bluuebunny/crossref_metadata_2025 huggingface dataset:
Getting a Grip on Research Data Management
Authors: Znamirowski Barb
Published: December 2021

In March 2021 the Tri-Agency released its Research Data Management Policy, including its three pillar requirements. This article reviews some key points from the Alliance RDM (Portage Network) workshop "Putting the Tri-Agency Policy into Practice: Workshopping Your Institutional Research Data Management Strategy."
The Influence of Having an Assigned Medicaid Primary Care Physician on Utilization of Otitis Media–related Services
Authors: Berman Stephen , Bondy Jessica , Lezotte Dennis , Stone Barbara , Byrns Patricia J.
Published: December 2021

Objective.

This study documents the influence of having an assigned Medicaid primary care physician (PCP) on the utilization of otitis media–related services.

Design/Methods.

This is a retrospective study using the 1991 Colorado Medicaid administrative database that followed 28 844 children <13 years who had at least 1 visit for otitis media.

Results.

Children continuously enrolled in Medicaid throughout the entire year were >4 times (odds ratio: 4.2 and 4.89, respectively) as likely to always or sometimes have a PCP compared with children who were discontinuously enrolled. The likelihood of ever using the emergency department for an otitis media–related visit was increased by 26% and 50%, respectively, when a child sometimes or never had a PCP compared with always having a PCP. The likelihood of ever filling an antibiotic for otitis media was reduced by 23% and 34%, respectively, when a child sometimes or never had a PCP compared with always having a PCP. The likelihood of ever having otitis media–related surgery was not affected by PCP status, but young children, 13 to 18 months of age, had higher referral rates when they had an assigned PCP.

Conclusions.

These findings suggest that having an assigned Medicaid PCP influences the utilization patterns of some otitis media–related medical services.
Trends and Variations in Smoking During Pregnancy and Low Birth Weight: Evidence From the Birth Certificate, 1990–2000
Authors: Ventura Stephanie J. , Hamilton Brady E. , Mathews T. J. , Chandra Anjani
Published: December 2021

Objective. This study compares patterns of tobacco use during pregnancy over time and across population subgroups and examines the impact of maternal smoking on the incidence of low birth weight (LBW). The study also evaluates the use of birth certificates to monitor prenatal smoking.

Methods. The birth certificates of all states (except California) and the District of Columbia for 2000 provided to Centers for Disease Control and Prevention’s National Center for Health Statistics were analyzed. Trends in maternal smoking were examined with data from birth certificates and other relevant sources.

Results. Smoking during pregnancy was reported for 12.2% of women who gave birth in 2000, down 37% from 1989 (19.5%), when this information was first collected on birth certificates. Throughout the 1990s, prenatal smoking rates were highest for older teenagers and women in their early 20s. Among population subgroups, the highest rates were reported for non-Hispanic white women who attended but did not complete high school. The incidence of LBW among singleton infants who were born to smokers was double that for nonsmokers. This relationship was observed in all age groups, for births to Hispanic and non-Hispanic white and black women, and within educational attainment subgroups. Even light smoking (<5 cigarettes daily) was associated with elevated rates of LBW.

Conclusion. Although prenatal smoking may be underreported on the birth certificate, the trends and variations in smoking based on birth certificate data have been confirmed with data from other sources. Birth certificate data can be useful in monitoring prenatal smoking patterns. Changes in the birth certificate questions that are to be implemented beginning in 2003 will help to clarify the levels and changes in smoking behavior during pregnancy so that smoking cessation programs can be more effectively designed to meet the needs of the populations at risk.
Clinical Aspects of Gastrointestinal Food Allergy in Childhood
Authors: Sicherer Scott H.
Published: December 2021

Gastrointestinal food allergies are a spectrum of disorders that result from adverse immune responses to dietary antigens. The named disorders include immediate gastrointestinal hypersensitivity (anaphylaxis), oral allergy syndrome, allergic eosinophilic esophagitis, gastritis, and gastroenterocolitis; dietary protein enterocolitis, proctitis, and enteropathy; and celiac disease. Additional disorders sometimes attributed to food allergy include colic, gastroesophageal reflux, and constipation. The pediatrician faces several challenges in dealing with these disorders because diagnosis requires differentiating allergic disorders from many other causes of similar symptoms, and therapy requires identification of causal foods, application of therapeutic diets and/or medications, and monitoring for resolution of these disorders. This review catalogs the spectrum of gastrointestinal food allergies that affect children and provides a framework for a rational approach to diagnosis and management.
Skin Manifestations of Food Allergy
Authors: Burks Wesley
Published: December 2021

The pediatrician is faced with evaluating a panoply of skin rashes, a subset of which may be induced by food allergy. Acute urticaria is a common manifestation of an allergic skin response to food, but food is rarely a cause of chronic urticaria. Approximately one third of infants/children with moderate to severe atopic dermatitis have food allergy. Although diagnosis of acute urticaria provoked by a food may be evident from a straightforward history and confirmed by diagnostic tests to detect food-specific IgE antibody, determination of the role of food allergy in patients with atopic dermatitis is more difficult and may require additional diagnostic maneuvers, including elimination diets and oral food challenges. The immunopathologic basis of food-allergic disorders that affect the skin and a rational approach to diagnosis and treatment are discussed. Additional disorders that are caused by or mimic ones caused by food allergy are reviewed.
A History of Child Health Equity Legislation in the United States
Authors: van Dyck Peter C.
Published: December 2021

The Issue. The mission of the Maternal and Child Health Bureau (MCHB) is comprehensive in scope and establishes the capacity, structure, and function for the MCHB to continually improve the health and well-being of pregnant women and children. The MCHB works in partnership with states and has broad authority to improve access to care and ensure the provision of quality preventive and primary care services. Specific provisions of legislation establish the framework for accomplishing this mission. With the increasing recognition of the social, economic, and environmental determinants of child health and the inequities that exist in access and quality of care for children, the Maternal and Child Health Bureau (MCHB) has set the following 3 goals for year 2003: 1) To eliminate disparities in health status outcomes through the removal of economic, social, and cultural barriers to receiving comprehensive, timely, and appropriate health care; 2) To ensure the highest quality of care through the development of practice guidance and data monitoring and evaluation tools; the use of evidence-based research; and the availability of a well-trained, culturally diverse workforce; and 3) To facilitate access to care through the development and improvement of the maternal and child health infrastructure and systems of care to enhance the provision of necessary, coordinated, quality health care. Priority MCHB strategies to accomplish these goals include improving and expanding 1) the cultural competence of providers (in particular to decrease sudden infant death syndrome [SIDS] among minorities), 2) emergency medical services for children, 3) health and safety in child care, 4) quality of primary pediatric care, and 5) the providing of every child with a medical home.
Maternal Phenylketonuria: Experiences From the United Kingdom
Authors: Lee Philip J. , Lilburn Maggie , Baudin Jenny
Published: December 2021

Charles Dent was one of the first physicians to recognize the teratogenic effects of maternal phenylalanine (Phe) on the fetus in 1956. This article describes the clinical experiences of women with phenylketonuria (PKU) within the unit that was established by Dent in the United Kingdom. Between 1977 and 2002, 79 infants were born to women with PKU. Of the 79, 18 (23%) were conceived while the women were on a normal diet with high blood Phe levels. The mean birth weight was 2.89 kg, and head circumference was 32.8 cm. At 1 year, the mean developmental quotient was 105.5 and at 4 years was 82.3. Four of these infants had congenital heart disease (2 of whom died as a result). In the remaining 61 infants, Phe-restricted diet started before conception. None of them had congenital heart disease. The mean birth weight was 3.23 kg, and head circumference was 34.0 cm. At 1 year, mean developmental quotient was 108.0 and at 4 years was 90.9. They continue to be followed up with additional neuropsychometric assessments at 8 and 14 years of age.

This cohort is a proportion of infants who were born to mothers with PKU in the United Kingdom. Between 1978 and 1997, 255 live births were reported. Of these, 56% were conceived on unrestricted diet with subsequently poor outcome. This relatively high rate of conception off PKU diet is likely to reflect the scarcity of medical services for adults with metabolic disorders.

We conclude that many features of the maternal PKU syndrome can be prevented but still occur because of the lack of appropriate resources to care for at-risk women. The precise targets for blood Phe and other nutrients during pregnancy are not entirely clear, neither are the reasons that some offspring are spared the harmful effects of Phe. The impact of the postnatal environment in which these infants find themselves requires additional assessment, too.
The Maternal Phenylketonuria Project: A Summary of Progress and Challenges for the Future
Authors: Clarke Joe T.R.
Published: December 2021

The results of the International Collaborative Study of Maternal phenylketonuria have shown that dietary phenylalanine restriction of women with hyperphenylalaninemia during pregnancy decreases the incidence of mental retardation, microcephaly, congenital heart disease, and intrauterine growth retardation in their offspring. The best results are achieved when treatment is initiated before conception. Psychosocial problems are the most pervasive obstacle to the achievement of optimum dietary treatment. Novel, nondietary approaches to the treatment of maternal phenylketonuria are under development.
The National Survey of Early Childhood Health
Authors: Blumberg Stephen J. , Halfon Neal , Olson Lynn M.
Published: December 2021

Objectives. The National Survey of Early Childhood Health (NSECH) is a new survey that was designed to provide nationally representative data on the health and development of children and to fill an information gap in the pediatric literature on parents’ views of the delivery of health care to their young children.

Design. The selection of topics was guided by previous studies conducted to examine parents’ expectations and needs in child health supervision visits. The NSECH is a random-digit-dial telephone survey of a nationally representative sample of 2068 children aged 4 to 35 months. This sample includes an oversample of black and/or Hispanic children so that results for these minority groups could be estimated with greater precision. The sampling frame for NSECH is from the State and Local Area Integrated Telephone Survey (SLAITS), which is a program of surveys conducted by the National Center for Health Statistics that makes economical use of the large sampling frame of the National Immunization Survey (NIS). SLAITS takes advantage of the NIS screening effort by fielding interviews on other health topics with households screened for the NIS. The respondent was the parent or guardian identified as the person most responsible for the sampled child’s medical care. Spanish-language interviews composed 19% of all completed interviews. The Council of American Survey Research Organizations response rate was 65.6%.

Conclusion. The NSECH provides a unique data set that allows a well-rounded picture of the health, health care utilization, health care content, and interpersonal quality of health services received by young children in the United States. It also contains important information about family characteristics, patterns of health-promoting behaviors, and family routines that are associated with promoting the developmental health of young children. NSECH results can also help national policy makers understand the health needs of families with young children and how well the health system is meeting those needs.
CONGENITAL MEGACOLON
Authors: SWENSON ORVAR
Published: December 2021

TWO years ago I had the privilege of presenting to this Academy our concepts of the pathology, the related dysfunction of the colon, and the surgical treatment of congenital megacolon. I should now like to relate our interim clinical experience with these patients and particularly to stress diagnostic criteria of this disease.

Children with constipation should, from a practical standpoint, be divided into two groups: those with chronic constipation on a habit or psychologic basis who should be treated medically; and those with congenital megacolon who should be treated surgically. The differentiation of the two groups is usually not difficult from the information gained in taking the history and performing the physical examination. The large majority of our patients with congenital megacolon have a history of constipation from birth. Often obstipation, vomiting and abdominal distention have been of such prominence during the first few days of life that a diagnosis of intestinal obstruction has been entertained and exploration occasionally performed. A considerable number of infants die of congenital megacolon in the first weeks of life. The surviving infants continue to have varying amounts of constipation with intermittent abdominal distention and require frequent enemas or some other aid in evacuation. In contrast to this the children with chronic constipation on a habit basis have histories of no symptoms until they are 2 or 3 years of age, and abdominal distention is rarely present. Furthermore, there is usually a history of parental overanxiety concerning intestinal function, and this emotional attitude toward the child's problem accounts for their tendency to exaggerate symptoms.
ADRENAL FUNCTION IN PREMATURE INFANTS
Authors: LANMAN JONATHAN T.
Published: December 2021

The urinary formaldehydogenic steroid excretion was measured in 5 ACTH-treated premature infants and in 3 premature infants born of toxemic mothers. One of these toxemic mothers received no therapy, one received ACTH antepartum, and one cortisone antepartum. Na, K and N balance studies were conducted in three of the above infants.

Steroid excretion rose during ACTH administration and fell 2 to 4 days after discontinuance of ACTH therapy. The fall was followed by a moderate rise, or rebound, in some cases. These findings indicate that the adrenals of young infants have a functional reserve and are capable of responding to either an increase or a decrease in the adrenocorticotrophic stimulus by a corresponding change in steroid production. This response resembles that seen in normal adults and is further evidence that this aspect of adrenal function is not impaired during involution of the fetal adrenal cortex.

ACTH administration in one infant produced an increase in sodium excretion during the first 16 days of therapy. This response is the opposite of that usually found in normal adults, and confirms a similar previous finding reported by Klein. Under continued ACTH therapy, the infant ultimately retained Na as does the normal adult. The cause for this early abnormal response is unknown, but it resembles one seen in adults with Cushing's disease, in whom desoxycorticosterone induces a loss of sodium.

The infant born of the cortisone-treated toxemic mother had normal postnatal urinary steroid values; the infant born of the ACTH-treated toxemic mother had unusually high postnatal values. These observations suggest that cortisone failed to cross the placenta in sufficient quantity to influence steroid excretion of the infant, but that ACTH administered to the mother reached the fetus and stimulated his adrenals.
ESTUDIO SOBRE EL NIÑO DESNUTRIDO
Authors: GÓMEZ POR FEDERICO , GALVÁN RAFAEL RAMOS , CRAVIOTO JOAQUIN , FRENK Y SILVESTRE
Published: December 2021

The study of the enzymatic activity in duodenal contents of 40 patients affected with third degree malnutrition shows that this activity was decreased with specially low figures for lipase.

A definite increase in enzymatic activity was discovered when the nutritional state of the patient improved, but no correlation was found between the figures for serum albumin and the amounts of pancreatic enzymes. Neither was there any correlation found among enzymatic activity, appetite, and diarrhea.

This study seems to prove there is a delay in the absorption of nonmodified protein in patients affected with third degree malnutrition.

The finding of decreased enzymatic activity in both Kwashiorkor and third degree malnutrition is another reason to consider that both illnesses are only a group of syndromes caused in most instances by the same common factor which is chronic undernourishment.
HERPES SIMPLEX OF THE NEWBORN INFANT
Authors: EPSTEIN HAROLD C. , CROUCH WALTER L.
Published: December 2021

A case of herpes simplex infection in the newborn infant is reported. No neutralizing antibody was found in the patient's serum at 10 or 24 days, but a neutralization index greater than 64,500 was found at 116 days.
SPECIAL REVIEWS
Authors: HORSFALL FRANK L.
Published: December 2021

THERE has arisen recently a tendency toward thinking that infectious diseases no longer present problems of social importance in the economically more advanced countries. This tend is more notable among a few biologists who are concerned with ideas about diseases than among physicians who are confronted daily with infectious diseases as established facts. The origin of the idea is easily traceable to the striking effects that modern antimicrobial drugs have had on the mortality of many severe infectious processes. Not only has the over-all mortality from microbial infections been diminished, but also, and more dramatically, the mortality in childhood has been greatly reduced. Judged from the viewpoint of the mortality statistician, the millennium is at hand and microbial infection need not be an important cause of untimely death. However, as every physician knows, infections are as common as in the old days and morbidity statistics have not been much improved by chemotherapeutic successes.

If viral diseases of the respiratory tract were the killers that untreated microbial infections of this tract are, no one could suppose that infectious diseases may be considered as only of minor importance. Although relatively few patients die of respiratory viral infections, the burden of disease they cause is enormous, greater than that of all other maladies in combination. It appears that mankind suffers throughout at least one-tenth of its life span from viral diseases of the respiratory tract. One may take the view that a cold on some other acute respiratory illness is an unpleasant inevitability which may go away in a week on so. However, the patient with one has a different view of the misery experienced and the time lost and knows, too, that another won't be too long in coming. His question is: What can be done to stop these things and let me get on with what I was doing?

At least seven separate viral diseases of the respiratory tract have been recognized and identified through careful study.
HEREDITARY ELLIPTOCYTOSIS ASSOCIATED WITH INCREASED HEMOLYSIS
Authors: Josephs Hugh W. , Avery Mary Ellen
Published: December 2021

Three cases of hereditary elliptocytosis have been presented. The criteria for diagnosis have been (1) the presence of a high percentage of elongated cells in stained smears and wet preparations, and (2) the finding of elongated cells in other members of the family including one parent in each case.

All 3 children had a marked anemia when first seen. Case 1 had an outspoken hemolytic anemia at 2 months of age. His hemoglobin is now practically normal, but he still has a slight but persistent reticulocyte increase. Cases 2 and 3 were first thought to be due to iron deficiency anemia. While iron deficiency may have been responsible for the degree of anemia that brought the cases under observation, a slight but persistent elevation in both reticulocyte count and stool urobilin concentration indicated the presence of increased hemolysis. The findings of a shortened erythrocyte life span in Case 3 supports this conclusion.

A review of the literature makes it clear that hereditary elliptocytosis is a potentially hemolytic disease. However, in the great majority of the cases the elliptocytosis appears as a harmless anomaly without pathological significance. In a certain number, to which considerable attention is now being paid, there may be a hemolytic anemia sometimes of a severity sufficient to require splenectomy. Between these 2 extremes there lies an indeterminate group in which there is evidence of hemolysis if one looks for it, in which there may or may not be anemia, and in which it is not always easy to know if the patient's symptoms are part of the disease. It is to this group that our patients belong.
LOW BIRTH WEIGHT IN FIBROCYSTIC DISEASE OF THE PANCREAS
Authors: Boyer Paul H.
Published: December 2021

The mean birth weights of 75 white females and 98 white males with fibrocystic disease of the pancreas were compared with the mean birth weights of control female and male infants. For each sex the mean birth weight of patients with fibrocystic disease of the pancreas was significantly lower than the mean for the control population.

The proportion of male and female infants whose birth weights were above 3000 gm., in the control population and in the group of patients with fibrocystic disease of the pancreas, was calculated. The percentage for patients with fibrocystic disease of the pancreas was much less than the one for control infants. The difference between the 2 groups was statistically significant.

The analysis of these figures favors the hypothesis that in fibrocystic disease of the pancreas there is a fetal or maternal metabolic disturbance of undetermined nature that apparently interferes with the normal growth of the fetus.

The mean birth weight of unaffected infants born to women who had followed a special pregnancy diet after having had a previous pregnancy resulting in a child with cystic fibrosis, was higher than the average birth weight for control newborns. The difference was of no statistical significance.

The mean birth weight for infants with fibrocystic disease of the pancreas whose mothers followed a special pregnancy diet was higher than the calculated mean birth weight for patients with fibrocystic disease of the pancreas whose mothers received no comparable dietary advice during pregnancy. The difference was not significant.

The known effect of a high protein intake during pregnancy, in enhancing the infant's birth weight, appears to apply even when the infant proves to have fibrocystic disease of the pancreas.

There is no clear explanation for the tendency to low birth weights in infants with fibrocystic disease of the pancreas. It seems logical to suggest that maternal or fetal metabolic factors may be responsible. The fact that the birth weight and perhaps the incidence of the disease may be modified by a liberal diet during pregnancy is a point that deserves further study.
REVIEW ARTICLE
Authors: Gajdusek D. Carleton
Published: December 2021

CURRENT opinion is divided as to the role of the encephalomyocarditis (EMC) group of viruses in human disease. In the serologic survey of Tarahumara Indians reported elsewhere in this issue it has been shown that antibody neutralizing significant amounts (namely, 20, 80, 1000, and 6000 LD50, respectively) of the AMS strain of EMC virus was found in 4 of the 56 serum specimens studied. This finding serves to focus attention again on the scattered reports suggesting the EMC virus as an etiologic agent in human disease.

History of the Discovery of EMC Viruses

Jungeblut and Sanders isolated from cotton rats inoculated with Yale-SK strain of poliomyelitis virus, a virus different from that which they had inoculated. They designated this new agent "Columbia-SK." Later Jungeblut and Dalldorf isolated an agent they called MM-virus from hamsters inoculated with central nervous system (CNS) tissue of a fatal case of undiagnosed paralysis suspected of being poliomyelitis. Many workers have assumed that these first isolations were of viruses latent in the laboratory rodents. Helwig and Schmidt obtained encephalomyocarditis (EMC) virus from a captive chimpanzee with myocarditis and hydrothorax in Florida; and Dick, Best, Haddow, and Smithburn obtained so-called Mengo encephalomyelitis virus in Uganda from a paralyzed rhesus monkey, later from mosquitoes (Taeniorrhynchus fuscopennatus), and from a wild mongoose caught near the monkey compound in Entebbe, Uganda. Accidental infection of a laboratory worker in Entebbe with Mengo virus demonstrated the pathogenicity of this agent for man. The worker developed an encephalitic illness and the virus was isolated from his serum.
THE TREATMENT OF HYPERTHYROIDISM IN CHILDHOOD WITH THIOURACIL DRUGS
Authors: Van Wyk Judson J. , Grumbach Melvin M. , Shepard Thomas H. , Wilkins Lawson
Published: December 2021

During the past 10 years thiouracil and propylthiouracil have been used to treat all children with hyperthyroidism in the Harriet Lane Home Endocrine Clinic. Follow-ups are available on 16 children whose disease began before 13 years of age. Eight of this group are now in a period of prolonged remission; 4 have required subsequent surgery, and 4 are still under treatment. The occurrence of adolescence has not been found to induce a relapse in any child who was previously in remission.

Reduction in the size of the goiter while the patient is receiving treatment has been found to be the best prognostic sign. The combined use of thyroid with antithyroid drugs has caused involution of the gland in those patients whose goiters remained large after treatment with propylthiouracil alone. The ultimate value of this combined treatment remains to be determined.

It is recommended that surgery be reserved for those children who are sensitive to antithyroid drugs, who fail to co-operate or cannot be followed closely. In the remainder, treatment with antithyroid drugs should be continued until there is substantial reduction in the size of the gland. A period of 2 years of continuous therapy is suggested as the minimal period of treatment.
AMERICAN ACADEMY OF PEDIATRICS, INC. PROCEEDINGS AND REPORTS
Authors: Wenner Herbert A.
Published: December 2021

There can be but one position in the controversial issues on immunization against paralytic poliomyelitis. That position is best attained by the continuous, systematic search for truth. The unfortunate presence of active virus in some lots of formalin-in-activated vaccine should not be the key issue in urging its abandonment. Immunologic principles on which the vaccine is based must receive major considerations. If there are faults in the methods of inactivation as applied to the production of vaccine, these must be done away with. If they cannot be done away with, then the formalin-treated vaccine cannot be used as a routine immunization procedure. But one should not distort technical errors into immunologic nightmares. It is presumptuous to state that resistance is acquired because of liminal amounts of live virus remaining after inactivation. There is no basis to be found for this in infection rates among vaccinated children. The approach should be open and based on pooled observations, experiments, and reasoning. Counter criticisms are necessary, especially from people who have tried to free their judgment of any but objective criteria. The growth of medical knowledge is not dependent on a few great discoveries. It depends equally as Müller states "on that slow accretion of multitudinous small steps that furnish the basis for and the necessary extension of those discoveries and also on the correction of even more numerous missteps continuously being made."
The Pathogenesis of Poliomyelitis
Authors: WENNER HERBERT A.
Published: December 2021

This book, written by one who can speak as an authority, is commended to students of medicine, to practitioners, and to investigators in the infectious diseases. The author has spent more than 20 years investigating the movement of poliomyelitis virus in body tissues. This monograph brings together much of that research and interprets it in the light of the author's experiences.

The theme of the monograph is that poliomyelitis virus has a basic neuronocytotropism. Dr. Faber considers the primary sites of virus multiplication to be the peripheral ganglia of the nervous system.
COMMITTEE ON NUTRITION
Authors:   EXECUTIVE BOARD, American Academy of Pediatrics, Inc.
Published: December 2021

THE Committee on Nutrition of the American Academy of Pediatrics was established as a Scientific Committee by action of the Executive Board on April 1, 1954. It was created through due recognition of the importance of nutrition in the welfare of infants, children and adolescents. It had become evident that there should be an authoritative body, particularly concerned with the science and practice of nutrition in the periods of rapid growth which occupy the attention of pediatricians. In this manner it was hoped that special consideration of factors which affect the nutrition of infants, children and adolescents could be emphasized.

The Committee should include persons capable of compiling and appraising the pertinent facts and who also would be sensitive to the needs of practitioners and to the position of purveyors of products intended for the nutrition of infants, children and adolescents.

This Committee of the Academy shall offer guidance in selecting means of achieving optimal nutrition in those periods of rapid growth. Consultation and cooperation with other existing authoritative bodies are considered desirable.

The Executive Board of the Academy on September 29, 1955, defined the scope and functions of the Committee on Nutrition to include:

1. Compilation of the essential facts which are the scientific basis for practical nutrition of infants, children and adolescents.

2. Publication of the findings of the Committee in a form suitable to convey the information to physicians, such as brief reports and commentaries in the official journal and publications of the Academy.

This Committee shall concern itself with standards for nutritional requirements, optimal practices and the interpretation of current knowledge of nutrition as these affect infants, children and adolescents.
OBITUARY
Authors: JONES WILEY
Published: December 2021

Dr. Franklin P. Gengenbach (known as "Frank" from coast to coast and North to South) was born in Philadelphia in 1875, graduated from the University of Pennsylvania in 1899, interned in Philadelphia and Boston, then studied in Vienna and Berlin in pediatrics. This is a very brief biography. Shortly after he came to Denver, the far West, he was the first physician to announce that he would specialize in a "new specialty," pediatrics, a term hardly known in Denver at that time and the first pediatrist then between Omaha and the west coast.
COMMITTEE ON SCHOOL HEALTH
Authors:   COMMITTEE ON SCHOOL HEALTH
Published: December 2021

COMPETITIVE athletics for children is an important subject; it is also a controversial one. It is generally agreed that athletic programs for children of all ages are a necessary part of their education and recreation. There are differences of opinion as to the time in a child's life at which games requiring considerable co-ordination should be introduced and the extent to which such games should be organized on a competitive basis. Because of this, educators, community leaders in recreation, and particularly parents, often turn to physicians, especially pediatricians, for guidance and direction when they consider the development of athletic programs. To aid physicians in this advisory role, the Committee on School Health of the American Academy of Pediatrics has summarized its study of the subject.

A considerable fund of information as to extent of organized competitive athletic programs among children and as to the effects these programs has been accumulated from the experience and investigation of recognized leaders in the fields of education and recreation, who have collaborated with interested and informed physicians. Those concerned with sports programs for children should give careful consideration to the opinions repeatedly expressed by these groups. Many of these opinions are contained in the appended reference list. The American Academy of Pediatrics definitely encourages and promotes continuing research to establish sound policies.

The Committee on School Health has considered the subject under the following headings:

Age

We are concerned in this statement with the question of competitive athletics for children 12 years of age and under.
Testing for "Sugar" in the Urine
Authors: DENNIS JAMES L.
Published: December 2021

During the past year many offices and laboratories have adopted as a routine the use of glucose oxidase treated paper strips (test-tapes) to identify "sugar" in the urine. Glucose oxidase is specific for glucose. The inherent danger of its use in routine urinalysis has been called to my attention by a recent consultation on a 6-month-old infant with a fully developed picture of galactosemia. Inquiry indicates that an early diagnosis had been missed because the "urinalysis for sugar" had always been negative.
IN-VITRO RESPONSE OF ENTEROPATHOGENIC ESCHERICHIA COLI TO VARIOUS ANTIBIOTICS
Authors: Metzger William I. , Jenkins Charles J.
Published: December 2021

Bacteriostatic and bactericidal action of various drugs were determined against 147 and 112 strains, respectively, of enteropathogenic E. coli of diverse origin.

Because of its over-all effectiveness combined with a high degree of killing action, neomycin would seem to be the drug of choice for the treatment of infantile diarrhea of E. coli etiology.

Of the bacteriostatic drugs tested, both the tetracycline group and chloramphenicol exhibited a degree of activity that would account for their clinical usefulness in this disease. However, fewer strains of E. coli were resistant to chloramphenical than to the tetracyclines.

Variation in bacteriostatic response occurred with all drugs but was most pronounced with the tetracyclines. The degree of variation emphasizes the need for laboratory control in the treatment of infantile diarrhea due to enteropathogenic E. coli.

The tetracycline drugs do not always show equal activity in the lower drug ranges, although cross resistance is common, and free substitution of one for the other is not recommended.

Streptomycin showed poor activity against most of the strains tested and probably would be of little value in most clinical cases.

All four serotypes exhibited the drug patterns noted but the group 0127:B8 contained the largest number of resistant strains.
ACUTE RESPIRATORY DISEASES
Authors: Adams John M.
Published: December 2021

This review might well be regarded as a summary of present knowledge of the large field of respiratory diseases and a brief review of the salient features, concerned primarily with the etiologic, pathogenic and therapeutic considerations. The etiologic, rather than the anatomic, approach to diagnosis is emphasized in order that an intelligent attitude towards therapy might be developed. The recent advances in discovery of new etiologic agents, e.g., adenoviruses, is discussed in some detail. Differential diagnosis includes such diseases as vesicular pharyngitis, lymphocytic choriomeningitis virus infections, infections mononucleosis, poliomyelitis, ornithosis, and rickettsial diseases. Specific use of antimicrobial drugs for certain viral infections is emphasized. Dosage of available therapeutic drugs is detailed for the diseases in which they have been shown to be effective, such as rickettsial diseases, ornithosis, and complicating bacterial infections. Prophylactic uses are outlined and a warning against the uncritical use of such therapy is given. Many problems remain unsolved, but rapid progress is being made.
SOLID INTRATHORACIC MASSES IN CHILDREN
Authors: Boyd Gladys L.
Published: December 2021

Two hundred nine primary opaque intrathoracic masses were seen at the Hospital for Sick Children in the past 25 years. Malignant potentialities were present in 49 per cent of these cases.

Summaries of unusual cases are presented and recommendations for diagnosis and treatment are made.
CLINICAL CONFERENCE
Authors: Cassels Donald E.
Published: December 2021

Dr. Cassels: In April, 1954, a 19-month-old white female was admitted to the hospital. Her family history was irrelevant. She had a normal birth and had not been ill until about a week before admission. At that time, while sitting at the table eating, she suddenly made a noise, threw up her hands and became unconscious, and would have fallen if she had not been caught. She regained consciousness, and promptly again lost consciousness. On the way to a neighborhood hospital she regained and lost consciousness twice. During the first 24 hours of illness she had eight episodes of unconsciousness. In each of these she was limp and flaccid. At no time was there any rigidity or movement nor did she vomit or lose sphincter control. At that hospital it was noted that the eyes were swollen somewhat and the abdomen was protuberant. Urinalysis revealed 2+ albumin. No other abnormalities were found.

On admission to Bobs Roberts Hospital there was only a trace of albumin in the urine without other abnormalities. The eyes were swollen, the abdomen greatly distended, and the liver was very large. There was no evidence of cardiac disease and the blood pressure was normal in all extremities.

During the first month or two of hospitalization she was quite distressed. She had difficulty in breathing, urinated poorly, and developed marked generalized edema. She had astonishing dyspnea without orthopnea and, curiously, she sought peculiar positions of comfort in the oxygen tent. One of the peculiar positions of comfort was lying on the left side, turned at about a 45-degree angle toward a face-down position. She resumed this position repeatedly when moved for examination or nursing care and resisted the usual sitting position assumed for comfort by a patient with respiratory distress.
FURTHER OBSERVATIONS ON HOMEOSTATIC DISTURBANCE IN ACRODYNIA
Authors: Cheek Donald B.
Published: December 2021

On the basis of data obtained from four cases of acrodynia, it was found that deficits of total body chloride and water were present. Normal concentrations of electrolytes and acid-base balance were, for the most part, preserved while the volumes of the fluid compartments were reduced.

Investigations relating to sweat in one patient showed that the volume was excessively high while the concentration of electrolyte was low—circumstances that arise to a lesser degree when a normal infant is subjected to heat stress. It was demonstrated that such losses could lead to chloride deficiency when the intake of food is inadequate. The insensible water loss was also very high, a prediction of increase in body metabolism.

Balance studies did not suggest a stable restoration of chloride and water. It was postulated that mercury gives rise to loss of salt through the kidneys with polyuria and sharp loss of weight early in the course of the disease, followed by a continued state of water and chloride deprivation.

The venous pressure was significantly elevated in three patients and in one patient the concentration of 17-hydroxcorticosteroids in the plasma was at the upper limit of normal. The findings concerning urinary excretion of 17-ketosteroids confirmed once again an increased production. Evidence was cited that patients with acrodynia can be resistant to the sodium-retaining action of desoxycorticosterone.
THE TREATMENT OF FAMILIAL HYPERCHOLESTEROLEMIA WITH A PLANT STEROL
Authors: Levkoff Abner H. , Knode K. T.
Published: December 2021

The ingestion of beta-sitosterol, a sterol derived from plants, brought about a significant reduction in the concentration of cholesterol in the serum of two siblings with familial hypercholesterolemia, forme fruste.
CHANGES IN THE EDITORIAL BOARD OF PEDIATRICS
Authors: MAY CHARLES D.
Published: December 2021

RECENTLY the Editorial Board of Pediatrics imposed upon themselves a plan of limited tenure, and the soundness of this arrangement has received the endorsement of the Executive Board. Members of the Editorial Board are now eligible for two successive terms of 3 years each. It is always with considerable regret that the completion of such a period of pleasant association and service must be faced, as the experience acquired during the years renders the members of the Editorial Board increasingly valuable. The Editorial Board was led to the adoption of a plan of limited tenure because of a firm conviction that the vitality of Pediatrics would be best preserved by the continuous introduction of new members. Appointments are staggered so that the best traditions of Pediatrics may be carefully preserved.
SCIATIC NEUROPATHY IN INFANTS RELATED TO ANTIBIOTIC INJECTIONS
Authors: Scheinberg Labe , Allensworth Mollie
Published: December 2021

Two cases of sciatic nerve injury in the newborn related to antibiotic injections are reported. One patient recovered after 1 year with conservative therapy; the other expired before an adequate period of observation had elapsed. The common factor in the instances of peripheral nerve injury which follow therapeutic injections in infants and children seems to be direct nerve injury by the needle itself or by the material introduced. Diagnosis is often difficult in infants. Conservative management for at least 1 year is advisable before resorting to surgical neurolysis. It is important to call attention to the fact that the increasing vogue for repeated intramuscular injections is accompanied by a definite risk of damage to nerves, and that the risk is especially great in young and malnourished infants. The paucity of gluteal musculature and frequency of struggling during the procedure increase the likelihood of nerve injury.
OLIGODYNAMIC ACTION OF METALLIC ELEMENTS AND OF METAL ALLOYS ON CERTAIN BACTERIA AND VIRUSES
Authors: MCKHANN CHARLES F. , CARLSON HARVE J. , DOUGLAS HARRIET
Published: December 2021

THE OLIGODYNAMIC action of metals and metal compounds was noted in 1893 by von Naegeli who pointed out that "definite metals and metal compounds confer in minute quanity of water solutions the ability to change and finally kill cells in a characteristic way." Many metallic elements have been observed to inhibit the growth of bacteria and to inactivate enzymes. Practical application of such activity of metals has been made in the purification of water and in the preservation of tomato juice, of cider, and of hides.

Metallic lead, cadmium, and mercury have been noted to exert an oligodynamic action at varying distances from micro-organisms, apparently the result of solution of small amounts of individual ions in the medium. Minute amounts of certain metals have been found to stimulate the growth of tumors in rabbits.

Although the virus of poliomyelitis and that of influenza have been shown to be inactivated in vitro by salts of heavy metals, studies with viruses similar to those made on the oligodynamic action of metallic elements on bacteria are not available. Furthermore several metals are now obtainable which were not included in earlier studies.

The purpose of this report is to present the results of investigations of the possible oligodynamic action of metallic elements and metal alloys on various species of bacteria and fungi, and on the viruses of poliomyelitis (Lansing strain) and on influenza A (PR8) by in vitro methods. Table I depicts the periodic arrangement of the elements and a list of the metals employed.

Materials and Methods

Metallic elements and alloys: The metallic elements were obtained in so far as possible as pure substances, but manufacturers' analyses were accepted and no attempts were made to ascertain if there might be traces of impurities present. The manufacturers' analyses of the composition of some of the metal alloys are listed in Table II with amounts of each ingredient stated on a percentage basis.
CUP FEEDING OF NEWBORN INFANTS
Authors: FREDEEN ROBERT C.
Published: December 2021

A method of feeding the artifically fed infant from a cup starting at birth has been described. Increase in weight is as great when this method is used as in breast or bottle fed infants. Cup feeding is particularly suited to the premature and feeble infant and those with oral defects. The impression has been gained that cup feeding instituted at birth does not lead to psychologic difficulties either in infancy or later childhood. The psychologic benefits of cup feeding have been discussed.
THE PEDIATRICIAN AND THE PUBLIC
Authors: HARPER PAUL
Published: December 2021

THREE communications are presented in this issue all of which are pertinent to the discussion of whether the Academy shall support the recommendation of its Committee for Improvement of Child Health that federal aid be sought for pediatric education. The editors of this column believe that support of this recommendation or some modification is of immediate and paramount importance. This position was ably presented in the statement by Maryland members of the Academy of Pediatrics. (Pediatrics 2:222, 1948.) The public demand for improved medical care will not be denied. The profession must lead in this program or be led. The most urgent need is for more and better training for all physicians—and this is also the area in which agreement among the profession should be most complete.

The first letter is from Dr. Donald G. Anderson, Secretary of the AMA Council on Medical Education and Hospitals, and presents the official view of the Council. It may be pointed out that this letter from Dr. Anderson indicates a legitimate change since the statement which he signed as a member of the Subcommittee on Medical Personnel of the Section on Professional Personnel at the National Health Assembly. The statement of this subcommittee contained the following:

". . . There is evidence to indicate the local support will be insufficient to meet the financial needs of a sound and expanding program of medical education, and that some form of federal support will be necessary. Federal appropriations should entail no federal control of the administration, curriculum and student admissions of the medical schools. . . ."

The second communication is from Dr. Allan M. Butler, Professor of Pediatrics at Harvard Medical School, which reviews the changing positions of the AMA with regard to medical care.

The final communication is from Dr. Paul Hawley, Chief Executive Officer, Blue Cross—Blue Shield Commissions. Dr. Hawley emphasizes the urgent need for the profession to take the lead in providing improved medical care to forestall the rising demand for socialized medicine. He makes the point that the profession in the recent past has not exercised such leadership and that time is running out.