Management of the child born small for gestational age through to adulthood: A consensus statement of the international societies of pediatric endocrinology and the Growth Hormone Research Society

Objective: Low birth weight remains a major cause of morbidity and mortality in early infancy and childhood. It is associated with an increased risk of health problems later in life, particularly coronary heart disease and stroke. A meeting was convened to identify the key health issues facing a child born small for gestational age (SGA) and to propose management strategies. Participants: There were 42 participants chosen for their expertise in obstetrics, peri- and neonatal medicine, pediatrics, pediatric and adult endocrinology, epidemiology, and pharmacology. Evidence: Written materials were exchanged, reviewed, revised, and then made available to all. This formed the basis for discussions at the meeting. Where published data were not available or adequate, discussion was based on expert clinical opinions. Consensus Process: Each set of questions was considered by all and then discussed in plenary sessions with consensus and unresolved issues identified. The consensus statement was prepared in plenary sessions and then edited by the group chairs and shared with all participants. Conclusions: The diagnosis of SGA should be based on accurate anthropometry at birth including weight, length, and head circumference. We recommend early surveillance in a growth clinic for those without catch-up. Early neurodevelopment evaluation and interventions are warranted in at-risk children. Endocrine and metabolic disturbances in the SGA child are recognized but infrequent. For the 10% who lack catch-up, GH treatment can increase linear growth. Early intervention with GH for those with severe growth retardation (height SD score, < -2.5; age, 2-4 yr) should be considered at a dose of 35-70 mu g/kg center dot d. Long-term surveillance of treated patients is essential. The associations at a population level between low birth weight, including SGA, and coronary heart disease and stroke in later life are recognized, but there is inadequate evidence to recommend routine health surveillance of all adults born SGA outside of normal clinical practice

The transition to Post-industrial BMI values among US children

Background: The trend in the BMI values of US children has not been estimated very convincingly because of the absence of longitudinal data. Our object is to estimate time series of BMI values by birth cohorts instead of measurement years. Methods: We use five regression models to estimate the BMI trends of non-Hispanic US-born black and white children and adolescents ages 2-19 between 1941 and 2004. Results: The increase in BMIZ values during the period considered was 1.3σ (95% CI: 1.16σ; 1.44σ) among black girls, 0.8σ for black boys, 0.7σ for white boys, and 0.6σ for white girls. This translates into an increase in BMI values of some 5.6, 3.3, 2.4, and 1.5 units respectively. While the increase in BMI values started among the birth cohorts of the 1940s among black girls, the rate of increase tended to accelerate among all four ethnic/gender groups born in the mid-1950s – early-1960s. Conclusion: Some regional evidence leads to the conjecture that the spread of automobiles and radios affected the BMI values of boys already in the interwar period. We suppose that the changes in lifestyle associated with the labor saving technological developments of the 20th century are associated with the weight gains observed. The increased popularity of television viewing was most prominently associated with the contemporaneous acceleration in BMI gain

Serum 25-Hydroxyvitamin D and Intact Parathyroid Hormone Influence Muscle Outcomes in Children and Adolescents

Increases in 25-hydroxyvitamin D concentrations are shown to improve strength in adults; however, data in pediatric populations are scant and equivocal. In this ancillary study of a larger-scale, multi-sited, double-blind, randomized, placebo-controlled vitamin D intervention in US children and adolescents, we examined the associations between changes in vitamin D metabolites and changes in muscle mass, strength, and composition after 12 weeks of vitamin D3 supplementation. Healthy male and female, black and white children and adolescents between the ages of 9 and 13 years from two US states (Georgia 34°N and Indiana 40°N) were enrolled in the study and randomly assigned to receive an oral vitamin D3 dose of 0, 400, 1000, 2000, or 4000 IU/d for 12 weeks between the winter months of 2009 to 2011 (N = 324). Analyses of covariance, partial correlations, and regression analyses of baseline and 12-week changes (post-baseline) in vitamin D metabolites (serum 25(OH)D, 1,25(OH)2 D, intact parathyroid hormone [iPTH]), and outcomes of muscle mass, strength, and composition (total body fat-free soft tissue [FFST], handgrip strength, forearm and calf muscle cross-sectional area [MCSA], muscle density, and intermuscular adipose tissue [IMAT]) were assessed. Serum 25(OH)D and 1,25(OH)2 D, but not iPTH, increased over time, as did fat mass, FFST, forearm and calf MCSA, forearm IMAT, and handgrip strength (p < 0.05). Vitamin D metabolites were not associated with muscle strength at baseline nor after the 12-week intervention. Changes in serum 25(OH)D correlated with decreases in forearm IMAT, whereas changes in serum iPTH predicted increases in forearm and calf MCSA and IMAT (p < 0.05). Overall, increases in 25(OH)D did not influence muscle mass or strength in vitamin D-sufficient children and adolescents; however, the role of iPTH on muscle composition in this population is unknown and warrants further investigation

Drugs of abuse and the adolescent athlete

Doping with endocrine drugs is quite prevalent in amateur and professional athletes. The World Anti-Doping Agency (WADA) has a list of banned drugs for athletes who compete and a strategy to detect such drugs. Some are relatively easy, anabolic steroids and erythropoietin, and others more difficult, human growth hormone (rhGH) and insulin like growth factor I (IGF-I). The use of such compounds is likely less in adolescent athletes, but the detection that much more difficult given that the baseline secretion of the endogenous hormone is shifting during pubertal development with the greatest rise in testosterone in boys occuring about the time of peak height velocity and maximal secretion of hGH and IGF-I

Funding of Marital Deduction Trusts Through Equalization Clauses: Confusing Concepts of Terminable Value and Terminable Interest

In a recent decision, the Tax Court concluded that an interest passing to a surviving spouse under a trust instrument qualified for a marital deduction where the interest was vested indefeasibly on the date of death but might have no value. The author suggests that the Internal Revenue Service attack upon this estate plan was based upon mistakenly equating terminable interest with terminable value-a confusion which has existed at least since the issuance of Revenue Procedure 64-19 in 1964

Funding of Marital Deduction Trusts Through Equalization Clauses: Confusing Concepts of Terminable Value and Terminable Interest

In a recent decision, the Tax Court concluded that an interest passing to a surviving spouse under a trust instrument qualified for a marital deduction where the interest was vested indefeasibly on the date of death but might have no value. The author suggests that the Internal Revenue Service attack upon this estate plan was based upon mistakenly equating terminable interest with terminable value-a confusion which has existed at least since the issuance of Revenue Procedure 64-19 in 1964

Why did the solar power sector develop quickly in Japan?

Thesis (S.M.)--Massachusetts Institute of Technology, Engineering Systems Division, Technology and Policy Program, 2007.Includes bibliographical references (leaves 175-181).The solar power sector grew quickly in Japan during the decade 1994 to 2003. During this period, annual installations increased 32-fold from 7MW in 1994 to 223MW in 2003, and annual production increased 22-fold, from 16MW in 1994 to 364MW in 2003. Over these years, the growth of Japan's solar power sector outpaced the global industry's growth, which is puzzling because Japan was in a recession during this period. At the same time, the U.S. was experiencing considerable economic expansion, yet the U.S. solar industry's growth was significantly slower than Japan's. This thesis focuses on the rapid development of Japan's solar power sector in order to address the central question, "Why did the solar power sector develop quickly in Japan?" To address this question, this thesis develops two comparative case studies: (1) Japan's solar power sector: 1994 to 2003 and (2) U.S. solar power sector: 1994 to 2003. These case studies provide detailed descriptions of the historical development of the solar power sectors in Japan and the U.S. based on data collected from International Energy Agency's PVPS program, Japan's New Energy Development Organization and the U.S. Energy Information Administration, among other sources.(cont.) A comparative analysis of these cases suggests that the rapid growth of Japan's solar power sector was enabled by interplay among (a) decreasing gross system prices price, (b) increasing installations, (c) increasing production and (d) decreasing costs. The second-order explanation for this interplay is that a mosaic of factors led to (a) decreasing prices, (b) increasing installations, (c) increasing production and (d) decreasing costs. This mosaic included the extrinsic setting (solar resource, interest rate, grid price), industrial organization (including the structure of the electric power sector and the structure within the solar power sector), demand-side incentives that drove down the "gap" with and provided a "trigger" for supply-side growth, and supply-side expansion that enabled significant cost reductions and price reductions that more than offset the decline in demand-side incentives. Within this complex interplay of numerous factors, roadmapping and industry coordination efforts played an important role by shaping the direction of Japan's solar power sector. This thesis concludes with "lessons learned" from Japan's solar power sector development, how these lessons may be applicable in a U.S. context and open questions for further research.by Michael G. Rogol.S.M

Quadrupedal movement training improves markers of cognition and joint repositioning

Introduction - Exercise, and in particular balance and coordination related activities such as dance, appear to have positive effects on cognitive function, as well as neurodegenerative conditions such as dementia and Parkinson’s disease. Quadrupedal gait training is a movement system requiring coordination of all four limbs that has previously been associated with cognitive development in children. There is currently little research into the effect of complex QDP movements on cognitive function in adults. Purpose - To determine the effects of a novel four-week quadrupedal gait training programme on markers of cognitive function and joint reposition sense in healthy adults. Methods - Twenty-two physically active sports science students (15 male and 7 female) were divided into two groups: a training group (TG) and a control group (CG). All participants completed the Wisconsin Card Sorting Task (WCST) and were tested for joint reposition sense before and after a four-week intervention, during which time the TG completed a series of progressive and challenging quadrupedal movement training sessions. Results - Participants in the TG showed significant improvements in the WCST, with improvements in perseverative errors, non-perseverative errors, and conceptual level response. This improvement was not found in the CG. Joint reposition sense also improved for the TG, but only at 20 degrees of shoulder flexion. Conclusions - Performance of a novel, progressive, and challenging task, requiring the coordination of all 4 limbs, has a beneficial impact on cognitive flexibility, and in joint reposition sense, although only at the specific joint angle directly targeted by the training. The findings are consistent with other studies showing improvements in executive function and joint reposition sense following physical activity

The Validity of Automatic Methods for Estimating Skeletal Age in Young Athletes:A Comparison of the BAUSport Ultrasound System and BoneXpert with the Radiographic method of Fels.

This study examined the validity of two automated methods (BAUSport, BoneXpert software using Fels, Greulich-Pyle, Tanner-Whithouse III protocols) for estimating skeletal age (SA) in young athletes in comparison to a reference standard (Fels). 85 male and female athletes, nine to seventeen years of age, from multiple sports were assessed for SA as part of an annual medical and health screening programme. Intra-class correlations demonstrated high degrees of association between the automatic methods for estimating SA (BAUSport r =.98; BoneXpert r =.96-.99) and the discrepancy between SA and chronological age (SA-CA) (BAUSport r =.93; BoneXpert r =.88-.97), with the reference standard. Concordance analyses for the categorisation of participants as early, on-time and late maturing also demonstrated substantial levels of agreement for both methods (BAUSport Kappa = .71; BoneXpert Fels Kappa = .63) with the reference standard. Bland-Altman plots comparing the automatic methods with the reference standard identified statistically significant fixed biases, ranging in magnitude from small to large. Collectively, these results suggest that BoneXpert and BAUSport can provide comparable estimates of SA and SA-CA in young athletes relative to the Fels method. Biases in the estimation of SA should, however, be considered and the automatic methods should be implemented as part of a comprehensive growth and maturity screening protocol. The non-invasive nature of the BAUSport method affords particular advantages (no radiation exposure, portability) in contexts where the regular estimation of SA is recommended