the component operation, e.g., start‐stop regimes. It is shown that the critical parameters calculated taking into account the nonstationary loading can be lower compared with ones determined for the stationary regimes, e.g., on the basis of the ASME Code B31G.
Three‐dimensional effects on fatigue crack closure in the small‐scale yielding regime – a finite element study
Authors: ROYCHOWDHURY S. , DODDS R. H. 
Published: July 2003

ABSTRACTPlasticity induced closure often strongly influences the behaviour of fatigue cracks at engineering scales in metallic materials. Current predictive models generally adopt the effective stress‐intensity factor (ΔΚeff = Κmax–Κop) in a Paris law type relationship to quantify crack growth rates. This work describes a 3D finite element study of mode I fatigue crack growth in the small‐scale yielding (SSY) regime under a constant amplitude cyclic loading with zero T‐stress and a ratio Κmin/Κmax = 0. The material behaviour follows a purely kinematic hardening constitutive model with constant hardening modulus. Dimensional analysis suggests, and the computational results confirm, that the normalized remote opening load value, Κop/Κmax, at each location along the crack front remains unchanged when the peak load (Κmax), thickness (B) and material flow stress (σ0) all vary to maintain a fixed value of . Through parametric computations at various K levels, the results illustrate the effects of normalized peak loads on the through‐thickness opening–closing behaviour and the effects of σ0/E, where E denotes material elastic modulus. The examination of deformation fields along the fatigue crack front provides additional insight into the 3D closure process.
The effect of material hardness and mean stress on the fatigue limit of steels containing small defects
Authors: KONDO Y. , SAKAE C. , KUBOTA M. , KUDOU T. 
Published: July 2003

ABSTRACTFatigue tests on material containing small defects were performed under a wide range of mean stress for three grades of steels with different hardness. The ΔKth of small defects had a peculiar dependency on material hardness and mean stress, which was quite different from those of long cracks or plain specimens. The crack closure of short cracks was measured. It was shown that the formation of the crack closure was affected by the material hardness and mean stress. This behaviour of crack closure resulted in characteristic fatigue limit properties of materials containing small defects.