Administration In Children Research Articles

Neurocognitive Changes after Sustained Ketamine Administration in Children with Chronic Pain.

IntroductionKetamine has received attention recently as an agent for chronic pain. There are concerns, however, regarding the neurocognitive changes patients might experience after ketamine exposure.MethodsThis prospective, uncontrolled study describes the neurocognitive functioning of 11 children with chronic pain before and after 2 weeks of daily oral ketamine exposure. Neurocognitive assessment was performed at baseline, Week 2, and Week 14. We hypothesized that there would be declines in neurocognitive scores at either Week 2 or Week 14.ResultsNo decline in neurocognitive function was detected in the children investigated. Mean scores for tests measuring executive function and memory were improved at Weeks 2 and 14 compared to baseline.DiscussionThis study did not detect any decline in neurocognitive scores in a small number of children exposed to 2 weeks of oral ketamine therapy. Randomized, controlled studies of the neurocognitive effects of ketamine in children are recommended to further investigate these preliminary findings.

1172Virological Efficacy of Peramivir Administration in Children with Influenza

1172Virological Efficacy of Peramivir Administration in Children with Influenza

Kinship Care

Kinship Care

Tu1196 Evaluation of the Pharmacokinetics and Safety of MMX Mesalamine Following Administration in Children and Adolescents With Ulcerative Colitis

AIM: Ulcerative colitis (UC) is a chronic inflammatory disease of the colon and rectum distinguished by relapsing and remitting gastrointestinal and systemic symptoms. Mesalamine (5-aminosalicylic acid; 5-ASA) has proven efficacy in the induction and maintenance of disease remission in patients with mild-to-moderate UC. This phase 1, multicenter, randomized, open-label study (NCT01130844) assessed the pharmacokinetic and safety profiles of 5-ASA and its major metabolite, acetyl-5-ASA (Ac-5-ASA), after administration of once-daily MMX mesalamine to children and adolescents with UC. METHODS: Study participants aged 5-17 years, with a UC diagnosis of ≥3 months were randomized to MMX mesalamine 30, 60, or 100 mg/kg/day (stratified by body weight) for 7 days. To achieve these doses in children, smaller-sized 300 mg and 600 mg tablets were developed for this study to augment the existing approved 1200 mg MMX mesalamine tablet. Patients were administered MMX mesalamine at home on Days 1-4 and on site on Days 5-7 when subjects attended for pharmacokinetic blood and urine sampling and for safety assessments. Plasma and urine concentrations of 5-ASA and Ac-5-ASA were determined by a validated LC/MS/MS assay. Key pharmacokinetic parameters for 5-ASA and Ac-5-ASA included maximum concentration (Cmax,ss), time of Cmax,ss (tmax), area under the curve for one dose interval (AUCss), and renal clearance (CLR), and percent of dose absorbed. RESULTS: A total of 52 patients (30F:22M with mean [standard deviation] age of 13.3 [3.06] years and median [range] time since UC diagnosis of 1.83 [0.2, 9.6] years) were randomized and treated: 21 at 30 mg/kg; 22 at 60 mg/kg; and 9 at 100 mg/kg. Steady state plasma concentrations for 5-ASA and Ac5-ASA were attained by Day 5 for all doses. On Day 7, mean AUCss and Cmax,ss for 5-ASA and Ac-5-ASA increased in a dose proportional manner between 30 and 60 mg/kg/day doses. Mean percentage of 5-ASA absorbed from MMX mesalamine was 29.4%, 27.0%, and 22.1%, for 30, 60, and 100 mg/kg/day doses, respectively. Mean CLR ranged from 5.0-6.5 L/h for 5-ASA and 10.0-16.2 L/h for Ac-5-ASA. The incidence of treatment-emergent adverse events was 19.2% overall. Events were similar among different dose and age groups, with no novel safety signals reported. CONCLUSIONS: The pharmacokinetic profile of 5-ASA and Ac-5ASA in children/adolescents with UC receiving MMX mesalamine across all dose levels was similar to the pharmacokinetic profile in historical adult data. MMX mesalamine was welltolerated at all doses and in all age groups; no new safety signals were identified.

Pregnant Teens in Foster Care: Concepts, Issues, and Challenges in Conducting Research on Vulnerable Populations

Teens in foster care give birth at over twice the rate of other teens. Unique challenges exist for these vulnerable teens and babies, yet research on such populations, particularly within the systems that serve them, is limited. A demonstration project at Inwood House, a residential foster care agency in New York City, from 2000 to 2005, at the same time that the Administration for Children's Services was exploring policy and practice changes for this population, is described. Research design and implementation issues, descriptive data, and experiences provide lessons for improving the evidence base to meet the needs of pregnant teens in care.

Assessment of Adequate Use of Asthma Inhalational Medication Administration in Children

Assessment of Adequate Use of Asthma Inhalational Medication Administration in Children

Washington State's adoption of a child welfare practice model: An illustration of the Getting To Outcomes implementation framework

Abstract Despite a great need for evidence-informed practices in child welfare, very few child welfare systems have implemented evidence-based case management models state-wide. While the literature on implementation from the perspective of model developers and researchers is steadily increasing, there has been little attention to the process of implementation originating from the reverse direction, by community organizations themselves, or with regard to going-to-scale implementation in child welfare. The Getting to Outcomes (GTO) model, which was originally created to help organizations choose and implement prevention programs, is a promising guide for child welfare systems seeking to initiate system-wide implementation of evidence-based practices. The GTO framework provides a step-by-step guide for surveying a system, building motivation, training, and evaluation. This article will illustrate the state-wide implementation of Solution-Based Casework (SBC), an evidence-based model of case management, by Washington State's Children's Administration, following the GTO framework. Despite some barriers and obstacles, the GTO model proved to be feasible and to aide in the implementation of SBC. Implications for the GTO model as a framework for empowering community organizations to choose and implement relevant evidence-based practices will be discussed.

Radiological Zebra Lines Correspond to Bisphosphonate Administration in Children with Osteogenesis Imperfecta

Bisphosphonates are widely used in the treatment of osteogenesis imperfecta due to their action of limiting bone resorption by inhibiting osteoclast activity. Sclerotic bands, which are known as metaphyseal lines, are observed in the metaphysis of the long bones in paediatric patients treated with bisphosphonates for osteogenesis imperfecta before closure of the growth plate, and the number of metaphyseal lines corresponds to the number of treatment cycles. Metaphyseal lines are sometimes called ‘radiological zebra lines’. This report of two paediatric patients with osteogenesis imperfecta receiving cyclic bisphosphonates describes the pattern of radiological zebra lines corresponding to bisphosphonate administration. The distances between the lines show an increasing interval towards the diaphysis in growing bones.

Integrated Health and Human Services Information Systems to Enhance Population-Based and Person-Centered Service

& 2013 Publ In this issue of the American Journal of Preventive Medicine, Vaithianathan and colleagues have made a valuable contribution in demonstrating how administrative data from human services systems can be used to develop a predictive risk model that identifies children at high risk of maltreatment and could support targeting of prevention and early intervention services. They integrated data from the New Zealand public benefit and child protective services systems to develop their risk algorithm. It is particularly relevant to the U.S. now as many state and local governments are using the impetus of national healthcare reform to redesign health and human services information and service delivery systems. As the authors note, predictive risk modeling (PRM) is most advanced in healthcare utilization, and it is an increasingly important tool in a wide range of innovations to improve quality and “bend the cost curve” in the U.S. healthcare system. The integration of data from multiple sources, including all-payer claims databases and electronic health records, is providing the foundation for identifying individuals at high risk, targeting interventions for chronic disease management, reducing hospital admissions and readmissions, improving end-of-life care, and recognizing many other opportunities for improvement. A whole new industry is emerging to capitalize on the analytic promise of “Big Data.” In recent years, heightened attention is also being directed to modernizing the information systems that support human services. The National Human Services Interoperability Architecture (NHSIA) initiative sponsored by the Administration for Children and Families (ACF) within the U.S. DHHS and the National

Ensuring “Meaningful Access” to the Courts for Individuals with Limited English Proficiency

Juvenile and Family Court JournalVolume 64, Issue 4 p. 45-49 Article Ensuring “Meaningful Access” to the Courts for Individuals with Limited English Proficiency Rosie Hidalgo, Rosie HidalgoSearch for more papers by this author Rosie Hidalgo, Rosie HidalgoSearch for more papers by this author First published: 25 November 2013 https://doi.org/10.1111/jfcj.12011 Author's Note: This article appeared in Synergy, a newsletter of the NCJFCJ's Resource Center on Domestic Violence: Child Protection and Custody (RCDV: CPC). Synergy, Vol. 16, No. 1 (Winter 2013), focused on immigration and child protection and custody issues in the context of domestic violence, was guest-edited by Casa de Esperanza, and was translated, for the first time, into Spanish. For a copy of the English and/or Spanish newsletter, please contact the RCDV: CPC at (800) 527-3223 or visit http://www.ncjfcj.org/resource-library/publication/domestic-violence. This article was supported by Grant Number 09EV0415 from the Administration of Children, Family and Youth Services Bureau, U.S. Department of Health and Human Services (DHHS). Its contents are solely the responsibility of the author(s) and do not necessarily represent the official view of DHHS or NCJFCJ. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume64, Issue4Fall 2013Pages 45-49 RelatedInformation

The Effectiveness of Emotional Management Group Training on Children's Self-concept

This study aimed to investigate the effectiveness of emotional management group training on self-concept of first grade elementary school children in Semnan, and also to evaluate gender differences in their self-concept. Therefore, 46 children (22 boys and 24 girls) of first grade of elementary school were randomly selected. Data collection was done through the administration of Children's Self-Concept Scale (CSCS). Pre-test, post-test single group design was used for evaluating the efficiency of group training. Data were analyzed using analysis of covariance (ANCOVA) and independent sample T-test. Data analysis showed that emotional management group training led to an improvement in self-concept of first grade elementary school children. Finding shows the practical importance of emotional management group training, while gender variable was not effective in that.

Revised Design for the Mother and Infant Home Visiting Program Evaluation

Home visiting programs in the United States seek to improve maternal and child health, child development, and family economic self-sufficiency by supporting and educating families with young children. Today, home visiting is seen as an important strategy for high-risk families who may be difficult to engage in other services. The Patient Protection and Affordable Care Act (ACA) of 2010 included $1.5 billion over five years for states to operate the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program. It also required a national evaluation of the programs. This document describes the design of that evaluation — the Mother and Infant Home Visiting Program Evaluation (MIHOPE). MIHOPE was launched in 2011 by the Administration for Children and Families and the Health Resources and Services Administration within the U.S. Department of Health and Human Services. The evaluation is being conducted by MDRC in partnership with Mathematica Policy Research, James Bell Associates, Johns Hopkins University, the University of Georgia, and Columbia University.MIHOPE will include the following components:-An analysis of state needs assessments will describe the communities that states chose to target with MIECHV program services.-An implementation study will collect information on the services provided by local programs as well as the factors that helped shape those programs.-An impact analysis will estimate the effects of home visiting programs on family outcomes, both overall and for key subgroups of families.-An economic analysis will assess program costs and savings.The study will include approximately 5,100 families with a pregnant woman or a child under 6 months old. Families who enroll in the study will be randomly assigned to a home visiting group or to a comparison group that can use other services available in their community. Families will be spread across about 85 local programs in about 12 states. Sites must be operating one of four national models of home visiting: Early Head Start-Home Visiting Option, Healthy Families America, Nurse-Family Partnership, or Parents as Teachers. These four models were chosen because they are being implemented using MIECHV program funds in at least 10 states.Data for the implementation and impact studies will be collected from a variety of sources, including interviews with parents; observations of the home environment; observed interactions of parents and children; direct assessments of children’s development; observations of home visitors in their work with families during home visits; logs, observations, and interviews with home visitors, supervisors, and program administrators; program model documentation from program developers, grantees, and local sites; and administrative data on child abuse, health care use, maternal health, birth outcomes, and employment and earnings.The study will produce a report to Congress in 2015 that includes information on families and sites included in the evaluation as well as information on how states made decisions about how to spend home visiting funds. Later reports will provide more information on program implementation, the effects of home visiting programs for families, and the features of programs that are associated with larger effects.

Quantification of the Variability in Response to Propofol Administration in Children

Closed-loop control of anesthesia is expected to decrease drug dosage and wake up time while increasing patient safety and decreasing the work load of the anesthesiologist. The potential of closed-loop control in anesthesia has been demonstrated in several clinical studies. One of the challenges in the development of a closed-loop system that can be widely accepted by clinicians and regulatory authorities is the effect of interpatient variability in drug sensitivity. This system uncertainty may lead to unacceptable performance, or even instability of the closed-loop system for some individuals. The development of reliable models of the effect of anesthetic drugs and characterization of the uncertainty is, therefore, an important step in the development of a closed-loop system. Model identification from clinical data is challenging due to limited excitation and the lack of validation data. In this paper, approximate models are validated for controller design by evaluating the predictive accuracy of the closed-loop behavior. A set of 47 validated models that describe the interpatient variability in the response to propofol in children is presented. This model set can be used for robust linear controller design provided that the experimental conditions are similar to the conditions during data collection.

89. The Federal State Personal Responsibility Education Program (PREP) and Tribal Personal Responsibility Education Program

In recent years, Tribal organizations and state entities have expressed interest in developing culturally relevant, evidence-based programs for teen pregnancy prevention. In response, as part of the Patient Protection and Affordable Care Act of 2010, the state PREP provides $55.25 million per annum in formula grants to States and $3.5 million to Tribal entities for teen pregnancy prevention programming. The state program is administrated by the federal Department of Health and Human Services, Administration for Children and Families through the Family and Youth Services Bureau.

Anatomical and Anthropometric Determinants of Intramuscular Versus Subcutaneous Administration in Children with Epinephrine Auto-Injectors

RationaleIntramuscular rather than subcutaneous delivery of epinephrine is important in the treatment of anaphylaxis. With increasing obesity there are growing concerns that auto-injectors will not deliver epinephrine into the muscle in a significant proportion of patients.MethodsSkin surface to muscle depth was measured by ultrasound at set distances down the thigh and leg in 93 children attending regional pediatric allergy clinics. Weight, height and waist circumference were also measured and BMI calculated.ResultsROC curve analysis showed that higher weight (area (lower and upper boundary) 0.68 (0.56 – 0.80), P = 0.004), BMI (0.84 (0.76 – 0.92), P < 0.001) and waist circumference (0.72 (0.61 – 0.83), P < 0.001), but not age (P = 0.06) or gender (P = 0.3) were associated with a skin surface to muscle depth greater than auto-injector needle length. One quarter of the distance down the thigh 82% of obese children and 25% of non-obese children had skin surface to muscle depth greater than needle length, while three quarters of the way down the thigh this was only the case in 17% of obese children and 2% of non-obese children. In all children skin surface to muscle depth was less than auto-injector needle length half way down the calf.ConclusionsParticularly in overweight or obese children, it is important to advise care givers to inject the epinephrine in the lower rather than upper half of the thigh. In children who are very obese injection into the calf provides an even greater chance of intramuscular administration. RationaleIntramuscular rather than subcutaneous delivery of epinephrine is important in the treatment of anaphylaxis. With increasing obesity there are growing concerns that auto-injectors will not deliver epinephrine into the muscle in a significant proportion of patients. Intramuscular rather than subcutaneous delivery of epinephrine is important in the treatment of anaphylaxis. With increasing obesity there are growing concerns that auto-injectors will not deliver epinephrine into the muscle in a significant proportion of patients. MethodsSkin surface to muscle depth was measured by ultrasound at set distances down the thigh and leg in 93 children attending regional pediatric allergy clinics. Weight, height and waist circumference were also measured and BMI calculated. Skin surface to muscle depth was measured by ultrasound at set distances down the thigh and leg in 93 children attending regional pediatric allergy clinics. Weight, height and waist circumference were also measured and BMI calculated. ResultsROC curve analysis showed that higher weight (area (lower and upper boundary) 0.68 (0.56 – 0.80), P = 0.004), BMI (0.84 (0.76 – 0.92), P < 0.001) and waist circumference (0.72 (0.61 – 0.83), P < 0.001), but not age (P = 0.06) or gender (P = 0.3) were associated with a skin surface to muscle depth greater than auto-injector needle length. One quarter of the distance down the thigh 82% of obese children and 25% of non-obese children had skin surface to muscle depth greater than needle length, while three quarters of the way down the thigh this was only the case in 17% of obese children and 2% of non-obese children. In all children skin surface to muscle depth was less than auto-injector needle length half way down the calf. ROC curve analysis showed that higher weight (area (lower and upper boundary) 0.68 (0.56 – 0.80), P = 0.004), BMI (0.84 (0.76 – 0.92), P < 0.001) and waist circumference (0.72 (0.61 – 0.83), P < 0.001), but not age (P = 0.06) or gender (P = 0.3) were associated with a skin surface to muscle depth greater than auto-injector needle length. One quarter of the distance down the thigh 82% of obese children and 25% of non-obese children had skin surface to muscle depth greater than needle length, while three quarters of the way down the thigh this was only the case in 17% of obese children and 2% of non-obese children. In all children skin surface to muscle depth was less than auto-injector needle length half way down the calf. ConclusionsParticularly in overweight or obese children, it is important to advise care givers to inject the epinephrine in the lower rather than upper half of the thigh. In children who are very obese injection into the calf provides an even greater chance of intramuscular administration. Particularly in overweight or obese children, it is important to advise care givers to inject the epinephrine in the lower rather than upper half of the thigh. In children who are very obese injection into the calf provides an even greater chance of intramuscular administration.

Introduction to the Special Issue: Subgroup Analysis in Prevention and Intervention Research

Prevention scientists, intervention developers, patients, providers, and clients are continually seeking more effective and efficient treatments for a wide range of social, behavioral, and public health problems. Across this range of problems, there is a common interest in developing a better understanding of impacts of interventions on specific subgroups. Among policymakers, an interest in the question “What works?” is now often accompanied by “What works for whom?” For example, the Obama administration has been emphasizing the use of rigorous research as part of evidence-based policy-making. In a 2009 memorandum to federal agencies and departments, the Office ofManagement and Budget emphasized both the importance of rigorous research on program effectiveness as well as evidence aimed at improving the life outcomes of individuals. In medicine and health policy, there has been a strong push toward comparative effectiveness research; the purpose of which is “to inform patients, providers, and decision-makers, responding to their expressed needs about which interventions are most effective for which patients under specific circumstances” (Federal Coordinating Council for Comparative Effectiveness Research 2009, p 3). One implication of this emphasis on what works has been greater attention to the research and methodologies associated with specific populations and subgroups. The analysis of subgroups can matter a great deal in prevention science and intervention research. First, many prevention scientists use subgroup findings to unpack significant main effects or to investigate why there was a lack of significant main effects. Prevention scientists frequently want to explore whether a program was more or less effective for a segment of the target population and why it may have been less effective for another subgroup. Rothwell (2005) argues that the importance of subgroup analysis is not in differential response to treatment, but in identifying how to maximize benefits from treatments and mitigate risk. Rothman (2012) highlights that moderated effects can help prevention scientists to refine theory, tailor prevention to specific contexts or to the needs of specific populations, or target intervention. Policy-relevant research around prevention and intervention science is regularly challenged to answer the question of what works for whom. Subgroup analysis can be seen to be directly linked to policy decisions around programmatic aims (e.g., Upward Bound), funding decisions (e.g., Even Start), and new initiatives targeting funding towards evidence-based programs (e.g., teen pregnancy and home visitation). Subgroup analysis, broadly, aims to measure change within and between groups. Subgroups are defined by characteristics measured at baseline. Subgroups can be characterized by variables that are easier to define, such as age, to those less well-defined, such as risk status. Subgroups can be continuous or categorical; variables with low, moderate, or high measurement error; and variables that are measured, latent, or estimated based on response to treatment. Subgroups can include individual characteristics or site-level variables. Subgroups may occur with more regularity in a population, such as gender, more infrequently such as families with multiple risk factors, or more difficult to represent in large numbers in prevention trials such as rural communities. Work by Rothwell (2005) and Wang et al. (2007) highlighted the issues with subgroup analysis within medical research. Rothwell (2005) specified best practices in study design, L. H. Supplee (*) : B. C. Kelly Office of Planning, Research and Evaluation, Administration for Children and Families, 370 L’Enfant Promenade SW, 7th Fl West, Washington, DC 20447, USA e-mail: lauren.supplee@acf.hhs.gov

Directions in Implementation Research Methods for Behavioral and Social Science

There is a growing interest, by researchers, policymakers, and practitioners, in evidence-based policy and practice. As a result, more dollars are being invested in program evaluation in order to establish "what works," and in some cases, funding is specifically tied to those programs found to be effective. However, reproducing positive effects found in research requires more than simply adopting an evidence-based program. Implementation research can provide guidance on which components of an intervention matter most for program impacts and how implementation components can best be implemented. However, while the body of rigorous research on effective practices continues to grow, research on implementation lags behind. To address these issues, the Administration for Children and Families and federal partners convened a roundtable meeting entitled, Improving Implementation Research Methods for Behavioral and Social Science, in the fall of 2010. This special section of the Journal of Behavioral Health Services & Research includes papers from the roundtable and highlights the role implementation science can play in shedding light on the difficult task of taking evidence-based practices to scale.

What Strategies Work for the Hard-to-Employ? Final Results of the Hard-to-Employ Demonstration and Evaluation Project and Selected Sites from the Employment Retention and Advancement Project

In the context of a public safety net focused on limiting dependency and encouraging participation in the labor market, policymakers and researchers are especially interested in individuals who face obstacles to finding and keeping jobs. The Enhanced Services for the Hard-to-Employ (HtE) Demonstration and Evaluation Project was a 10-year study that evaluated innovative strategies aimed at improving employment and other outcomes for groups who face serious barriers to employment. The project was sponsored by the Administration for Children and Families (ACF) Office of Planning, Research and Evaluation in the U.S. Department of Health and Human Services, with additional funding from the U.S. Department of Labor. This report describes the HtE programs and summarizes the final results for each program. Additionally, it presents information for three sites from the ACF-sponsored Employment Retention and Advancement (ERA) project where hard-to-employ populations were also targeted.Three of the eight models that are described here led to increases in employment. Two of the three — large-scale programs that provided temporary, subsidized jobs to facilitate entry into the workforce for long-term welfare recipients in one program and for ex-prisoners in the other — produced only short-term gains in employment, driven mainly by the transitional jobs themselves. The third one — a welfare-to-work program that provided unpaid work experience, job placement, and education services to recipients with health conditions — had longer-term gains, increasing employment and reducing the amount of cash assistance received over four years. Promising findings were also observed in other sites. An early-childhood development program that was combined with services to boost parents’ self-sufficiency increased employment and earnings for a subgroup of the study participants and increased the use of high-quality child care; the program for ex-prisoners mentioned above decreased recidivism; and an intervention for low-income parents with depression produced short-term increases in the use of in-person treatment. But other programs — case management services for low-income substance abusers and two employment strategies for welfare recipients — revealed no observed impacts.While these results are mixed, some directions for future research on the hard-to-employ emerged: The findings from the evaluations of transitional jobs programs have influenced the design of two new federal subsidized employment initiatives, which are seeking to test approaches that may achieve longer-lasting effects. The HtE evaluation illustrates some key challenges that early childhood education programs may face when adding self-sufficiency services for parents, and provides important lessons for implementation that can guide future two-generational programs for low-income parents and their young children. Results from the HtE evaluation suggest future strategies for enhancing and adapting an intervention to help parents with depression that may benefit low-income populations. Evidence from the HtE evaluation of employment strategies for welfare recipients along with other research indicates that combining work-focused strategies with treatment or services may be more promising than using either strategy alone, especially for people with disabilities and behavioral health problems.

Development of a Population Pharmacokinetic Model for Parecoxib and Its Active Metabolite Valdecoxib after Parenteral Parecoxib Administration in Children

Parecoxib is a cyclooxygenase-2 selective inhibitor used in management of postoperative pain in adults. This study aimed to provide pediatric pharmacokinetic information for parecoxib and its active metabolite valdecoxib. Thirty-eight children undergoing surgery received parecoxib (1 mg/kg IV to a maximum of 40 mg) at induction of anesthesia, and plasma samples were collected for drug measurement. Population pharmacokinetic parameters were estimated using nonlinear mixed effects modeling. Area under the valdecoxib concentration-time curve and time above cyclooxygenase-2 in vitro 50% inhibitory concentration for free valdecoxib were simulated. A three-compartment model best represented parecoxib disposition, whereas one compartment was adequate for valdecoxib. Age was linearly correlated with parecoxib clearance (5.0% increase/yr). There was a sigmoid relationship between age and both valdecoxib clearance and distribution volume. Time to 50% maturation was 87 weeks postmenstrual age for both. In simulations using allometric-based doses the 90% prediction interval of valdecoxib concentration-time curve in children 2-12.7 yr included the mean for adults given 40 mg parecoxib IV. Simulated free valdecoxib plasma concentration remained above the in vitro 50% inhibitory concentrations for more than 12 h. In children younger than 2 yr, a dose reduction is likely required due to ongoing metabolic maturation. The final pharmacokinetic model gave a robust representation of parecoxib and valdecoxib disposition. Area under the valdecoxib concentration-time curve was similar to that in adults (40 mg), and simulated free valdecoxib concentration was above the cyclooxygenase-2 in vitro 50% inhibitory concentration for free valdecoxib for at least 12 h.

Implementing Child Abuse Prevention and Treatment Act (CAPTA) Requirements to Serve Substance-Exposed Newborns: Lessons From a Collective Case Study of Four Program Models

The Child Abuse Prevention and Treatment Act (CAPTA) of 2003 requires states to develop procedures to notify child protective services of newborns prenatally exposed to illegal substances and develop plans of safe care. In 2005 the Administration for Children and Families awarded grants to four programs to develop models for implementing these CAPTA requirements. Although the programs were quite varied, they encountered similar challenges collaborating across agencies, developing effective protocols for identifying exposed newborns, and engaging families in services. This article describes the programs, discusses how they implemented CAPTA requirements, and presents recommendations for other communities.