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ObjectivesTo compare prevalence and severity of diaper dermatitis (DD) in infants and toddlers (babies) across three countries (China, USA, and Germany), including diapered skin measures and caregiver practices.MethodsA cross-sectional study of 1791 babies (~600 from each country) was recruited at each clinical site. Based on regional toilet-training habits, exclusively diaper-wearing infants were recruited between ages 2-8 months in China and 2-18 months in the USA and Germany. DD was measured, as well as skin pH, transepidermal water loss (TEWL), and relative humidity (RH) in the diapered region. Caregiver habits were collected via a questionnaire and included information on hygienic practices.ResultsDiaper dermatitis was highest in the perianal area, followed by the intertriginous, genital, and buttock regions. In general, DD was significantly lower in babies in China, highest in Germany, and intermediate in the USA. This rank ordering of DD by geography was also observed in baby age 2-8 months. The lower DD observed in China was associated with lower skin pH and TEWL on diapered skin and decreased RH in the diaper. Chinese caregivers had the highest rate of prophylactic topical product usage, the most robust cleaning of the diapered area, lack of cleansing after urine-only diaper changes, and Chinese infants spent the least time in an overnight diaper.ConclusionsThese data suggest caregiver behaviors including prophylactic use of topical products, thorough cleaning after stooling and reduced time in an overnight diaper are associated with less DD, lower superficial skin pH, and enhanced skin barrier.

A significant uncertainty in assessments of the role of clouds in climate is the characterization of the full distribution of their sizes. Order-of-magnitude disagreements exist among observations of key distribution parameters, particularly power law exponents and the range over which they apply. A study by suggested that the discrepancies are due in large part to inaccurate fitting methods: they recommended the use of a maximum likelihood estimation technique rather than a linear regression to a logarithmically transformed histogram of cloud sizes. Here, we counter that linear regression is both simpler and equally accurate, provided the simple precaution is followed that bins containing fewer than ∼ 24 counts are omitted from the regression. A much more significant and underappreciated source of error is how to treat clouds that are truncated by the edges of unavoidably finite measurement domains. We offer a simple computational procedure to identify and correct for domain size effects, with potential application to any geometric size distribution of objects, whether physical, ecological, social or mathematical. [ABSTRACT FROM AUTHOR]

The geometries and topologies of leaves, flowers, roots, shoots, and their arrangements have fascinated plant biologists and mathematicians alike. As such, plant morphology is inherently mathematical in that it describes plant form and architecture with geometrical and topological techniques. Gaining an understanding of how to modify plant morphology, through molecular biology and breeding, aided by a mathematical perspective, is critical to improving agriculture, and the monitoring of ecosystems is vital to modeling a future with fewer natural resources. In this white paper, we begin with an overview in quantifying the form of plants and mathematical models of patterning in plants. We then explore the fundamental challenges that remain unanswered concerning plant morphology, from the barriers preventing the prediction of phenotype from genotype to modeling the movement of leaves in air streams. We end with a discussion concerning the education of plant morphology synthesizing biological and mathematical approaches and ways to facilitate research advances through outreach, cross-disciplinary training, and open science. Unleashing the potential of geometric and topological approaches in the plant sciences promises to transform our understanding of both plants and mathematics.

Predation exerts strong selection pressure on morphological traits and is often studied in freshwater fishes. A common morphological ecophenotype driven by predation from pursuit predators is the predator‐associated burst speed (PABS) ecophenotype. This ecophenotype, characterized by a smaller head, smaller body, and larger caudal region, is commonly found in western mosquitofish (Gambusia affinis) residing in environments with sunfish (family Centrarchidae) predators. However, the repeatability and transferability of the PABS ecophenotype across populations have not been tested. The four objectives of this study were to (1) assess the repeatability of methods to confirm the presence of the PABS ecophenotype in independent populations, (2) test whether morphology is correlated with predator abundance, (3) assess the repeatability of utilizing a discriminant function analysis (DFA) to accurately classify fish to predator status, and (4) use a DFA to conduct a cross‐validation test of the PABS model using previously studied populations of G. affinis to predict predator status of newly studied populations. There was consistency in the occurrence of the PABS ecophenotype among populations with predators. Permuted MANOVA (PMANOVA) models fit to each dataset revealed a significant effect of collection site nested within predator status (i.e., presence or absence of predator), suggesting location‐specific variations of the PABS ecophenotype. In addition, a PMANOVA model fit to body shape as a function of predator abundance (i.e., 0, 0.1–1.0, or >1.0 predators per minute of electrofishing) revealed a significant effect of predation level in the newly studied populations, suggesting morphology differs among populations with varying predator abundances. Cross‐study validation of the DFA revealed low between‐study accuracy compared to within‐study accuracy, but elongation of the caudal region in the presence of predators was consistent across studies. Our findings ultimately suggest that although the PABS ecophenotype at studied locations provides partial predictive capacity at unstudied locations, the nature and magnitude of the PABS ecophenotype depend on environmental settings, encounter histories with predators, level of abundance of predators, or other spatially structured mechanisms. [ABSTRACT FROM AUTHOR]

The deterministic motions of clouds and turbulence, despite their chaotic nature, nonetheless follow simple statistical power-law scalings: a fractal dimension D relates individual cloud perimeters p to measurement resolution, and turbulent fluctuations scale with separation distance through the Hurst exponent ℌ. It remains uncertain whether atmospheric turbulence is best characterized by split isotropy that is three-dimensional with ℌ = 1/3 at small scales and two-dimensional with ℌ = 1 at large scales, or by wide-range anisotropic scaling with an intermediate value of ℌ. Here, we introduce an "ensemble fractal dimension" De – analogous to D – that relates the total cloud perimeter per domain area 풫 as seen from space to measurement resolution, and show theoretically how turbulent dimensionality and cloud edge geometry are linked through ℌ = De − 1. Observationally, by progressively coarsening the resolution of cloud mask arrays from various global satellite platforms and a numerical simulation of a tropical domain we find the scaling De ~ 5/3, or ℌ ~ 2/3, a value nearly consistent with a previously proposed "23/9D" anisotropic turbulent scaling. Remarkably, the same scaling links two "limiting case" estimates of 풫 evaluated at the planetary scale and the Kolmogorov microscale, as separated by 11 orders of magnitude, suggesting that cloud and turbulent behaviors are constrained by basic planetary parameters. [ABSTRACT FROM AUTHOR]

Cloud area distributions are a defining feature of Earth's radiative exchanges with outer space. Cloud perimeter distributions n (p) are also interesting because the shared interface between clouds and clear sky determines exchanges of buoyant energy and air. Here, we test using detailed model output and a wide range of satellite datasets a first-principles prediction that perimeter distributions follow a scale-invariant power law n (p) ∝ p-(1+β) , where the exponent β = 1 is evaluated for perimeters within moist isentropic atmospheric layers. In model analyses, the value of β is closely reproduced. In satellite data, β is remarkably robust to latitude, season, and land–ocean contrasts, which suggests that, at least statistically speaking, cloud perimeter distributions are determined more by atmospheric stability than Coriolis forces, surface temperature, or contrasts in aerosol loading between continental and marine environments. However, the satellite-measured value of β is found to be 1.26 ± 0.06 rather than β = 1. The reason for the discrepancy is unclear, but comparison with a model reproduction of the satellite perspective suggests that it may owe to cloud overlap. Satellite observations also show that scale invariance governs cloud areas for a range at least as large as ∼ 3 to ∼ 3 × 10 5 km 2 , and notably with a corresponding power law exponent close to unity. Many prior studies observed a much smaller range for power law behavior, and we argue this difference is due to inappropriate treatments of the statistics of clouds that are truncated by the edge of the measurement domain. [ABSTRACT FROM AUTHOR]

Proposes a problem-solving process for finding unique solutions for specific learning problems of medical students, particularly in clinical preceptorships. Suggestions are offered for evaluation of the problem learner, including more emphasis on peer and self-evaluation and insights into teaching and implementing the proposed model, including the use of role-playing. (Author/MSE)

The importance of patient-centered care and the role of families in decision-making are becoming more recognized. Starting with a single acute care unit, a multidisciplinary improvement team at Cincinnati Children's Hospital developed and implemented a new process that allows families to decide if they want to be part of attending-physician rounds. Family involvement seems to improve communication, shares decision-making, and offers new learning for residents and students. Despite initial concerns of staff members, family-centered rounds has been widely accepted and spread throughout the institution. Here we report our experiences as a potential model to improve family-centered care and teaching. Key Words: family-centered, teaching rounds, discharge delay, THE COMMONLY ACCEPTED view of patients as passive recipients of health care is changing. The Institute of Medicine highlighted the importance of patient-centered care in Crossing the Quality Chasm: A [...]

OBJECTIVE. Evaluation procedures that rely solely on attending physician ratings may not identify residents who display poor communication skills or unprofessional behavior. Inclusion of non-physician evaluators should capture a more complete account of resident competency. No published reports have examined the relationship between resident evaluations obtained from different sources in pediatric settings. The objective of this study was to determine whether parent and nurse ratings of specific resident behaviors significantly differ from those of attending physicians. METHODS. Thirty-six pediatric residents were evaluated by parents, nurses, and attending physicians during their first year of training. For analysis, the percentage of responses in the highest response category was calculated for each resident on each item. Differences between attending physician ratings and those of parents and nurses were compared using the signed rank test. RESULTS. Parent and attending physician ratings were similar on most items, but attending physicians indicated that they frequently were unable to observe the behaviors of interest. Nurses rated residents lower than did attending physicians on items that related to respecting staff (69 % vs 97 %), accepting suggestions (56 % vs 82%), teamwork (63% vs 88%), being sensitive and empathetic (62% vs 85%), respecting confidentiality (73% vs 97%), demonstrating integrity (75% vs 92%), and demonstrating accountability (67% vs 83%). Nurse responses were higher than attending physicians on anticipating postdischarge needs (46% vs 25%) and effectively planning care (52% vs 33%). CONCLUSIONS. Expanding resident evaluation procedures to include parents and nurses does enhance information that is gathered on resident communication skills and professionalism and may help to target specific behaviors for improvement. Additional research is needed to determine whether receiving feedback on parent and nurse evaluations will have a positive impact on resident competency. Key Words medical education resident education/ training, multisource feedback patient--doctor communication, professionalism Abbreviations ABIM--American Board of Internal Medicine PSQ--Patient Satisfaction Questionnaire, COMMUNICATION AND PROFESSIONALISM are fundamental to the patient-physician relationship. Effective communication improves patient satisfaction and health outcomes, (1,2) whereas poor communication and unprofessional behavior are linked to patient complaints and [...]

Objective. Several studies have demonstrated that acute otitis media (AOM) in children can be managed without antibiotics. Because children with AOM have traditionally been treated with antibiotics in the United States, there are concerns that parents may not be comfortable with their children being treated with pain control alone. Recently, Cates in England showed that antibiotic usage for AOM could be decreased by prescribing a safety-net antibiotic prescription (SNAP) to be filled if symptoms do not resolve with observation after 48 hours. It is not clear whether a SNAP will be acceptable to parents in other settings such as the United States. The objective of our study was to determine whether parents in the United States find a SNAP for AOM acceptable and whether antibiotic usage could be decreased by its use. Methods. A pediatric practice-based research network in a midwestern community of 1.8 million was the setting for this study. The Cincinnati Pediatric Research Group (CPRG) includes practices in Ohio, Kentucky, and Indiana. Children who were between 1 and 12 years of age and presented to the offices of the CPRG with uncomplicated AOM were eligible for the study. Children were excluded when they had temperature >101.5[degrees]F, had an ear infection in the past 3 months, showed signs of another bacterial infection, or were toxic appearing. Families were given acetaminophen, ibuprofen, or topical otic anesthetic drops for pain control. They were also given a prescription for an antibiotic and instructed not to fill it unless symptoms either increased or did not resolve after 48 hours. The data were entered directly by investigators via an Internet site. Results. A total of 194 children were enrolled in 11 offices over 12 months; 175 (90%) completed the follow-up interview. The average child's age was 5.0 years. Only 55 (31%) of the 175 who were contacted for follow-up had filled their antibiotic prescription. Compared with their previous experience, parents were overwhelmingly willing to treat AOM with pain medication alone ([chi square] = 111). Seventy-eight percent (95% confidence interval: 71%-84%) of parents reported that the pain medication was effective. Sixty-three percent (95% confidence interval: 55%-70%) of parents reported that they would be willing to treat future AOM episodes without antibiotics and with pain medication alone. Conclusions. A subset of parents find a safety-net prescription and pain control acceptable in the treatment of AOM, and antibiotic usage can be lowered with this strategy. Pediatrics 2003;112:527-531; acute otitis media, safety-net antibiotic prescription, practice-based research network, observation., Acute otitis media (AOM) is the most commonly treated bacterial infection in children. (1) Treatment of this infection accounts for >50% of pediatric antibiotic prescriptions and as much as $5 [...]

Background. Health disparities between children from urban minority backgrounds and children from more affluent backgrounds are well-recognized. Few studies specifically address urban children's perceptions of their health-related quality of life (HRQOL) or the factors that contribute to these perceptions. Since schools are pivotal to children's intellectual, social, and emotional development, school connectedness may be a factor that contributes to their perception of HRQOL. Objective. To examine children's perceptions of HRQOL in an elementary school-based population of urban children. Methods. The study population consisted of 2nd, 3rd, and 5th graders from 6 urban kindergarten to 8th grade schools and their parents. Children completed a survey that included questions on HRQOL and school connectedness. Parents completed a telephone survey that assessed demographics, the child's health, health care usage, and parental health status. Data on school absences and mobility from the computerized school database were linked to survey data. Bivariate analyses were used to evaluate the association between child report of HRQOL and collected variables, including school connectedness. Multivariable linear regression was conducted to identify the factors best predicting HRQOL in these urban children. Results. Of the 1150 eligible students, parent and child survey data were available for 525 (45.6%). Fifty-one percent of students were male and 89% were black. Ninety-four percent of parents were female, 29% were married, and 62% had family incomes below $20 000 per year. The mean total score for HRQOL was 67.2, with a possible range of 0 to 100 (higher scores reflecting better HRQOL). In the multivariable analysis, child grade, the relationship of the "parent" to the child, employment, family income, type/presence of insurance, and school connectedness were significantly associated with the HRQOL total score. Conclusions. Young urban children self-report low HRQOL scores and do so as early as the 2nd grade. These low scores, which reflect children's own perceptions of impaired psychological and physical health, have potential implications for the success of urban children in their learning environments. The association between HRQOL and school connectedness might suggest that health and educational programs that improve a child's attachment to school could result in improved perceptions of health by urban children. Pediatrics 2003;111: 1372-1381; school health, underserved populations, health status., ABBREVIATIONS. HRQOL, health-related quality of life; CSDHP, Cincinnati School Health Demonstration Project; SF, short form. Health disparities between children from urban minority backgrounds and those from more affluent backgrounds are [...]

Parasite populations associated with different host species can encounter a variety of isolating reproductive barriers, leading to each population independently accumulating genome‐wide genetic differences due to their host associations. This phenomenon is called host‐associated differentiation (HAD) and has been proposed as an indicator of early diversification among parasitic arthropods. Although many parasite–host case study systems have been tested for the genetic signature of HAD (e.g., FST≥0.15 between sympatric, host‐associated populations in the absence of allopatry), it is unknown which isolating reproductive barriers best predict the general occurrence of HAD. HAD development has been attributed to biological and ecological factors that either directly generate reproductive isolation between parasites living on different hosts, such as 'immigrant inviability' (i.e., lower fitness of immigrants in non‐native environments), or that promote the accumulation of host‐specific genetic adaptations, such as the gallmaking feeding mode. In fact, some of these factors are shared across multiple case studies, suggesting that the occurrence of HAD is generalizable and can be predicted based on the incidence of significant biological and ecological factors. By means of a discriminant function analysis (DFA), this research assessed 108 arthropod parasite–host case studies for ecological and biological factors significantly correlated with the occurrence of HAD and whether these factors could be used to distinguish the presence of HAD from its absence. The DFA demonstrated that case studies that developed HAD could be distinguished from case studies that did not develop HAD. The results of the DFA were corroborated by a 'non‐iterative partial least squares' (NIPALS) discriminant model and a nominal logistic regression. Case studies with HAD could be robustly separated from case studies without HAD based on the incidence of these predictive factors: immigrant inviability, gallmaking, endophagy, recent range invasions of either hosts or parasites, differential host phenology, and differential parasite morphology. These results were used in an infinite random forest analysis to generate a hierarchy of conditional probabilities that separated HAD presence from absence. The results provide researchers with a tool for reliably predicting which untested parasite–host system would likely develop HAD. Immigrant inviability, gallmaking, and their combination were strongly correlated with the presence of HAD, which indicated parasite–host systems with these traits were highly likely to develop HAD. Contrary to expectation, endophagous feeding was negatively correlated with HAD presence, which indicated phytophagous endophagous feeders (excepting gallmakers) were highly unlikely to develop HAD. Furthermore, parasitoids were shown to be just as likely to develop HAD as not. Unfortunately, potentially significant predictive factors (e.g., allochrony) were excluded from analysis because too few case studies have been specifically tested for these factors. Furthermore, this analysis was biased by the lack of 'negative' publication results and the overrepresentation of research laboratories that primarily study HAD. Future research should accumulate novel HAD case studies that specifically test for allochrony, differential microbial associations, and morphological differentiation. [ABSTRACT FROM AUTHOR]