Plasma-derived human C1-esterase inhibitor does not prevent mechanical ventilation-induced pulmonary complement activation in a rat model of Streptococcus pneumoniae pneumonia.

Mechanical ventilation has the potential to cause lung injury, and the role of complement activation herein is uncertain. We hypothesized that inhibition of the complement cascade by administration of plasma-derived human C1-esterase inhibitor (C1-INH) prevents ventilation-induced pulmonary complement activation, and as such attenuates lung inflammation and lung injury in a rat model of Streptococcus pneumoniae pneumonia. Forty hours after intratracheal challenge with S. pneumoniae causing pneumonia rats were subjected to ventilation with lower tidal volumes and positive end-expiratory pressure (PEEP) or high tidal volumes without PEEP, after an intravenous bolus of C1-INH (200 U/kg) or placebo (saline). After 4 h of ventilation blood, broncho-alveolar lavage fluid and lung tissue were collected. Non-ventilated rats with S. pneumoniae pneumonia served as controls. While ventilation with lower tidal volumes and PEEP slightly amplified pneumonia-induced complement activation in the lungs, ventilation with higher tidal volumes without PEEP augmented local complement activation more strongly. Systemic pre-treatment with C1-INH, however, failed to alter ventilation-induced complement activation with both ventilation strategies. In accordance, lung inflammation and lung injury were not affected by pre-treatment with C1-INH, neither in rats ventilated with lower tidal volumes and PEEP, nor rats ventilated with high tidal volumes without PEEP. Ventilation augments pulmonary complement activation in a rat model of S. pneumoniae pneumonia. Systemic administration of C1-INH, however, does not attenuate ventilation-induced complement activation, lung inflammation, and lung injury.

Testing Predictive Developmental Hypotheses.

Predictive developmental hypotheses play a crucial role in developmental theories. These hypotheses link early developmental behaviors or processes to later developmental outcomes. Empirical tests of predictive developmental hypotheses are generally based on standard regression models. It is argued that hierarchical linear models or longitudinal multilevel models offer a better alternative. A multivariate longitudinal model linking developmental data to a criterion is described and an application is given. The application, derived from attachment theory, pertains to the prediction of infant behavior in the Strange Situation. It is concluded that the proposed approach offers a valuable tool to the developmentalist, both from a theoretical and methodological point of view.

The electronic mood device: design, construction, and application.

The electronic mood device (EMD) is designed to help answer questions about the variability and dynamics of emotions. It is a small, portable instrument used for repeated recording of moods and feelings. Both construction and operation of the EMD are described. The EMD can best be conceived of as an electronic mood adjective checklist. Persons using the EMD are signaled at designated (e.g., hourly) or random intervals to register their mood or feelings. Paper and pencil are not required. An application is given. It shows how feelings vary within and between persons and during the day. It is concluded that the EMD offers several advantages over paper-and-pencil instruments. Retrospective use is impossible. Timing and registration are accurate. Data handling is fast. Potential future applications are suggested.

Scales for teachers' assessment of inhibition and security seeking in kindergarten children.

For young children separation from their primary caregivers can give rise to feelings of emotional insecurity, which are manifested by inhibition of behavior and seeking security from a substitute caregiver. The present study examined the quality of two new scales, the Inhibition Scale and the Security Seeking Scale, developed for teachers' assessment of inhibition and security-seeking behaviors. Participants were 121 kindergarten children. Reliability and short-term stability of both scales proved to be good. Relationships with four major dimensions of personality, Extraversion, Conscientiousness, Agreeableness, and Emotional Stability, were examined by means of teachers' judgements on the School Behavior Checklist Revised. The validity of the Inhibition Scale and the Security Seeking Scale was supported by the findings. Scores on both scales appeared to be negatively related to those on Extraversion and Emotional Stability. The negative association with scores on Extraversion was stronger for scores on the Inhibition Scale than for those on the Security Seeking Scale. Neither scale was related to the nonemotional dimension Conscientiousness. In addition, scores on both the Inhibition and Security Seeking Scale appeared negatively related to the time passed since entry into kindergarten.

Vertical facial growth and statural growth in girls: a longitudinal comparison.

Individual and average growth patterns of the facial dimensions Nasion-Gnathion and Sella-Gonion, as related to statural growth were studied. The sample consisted of 134 girls aged 7-14 years. Data were analysed using a multivariate extension of the multilevel model for longitudinal data. The results confirmed that the mean growth curves of Nasion-Gnathion, Sella-Gonion and body height parallel each other to a large extent. At an individual level it appeared that the pubertal growth spurt of body height and the growth spurts of both facial dimensions are coincident. The major results of the present study pertain to the dynamic (age-dependent) relationship between statural growth and the growth of the face. It appears that there exists a stronger relationship between the growth velocities of standing height, Sella-Gonion and Nasion-Gnathion than between the actual lengths of the three variables themselves. The strongest relation was found between the growth velocity of body height and that of Sella-Gonion. These findings may be a contribution for diagnosis and treatment planning of individual cases.

Early palatal changes after initial palatal surgery in children with cleft lip and palate.

Early palatal growth and development after primary palatal closure was studied in children with different types of cleft lip and palate (CLP). Palatal dimensions were measured on dental casts taken at fixed ages, from 9 months to 4 years of age. The results showed that soft and hard palatal closure in one stage had a significant impeding influence on posterior sagittal palatal growth compared to closure of the soft palate only. Timing of surgery possibly had a small temporary restrictive effect on posterior transverse palatal growth and development. Type and severity of the oral cleft had a significant effect on transverse palatal development and anterior sagittal dimensions. Anterior arch width was reduced in children with a complete unilateral (U) CLP or bilateral (B) CLP. The palates of the latter children had consistently larger anterior arch depths. Compared to normal children, palates of cleft children changed anteriorly from wider at 9 months of age to narrower at 4 years of age. Arch depths were smaller in cleft children except for anterior arch depths in children with complete BCLP.

Prediction of early palatal growth and development in children with cleft lip and palate.

With the use of multilevel modeling of longitudinal data, the relationship between the developmental status of the palate at 4 years of age and early palatal growth and development from birth to 1.5 years of age was studied. A model to predict palatal depths and widths at 4 years of age was developed and tested. The sample consisted of 130 children with cleft lip and/or palate. They were divided into three groups according to surgical treatment; (1) no palatal surgery, (2) soft palatal surgery, and (3) soft and hard palatal surgery. Results showed that in groups 1 and 2, the total arch depth at 4 years of age is strongly related to the initial arch depth at birth. No or low correlations were found between palatal depth at 4 years of age and the growth velocity at birth. The anterior arch width in groups 2 and 3 at 4 years of age appeared to be strongly related to the early growth velocity. In group 1, a moderate correlation with the palatal width and growth velocity at birth was observed. The results of the individual predictions of arch depths and arch widths were reasonable to fair. It was concluded that prediction of individual arch variables at 4 years of age is possible, although within limits. Clinically this means that extreme development can be discriminated from more average development.

A photographic scale to measure facial aesthetics.

The aim of this study was to develop a measurement scale to quantify facial aesthetics. Four series of 36 standardized facial photographs (boys 11-13 years; girls 11-13 years; boys 14-16 years; girls 14-16 years) were judged twice by eight orthodontists, eight laymen, and eight children. This was undertaken by comparing each photograph with one reference photograph of a child of the same sex and age. Pearson's correlation coefficients were calculated to determine intra-observer agreement (median Pearson's correlation r = 0.78), and to assess the correlation between the scores of each judge and those of the others in that panel (median Pearson's correlation r = 0.71). Alpha coefficients were calculated as a measure for the reliability of the composed scores (median alpha coefficient alpha = 0.90). Finally, the correlation between the three jury panels was established (median Pearson's correlation r = 0.84). The results showed that the reproducibility of rating facial aesthetics is good. Moreover, a high level of agreement was found between the ratings of different panels. Therefore, a mean overall score for each judged photograph could be calculated. Finally, for each age and sex group a metric scale was composed, consisting of five photographs with their scores. These scales can be used to evaluate the results of orthodontic treatment with respect to facial aesthetics.

Colors and emotions: preferences and combinations.

Within three age groups (7-year-old children, 11-year-old children, and adults), preferences for colors and emotions were established by means of two distinct paired-comparison tasks. In a subsequent task, participants were asked to link colors to emotions by selecting an appropriate color. It was hypothesized that the number of times that each color was tied to a specific emotion would be predictable from the separate preferences for colors and emotions. Within age groups, participants had consistent preferences for colors and emotions, but preferences differed from one age group to another. Especially in the youngest group, the pattern of combinations between colors and emotions appeared to be meaningfully related to the preference order for colors and emotions.

Prematurity, posture and the development of looking behaviour during early communication.

This study concerns the developing relationship between motor control and looking behaviour in full term (N = 15) and pre-term (N = 29) infants during face-to-face interaction with the mother at 6, 12 and 18 weeks of corrected age. Infants with inborn errors or major medical complications were excluded. In the pre-term infants the development of head and arm postures during interaction differed from the full term pattern, especially in infants born before 32 weeks and/or small-for-gestational age. The full term infants were more advanced than other infants in the ability to grasp an object. These findings were related to group differences in looking behaviour, suggesting that differences in the development of looking behaviour may be (partly) accounted for by differences in the development of motor control.

Palatal changes after lip surgery in different types of cleft lip and palate.

This study concerns palatal development during 6 months following primary lip closure. The sample consisted of 75 children with different forms of cleft lip and palate and 51 noncleft children. The palate was measured at 3 months of age, just before lip surgery, after surgery at 6 months, and again at 9 months of age. The results showed that lip closure has a strong effect in the anterior alveolar region. This effect was restricted to 3 months after surgery. The changes in complete clefts were more explicit than in incomplete cleft forms. Furthermore, the data showed that arch depth reduction due to lip surgery was compensated for by continued anteroposterior palatal growth. Early orthopedics appeared to prevent major palatal collapse immediately after lip surgery. Finally simultaneous closure of the alveolar cleft at the nasal side resulted in continued reduction of anterior cleft width.

The development of head position preference in preterm infants beyond term age.

Healthy full-term infants show a developmental trend in head position from an initial right-sided preference to one with the head in midline around the age of 12 weeks. We studied the effects of intrauterine growth retardation (IUGR) and the degree of prematurity on both aspects of development from 35 weeks postmenstrual age to 18 weeks corrected age in 35 preterm infants without overt neurological abnormalities and whose gestational ages ranged from 27 to 34 weeks. Our data reveal that, during the preterm period, infants born after pregnancies of 32 weeks or less showed a lack of right-sided preferences for head turning after release from midline but not for the subsequent maintenance of a position. IUGR did not seem to affect either preference. After term age a right-sided preference diminished while a head midline position increased. The latter was not significantly delayed in relation to birth before 32 weeks gestation or IUGR. However, when infants were classified on the basis of neurological differences as reflected in a (mildly) abnormal movement quality, a delay in the attainment of a midline posture was observed, which suggests it is related to a suboptimal neurological condition. This delay, however, was also accounted for by the side-to-side flattening of the skull.

Early hospitalization and disturbances of infant behavior and the mother-infant relationship.

The impact of brief early hospitalization was investigated in a controlled natural experiment of 14 children with cleft lip and palate (CLP) who were hospitalized for palatal repair at 9.5 months of age, and another 13 CLP children who were hospitalized at 12.5 months of age; 14 children without clefts who were not hospitalized served as controls. After hospitalization children were more likely to avoid their mothers both following a brief stressful separation at home and in the Strange Situation. It was suggested that CLP children may have learned to cope with stress by shifting the attention away from the mother.

Emergence of the deciduous canines and molars in CLP children.

The emergence of the deciduous canines and molars was investigated as part of a longitudinal study into the emergence of the deciduous dentition in Dutch cleft lip and/or palate children (CLP) (Kramer et al., 1989). The study comprised a group of 71 CLP children and 74 normal children that served as a control. Mean emergence ages of the deciduous upper and lower canines and molars were studied. Emergence of the deciduous primary molar on the cleft side was delayed 2 months in the upper jaw and 1 month in the lower jaw in children with an unilateral cleft lip and palate. The deciduous primary molar on the non-cleft side was not delayed as compared with normal children. Local anatomical relationships could be a possible explanation for these findings. The deciduous canines and secondary molars in both jaws showed no significant differences in mean emergence ages as compared with the control group, nor between the different cleft types. No sex differences were found in any of the groups. A table is presented containing the mean emergence ages of all the teeth of the deciduous dentition for the various CLP-groups, divided in cleft and non-cleft side, and the control group.

Effects of lip adhesion and presurgical orthopedics on facial growth: an evaluation of four treatment protocols.

Differences in craniofacial morphology in uni and bilateral cleft lip and palate were studied by roentgenocephalometry: 35 American children, treated with a lip adhesion procedure, and 26 Dutch children treated with a preoperative orthopedic procedure, both followed by a lip and/or palatal repair, were compared. A multivariate statistical approach was used to study the effects of the surgical procedures and of the age of the child when operated upon. The variables affected by the type of operation were: the relative length of the maxilla (PNS-ANS); the SNA angle; and the relative length of the mandible (Go-Po). The length of the maxilla was on average longer for those treated with preoperative orthopedics and the maxilla was largest for children whose hard palate had yet to be closed. This was also the case for the SNA angle except for children treated with the combined lip-soft palate closure procedure. The mandible followed pattern displayed by the maxillary length; it was larger for those treated with preoperative orthopedics. Significant effects of the timing of the surgery on the variables studied were also found. Postponement of the definitive lip closure resulted in a reduction of the maxillary length, whereas delay of soft palatal closure resulted in an increase of the maxillary length.

Reproductive history of mothers of children with solitary, nonsyndromic cleft lip and/or palate.

The reproductive history was studied to evaluate if the three types of solitary, nonsyndromic clefts: cleft lip (CL), cleft lip and palate (CLP), and cleft palate (CP) are homogeneous entities. Occurrence of fetal loss, maternal health, and drug consumption of the mother during the pregnancy were compared in cases involving three types of clefts. Data was gathered from 87 children with clefts, 55 males and 32 females. Spontaneous abortions and vaginal bleeding were found to occur significantly more often in the (older) mother of a CLP child. This suggests that the factors involved in the etiology of CLP differ from the factors involved in CL and CP. Therefore, grouping of data of the three types of clefts in studies on the etiology should be avoided.

Growth comparison between children with cleft lip and/or palate and controls.

General growth from birth to 2.5 years of age of 45 children with a solitary, nonsyndromic cleft lip and/or palate (CL/P) was compared to that of 50 controls. Weight, height, and head circumference were studied in relation to possible influencing factors. Growth of children with CL/P was found to be similar, to a large extent, to that of the control sample, with the exception of growth measured by height. Whereas males in the control group are generally taller than females, the reverse is seen for the CL/P group. Feeding difficulties and intestinal disorders, airway infections, and cleft restoring operations do not account for differences among the groups with CL/P and the control group as was suggested in the literature. Feeding difficulties and intestinal disorders between 12 and 18 months of age and airway infections between 0 and 3 months of age were identified as having a negative influence on growth, measured by weight and height, though not on head circumference.

[Esthetics of face; development of a scale for the measurement of facial esthetics]. / Esthetiek van het gelaat. Ontwikkeling van een schaal voor het meten van de esthetiek van het gelaat.

The aim of this study was to develop a measurement scale to quantify facial appearance. Four series of 36 facial photographs, boys and girls at two ages, were judged twice by three different panels by means of ratio estimation. Pearson's correlation coefficients were calculated to determine intra- and inter-observer agreement (median r = .78 and .71 respectively) as well as inter-panel agreement (median r = .84). Cronbach's alpha coefficients were established as a measure for the homogeneity within each jury panel (median alpha = .906). The results showed that reproducibility of the ratings as well as agreement between different observers were sufficient. Therefore, a mean overall score for each photograph could be calculated. Finally, for each group a metric scale was composed, consisting of five photographs with their scores.