In response to the subject, i wish to pen down my recent experience
of normal growth of twins till 6 months on exclusive breast feeding.
A pair of male twins were born to at term to a 2nd gravida mother by
normal vaginal route, the birth weight was 3.2kg and 3.0kg. The mother was
motivated and advised breast feeding in delivery room and subsequently in
postnatal ward. The parents belonged to lower socico...
In response to the subject, i wish to pen down my recent experience
of normal growth of twins till 6 months on exclusive breast feeding.
A pair of male twins were born to at term to a 2nd gravida mother by
normal vaginal route, the birth weight was 3.2kg and 3.0kg. The mother was
motivated and advised breast feeding in delivery room and subsequently in
postnatal ward. The parents belonged to lower socicoeconomic status.
the babies were followed up after discharge every fortnight for 2 months
and later every month till 6 months age. they were exclusively breast fed,
and weighed 7.6 and 7.3 kg at 6 months. The only advise given to mother
was nutrion advise and eating for three(mother and twins).She was advised
and motivated for benefits of breast feeding.The mother had some extra
calories about 6 kg of fats with suji and nuts(panjeeree) which is
commonly given to lactating mothers in northern India.
I feel breast feeding of twins is possible if the health personnel give 5
min advise tomother in delivery room and followed up by same person
subsequently.
It is not unusual that health personnel shift feeding to other milks
rather than giving ear to her problems and nutrition advise. although all
mothers may not produce as much milk as this mother , but most can hanve
enoughmilk for abot 4 months with some supplemntary feeds by katori or
spoon; my advise is" eat more of all food items from family pot".
This letter is in response to “Accuracy and Precision of Test
Weighing to Assess Milk Intake in Newborn Infants: 2006;91;F 330-332 (1),
in which the investigators conclude that test-weighing is too imprecise
for routine clinical use. This conclusion is contrary to a series of very
well-controlled studies on test-weighing in term and premature infants.
Our concerns with the conclusions of this study ar...
This letter is in response to “Accuracy and Precision of Test
Weighing to Assess Milk Intake in Newborn Infants: 2006;91;F 330-332 (1),
in which the investigators conclude that test-weighing is too imprecise
for routine clinical use. This conclusion is contrary to a series of very
well-controlled studies on test-weighing in term and premature infants.
Our concerns with the conclusions of this study are as follows.
First, the investigators’ use of the term “precision” is incorrect.
The precision of a measure (also known as its reliability) is the ability
of a measurement to be reproduced consistently; precision refers to the
repeatability of a measurement. To obtain a measure of precision, the
object of interest must be measured more than once under the same
circumstances. An assessment of the precision of test-weighing would
entail obtaining repeated measurements of the infants’ weights and/or the
milk volume before and after feedings such as performed in previous
studies of the reliability of test-weighing (2). However, these
investigators did not perform repeated infant or milk weights, so they did
not measure precision. Thus, their claim that test weights are imprecise
is incorrect. Similarly, the investigators’ conclusion that their data
demonstrate the accuracy of test-weighing is incorrect. Instead, their
data reveal large and clinically important differences between the actual
volume consumed and the volume estimated by test-weighing in many of the
cases. Thus, the test-weighing procedure, as reported in their
investigation, did not yield accurate results.
The large measurement error reported in this study is inconsistent
with the results of previously published research and is likely due the
lack of research control in this study. The lack of control is evident in
several aspects of the procedure, including the administration of infant
feedings, infant weighing procedures, evaluation of the volume of milk
consumed and the choice of an infant scale. In previous studies on this
topic, infants’ clothing and equipment have been standardized and
controlled, and the clinicians are well-prepared for their role in the
procedures. Previously published research has also demonstrated that the
reliability (precision) of infant weighing procedures is significantly
affected by the presence of equipment such as IVs and oxygen nasal
cannulae (3), so the management of that equipment during the test weighing
procedure requires careful control. Additionally, in previous studies,
infants were removed from analysis when regurgitation or spitting up
resulted in milk being spilled outside the clothing that was a part of the
pre- and post-weights. Obviously, when actual milk consumed is not
measured as a part of the test-weight, the estimate will be inaccurate.
Additionally, the scale used to obtain the test weights was not adequately
described. Although the investigators tested the repeatability of weights
obtained on the scales using 1500 and 4000 g weights, they did not report
whether the scale had the capability to accurately measure small weights –
such as oral intakes as small as 1-2 g. The scales used in previous
studies were specifically designed to detect these small differences in
weight. Finally, the practice of using syringes to measure milk volume
rather than weighing the milk before and after feeding is puzzling. All of
these factors may have contributed to the error in the test-weight
estimates in the current study.
Finally, there are incorrect statements in this research report. The
authors suggest that previous investigators have not adequately quantified
the precision and accuracy of test-weighing, and have reported only
correlation coefficients to describe the accuracy of test weights. This is
simply incorrect; our studies of test-weighing include numerous statistics
appropriate for quantifying the magnitude of error in physical measures
such as weight (4). The statistics reported in those studies included the
mean differences, standard deviation of the net differences, mean absolute
differences, maximal differences, percentage of differences exceeding 5
g, and the overall percentage of error in the measurement, calculated as
(((|actual-estimated values|) / actual value)*100) (5; 6). The
investigators also incorrectly assert that “differences of up to 30 ml”
have been reported by all previous studies. This is also incorrect; in our
1990 publication addressing the accuracy of test-weights for premature
infants (5), the maximum difference between the actual and estimated
values for the electronic scale was 10 ml, and only 6.25% of the
differences exceeded 5 ml.
In summary, test-weighing, when performed with standard research
controls and electronic scales that weigh to the nearest 1 to 2 g, has
been demonstrated to be accurate in well-controlled clinical trials and
has been endorsed by the World Health Organization as a method of
accurately estimating intake. The lower accuracy in measures reported by
these investigators underscore the need to carefully select a scale and
control for the procedures used for test-weighing in the clinical setting
to the extent possible, but do not indicate that test-weighing is too
inaccurate for clinical use.
Paula P. Meier, DNSC, RN
Janet L. Engstrom, PhD, RNC, CNM
Rush University Medical Center
Chicago Illinois United States
References:
1. Savenije OEM, Brand PLP. Accuracy and precision of test weighing
to assess milk intake in newborn infants. Arch Dis Child Fetal Neonatal Ed
2006; 91 (5): F330-332.
2. Kavanaugh K, Engstrom JL, Meier PP, Lysakowski TY. How reliable
are scales for weighing preterm infants. Neonatal Network 1990;9(3): 29-
32.
3. Engstrom JL, Kavanugh K, Meier PP, Boles E, Hernandez J, Wheeler
D, Chuffo R. Reliability of in-bed weighing procedures for critically ill
infants. Neonatal Network 1995;14(5):27-33.
4. Engstrom JL. Assessment of the reliability of physical measures.
Research in Nursing and Health 1988;11:383-389.
5. Meier PP, Lysakowski, TY, Engstrom JL, Kavanaugh KL, Mangurten H.
The accuracy of test weighing for preterm infants. Journal of Pediatric
Gastroenterology and Nutrition 1990;10:62-5.
6. Meier, PP, Engstrom JL, Crichton CL, Clark DR, Williams MM,
Mangurten HH. A new scale for in-home test-weighing for mothers of preterm
and high risk infants. Journal of Human Lactation 1994;10:163-8.
The recent paper of Groenendaal et al supports the hypothesis that
peroxynitrite formation and subsequent tyrosine nitration occur in the
neonatal human brain after perinatal asphyxia (1). As we are currently
studying the nitration of plasma proteins in the newborn (2), we would
like to share our experience in this issue.
Our aim was to identify plasma proteins whose nitration is increased in
newborns...
The recent paper of Groenendaal et al supports the hypothesis that
peroxynitrite formation and subsequent tyrosine nitration occur in the
neonatal human brain after perinatal asphyxia (1). As we are currently
studying the nitration of plasma proteins in the newborn (2), we would
like to share our experience in this issue.
Our aim was to identify plasma proteins whose nitration is increased in
newborns who suffered perinatal asphyxia, as markers of increased
peroxynitrite generation. Blood samples were collected from 21 asphyxiated
term newborns and 35 normal term infants in EDTA containing tubes and
rapidly centrifuged at 4°C. Plasma was prepared from arterial blood taken
during the first hour of life and venous blood taken at days 1 and 4 of
life. Nitrated plasma proteins were immunoprecipitated with an affinity-
purified anti-3-nitrotyrosine antibody and subjected to SDS-PAGE. Gels
were stained with colloidal Coomassie Blue revealing approximately 30
bands which were excised for identification by mass spectrometry. Among
these, we identified albumin, fibrinogen, plasminogen, fibronectin
precursor protein, vitamin D binding protein as well as a few erythrocyte
proteins. Variations in the degree and the pattern of plasma protein
nitration were observed in asphyxiated versus normal newborns. We have
also developed a novel double-sandwich ELISA allowing the quantitative
determination of nitrated plasma albumin (3). We observed a statistically
significant increase of nitrated albumin concentration in day 1 venous
blood of the 7 newborns who developed moderate or severe post-asphyxic
encephalopathy as compared to the 14 newborns with a normal neurological
evolution or mild encephalopathy.
In conclusion, our data confirm the occurrence of nitrative stress after
perinatal asphyxia. Nitrated plasma albumin concentration is currently
being tested in neonatal practice as a potential marker and guidance for
the management and follow-up of newborns potentially affected by nitrative
stress and resulting end-organ injury. Research in this area may open new
and exciting perspectives in neuroprotection.
References:
1. Groenendaal F, Lammers H, Smit D, Nikkels PGJ. Nitrityrosine in brain
tissue of neonates after perinatal asphyxia. Arch Dis Child Fetal Neonatal
Ed 20006;91:F429-F433.
2. Bottari S, Csibi A, Vermeylen D, Damis E, Cavedon C, Touma J, Salamé A,
Wayenberg J-L. Nitration pattern of plasma proteins in newborns suffering
from perpartal asphyxia: preliminary results. J Mat-Fet Neonat Med
2006;19(suppl 1):34.
3. Cavedon C, Bottari S, Vermeylen D, Damis E, Touma J, Salamé A,
Wayenberg J-L. Nitrated albumin as a potential marker of nitrating stress
in newborns: preliminary results. J Mat-Fet Neonat Med 2006;19(suppl
1):35.
As clearly mentioned in the review of Anand and Hall in this journal,
rapid advances have been made in the use of pharmacological analgesia and
sedation due to improved knowledge on pharmacokinetics and –dynamics of
various analgesics in neonates (1).
Based on meta-analysis on the effectiveness of multimodal analgesia in
postoperative non-neonatal patients, it is to be anticipated that non-
selectiv...
As clearly mentioned in the review of Anand and Hall in this journal,
rapid advances have been made in the use of pharmacological analgesia and
sedation due to improved knowledge on pharmacokinetics and –dynamics of
various analgesics in neonates (1).
Based on meta-analysis on the effectiveness of multimodal analgesia in
postoperative non-neonatal patients, it is to be anticipated that non-
selective cyclo-oxygenase (NS-COX) inhibitors might also be effective in
the alleviation of pain in neonates (2). However, any administration of a
given drug should be a balanced decision based on the potential
(dis)advantages. We therefore would like to mention some recently reported
observations on the impact of various NS-COX inhibitors based on data in
part collected during the Multicenter Ibuproben Prophylaxis study, a
randomized, placebo-controlled trial on the effects of ibuprofen
administration on the incidence of intraventricular hemorrhage in extreme
preterm neonates.
Based on observations collected in the Leuven cohort of this MIPS trial,
we documented a significant decrease in amikacin clearance (- 18 to 21 %)
when ibuprofen was co-administered. This decrease was of similar
magnitude when the impact was evaluated in preterm neonates up to 34 weeks
and there was no additional difference in reduction of amikacin clearance
when the impact of ibuprofen was compared with a historical cohort of
preterm neonates treated with acetylsalicylic acid (3,4). Since
aminoglycoside clearance reflects glomerular filtration rate, these data
suggest that the administration of either ibuprofen or acetylsalicylic
acid has an important impact on GFR, independent of the gestational age
(3,4). It is to be anticipated that the impact of indomethacin will at
least be of similar magnitude (5). The differences in impact of various NS
-COX on regional perfusion - both renal and cerebral - can be further
evaluated by integrating these additional, secondary outcome variables in
the initial protocols of such multi-center RCT studies (3,4,6).
In the meanwhile, based on the above mentioned observations, we fully
agree with the authors that the use of NS-COX to treat pain in neonates is
indeed limited based on the presently available knowledge.
References:
1.Anand K, et al. Pharmacological therapy for analgesia and sedation
in the newborn. Arch Dis Child Fetal Neonatal Ed 2006;91;448-53.
2.McQuay HJ, et al. Postoperative analgesia and vomiting, with
special reference to day-case surgery: a systematic review. Health Technol
Assess 1998;2:1-236.
3.Allegaert K, et al. Limited predictability of amikacin clearance in
extreme premature neonates at birth. Br J Clin Pharmacol 2006;61:39-48.
4.Allegaert K, et al. The impact of ibuprofen on renal clearance in
preterm infants is independent of the gestational age. Pediatr Nephrol
2005;20:740-3
5.Fowlie P, et al. Prophylactic indomethacin for preterm infants: a
systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed
2003;88:F464-6.
6.Naulaers G, et al. Ibuprofen and cerebral oxygenation and
circulation. Arch Dis Child Fetal Neonatal Ed 2005;90:F75-6.
The authors mention that they used a caffeine base dose of 25mg/kg
for the neonates in the study. This equates to 50mg/kg of caffeine citrate
and is more than twice the usual recommended loading dose(1)for this
indication. Is this an error in the script of the article or did they
indeed use this dose to get the 'maximum benefit'.
The letters in response to our study1 raise interesting points. Dr.
MacDonald suggests that breast-feeding rates at discharge may have
accounted for the difference in gestational age at discharge between
infants in California and the United Kingdom because of the association of
lower socio-economic status and breast-feeding rates. Unfortunately, we
do not have data from the United Kingdom Neonatal...
The letters in response to our study1 raise interesting points. Dr.
MacDonald suggests that breast-feeding rates at discharge may have
accounted for the difference in gestational age at discharge between
infants in California and the United Kingdom because of the association of
lower socio-economic status and breast-feeding rates. Unfortunately, we
do not have data from the United Kingdom Neonatal Staffing Study to
explore this question. Data from the Moderately Premature Infant Project
showed that more infants in California compared to Massachusetts received
breastmilk at discharge (83 versus 63 %), suggesting that according to Dr.
MacDonald’s hypothesis infants in California should have been discharged
later (length of stay in California was marginally shorter than in
Massachusetts). We realize that receiving breastmilk at discharge may
only be a poor proxy of actual breast-feeding at discharge. The general
approach to oral feeding in most study NICUs includes a combination of
bottle and breast-feeding, depending on infants’ clinical status, parental
desires and maternal availability. Discharge is not usually delayed for
purposes of achieving full breast-feeding.
Dr. Adhvaryu describes how his NICU utilizes a specialized neonatal
community team to reduce the length of stay and readmission rates to
levels that are comparable to the California data. This supports the
theory that health care systems that employ a more coordinated care
approach experience more efficient care delivery.
Dr. Adhvaryu cites the use of home nasogastric feedings as one of the
components of their community program. We think that the variation of the
responses in terms of the approach to feeding supports our conclusion that
organization of care is an important contributor to patient outcomes
beyond underlying clinical risk and socio-economic status. We accept that
our study may provide more questions than answers and that examining the
relationship between the approach to feeding, length of stay and future
health status is worthy of future research.
Reference:
(1) Profit J, Zupancic JA, McCormick MC, Richardson DK, Escobar GJ,
Tucker J et al. Moderately premature infants at Kaiser Permanente Medical
Care Program in California are discharged home earlier than their peers in
Massachusetts and the United Kingdom. Arch Dis Child Fetal Neonatal Ed
2006; 91(4):F245-F250.
Nandakumar and Sankar have opended a debate that targets a very
interesting conundrum. The aim of medical management in the process of
neonatal abstinence seems to me to be centred on ensuring that the infant
has a symptom and stress free withdrawal from addictive drugs. By and
large the Finnegan score or simple observation requires active
demonstration of withdrawal symptoms before intervention. Ho...
Nandakumar and Sankar have opended a debate that targets a very
interesting conundrum. The aim of medical management in the process of
neonatal abstinence seems to me to be centred on ensuring that the infant
has a symptom and stress free withdrawal from addictive drugs. By and
large the Finnegan score or simple observation requires active
demonstration of withdrawal symptoms before intervention. How much
demonstration of withdrawal do we require before offering respite to a
distressed baby. Most scoring systems demands a score of X for a period of
Y. For most of us who work with these infants, management during this
period is distressing in itself, let alone the stress caused to the baby.
More sensitive ways of minimising stress and distress linked to earlier
detection of withdrawal are required. Thresholds for intervention should
be lower and medication doses should suppress almost all symptoms sooner
rather than later. The notion that a baby should earn the right to
adequate medication by demonstration of real symptoms has no place in
current practice. The swaddled, well fed baby may well be "manageable" but
he is still effectively going "cold turkey" - a situtation that is
somewhat unfair. Clonidine in addition to morphine may have significant
advantages and less stigma. The withdrawing baby needs compassionate care
that recognises the degrees of stress and distress with early treatment
rather than a reluctant medication intervention in a baby "hanging out".
We read with interest the article by Marlow et al on the long term
respiratory and neurodevelopmental outcomes in babies, 28 weeks of
gestation or less, in the UKOS trial[1].
It was reassuring to learn that babies in the HFOV arm were no worse than
the controls in terms of their long term neurodevelopment outcome. This is
contrary to the neurodevelopmental outcomes observed in the HiFi trial
[2]....
We read with interest the article by Marlow et al on the long term
respiratory and neurodevelopmental outcomes in babies, 28 weeks of
gestation or less, in the UKOS trial[1].
It was reassuring to learn that babies in the HFOV arm were no worse than
the controls in terms of their long term neurodevelopment outcome. This is
contrary to the neurodevelopmental outcomes observed in the HiFi trial
[2].
However we have some general queries about the paper;
1.As there is only data from 428 of 529 survivors with almost one
third lost to follow-up (164 infants, 27% of survivors), it may be
possible that lower rates of neurodevelopmental disability observed in the
UKOS trial reflects underreporting.
This may represent an ascertainment bias and underreporting of those with
the worst neurodevelopment outcomes.[3] .
2.It was not clear why outcome data on 55 infants (13% of survivors)
was not included in the analysis even though analysis was on an “intention
to treat basis”.
3.In table-1 the number of infants with no outcome data returned (171
infants) doesn’t match the number derived from figure-1(164 infants).
At present those unanswered points may limit the external validity of
the study findings.
References:
1.N Marlow, A Greenough,J L Peacock S Limb, A H Jonhson,S A Calvert,
for the United Kingdom Oscillatory Study Group.
Randomized trial of high frequency oscillatory ventilation or conventional
ventilation in babies of gestational age 28 weeks or less: repiratory and
neurological outcome at 2 years.
(Arch Dis Child Fetal Neonatal Ed 2006; 91 No 5:F320–F326).
2.HiFi study group; High frequency oscillatory ventilation compared
with conventional intermittent mechanical ventilation in the treatment of
respiratory failure in preterm infants; Neurodevelopmental status at 16-24
months of post term age.
J Pediatr 19900; 17:939-946.
3.Win Tin, Susan Fritz, Unni Wariyar, Edmund Hey.
Outcome of very preterm birth: children reviewed with ease at 2 years
differ from those followed up with difficulty.
(Arch Dis Child Fetal Neonatal Ed 1998; 79:F83–F87).
We were extremely surprised by Dr Reed’s letter regarding the above
paper, so we wondered if she had read it thoroughly.
She suggests there may be a conflicting interest, Archives rather
terms this competing interest which they define as “when professional
interest (such as patients welfare or the validity of research) may be
influenced by a secondary interest (such as financial or perso...
We were extremely surprised by Dr Reed’s letter regarding the above
paper, so we wondered if she had read it thoroughly.
She suggests there may be a conflicting interest, Archives rather
terms this competing interest which they define as “when professional
interest (such as patients welfare or the validity of research) may be
influenced by a secondary interest (such as financial or personal
rivalry).
Abbott laboratories is an international company (not UK concentrated
as implied by Dr Reed) which markets Palivizumab, as RSV prophylactic
agent for use in prematurely born infants with or without bronchopulmonary
disease and term born infants with certain types of congenital heart
disease.
Our paper was about the healthcare utilisation of preschool children
who had or had not required home oxygen on discharge from the NICU – it
was not about RSV prophylaxis.
The JCVI already in 2002 following the paper by Thomas et al working
at St George’s has recommended RSV prophylaxis to prematurely born infants
with BPD who had been discharged home on oxygen, as Thomas has shown this
was cost neutral.
Thus we conclude Dr Reed’s implied criticism of Archives to be
unfounded and hence unjust.
Yours sincerely
Professor Anne Greenough
Professor of Neonatology
and Clinical Respiratory Physiology
The conclusions reached by Savenije and Brand are reassuring to those
of us who abandoned test weighing some years ago. Practice in Sheffield
was strongly influenced by the study of Whitfield et al, cited as
reference 4 by the current authors, who refer to it as a study supporting
the practice of test weighing. The authors might wish to note that the
final sentence of the abstract in Whitfield's study...
The conclusions reached by Savenije and Brand are reassuring to those
of us who abandoned test weighing some years ago. Practice in Sheffield
was strongly influenced by the study of Whitfield et al, cited as
reference 4 by the current authors, who refer to it as a study supporting
the practice of test weighing. The authors might wish to note that the
final sentence of the abstract in Whitfield's study, published 25 years
ago was: "Test weighing with clinical baby scales is an unreliable and
inaccurate indication of feed intake in breast-fed infants."
Dear Editor,
In response to the subject, i wish to pen down my recent experience of normal growth of twins till 6 months on exclusive breast feeding. A pair of male twins were born to at term to a 2nd gravida mother by normal vaginal route, the birth weight was 3.2kg and 3.0kg. The mother was motivated and advised breast feeding in delivery room and subsequently in postnatal ward. The parents belonged to lower socico...
Dear Editor,
This letter is in response to “Accuracy and Precision of Test Weighing to Assess Milk Intake in Newborn Infants: 2006;91;F 330-332 (1), in which the investigators conclude that test-weighing is too imprecise for routine clinical use. This conclusion is contrary to a series of very well-controlled studies on test-weighing in term and premature infants. Our concerns with the conclusions of this study ar...
Dear Editor,
The recent paper of Groenendaal et al supports the hypothesis that peroxynitrite formation and subsequent tyrosine nitration occur in the neonatal human brain after perinatal asphyxia (1). As we are currently studying the nitration of plasma proteins in the newborn (2), we would like to share our experience in this issue. Our aim was to identify plasma proteins whose nitration is increased in newborns...
Dear editor,
As clearly mentioned in the review of Anand and Hall in this journal, rapid advances have been made in the use of pharmacological analgesia and sedation due to improved knowledge on pharmacokinetics and –dynamics of various analgesics in neonates (1). Based on meta-analysis on the effectiveness of multimodal analgesia in postoperative non-neonatal patients, it is to be anticipated that non- selectiv...
Dear Editor,
The authors mention that they used a caffeine base dose of 25mg/kg for the neonates in the study. This equates to 50mg/kg of caffeine citrate and is more than twice the usual recommended loading dose(1)for this indication. Is this an error in the script of the article or did they indeed use this dose to get the 'maximum benefit'.
Reference:
(1) BNF for children 2006
Dear Editor,
The letters in response to our study1 raise interesting points. Dr. MacDonald suggests that breast-feeding rates at discharge may have accounted for the difference in gestational age at discharge between infants in California and the United Kingdom because of the association of lower socio-economic status and breast-feeding rates. Unfortunately, we do not have data from the United Kingdom Neonatal...
Dear Editor,
Nandakumar and Sankar have opended a debate that targets a very interesting conundrum. The aim of medical management in the process of neonatal abstinence seems to me to be centred on ensuring that the infant has a symptom and stress free withdrawal from addictive drugs. By and large the Finnegan score or simple observation requires active demonstration of withdrawal symptoms before intervention. Ho...
Dear Editor,
We read with interest the article by Marlow et al on the long term respiratory and neurodevelopmental outcomes in babies, 28 weeks of gestation or less, in the UKOS trial[1]. It was reassuring to learn that babies in the HFOV arm were no worse than the controls in terms of their long term neurodevelopment outcome. This is contrary to the neurodevelopmental outcomes observed in the HiFi trial [2]....
Dear Editor,
We were extremely surprised by Dr Reed’s letter regarding the above paper, so we wondered if she had read it thoroughly.
She suggests there may be a conflicting interest, Archives rather terms this competing interest which they define as “when professional interest (such as patients welfare or the validity of research) may be influenced by a secondary interest (such as financial or perso...
Dear Editor,
The conclusions reached by Savenije and Brand are reassuring to those of us who abandoned test weighing some years ago. Practice in Sheffield was strongly influenced by the study of Whitfield et al, cited as reference 4 by the current authors, who refer to it as a study supporting the practice of test weighing. The authors might wish to note that the final sentence of the abstract in Whitfield's study...
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