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This prospective study aimed to establish the effect of recombinant human growth hormone (rhGH) on intestinal function in children with short bowel syndrome (SBS). Eight children with neonatal SBS were included. All were dependent on parenteral nutrition (PN) for3 years (range, 3.8-11.6 years), with PN providing50% of recommended dietary allowance for age (range, 50%-65%). The subjects received rhGH (Humatrope) 0.13 mg/kg/d subcutaneously over a 12-week period. The follow-up was continued over a 12-month period after rhGH discontinuation. Clinical and biological assessments were performed at baseline, at the end of the treatment period, and 12 months after the end of treatment. No side effects related to rhGH were observed. PN requirements were decreased in all children during the course of rhGH treatment. Between baseline and the end of treatment, significant increases were observed in concentrations (mean ± standard deviation) of serum insulin-like growth factor 1 (103.1 ± 49.9 µg/L vs 153.5 ± 82.2 µg/L; P.01), serum insulin-like growth factor-binding protein 3 (1.7 ± 0.6 mg/L vs 2.5 ± 0.9 mg/L; P.001), and plasma citrulline (16.5 ± 14.8 µmol/L vs 25.2 ± 18.3 µmol/L; P.05). A median 54% increase in enteral intake (range, 10%-244%) was observed (P.001) and net energy balance improved significantly (P.002). It was necessary for 6 children to be maintained on PN or restarted after discontinuation of rhGH treatment, and they remained on PN until the end of the follow-up period. A 12-week high-dose rhGH treatment allowed patients to decrease PN, but only 2 patients could be definitively weaned from PN. Indications and cost-effectiveness of rhGH treatment for SBS pediatric patients need further evaluation.

We examined the relationship between body fat and body mass index (BMI) in a multiethnic population of obese children. BMI z-scores were compared to DEXA measures of whole body composition and regional fat distribution. Fat mass index (FMI) was best predicted by the equation: 1/[(0.159- 0.013 x percentile of total abdominal fat)- (0.01 x BMI z-score)], where percentile of abdominal fat ranges from 1 to 5. Predicted FMI had high agreement with FMI measured by DEXA. There were no detectable differences in this relation between different ethnic groups. Both BMI and abdominal fat should be used as a proxy to determine adiposity.

In this paper, a scheduling approach that combines multiple dispatching criteria into a single rule, with the objective of simultaneously optimizing multiple performance measures is proposed. This is accomplished using a linear combination with relative weights. The weights identify the contribution of the different criteria. The weights' assignments to the different criteria are optimized using a mixture design of experiments (DOE) and multiple response optimization. Results using this new approach show significant improvement versus the use of a single dispatching criterion.

Today's highly competitive semiconductor markets place a great emphasis on responsiveness to customers. In the past, competition has primarily focused on the product design arena. More recently, short lead times and good on-time delivery performance have become equally important to winning customer satisfaction. To meet these criteria, a recent thrust of manufacturing management has focused on the use of effective scheduling techniques to manage wafer movement. Dabbas and Fowler (1999) proposed an approach that combines multiple dispatching criteria into a single rule with the objective of maximizing multiple response measures simultaneously. This is accomplished using a linear combination with relative weights. The weights identify the contribution of the different criteria. This paper details the use of experimental design methodology as well as a desirability function approach in the optimization of the weights' assignment to the different criteria. The basic idea of the desirability function approach ...

The semiconductor manufacturing process is a very complex process due to the large number of processes, the diverse equipment set, and the complexities associated with its non-linear process flows. Today, management seeks effective real time reporting on different key parameters such as work-in-process (WIP), cycle time, scrap, and tool up-time in an effort to monitor factory performance so that the business goals are met. The complexity of wafer fabrication (fab) processing, however, has necessitated the need for multiple multi-million dollar Computer Integrated Manufacturing (CIM) systems to be implemented in order to collect real time data. CIM systems deployed in semiconductor manufacturing settings capture real time data about every detail of the factory such as equipment throughputs, WIP, and product and equipment history. Most of the data collected, however, tends to be archived rather than used due to the difficulty of data extraction and presentation. The challenge, therefore, is to transform the massive data in the different CIM databases into meaningful information that is easy to access as well as easy to interpret and manipulate. This paper presents an integrated relational database approach for modeling and collecting semiconductor manufacturing data from multiple database systems and transforming the data into useful reports. A summary of the key reports generated is presented as well. These reports help to monitor factory performance by tracking different key metrics. These reports were implemented in one of Motorola’s wafer fabs and have contributed significantly in improving factory performance.

The scheduling problem of semiconductor manufacturing systems has multiple responses of interest. The objective is to simultaneously optimize these different responses or to find the best-compromised solution. Most previous research in the area of semiconductor manufacturing systems has focused on optimizing a single performance measure. Dabbas and Fowler proposed a modified dispatching approach that combines multiple dispatching criteria into a single rule with the objective of simultaneously optimizing multiple objectives. In this paper, we validate their proposed approach using two different fab models at different levels of complexity: a hypothetical six stage-five machines Mini-Fab model and a full scale wafer fab model adapted from an actual Motorola wafer fab. We also discuss the actual implementation of the proposed dispatching algorithm into a scheduler for daily operation at a Motorola wafer fabrication facility. Results show an average 20% improvement for all responses when using the proposed dispatching approach.

Preoperative evaluation of squamous cell carcinoma antigen (SCCa) was performed in 220 patients with surgically treated early-stage carcinoma of the cervix. The median duration of follow-up was 1.9 years. SCCa was significantly higher in tumors with a squamous element (P0.001). There was a squamous element in 171 tumors. SCCa was elevated (2 ng/ml) in 21.6%. Significantly higher levels were associated with stage II disease (P0.001), tumors4-cm size (P0.001), and lymph node metastases (P0.001). The positive predictive value for lymph node metastases at2,4, and8.6 ng/ml SCCa is 51.4, 70.0, and 100% and the sensitivity is 58.1, 45.2, and 22.6%, respectively. Low SCCa is a poor predictor of absence of lymph node metastasis. The median SCCa for patients who developed tumor recurrence was greater than those who remained disease free (1.7 and 1.0 ng/ml, respectively, P = 0.009); however, in a multivariate analysis only lymph node metastasis and tumor size were of independent prognostic significance (P = 0.002 and P = 0.004, respectively). SCCa level8.6 ng/ml is highly predictive of lymph nodal disease. There is no independent prognostic significance in patients with early-stage surgically treated cervical carcinoma.

We examined the relationship between body fat and body mass index (BMI) in a multiethnic population of obese children. BMI z-scores were compared to DEXA measures of whole body composition and regional fat distribution. Fat mass index (FMI) was best predicted by the equation: 1/[(0.159- 0.013 x percentile of total abdominal fat)- (0.01 x BMI z-score)], where percentile of abdominal fat ranges from 1 to 5. Predicted FMI had high agreement with FMI measured by DEXA. There were no detectable differences in this relation between different ethnic groups. Both BMI and abdominal fat should be used as a proxy to determine adiposity.

Recently, thrombophilia (acquired and inherited) has been implicated in recurrent IVF-ET failure. The objective of this study was to determine the effect and safety of thromboprophylaxis using low-molecular-weight heparin (LMWH) in women with recurrent in vitro fertilization (IVF)-embryo transfer (ET) failure and thrombophilia.Eighty-three women with history of three or more previous IVF failures and who had at least one thrombophilic defect were eligible for this study. Patients were randomly allocated into two groups: Group A (n = 42) received enoxaparin 40 mg/day, and group B (n = 41) received placebo (NaCl 0.9%). Both treatments started on the day of ET and continued until delivery or foetal demise was diagnosed. The primary outcomes were the implantation, pregnancy and live birth rates.Patients who received LMWH for thromboprophylaxis had a significant increase in the implantation and pregnancy rates compared with the placebo group (20.9% vs. 6.1% and 31% vs. 9.6%, respectively; p0.001 and p0.05, respectively). A significant increase in the live birth rate was observed in the heparin-treated group compared with placebo (23.8% vs. 2.8%, respectively; p0.05). The abortion rate was significantly higher in the placebo-treated group compared to the heparin-treated group (p0.05). The frequency of treatment complications did not differ between the two study groups.LMWH is a safe and effective thromboprophylactic treatment for women with thrombophilia and recurrent IVF-ET failures. The implantation rate, pregnancy and live birth rates are significantly increased with such treatment.

To examine the indications and rate of cesarean section in referral hospitals.Between January 2003 and December 2005, a total of 11,506 women delivered at King Hussein Medical Center, of which 2,075 cesarean sections (CS) were performed. Patients who underwent cesarean section were divided into three age subgroups:25 yr (n = 3,118), 25-35 (n = 6,147), and35 yr (n = 2,241), and two parity subgroups - primiparous (n = 3,326) and multiparous (n = 8,180). Information abstracted included maternal characteristics and indications for CS. Statistical analyses were performed using the Pearson chi-square test and Fisher's exact test to evaluate differences between the various subgroups.From a total of 11,506 deliveries that took place, 2,075 cesarean sections were performed with an incidence of 18%. According to age, the CS rate was 11.85%, 20.5% and 19.9%, respectively, in the three age subgroups. According to parity, the CS rate was 16.3% and 18.7% in the primiparous and multiparous women, respectively. When matched to age, the indications for CS showed no significant difference among the three age subgroups. When matched to parity, the indications also showed no significant difference between the two parity subgroups except for dystocia which was significantly higher in the primiparous compared to multiparous women (p0.01), and for repeated CS which was significantly higher in the multiparous compared to primiparous women (p0.0001)Some indications for cesarean section such as dystocia and fetal distress were over-utilized resulting in a high CS rate. Proper management of labor and precise interpretation of fetal heart tracing might be effective in reducing the cesarean section rate.

More information is needed regarding the prognosis of children receiving home parenteral nutrition (HPN). This article describes 20-year outcome data in children receiving HPN and provides separate profiles for the major pediatric diagnostic subgroups.This retrospective study included children who started receiving HPN between January 1, 1980, and December 31, 1999, in a single pediatric HPN center.A total of 302 children were recruited, 230 (76%) with primary digestive disorders and 72 (24%) with nonprimary digestive disorders. Median age at HPN onset was 1.5 years. Median duration of HPN was 1.3 years. By January 1, 2000, 54% had weaned from HPN, 26% were still receiving HPN, 16% had died, and 4% had undergone intestinal transplantation. The survival probabilities at 2, 5, 10, and 15 years were 97%, 89%, 81%, and 72%, respectively. The likelihood and cause of death depended on the underlying diagnosis. Nine percent of children with primary digestive disorders died, 24% from their primary disease and 48% from liver disease or sepsis. Children with intractable diarrhea of infancy had the highest mortality rate (25%) and the highest incidence of liver disease (48%; P = 0.0002). Thirty-eight percent of children with primary nondigestive diseases died, 94% from their primary disease and 6% from liver disease or sepsis.Outcome and survival of children receiving HPN are mainly determined by their underlying diagnosis. Nearly all children with primary digestive disease survive if referred early to an expert center.

Objectif Evaluer une prise en charge nutritionnelle par education therapeutique de femmes enceintes sur le risque d’obesite de l’enfant. Patientes et methodes Deux cent soixante-quinze femmes enceintes d’IMC > 25 (32,5 ± 5,4 kg/m2) ont ete incluses avant 22 SA et randomisees en un groupe controle (n = 136 : suivi habituel avec au moins une consultation dietetique) et un groupe interventionnel (n = 132 : education therapeutique nutritionnelle avec 6 seances collectives ou individuelles, sans objectif ponderal). Le critere d’evaluation principal etait la croissance ponderale infantile acceleree (> 0,67 DS) a l’âge de 2 ans, facteur de risque d’obesite infantile. Resultats Les evenements pendant la grossesse ne differaient pas entre les 2 groupes, dont incidence du diabete gestationnel, gain de poids maternel et poids de naissance. Le taux de croissance ponderale infantile acceleree a 2 ans etait semblable dans les 2 groupes : en ITT (59,1 vs 60,3 %, p = 0,84), en donnees disponibles (DD n = 206), en per-protocole (PP n = 177). A 2 ans, le surpoids avait plus souvent disparu dans le groupe interventionnel pour la mere (DD, n = 149 : 87,1 vs 96,2 %, p = 0,04) et etait moins frequent chez l’enfant (DD, n = 204 : 0 vs 6,8 %, p = 0,014 ; PP, n = 176 : 0 vs 6,4 %, p = 0,03). Discussion Une intervention par education therapeutique nutritionnelle chez des femmes enceintes en surpoids n’a pas d’impact sur la croissance ponderale acceleree de l’enfant a 2 ans mais semble limiter le nombre de meres et d’enfants en surpoids a 2 ans.

Introduction Notre objectif etait d'evaluer si une prise en charge nutritionnelle de femmes obeses ou en surpoids pendant leur grossesse permettait de reduire le risque d'obesite de l'enfant. Patients et methodes Nous avons inclus dans 4 centres francais 275 femmes enceintes ( n =136: prise en charge habituelle avec au moins une consultation dietetique) et un groupe interventionnel ( n =132). L'intervention a comporte 2 consultations dietetiques individuelles et 4 seances collectives (a 20, 28, 35 SA et 2 mois apres l'accouchement) s'inscrivant dans une action d'education therapeutique nutritionnelle maternelle et infantile, dont l'objectif n'etait pas une reduction ponderale. Le critere d'evaluation principal etait la croissance ponderale infantile acceleree (> 0,67 DS) durant les 2 premieres annees de vie, un facteur de risque d'obesite dans l'enfance. Resultats Les evenements pendant la grossesse ne differaient pas entre les 2 groupes, dont incidence du diabete gestationnel, gain de poids maternel et poids de naissance. Le taux de croissance ponderale infantile acceleree a 2 ans ne differait pas entre les groupes: en ITT (59,1 vs 60,3 %, p =0,84), en donnees disponibles (DD n =206), en per-protocole (PP n =177). A 2 ans, le surpoids etait moins frequent dans le groupe interventionnel pour la mere (DD, n =149: 87,1 vs 96,2 %, p =0,04 ; P P, n =128: 95,8 vs 89,3 %, p =0,18) et l'enfant (DD, n =204: 0 vs 6,8 %, p =0,014 ; P P, n =176: 0 vs 6,4 %, p =0,03). Conclusion Une intervention basee sur l'education therapeutique nutritionnelle chez des femmes en surpoids, debutee apres 3 mois de grossesse, n'a pas d'influence sur la croissance ponderale de l'enfant a 2 ans mais semble limiter le nombre de meres et d'enfants en surpoids a 2 ans Declaration d’interet Les auteurs declarent ne pas avoir d'interet direct ou indirect (financier ou en nature) avec un organisme prive, industriel ou commercial en relation avec le sujet presente.

Objectif Comparer le developpement pubertaire, la prevalence de l’hirsutisme et des anomalies du cycle menstruel et le profil hormonal d’adolescentes diabetiques de type 1 (DID) et d’adolescentes obeses. Patients et methodes Les donnees cliniques et biologiques ont ete recueillies chez 78 patientes DID et 96 patientes obeses âgees de 11,9 ans a 17,9 ans et ayant un stade pubertaire Tanner 4 ou 5. Resultats On retrouve une augmentation de la prevalence de l’hirsutisme et des troubles de regles chez les patientes DID (21 % et 44 % respectivement) et chez les patientes obeses (36,5 % et 42 % respectivement). L’âge de la pubarche, thelarche et de la menarche est plus tardif chez les patientes DID compare aux patientes obeses. L’hirsutisme chez les patientes DID comme les patientes obeses est lie a une hyperandrogenie biologique avec une augmentation de la fraction libre calculee de la testosterone. Cette augmentation du taux libre de testosterone est liee a une elevation des taux de testosterone totale chez les adolescentes DID, alors qu’elle est due a une diminution du taux de la SHBG (Sex Hormone Binding Globulin) chez les adolescentes obeses. Chez les patientes DID, le taux de testosterone libre est correle positivement au taux d’hbA1c. Les anomalies du cycle menstruel sont associees a une hyperandrogenie biologique uniquement chez les patientes DID Conclusion L’hirsutisme et les troubles des regles sont frequents chez les adolescentes DID et les adolescentes obeses. Malgre une hyperandrogenie presente dans les 2 groupes de patientes, le profil hormonal de chacun differe. En effet l’hyperandrogenie chez les patientes DID est liee a une augmentation de la secretion d’androgenes alors que celle-ci est essentiellement due a une diminution de la SHBG chez les patientes obeses. L’origine de l’insuline, exogene chez les patientes DID, endogene chez les patientes obeses pourrait expliquer cette difference hormonale.

In children who depend on long-term parenteral nutrition (PN), a major goal is to obtain optimal growth. The aim of this retrospective study was to analyze growth in children on long-term cyclic nocturnal home PN, over at least 8 years before puberty. Nine boys and 7 girls were studied. Their mean age at the time of study was 11 years with a mean PN duration of 10.5 (8.6–16.4) years. Diseases were short bowel syndrome (5), intractable diarrhea (4), chronic intestinal pseudo-obstruction (4) and long segment Hirschsprung’s disease (3). In each child, periods of at least 2 years were analyzed: either periods of regular growth (R: height gain >50th percentile), or slow growth (S: height gain ≤25th percentile). Results were expressed as mean ± SD. Comparisons were performed using either Student’s test for unpaired data or Wilcoxon’s test for paired data. PN provided a mean of 224 ± 80 mg nitrogen/kg/day and 43 ± 14 kcal/kg/day equivalent to 50% of recommended supplies. At the time of study, the population presented with weight (W) = –0.7 ± 0.8 SD and height (H) = –1.5 ± 1.3 SD. The difference between W and expected W for H (W/H) was significant (p < 0.002). W/H ratio was 105 ± 11%. For the total PN duration, weight gain was +0.2 ± 1.5 SD and height loss was –0.75 ± 1.4 SD. An excess weight gain occurred in parallel with the deflection of height gain. Of the 16 children, regular prepubertal growth was achieved in 4 only. The other 12 showed alternate periods of R and S. In 8 of them, 26.5 years of R and 33.5 years of S were compared, each child being his own control. PN nitrogen and energy supplies were significantly higher during R periods than during S periods. In the absence of any disease or treatment explaining the failure to thrive, inadequate PN supplies, especially in terms of nitrogen supply, are thought to be responsible for a negative nitrogen balance and slowed growth. In case of any deflection away from the individual growth curve, it is recommended to adjust the PN supply early, especially nitrogen supply.

Obesity is a cardiovascular risk factor in adults. Poorly is known about effect of obesity on cardiovascular system in children. Mechanical properties of a great elastic trunk, the common carotid artery (CCA) and endothelium function of the brachial artery were studied in 130 obese children (age: 12 +/- 3 years, body mass index (BMI): 29 +/- 5.5 kg/m2, without hypertension (115 +/- 19/58 +/- 8 mmHg). These patients had a vascular high resolution echographical analysis. Cross sectional compliance (CSC), cross sectional distensibility (CSD) and incremental elastic modulus (Einc) were analysed at the CCA site. The brachial artery dilation was measured after hyperthemia (flow mediated dilation, FMD), an endothelium dependent function and after sublingually glyceryl trinitrate (GTNMD), an independent endothelium function. Fat mass composition and distribution were assessed by dual-energy X-ray absorptiometry in 70 patients. In 50 obese patients an oral glucose tolerance test was done to determine insulin resistance. The obese children had significantly lower CSC and CSD than the healthy controls (respectively 0.12 +/- 0.04 vs 0.14 +/- 0.05 mm2.mmHg-1; p0.05 and 0.5 +/- 0.2 vs 0.8 +/- 0.4 mmHg(-1).10(-2); p0.001). Obese children had higher value than the controls for Einc (2.4 +/- 0.4 vs 1 +/- 0.24 mmHg.10(3); p0.001) that correlated poorly with fasting insulin concentrations (r = 0.34; p0.06) and BMI (r = 0.34; p0.01). FMD was significantly lower in obese children than in controls (6 +/- 3 vs 8 +/- 4%, p0.01) without modification of GTNMD (17 +/- 6 vs 18 +/- 7%, NS). These two parameters were respectively correlated with the android fat distribution (r = 0.36; p0.01; r = 0.49; p0.001). The CCA stiffness of obese children is linked to the amount of the overweight and to insulin resistance. The android fat distribution is related to endothelium dysfunction.

The purpose of this study was to evaluate the type and frequency of psychopathological disorders observed in obese children and adolescents. We also looked for a correlation between psychic disorders in the obese children, the degree of obesity and paternal psychopathology.The study group included 84 obese children and adolescents aged 5 to 16 years (mean age 10.9 +/- 2.8 years). There were 55 girls and 29 boys. The z-score expressing deviation from the ideal body mass index (IMC) varied from +2 to +10.6 (mean 4 + 1.9). Psychopathological disorders observed in these obese patients were compared in children and adolescents with insulin-dependent diabetes mellitus. The standard diagnostic interview (K-SADS PL) and self-administered questionnaires (Sielberger STAIC-Trait for anxiety and CDI for depression in children or CBCL or GHQ for their parents) were also used to evaluate psychic disorders.More than half of the obese children (47 out of 84) had a DSM-IV diagnosis, often involving anxiety (n = 28). The rate of internalized and externalized psychopathological disorders (measured by STAIC-Trait and CBCL) was higher in the obese children than in the diabetics. The children's psychopathological disorders were more marked if their parents were perturbed, particularly when their mother had an internalized disorder. No correlation was found between the degree obesity and psychopathological disorders in the obese children and adolescents.Our findings show the frequency of mental disorders in obese children and point out the importance of parental psychopathology. This underlines the usefulness of a pedopsychiatric approach implicating the entire family for therapeutic management of these patients.

This study aimed to assess the incidence and etiology of central venous catheter (CVC) infections in children on home parenteral nutrition (HPN).207 CVC-years were studied retrospectively in 47 children on HPN, aged 8.1+/-5.0 years.125 CVC were used (means: 2.6 CVC/patient and 21 months utilization/CVC). Half of the hospitalizations (162) were due to proven CVC-related infections. The mean infection incidence was 2. 1/1000 HPN days. The total population divided in two groups below and above this value: group one including 24 children, incidenceor = 2.1 per 1000 days (mean: 0.83) and group two including 23 children, incidence2.1 per 1000 days (mean: 4.3). No differences were found between the two groups in terms of underlying disease, presence of ostomies, age at the time of HPN onset, or micro-organisms responsible. The only differences (p0.05) were the mean duration of HPN (longer in group one) and the delay between HPN onset and the first infection (longer in group one).This study does not highlight any risk factors for CVC infection. However, early CVC infections after HPN onset appear to predict a bad prognosis.

(1999). Advanced heterotopic pregnancy. Journal of Obstetrics and Gynaecology: Vol. 19, No. 6, pp. 677-678.

Evaluation of Physical Capacities of Obese Children: The use of a Test for Cardiovascular Fitness in their Follow up: P036

Similar to laws of nature, evolution in semiconductor design, manufacturing, and functionality has been influencing our everyday life. With ever decreasing costs per bit, microelectronics are steadily penetrating and revolutionising our lives. Examples range from desktop computers to pagers and mobile phones to name just a few. One key enabler and driver has been the continuous design shrinks of Integrated Circuit (ICs) devices. However, despite the frequent design shrinks and all the equipment and process innovation that comes with them, the added complexity of new chip manufacturing requires wafer size scaling to maintain a competitive cost to performance ratio demanded by the consumer market. To stay competitive is only possible by enhancing the number of die per wafer, or in other words, convert to the next diameter. As a result, Motorola has been consolidating its older 4" factories into existing 6" and 8" factories to support newer technology and to continue to be cost competitive. Factory consolidation, however, is not a trivial matter. It requires the transfer and requalification of different product lines and processes from one factory to another, the redeployment of people as well as the transfer of equipment from one factory to another. In this paper, we will review the key challenges faced by management and the management's approach and strategies practised in a recent factory shutdown at one of the Motorola manufacturing sites in Phoenix, Arizona.