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At least 1,081 records · Page 60Linked to original sources
PubMed2006

Associations between childhood refraction and parental smoking.

PURPOSE: Motivated by pharmacologic findings linking nicotinic acetylcholine receptors to eye development in chicks, the authors studied whether the refractions of children who were passively exposed to cigarette smoke by their parents differed from those of nonexposed children. METHODS: A cross-sectional study was conducted among 323 patients (mean +/- SD age, 8.7 +/- 4.4 years; range, 1-20) in a tertiary care pediatric ophthalmology clinic. Half (162/323) of the subjects had strabismus. The accompanying parent completed a detailed questionnaire on parental smoking history and on putative risk factors for myopia. The results were compared to the subjects' cycloplegic refractions. RESULTS: If one or both parents ever smoked, their children had a lower myopia prevalence (12.4% vs. 25.4%; P = 0.004) and more hyperopic mean refractions (1.83 +/- 0.24 vs. 0.96 +/- 0.27 diopters; P = 0.02) than those whose parents never smoked. Smoking by either parent during the mother's pregnancy had a similar effect on the child's refraction. The associations largely persisted, both in multivariate models that included adjustments for the child's age, child's body mass index, child's nearwork activity, parental myopia, and parental education and also in analysis by subgroups stratified by strabismus status. CONCLUSIONS: Despite the complex constituents of cigarette smoke, neuropharmacology perspectives may prove useful in the development of new hypotheses to understand the mechanisms governing refractive development, not only in experimental animals but also in children. The associations of less prevalent myopia and a more hyperopic mean refraction with both prenatal and childhood exposures to tobacco smoke suggest that nongenetic, environmental exposures may have long-term influences on refraction and that further study of the role of nicotinic acetylcholine receptors in refractive development is warranted.

Adolescent↗
PubMed1987

Duty to protect.

Explore the source record for details and available documents.

California↗
PubMed1994

The PACT model.

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Activities of Daily Living↗
PubMed1992

Predicting length of hospitalization of sick neonates from their initial status.

It has been suggested that the estimated date of confinement (EDC) may be used to predict the length of hospital stay for sick newborns. We have found this method unreliable and designed the following study to develop a mathematical model to predict length of stay (LOS). We reviewed the records of 393 neonates. Statistical analysis was performed using multiple linear regression. The factors that reached statistical significance were birth weight (BW), gestational age (GA), and a combined respiratory score (RES). The RES was developed to quantify the degree of initial respiratory illness. Through this model we developed the following formula: log(e) (LOS) = 4.395-0.023 (GA) -0.00054(BW) + 0.0274 (RES). The R value is 0.78. The model predicts an LOS +/- 10 days in 73% of cases. Overall, this model yields a 29% improvement in predictability of LOS compared with a model which used EDC only. This formula may provide useful information for parents and caregivers of hospitalized neonates.

Academic Medical Centers↗
PubMed1994

The overdiagnosis of Lyme disease in children residing in an endemic area.

The medical records of 227 children ages 1 to 19 years referred to the Lyme disease pediatric clinic over a 32-month period since May 1990 were reviewed. Clinico-serologic criteria for a positive diagnosis were applied. One hundred thirty-eight of 227 referred children did not fulfill those criteria and became the study population. Four subsets of patients emerged: (1) 54 patients with predominantly subjective symptoms; (2) 52 patients with objective evidence for an alternative diagnosis; (3) eight patients who had documented infection in the past and continued with symptoms after antibiotic treatment; and (4) 24 patients with a history of tick attachment or prenatal/family history of Lyme disease. Serologic testing data from commercial laboratories were available for the 54 children from the "predominantly subjective" group; 50% were negative, and 50% were borderline or positive. Ninety-two percent of these patients were negative at retesting by our enzyme-linked immunosorbent assay (ELISA) and 100% were negative by Western blot. Fifty-seven percent of these patients had received treatment prior to our evaluation. Children residing in an endemic area who present with vague symptoms are being diagnosed with and treated for Lyme disease without clinical or serologic documentation. In addition, fear in the lay community may be inducing doctors to diagnose Lyme disease in patients with symptoms that may be suggestive of an alternative diagnosis.

Adolescent↗
PubMedDate not supplied

Survey of patient and clinician attitudes on adherence in a rural HIV clinic.

Adherence is critical to the success of antiretroviral therapy, with near perfect medication taking required for optimal results. Many factors may affect a patient's ability to adhere to antiretroviral therapy, including complexity of the regimen and adverse effects from medications. Previous research showed that some disparity may exist between clinicians' and patients' attitudes regarding characteristics of a regimen that are likely to affect adherence. The present survey was conducted in a rural HIV clinic and confirmed that similar differences were present in clinician and patient perceptions of adherence barriers. The patient population noted side effects and complexity of schedule as most likely to affect adherence, illustrating the need for thorough discussion of new regimens and involvement of the patient in treatment decisions.

Ambulatory Care Facilities↗
PubMed2005

Child custody and visitation decisions when the father has perpetrated violence against the mother.

This research evaluated the effectiveness of statutes mandating a presumption against custody to a perpetrator of domestic violence (DV) and judicial education about DV. Across six states, the authors examined 393 custody and/or visitation orders where the father perpetrated DV against the mother and surveyed 60 judges who entered those orders. With the presumption, more orders gave legal and physical custody to the mother and imposed a structured schedule and restrictive conditions on fathers' visits, except where there was also a "friendly parent" provision and a presumption for joint custody. The presumption is effective only as part of a consistent statutory scheme. Although 86% of judges had received DV education, they scored no better in knowledge or attitudes. More of their orders gave mothers sole physical custody, and knowledge was associated with maternal custody, yet fewer structured or restricted fathers' visitation. Quality of DV education is more important than statutory mandate.

Adult↗
PubMed2005

Hepatic resection at a major community-based teaching hospital can result in good outcome.

BACKGROUND: The relationship between volume and outcome has been established in the literature for several complex surgical procedures. Improved outcome has been suggested at high-volume hospitals or with high-volume surgeons. METHODS: The objective of this study was to evaluate the experience of a low-volume hospital with major liver resections. The setting of the study was a community-based teaching hospital with a surgical residency training program. RESULTS: A total of 46 major liver resections were performed between January 1992 and December 2002. Procedures performed were hepatic lobectomies (n = 15; right, n = 11; left, n = 4), trisegmentectomies (n = 5; right, n = 3; left, n = 2), segmentectomies (n = 16; left lateral, n = 12; right posterior, n = 4), and wedge resections (n = 10). Operations were performed by 14 different surgeons; however, 23 operations were performed by 1 surgeon. Sixteen patients (34%) developed 23 complications. The average length of hospital stay was 9.7 days. There were no 30-day postoperative mortalities. Out of 46 patients who underwent major liver resection over the last 10 years, 13 patients are still alive. Overall survival ranged from 3 to 84 months, with a median survival of 30.6 months. The actual 5-year survival was 36% (8 of 22) for all patients operated on >5 years ago, and the actual 2-year survival was 61% (20 of 33). CONCLUSIONS: Major liver resection can be performed safely with low rates of morbidity and operative mortality with careful selection of patients at a low-volume community-based teaching hospital.

Adolescent↗
PubMed2004

Altered quadriceps control in people with anterior cruciate ligament deficiency.

PURPOSE: The purpose of this study was to determine whether similar patterns of quadriceps dysfunction are observed when people with anterior cruciate ligament (ACL) deficiency perform static and dynamic tasks. METHODS: EMG data were collected from 15 subjects with an ACL deficient knee and 15 uninjured subjects as they performed static and dynamic tasks that were isolated to the knee and presented no threat to joint stability. The dynamic task was cyclic flexion and extension in the terminal 30 degrees of knee extension; the static task was an established isometric target-matching protocol. The muscle activity patterns observed during the tasks were evaluated and compared. RESULTS: The subjects with ACL deficiency exhibited quadriceps muscle control strategies that were significantly different from those of the uninjured subjects. This was true in both the dynamic and the static tasks. The findings were most noteworthy in the vastus lateralis muscle. Good agreement (r = -0.73 to -0.75) was observed in subjects' static and dynamic VL results; more moderate agreement was observed in results of the other quadriceps muscles. CONCLUSION: Diminished quadriceps control was observed when people with ACL deficiency performed static and dynamic tasks. The most striking feature of this impaired control was failure to turn the quadriceps "off" when performing flexion tasks in which the knee extensors are usually "silent." Our findings suggest that quadriceps dyskinesia after ACL injury is relatively global. Changes in neural function and muscle physiology after ACL injury are put forth as the most likely source of the observed dyskinesia.

Adolescent↗
PubMed2006

Lower extremity muscle morphology in young athletes: an MRI-based analysis.

PURPOSE: This study was conducted to describe lower extremity muscle morphology (volume and peak cross-sectional area (CSA)) in young athletes and compare these with previously reported values. A second aim was to determine if muscle morphological values differ significantly between sides, implying that unilateral measurements cannot represent both limbs accurately. METHODS: Axial spin-echo T1-weighted magnetic resonance (MR) images were obtained between the ankle mortise and iliac crest in 10 athletes (age 18.8 +/- 3.7 yr). Subsequently, each subject's three-dimensional anatomy was digitally reconstructed. Muscle volume, peak CSA, and length were calculated for 13 muscles. RESULTS: The mean volumes and CSA for the current sample of athletes were larger than previously reported values (primarily from cadaver studies of nonathletes). The ratio of total quadriceps volume to total hamstrings volume averaged nearly 3:1 (2.9 +/- 0.2), whereas previous reports have been closer to 2:1 (2.1 +/- 0.2). The relative contribution of each muscle to the muscle group (hamstrings or quadriceps) volume was also different for these athletes. Significant differences in side-to-side muscle morphology were observed in several knee muscles (P < 0.03). Vastus medialis muscle volume was larger in the dominant leg (difference between sides: 59 +/- 25 cm3, representing 15.9 +/- 6.7% of its average volume), whereas vastus lateralis muscle volume was larger in the nondominant leg (difference: 54 +/- 47 cm3 representing 9.6 +/- 8.3% of its average). Despite this, total quadriceps volumes were similar between sides. CONCLUSIONS: Findings suggest that the morphology data presented in this study should be used instead of data from cadavers when studying young athletic people. These data should improve the accuracy of biomechanical modeling in the athletic population.

Adolescent↗
PubMed2006

The rotor tip inside a bearing of a thermophilic F1-ATPase is dispensable for torque generation.

F(1)-ATPase is an ATP-driven rotary molecular motor in which the central gamma-subunit rotates inside a stator cylinder made of alpha(3)beta(3) subunits. To elucidate the role of rotor-stator interactions in torque generation, we truncated the gamma-subunit at its carboxyl terminus, which forms an alpha helix that penetrates deeply into the stator cylinder. We used an alpha(3)beta(3)gamma subcomplex of F(1)-ATPase derived from thermophilic Bacillus PS3 and expressed it in Escherichia coli. We could obtain purified subcomplexes in which 14, 17, or 21 amino-acid residues were deleted. The rotary characteristics of the truncated mutants, monitored by attaching a duplex of 0.49-microm beads to the gamma-subunit, did not differ greatly from those of the wild-type over the ATP concentrations of 20 nM-2 mM, the most conspicuous effect being approximately 50% reduction in torque and approximately 70% reduction in the rate of ATP binding upon deletion of 21 residues. The ATP hydrolysis activity estimated in bulk samples was more seriously affected. The 21-deletion mutant, in particular, was >10-fold less active, but this is likely due to instability of this subcomplex. For torque generation, though not for rapid catalysis, most of the rotor-stator contacts on the deeper half of the penetrating portion of the gamma-subunit are dispensable.

Bacillus↗
PubMed1999

Characterization of Lyme meningitis and comparison with viral meningitis in children.

OBJECTIVES: The objectives of this study were to characterize Lyme meningitis (LM) in the pediatric population; to compare LM with viral meningitis (VM) with respect to epidemiology, history and physical examination, and laboratory data; and to provide means of early distinction of Lyme neuroborreliosis from other forms of aseptic meningitis. METHODS: This retrospective analysis involved children admitted to Alfred I. duPont Hospital for Children between 1990 and 1996 whose discharge diagnoses indicated viral or aseptic meningitis or Lyme disease. LM was defined as the presence of cerebrospinal fluid (CSF) pleocytosis with positive Lyme serology and/or erythema migrans. Patients were considered to have VM if they exhibited CSF pleocytosis and had a positive viral culture. Demographic, clinical, and laboratory data were collected for each patient, and patients with LM were compared with age-matched patients with VM. RESULTS: Of 179 patient records, 12 patients with LM and 10 patients with VM (all, >2 years old) were identified by using the above criteria. In comparing LM patients with VM patients, we noted no differences among demographic variables. Children with LM had significantly lower temperatures at the time of presentation. The presence of headache, neck pain, and malaise was similar for the two groups, but the duration of these symptoms was significantly longer among LM patients. Five children with LM had cranial neuropathies. All but 1 LM patient exhibited either papilledema, erythema migrans, or cranial neuropathy. These three findings were absent in the VM group. On CSF analysis, LM patients had fewer white blood cells (mean, 80/mm3 versus 301/mm3) and a significantly greater percentage of mononuclear cells than the VM patients. CONCLUSIONS: In this study, in a Lyme-endemic area, LM was about as common as VM in older children who were hospitalized with aseptic meningitis. Attention to pertinent epidemiologic and historical data, along with physical and CSF findings, allows early differentiation of LM from VM.

Child↗
PubMed2003

A model of determining a fair market value for teaching residents: who profits?

CONTEXT: Centers for Medicare & Medicaid Services (CMS) Health Resources and Services Administration Children's Hospitals Graduate Medical Education (GME) Payment Program now supports freestanding children's teaching hospitals. OBJECTIVE: To analyze the fair market value impact of GME payment on resident teaching efforts in our pediatric intensive care unit (PICU). DESIGN: Cost-accounting model, developed from a 1-year retrospective, descriptive, single-institution, longitudinal study, applied to physician teachers, residents, and CMS. SETTING: Sixteen-bed PICU in a freestanding, university-affiliated children's teaching hospital. PARTICIPANTS: Pediatric critical care physicians, second-year residents. MAIN OUTCOME MEASURES: Cost of physician opportunity time; CMS investment return; the teaching physicians' investment return; residents' investment return; service balance between CMS and teaching service investment margins; economic balance points; fair market value. RESULTS: GME payments to our hospital increased 4.8-fold from 577 886 dollars to 2 772 606 dollars during a 1-year period. Critical care physicians' teaching opportunity cost rose from 250 097 dollars to 262 215 dollars to provide 1523 educational hours (6853 relative value units). Residents' net financial value for service provided to the PICU rose from 245 964 dollars to 317 299 dollars. There is an uneven return on investment in resident education for CMS, critical care physicians, and residents. Economic balance points are achievable for the present educational efforts of the CMS, critical care physicians, and residents if the present direct medical education payment increases from 29.38% to 36%. CONCLUSIONS: The current CMS Health Resources and Services Administration Children's Hospitals GME Payment Program produces uneven investment returns for CMS, critical care physicians, and residents. We propose a cost-accounting model, based on perceived production capability measured in relative value units and available GME funds, that would allow a clinical service to balance and obtain a fair market value for the resident education efforts of CMS, physician teachers, and residents.

Adult↗
PubMed2006

Prediction of Lyme meningitis in children from a Lyme disease-endemic region: a logistic-regression model using history, physical, and laboratory findings.

BACKGROUND: Differentiating Lyme meningitis (LM) from other forms of aseptic meningitis (AM) in children is a common diagnostic dilemma in Lyme disease-endemic regions. Prior studies have compared clinical characteristics of patients with LM versus patients with documented enteroviral infections. No large studies have compared patients with LM to all patients presenting with AM and attempted to define a clinical prediction model. OBJECTIVE: To create a statistical model to predict LM versus AM in children based on history, physical, and laboratory findings during the initial presentation of meningitis. METHODS: Children older than 2 years presenting to the Alfred I. duPont Hospital for Children between October 1999 and September 2004 were identified if both Lyme serology and cerebrospinal fluid (CSF) were collected during the same hospital encounter. Patients were considered to have Lyme disease only if they met Centers for Disease Control and Prevention criteria (documented erythema migrans and/or positive Lyme serology). Patients were eligible for study inclusion if they had documented meningitis (CSF white blood cell count: >8 per mm3). Retrospective chart review abstracted duration of headache and cranial neuritis (papilledema or cranial nerve palsy) on physical examination and percent CSF mononuclear cells. Using logistic-regression analysis, the type of meningitis (LM versus AM) was simultaneously regressed on these 3 variables. The Hosmer-Lemeshow test was performed and the area under the receiver operating characteristic curve was calculated. RESULTS: A total of 175 children with meningitis were included in the final statistical model. Logistic-regression analysis included 27 patients with LM and 148 patients classified as having AM. Duration of headache, cranial neuritis, and percent CSF mononuclear cells independently predicted LM. The Hosmer-Lemeshow test revealed a good fit for the model, and the Nagelkerke R2 effect size demonstrated good predictive efficacy. Odds ratios based on the logistic-regression results were calculated for these variables. The final model was transformed into a clinical prediction model that allows practitioners to calculate the probability of a child having LM. CONCLUSIONS: Longer duration of headache, presence of cranial neuritis, and predominance of CSF mononuclear cells are predictive of LM in children presenting with meningitis in a Lyme disease-endemic region. The clinical prediction model can help guide the clinician about the need for parenteral antibiotics while awaiting serology results.

Child↗
PubMedDate not supplied

A survey of biosecurity practices as risk factors affecting broiler performance on the Delmarva Peninsula.

A 10-page questionnaire on biosecurity practices was mailed to 187 growers on the Delmarva Peninsula in October 2000. The growers were selected by three broiler integrators on the basis of flock performance and were classified as cases (bottom 10% performers) and controls (top 10% performers). After two mailings, 71 growers (38%) responded to the survey, of which 47 (66.2%) represented good performers and 24 (33.8%) represented poor performers. Univariate and multivariate statistical analyses revealed that increased frequency of sanitizing water lines was statistically significantly associated with good flock performance (P = 0.0449). The presence of wild birds inside poultry houses during grow-out showed a slightly statistically significant association with poor flock performance (P = 0.0633).

Animal Husbandry↗
PubMedDate not supplied

The development and validation of a geographic information system database for the poultry industry on the Delmarva Peninsula.

A geographic information system (GIS) database of the poultry industry on the Delmarva Peninsula was developed through a cooperative agreement between the Delmarva Poultry Industry, Inc., and the Virginia-Maryland Regional College of Veterinary Medicine. The purpose of this database was to facilitate disease surveillance and assist in managing the response to outbreaks and other emergencies. Two methods of data collection were employed and are described in this paper. The first method was to visit each poultry farm and collect the latitude and longitude coordinates with a handheld global positioning system unit. The second method used property ownership information, aerial photographs, and a GIS to determine the latitude and longitude of each poultry farm. There was no significant difference between the two methods in the accuracy of the results, but there was a large difference in the amount of time and money necessary to obtain the data. These findings indicate that whereas there are many ways to obtain accurate data for a GIS database, other factors may influence which method is chosen. A subset of farms contained within the database was visited to assess the accuracy of the locations contained within the database. Of the 240 farms visited for validation, 212 showed evidence of a functioning or previously functioning poultry operation. The corresponding error rate was 11%. This demonstrates the need to assure that the database is kept up to date to ensure that attrition among poultry growers is recorded. Several potential factors that might contribute to sources of error are discussed.

Agriculture↗
PubMed2002

Infrapopulation sizes of co-occurring trematodes in the snail Ilyanassa obsoleta.

This study addresses the infrapopulation sizes of 2 larval trematode species Himasthla quissetensis and Zoogonus rubellus as they co-occur within their estuarine snail host Ilyanassa obsoleta. Rediae of H. quissetensis and sporocysts of Z rubellus were counted in snails singly infected with each parasite and in snails infected with both. Comparisons of the counts indicate that infrapopulations of H. quissetensis were unaffected by co-occurrence with Z rubellus. However, Z. rubellus infrapopulations were reduced when co-occurring with H. quissetensis. It is proposed that this situation does not result from an interspecific interaction between parasite species. Although this double infection is relatively frequent in certain snail populations, it is contended that these trematode species do not co-occur often enough to evolve responses to one another. However, the host environment must be encountered in each life cycle, and both trematode species must be adapted to use it. On this basis, whatever happens when these 2 species occupy the same host is based on adaptations of the parasites to the host. It is proposed that these parasites are adapted to self-limit their infrapopulations in the snail host. They can, thus, preserve and use the host for many years and thereby enhance total cercarial transmission (fitness). Infrapopulation sizes would be determined by host resource levels, which, among other factors, would be influenced by the presence of multiple parasite species. In single infections, by far the most common situation, host resource levels would be set by the nutritional status or age (size) of the host (or both). The reduced infrapopulation sizes of Z rubellus on co-occurrence suggest that this trematode is more sensitive to host resource levels than is H. quissetensis.

Animals↗