Is screening urinalysis in children worthwhile?

Screening urinalysis in asymptomatic children has not been shown to be beneficial (strength of recommendation: B; based on extrapolation from 1 meta-analysis). It is unlikely to be cost-effective and should be discontinued. While random urinalyses can be used for case finding of glucosuria, hematuria, pyuria, bacteriuria, and proteinuria, the routine use of screening urinalysis in asymptomatic patients is not likely to be an effective strategy

Does ambulatory blood pressure monitoring aid in the management of patients with hypertension?

Twenty-four hour ambulatory blood pressure monitoring (ABPM) has a higher correlation with target end-organ damage than standard office measurements and is superior for risk stratification. Because it is more complicated to implement than office-based measurements, it should be reserved for: establishing the diagnosis of white-coat hypertension or borderline hypertension in previously untreated patients; evaluating previously treated patients with resistant hypertension; diagnosing and treating hypertension disorders of pregnancy; and identifying nocturnal hypertension. (Grade of recommendation: B, based on consistent cohort studies and trials, requiring extrapolation in certain clinical circumstances

Can you differentiate bacterial from viral pediatric infections based on the CBC?

No--the complete blood count (CBC) alone does not have adequate sensitivity or specificity to tell bacterial from viral infections (strength of recommendation [SOR]: B, cohort studies). When used in conjunction with other clinical parameters in validated decision-making algorithms, the CBC can help detect serious bacterial infections in pediatric patients with fever (SOR: B, cohort studies)

What is the clinical workup for failure to thrive?

The clinical evaluation of failure to thrive (FTT) includes a thorough history and physical examination; observation of parent-child interactions; observation and documentation of the child's feeding patterns; and a home visit by an appropriately trained health care professional (Strength of Recommendation [SOR]: C). Further diagnostic testing should be performed as indicated by positive findings from the history and physical exam or if the child's weight has not improved at follow-up (SOR: C)

Micro-sensor thin-film anemometer

A device for measuring turbulence in high-speed flows is provided which includes a micro-sensor thin-film probe. The probe is formed from a single crystal of aluminum oxide having a 14.degree. half-wedge shaped portion. The tip of the half-wedge is rounded and has a thin-film sensor attached along the stagnation line. The bottom surface of the half-wedge is tilted upward to relieve shock induced disturbances created by the curved tip of the half-wedge. The sensor is applied using a microphotolithography technique

When is it OK for children to start drinking fruit juice?

Children should be at least 6 months of age (strength of recommendation [SOR]: C, expert opinion) and parents should provide only 100% fruit juice in a cup (not a bottle). Intake should be limited to 4 to 6 oz a day until 12 months of age (SOR: C, expert opinion). It's important to reiterate to parents that breastfeeding is the preferred source of infant nutrition for the first 6 (preferably 12) months of life (SOR: A, systematic reviews)

A programme for risk assessment and minimisation of progressive multifocal leukoencephalopathy developed for vedolizumab clinical trials

Introduction Over the past decade, the potential for drug-associated progressive multifocal leukoencephalopathy (PML) has become an increasingly important consideration in certain drug development programmes, particularly those of immunomodulatory biologics. Whether the risk of PML with an investigational agent is proven (e.g. extrapolated from relevant experience, such as a class effect) or merely theoretical, the serious consequences of acquiring PML require careful risk minimisation and assessment. No single standard for such risk minimisation exists. Vedolizumab is a recently developed monoclonal antibody to α4β7 integrin. Its clinical development necessitated a dedicated PML risk minimisation assessment as part of a global preapproval regulatory requirement. Objective The aim of this study was to describe the multiple risk minimisation elements that were incorporated in vedolizumab clinical trials in inflammatory bowel disease patients as part of the risk assessment and minimisation of PML programme for vedolizumab. Methods A case evaluation algorithm was developed for sequential screening and diagnostic evaluation of subjects who met criteria that indicated a clinical suspicion of PML. An Independent Adjudication Committee provided an independent, unbiased opinion regarding the likelihood of PML. Results Although no cases were detected, all suspected PML events were thoroughly reviewed and successfully adjudicated, making it unlikely that cases were missed. Conclusion We suggest that this programme could serve as a model for pragmatic screening for PML during the clinical development of new drugs

Impact of age and race on outcomes of a program to prevent excess weight gain and disordered eating in adolescent girls

Interpersonal psychotherapy (IPT) prevents weight gain and reduces loss-of-control (LOC)-eating in adults. However, IPT was not superior to health-education (HE) for preventing excess weight gain and reducing LOC-eating over 1-year in adolescent girls at risk for excess weight gain and eating disorders. Limited data suggest that older and non-White youth may be especially responsive to IPT. In secondary analyses, we examined if age or race moderated weight and LOC-eating outcomes. The 113 participants (12–17 years; 56.6% White) from the original trial were re-contacted 3 years later for assessment. At baseline and follow-up visits through 3 years, we assessed BMI, adiposity by dual energy X-ray absorptiometry, and LOC-eating presence. In linear mixed models, baseline age moderated 3-year BMI outcome; older girls in IPT had the lowest 3-year BMI gain compared to younger girls in IPT and all girls in HE, p = 0.04. A similar pattern was observed for adiposity. Race moderated 3-year LOC-eating; non-White girls in IPT were most likely to abstain from LOC-eating at 3 years compared to all other girls, p = 0.04. This hypothesis-generating analysis suggests future studies should determine if IPT is especially efficacious at reducing LOC-eating in older, non-White adolescents

Atmospheric potential oxygen: New observations and their implications for some atmospheric and oceanic models

Measurements of atmospheric O2/N2 ratios and CO2 concentrations can be combined into a tracer known as atmospheric potential oxygen (APO ≈ O2/N2 + CO2) that is conservative with respect to terrestrial biological activity. Consequently, APO reflects primarily ocean biogeochemistry and atmospheric circulation. Building on the work of Stephens et al. (1998), we present a set of APO observations for the years 1996-2003 with unprecedented spatial coverage. Combining data from the Princeton and Scripps air sampling programs, the data set includes new observations collected from ships in the low-latitude Pacific. The data show a smaller interhemispheric APO gradient than was observed in past studies, and different structure within the hemispheres. These differences appear to be due primarily to real changes in the APO field over time. The data also show a significant maximum in APO near the equator. Following the approach of Gruber et al. (2001), we compare these observations with predictions of APO generated from ocean O2 and CO2 flux fields and forward models of atmospheric transport. Our model predictions differ from those of earlier modeling studies, reflecting primarily the choice of atmospheric transport model (TM3 in this study). The model predictions show generally good agreement with the observations, matching the size of the interhemispheric gradient, the approximate amplitude and extent of the equatorial maximum, and the amplitude and phasing of the seasonal APO cycle at most stations. Room for improvement remains. The agreement in the interhemispheric gradient appears to be coincidental; over the last decade, the true APO gradient has evolved to a value that is consistent with our time-independent model. In addition, the equatorial maximum is somewhat more pronounced in the data than the model. This may be due to overly vigorous model transport, or insufficient spatial resolution in the air-sea fluxes used in our modeling effort. Finally, the seasonal cycles predicted by the model of atmospheric transport show evidence of an excessive seasonal rectifier in the Aleutian Islands and smaller problems elsewhere. Copyright 2006 by the American Geophysical Union