bluuebunny/crossref_metadata_2025 huggingface dataset:
Pleural Fluid in Hospitalized Pediatrc Patients
Authors: Alkrinawi S. , Chernick V.
Published: June 2007

We reviewed 105 charts of children who were hospitalized in a major teaching hospital between 1987 and 1993 with a diagnosis of pleural effusion established by radiographic study of the chest. There were 75 males and 30 females; mean age was 7.2 years (range 1 day-18 years). Pleural fluid was secondary to trauma, renal disease, or malignancy in 31.5% of patients. Parapneumonic effusions were found in the majority of patients, 64/105 (61%). However, in only 38 of the 64 patients (59%) was an organism isolated from any source. The most common bacterial organism cultured was Haemophilus influenzae (11 patients), followed by Staphylococcus aureus (seven patients). In five of 38 patients, a viral etiology was diagnosed. Pleural fluid was examined in only 35 patients (34%) and a pathogen found in only five (three bacterial, one Candida, one respiratory syncytial virus). It was possible to classify only 17 cases as exudate (fluid/blood protein ratio ≥0.5) and six cases as transudate (fluid/blood protein <0.5). Of 64 patients with suspected pleural fluid secondary to infection, 25 (39%) underwent thoracentesis and only 17 (27%) required tube drainage. This study demonstrates a wide spectrum of etiologies for pleural fluid in children, as well as the reduced use of thoracentesis or chest tube drainage in suspected infection. We speculate that this is probably because of the extensive empiric use of broad-spectrum antibiotics. The biochemical criteria established for adults for distinguishing pleural fluid exudates and transudates need to be studied in children.
The Association Between Parental Health Beliefs and Immunization Status Among Children Followed by Private Pediatricians
Authors: Taylor James A. , Cufley Davonna
Published: June 2007

To determine the association between parental health beliefs and the immunization status of their children, parents of children seen in two private pediatric practices completed a questionnaire on attitudes about immunizations. Five components of health beliefs were surveyed: perceived benefits of immunizations, susceptibility to diseases prevented by immunizations, severity of those diseases, parental feelings of self-efficacy in promoting their child's health, and barriers to immunization. Responses to the health-beliefs statements were transformed to an ordinal scale between 1 and 6, with ‘6’ corresponding to strongly positive feelings about immunizations. Immunization data were abstracted from practice medical records. Overall, 162/194 (83.3%) study children were fully immunized. There were no significant differences between parents of fully immunized children and those of under-immunized children in total health-beliefs score or for the benefits, susceptibility, severity, or barriers components. Self-efficacy scores were significantly higher among parents of fully immunized children (P= 0.019); however, this was largely due to differences in the subgroup of children of mothers with lower education levels. The results of this study suggest that among parents of children followed by private pediatricians, health beliefs do not significantly influence immunization status.
Behavioral Descriptors that Differentiate Between Seizure and Nonseizure Events in a Pediatric Population
Authors: Williams Jane , Grant Mitzie , Jackson Matt , Shema Sarah J. , Sharp Gregory , Griebel May , Lange Bernadette , Mancias Pedro , Bates Stephen
Published: June 2007

The diagnosis and treatment of epilepsy relies heavily on descriptions of behavioral changes noted during seizure episodes. A pilot study was completed to determine the frequency of occurrence of behaviors commonly associated with seizures in a pediatric population (n=153). Caretakers of the children (ages=4 months to 19 years) were asked to respond to a checklist containing 40 behavioral descriptors. Thirteen descriptors were found to differentiate between seizure and nonseizure events. Twelve of these behaviors were endorsed significantly more frequently by caretakers of children with seizures including the following: does not remember what happened, moves mouth funny, drools, jerking/twitching, becomes stiff, changes in breathing, stares off, bites or chews tongue, eyes look glassy, will not respond, mumbles or slurs words, and eyes or head turn to one side. One behavior, fidgets in seat, was significantly more associated with nonseizure episodes. The behavioral descriptors may be presented in a checklist format or incorporated within a clinical interview in primary care settings for initial screening of children with possible seizure disorders.
Weight Gain: A Possible Factor in Deciding Timing for Inguiinal Hernia Repair in Premature Infants
Authors: Desch Larry W. , DeJonge Mitchell H.
Published: June 2007

A retrospective study was done to determine whether improved weight gain follows inguinal hernia repair in the premature infant and whether the presence of an inguinal hernia is associated with comparatively poorer weight gain prior to repair. Demographic and growth data from 28 premature infants who had undergone hernia repair were compared with corresponding data from 25 matched “control” premature patients. The two groups' weight for age Z scores for both time periods (i.e., before and after hernia repair) were then determined and analyzed. The differences found in Z scores between these two groups indicated that premature infants who have inguinal hernias seem to grow better after the hernia repair as compared with before the surgery. Despite issues related to group matching, the results of this study indicate that weight gain may be an additional factor to consider in determining the appropriate time to do surgical correction of a premature infant's inguinal hernia.
Diabetic Ketoacidosis (DKA): Treatment Guidelines
Authors: Rosenbloom Arlan L. , Hanas Ragnar
Published: June 2007

Diabetic ketoacidosis (DKA), resulting from severe insulin deficiency, accounts for most hospitalization and is the most common cause of death, mostly due to cerebral edema, in pediatric diabetes. This article provides guidelines on management to restore perfusion, stop ongoing ketogenesis, correct electrolyte losses, and avoid hypokalemia and hypoglycemia and the circumstances that may contribute, in some instances, to cerebral edema (overhydration, rapid osmolar shifts, hypoxia). These guidelines emphasize the importance of monitoring glycemia, electrolytes, hydration, vital signs, and neurologic status in a setting where response can be rapid if necessary (e.g., mannitol for cerebral edema). Most important is the prevention of DKA in established patients by close supervision of those most likely to omit insulin, or during illness, and a high index of suspicion for diabetes to prevent deterioration to DKA in new patients, particularly those under age 5, who are at greatest risk of complications.
Environmental and Life-style Risk Factors for Lyme Disease in Children
Authors: Klein Joel D. , Eppes Stephen C. , Hunt Patricia
Published: June 2007

Risk factors for Lyme disease and/or infection with Borrelia burgdorferi in children are not defined. A case-control study was performed using Lyme disease patients from our Lyme Clinic population. Age- and sex-matched controls from the same neighborhood were identified by the Lyme patients' families. A site visit was made to each case/control neighborhood. Twenty-four environmental variables, especially the ecologic characteristics of the home environment, were examined. Forty-five items were surveyed by parent questionnaire, including certain “high-risk” activities and behaviors, whether ticks or certain animals were present on the property, and whether antitick measures were used. Control subjects had serologic assays for antibodies to B. burgdorferi. Forty-four Lyme disease patients and 44 well-matched control subjects participated; 2 controls were seropositive. Significant associations with Lyme disease were found for deer ticks in the home environment, ground cover containing moist humus, and leaf litter in the yard. Among the 45 items related to life-style, there was no correlation with Lyme disease for the use of any antitick measures or for any childhood activities; in fact, an inverse correlation was observed for camping and fishing. We conclude that conditions in the immediate home environment, including certain ecologic factors that favor the presence of Ixodes ticks, are associated with an increased risk for Lyme disease in children.
Sweeteners, Dyes, and Other Excipients in Vitamin and Mineral Preparations
Authors: Kumar Ashir , Aitas Anastassios T. , Hunter Anthony G. , Beaman Dana C.
Published: June 2007

Multivitamins and mineral preparations are widely used for infants and children. All of these preparations contain a variety of excipients (“inert ingredients”). Excipients are generally safe; however, adverse effects have been attributed to them. Complete information about the excipients in various preparations is not readily available. The information about sweeteners, dyes, and other excipients (flavorings, preservatives, stabilizers, and fillers) for 41 chewable/liquid multivitamin and mineral preparations was obtained and tabulated. Sucrose was present in 63% (26/41) of preparations followed by lactose in 29% (12/41) of preparations. On average, a preparation contained two sweeteners. The FD&C yellow #6 (sunset yellow) was the most common dye, present in 46% (19/41) of the preparations followed by FD&C Red #40 in 29% (12/41). For 34% (14/41) of the preparations, no color or dye was identified by the manufacturers. The tables listing excipients and their adverse effects are presented and should be helpful to health care providers in selecting preparations containing individual excipients when an adverse reaction occurs or there exists a contraindication for using the excipient. The mandatory listing of all excipients is the only way to assure that physicians and consumers will be fully informed about the hidden ingredients.
A Double-Blind, Placebo-Controiled Trial of Decongestant-Antihistamine for the Treatment of Sinusitis in Children
Authors: Mccormick David P. , John Susan D. , Swischuk Leonard E. , Uchida Tatsuo
Published: June 2007

We studied the effectiveness of nasal decongestant-antihistamine in treating acute sinusitis in children. All subjects received oral amoxicillin for 14 days. Subjects randomized to the decongestant-antihistamine group received nasal oxymetazolone and oral syrup containing brompheniramine and phenylpropanolamine. Controls received placebo nasal saline and oral syrup. In both groups symptoms resolved quickly, and radiographs improved significantly. Responses to treatment were similar between the two groups. Water's radiographs of the maxillary sinuses proved reliable in the assessment of the degree of sinus involvement. We conclude that decongestant-antihistamine need not be given to the child with acute maxillary sinusitis.
Comparative Evaluation of Cefixime versus Amoxicilhin-Clavulanate Following Ceftiaxone Therapy of Pneumonia
Authors: Amir Jacob , Harel Liora , Eidlitz-Markus Tal , Varsano Ltzhak
Published: June 2007

Preliminary results have recently shown that an early switch from parenteral antimicrobials to an oral substitute provides an effective means of treating pneumonia in pediatric patients. In a controlled randomized study, 62 children with community-acquired lobar/segmental pneumonia were selected to receive 8 days of cefixime or amoxicillin-clavulanate after an initial therapy of two doses of parenteral ceftriaxone. Enrollment criteria included: age 6 months to 5 years, fever >38.5°C, white blood cell (WBC) count >15,000/mm3, and lobar/segmental pneumonia on chest radiograph. Twenty-nine patients were randomized to receive oral cefixime and 33 to oral amoxicillin-clavulanate. The two groups were comparable in the following pretreatment parameters: age, duration of illness, temperature, mean WBC count, erythrocyte sedimentation rate, C-reactive protein, and need for hospitalization. Days of resolution of high fever, tachypnea, cough, grunting, and laboratory test abnormalities were similar in the two groups. Clinical response at the end of treatment showed cure, improvement, and failure in 97%, 3%, and 0%, respectively, in the cefixime group and in 88%, 6%, and 6%, respectively in the amoxicillin-clavulanate group (P=NS). We conclude that young children with community-acquired lobar/segmental pneumonia can be successfully treated with 2 days of parenteral ceftriaxone followed by 8 days of oral cefixime or amoxicillin-clavulanate.
Chromosome 22q1l Deletion Syndrome: An Update and Review for the Primary Pediatrician
Authors: Thomas Janet A. , Graham John M.
Published: June 2007

Chromosome 22ql1 deletion syndrome is a relatively newly described syndrome that encompasses the majority of patients previously felt to have velo-cardio-facial syndrome, DiGeorge syndrome, and conotruncal anomaly face syndrome. The disorder is characterized by a deletion of band 11 on the long arm of chromosome 22 most often recognized by fluorescent in situ hybridization (FISH) techniques. Extensive laboratory investigations are currently ongoing to uncover the specific genes involved and their functions. Phenotypically, individuals present with congenital heart disease, palatal abnormalities, facial dysmorphism, and developmental delay, as well as variable degrees of immunodeficiency, hypocalcemia, and endocrine abnomalities. The primary care physician has an important role in caring for these patients and their families. We review the current state of knowledge regarding chromosome 22q11 deletion syndrome, with an emphasis on the clinical presentation and on prevention and treatment of the known complications associated with this multisystem disorder. Chromosome 22ql1 deletion syndrome can be inherited in an autosomal dominant fashion or result from a de novo deletion or translocation. Hence, this syndrome may have significant reproductive risks to affected individuals and families.
Maternally Reported Fetal Activity Levels and Developmental Diagnoses
Authors: Accardo Pasquale , Tomazic Terry , Fete Timothy , Heaney M. Susan , Lindsay Ronald , Whitman Barbara Y.
Published: June 2007

Retrospective maternal report of fetal activity level was compared with developmental diagnosis in 608 consecutively referred children. Maternal history of fetal activity level was also obtained from 140 unmatched well children in a general pediatric clinic. Fetal hyperactivity was positively associated with a diagnosis of child hyperactivity, and fetal hypoactivity was positively associated with a diagnosis of mental retardation in the children. Maternal histories of fetal activity level in the control group weakened the strength of the association between fetal hyperactivity and child hyperactivity but did not affect the association between fetal hypoactivity and mental retardation in children.
Laboratory Predictors of Fluid Deficit in Acutely Dehydrated Children
Authors: Teach Stephen J. , Yates Eugene W. , Feld Leonard G.
Published: June 2007

To determine which laboratory studies are most predictive of the fluid deficit in acutely dehydrated children, we studied a convenience sample of 40 children requiring intravenous fluid resuscitation. Nine laboratory studies (serum BUN/cr, total serum C02, serum uric acid, serum anion gap, urine anion gap, venous pH, venous base deficit, urine specific gravity, and fractional excretion of sodium) were individually assessed in simple linear regression models with fluid deficit as the dependent variable. Only the serum BUN/cr and serum uric acid were significantly associated with increasing fluid deficit (r=0.52, P=0.0005 and r=0.35, P=0.03, respectively). The sensitivities and specificities of these two laboratory studies for the detection of >5% fluid deficit were poor. Conventional laboratory studies used to assess dehydration in children are poorly predictive of fluid deficits.
The Practical Aspects of Diagnosing and Managing Children with Attention Deficit Hyperactivity Disorder
Authors: Wolraich Mark L. , Baumgaertel Anna
Published: June 2007

AD/HD is a behaviorally defined disorder with specific behavioral criteria. The most recent definitions decrease heterogeneity by defining subtypes although the current treatments tend to be more generic. The main well-established treatments are stimulant medication and behavior modification, which are most effective when used together.
Using the Clinical Linguistic and Auditory Milestone Scale for Developmental Screening in High-Risk Preterm Infants
Authors: Beilcher Harolyn M. E. , Gittlesohn Alan , Capute Arnold J. , Allen Marilee C.
Published: June 2007

Eighty-one preterm infants (mean gestational age 29 weeks, range 24-36 weeks) discharged from The Johns Hopkins Hospital Neonatal Intensive Care Unit were followed up sequentially from birth to 2 years of age by use of the Clinical Linguistic and Auditory Milestone Scale (CLAM,S) to evaluate language development. Children were studied during three time intervals: Interval 1: 3-5 months chronologic age (CA); Interval 2: 9-14 months (CA); and Interval 3: 18-24 months (CA). Psychometric test scores were compared with CLAMS Language Quotients (LQ) by use of full, partial (75%, 50%, 25%), and no ‘correction’ for weeks of prematurity to determine whether ‘correcting’ for prematurity would yield a more accurate estimate of eventual cognitive outcome. CLAMS LQ at Interval 1 was highly correlated with CLAMS LQ at Interval 2 and CLAMS LQ at Interval 2 correlated well with CLAMS LQ at Interval 3 (r=0.57 and 0.64, respectively, P=0.0001). Correlations indicated that there was an orderly, sequential development of language in the preterm infant. CLAMS evaluations correlated significantly with psychometric test results during Interval 2 and Interval 3 (r=0.34, P<0.02 and r=0.75, P=0.0001, respectively). The CLAMS proved to be a useful instrument for monitoring preterm language development in the primary pediatric care setting.
The Incidence of Acute and Remote Seizures in Children with Intraventricular Hemorrhage
Authors: Strober Jonathan B. , Bienkowski Robert S. , Maytal Joseph
Published: June 2007

Seizures are a well-known complication of intraventricular hemorrhage (IVH) in premature infants; however, the rate at which they occur is not known. The authors decided, therefore, to investigate both the incidence of acute and remote seizures in infants with IVH and the association with the grade of hemorrhage. One hundred and three infants with IVH were identified and their records were reviewed for acute seizures, remote seizures, and associated morbidity and mortality. The average gestational age of these infants was 29 weeks (range, 23-40 weeks). Of the 103 infants, 32 (31%) developed grade 4 IVH; 19 (18%), grade 3 IVH; and 52 (50%), grades 1 and 2 1VH. Seventeen (17%) patients had acute seizures during their first month of life. Six of the 61 patients (10%) who survived the neonatal period and for whom follow-up data were available had, remote seizures. Infants with grade 4 IVH had significantly more acute seizures than infants with grades 1 and 2. In this cohort, only infants with grades 3 and 4 IVH developed remote seizures. Furthermore, among infants with grade 4 IVH acute seizures were a significant risk factor for development of remote seizures. The use of long-term antiepileptic drug therapy in neonates with a history of acute seizures is not established. These results suggest that antiepileptic drug therapy beyond the neonatal period should be reserved for infants with grade 4 IVH with history of acute seizures.
Neonatal Hypoglycemia, Part I: Background and Definition
Authors: Halamek Louis P. , Benaron David A. , Stevenson David K.
Published: June 2007

Hypoglycemia in the neonate remains a common problem. The association of low blood glucose concentrations and abnormal development has prompted extensive research into the anticipation, evaluation, and treatment of neonatal hypoglycemia. Glucose homeostasis in the fetus and neonate is a developmentally regulated dynamic process involving a number of intricate physiologic mechanisms. In addition, the determination of glucose concentrations is dependent upon both the type of tissue analyzed and the limitations of the specific method employed. The complexity of glucose metabolism makes it difficult to precisely define “normal” and “abnormal” glucose levels in preterm and term neonates.
Paradoxical Reactions in Children Associated with Midazolam Use During Endoscopy
Authors: Massanari Marc , Novitsky Janie , Reinstein L. Julio
Published: June 2007

All 2,617 children who received midazolam and meperidine for a variety of endoscopic procedures were monitored for the development of adverse behavioral problems. Thirty-six (1.4%) of the children (ages 1-17 years) experienced a paradoxical behavioral reaction, which consisted of inconsolable crying, combativeness, disorientation, dysphoria, tachycardia, agitation, and restlessness. The reaction occurred at a mean of 17 minutes after the administration of midazolam. Following treatment with flumazenil, the reaction dissipated within a mean of 14 minutes. Three of the 36 patients underwent additional endoscopic procedures utilizing only meperidine. No similar reaction was observed in these patients. Awareness of the reaction and prompt administration of flumazenil decreased the duration of the reaction.
Efficacy of Amlodipine in Pediatric Bone Marrow Transplant Patients
Authors: Khattak Sohail , Rogan John W. , Saunders E. Fred , Theis Jochen G. W. , Arbus Gerald S. , Koren Gideon
Published: June 2007

The calcium antagonist amlodipine may have the potential for expanded use in children owing to its physiochemistry and pharmacokinetic profile that facilitates once-daily dosing in a liquid formulation. Its safety and efficacy have not been previously evaluated in children. A retrospective analysis of 15 pediatric bone marrow transplant patients who had amlodipine incorporated into their antihypertensive drug regimen reveals significantly lower blood pressure as compared with baseline therapy (123.5 ±2.1 mmHg and 117.2 ±2.2 mmHg, systolic blood pressure before and during amlodipine, P<0.05; 81.5 +1.8 mmHg and 75.5 ±2.6 mmHg, diastolic blood pressure before and during amlodipine, P<0.05). Amlodipine provided improved blood pressure control in this cohort and may provide a valuable pharmacologic alternative for treatment of pediatric hypertension.
CHARGE Association: An Update and Review for the Primary Pediatrician
Authors: Blake Kim D. , Davenport Sandra L. H. , Hall Bryan D. , Hefner Margaret A. , Pagon Roberta A. , Williams Marc S. , Lin Angela E. , Graham John M.
Published: June 2007

CHARGE association is a nonrandom pattern of congenital anomalies that occurs together more frequently than one would expect on the basis of chance. This common multiple anomaly condition has an estimated prevalence of 1:10,000. The number of children diagnosed with CHARGE association is increasing, owing presumably to greater awareness of this condition and advances in the care of complex, chronically ill children, resulting in improved survival and outcome. This review of ClHARGE association presents diagnostic criteria that may define a concise, recognizable syndrome with a single pathogenetic basis. This review also summarizes our current understanding of the management for this complex and chronic multiple congenital anomaly condition and discusses the pathogenetic basis for this condition.
Infectious Diseases Presentations of Mmchausen Syndrome by Proxy: Case Report and Review of the Literature
Authors: Goldfarb Johanna , Lawry Kathleen W. , Steffen Rita , Sabella Camille
Published: June 2007

Munchausen syndrome by proxy is a form of abuse, usually of a child by a parent, in which a factitious illness is reported or produced in the child, resulting in unnecessary medical evaluations and treatments. A dramatic case of a 17-month-old infant with recurrent polymicrobial bacteremia prompted a review of cases diagnosed by the Pediatric Infectious Diseases consultation service at our referral children's hospital and a review of the infectious diseases presentations in the medical literature. The infectious diseases presentations of the syndrome as well as criteria for the diagnosis are reviewed and discussed.
Discordant Puberty in Monozygotic Twin Sisters with Neurofibromatosis Type 1 (NFl)
Authors: Kelly Thaddeus E. , Sproul George T. , Huerta Milagros G. , Rogol Alan D.
Published: June 2007

Monozygotic twin sisters are reported who have discordant pubertal growth and sexual development. Although both sisters were physiologically appropriate for chronological age in their pubertal development, their adolescent development was considerably different from that expected of monozygotic twin sisters. The more pubertally advanced sister by magnetic resonance imaging had an optic pathway glioma while none was present in her twin sister. Precocious puberty is not an unexpected complication of neurofibromatosis type 1 and is always associated with the presence of an optic pathway glioma. These sisters emphasize the striking similarity that is expected of monozygotic twins and the need for investigation when intertwin differences in growth and/or development arise.
Evaluation of Boys with Marked Breast Development at Puberty
Authors: Sher Ellen S. , Migeon Claude J. , Berkovitz Gary D.
Published: June 2007

During the 10-year period from 1979 to 1988 we evaluated 60 boys who were more than 9 years old and who had significant breast development (greater than 4 cm in diameter) around the time of puberty. An endocrine abnormality was identified in seven subjects. The pathology included Klinefelter's syndrome; 46, XX maleness; primary testicular failure; partial androgen insensitivity; fibrolamellar hepatocarcinoma; and increased aromatase activity. Eight of the remaining 53 subjects had underlying medical problems, five of them having neurologic disorders. The 45 remaining subjects were considered to have significant idiopathic gynecomastia, a condition sometimes referred to as macromastia. These boys tended to be both taller and heavier than average, the mean Z score for height being 1.4 SDs above the mean and the mean weight score being 2.7 SDs above the mean. This study underscores the observation that pathologic causes of marked pubertal gynecomastia are unusual. However, the potential for significant health problems among boys with marked breast development supports the need for an endocrine evaluation of all affected subjects. Our data also indicate that boys with marked idiopathic breast development have greater body mass than other boys of similar age. This may contribute in part to the greater breast development in these subjects.
Infants with Birth Weight 1,000-1,499 Grams Born in Three Time Periods: Has Outcome Changed Over Time?
Authors: Piecuch Robert E. , Leonard Carol H. , Cooper Bruce A.
Published: June 2007

The objective of this study was to see whether outcome of infants of larger birth weight (1,000-1,499 grams) has changed with advances in neonatology. The outcome of infants born in a recent time period (1989-1991) was compared with that of infants born previously, in 1984-1986 and 1979-1981. Univariate analyses were conducted on the association of medical risk factors and date of birth with outcome. More than 90% of infants in each time period were neurologically normal and more than 80% were cognitively normal. Predictor variables were intracranial hemorrhage for poor neurologic outcome and days on oxygen for poor cognitive outcome. We found that neurodevelopmental outcome was stable over three time periods.
Study of Skin Rashes After Antibiotic Use in Young Children
Authors: Huang Shih-Wen , Borum Peggy R.
Published: June 2007

Immunoglobulin E (IgE)-mediated drug sensitivity in children is uncommon. However, undefined skin rash following antibiotic ingestion in younger children is commonly observed in clinical practice. We studied 86 consecutively referred patients to our allergy clinic over a 5-year period. We found that the majority of children (80%) with skin rashes were under 3 years of age. All the children had been treated with antibiotics for a bacterial upper respiratory infection (URI; otitis media, sinusitis, or pharyngitis), 73 (85%) had erythematous rash, 13 (15%) had urticaria occurring 3-5 days after the treatment, and 43 (50%) reported a repeated rash with the use of two or more different antibiotics. There were no reports of systemic reactions or histories of accompanying food allergy. When patients were given the suspected antibiotics while they were well, none developed rash. However, in the next bacterial infection, 62 (72%) chose to receive dye-free suspensions of the suspected antibiotics. Only three patients (3.5%) elected for the dye-containing suspension. Of the 62 patients who received dye-free suspensions, only eight developed a mild skin rash, which was managed successfully. We conclude that a practical approach for non-IgE-mediated skin rash needs to be evaluated. The current practice of complete avoidance of the suspected antibiotics without further evaluation may be unwarranted.
Current Attitudes Regarding Use of Antimicrobial Agents: Results from Physicians' and Parents' Focus Group Discussions
Authors: Barden Louise S. , Dowell Scott F. , Schwartz Benjamin , Lackey Cheryl
Published: June 2007

Antibiotics are widely prescribed for children with nonspecific upper respiratory tract infections, contributing to the recent emergence of resistant pneumococci. To understand the reasons for the overprescription of antibiotics, we conducted focus groups with parents and with pe-diatricians and family physicians to assess their attitudes regarding the use of antibiotics. Physicians asserted that their own antibiotic prescribing could be safely reduced. Parental expectation to receive antibiotics was a major factor influencing their overuse of antibiotics. Parents indicated that they would be satisfied with the medical visit even if antibiotics were not prescribed, provided the physician explained the reasons for the decision. This study highlights differences in physician and parent perceptions about antibiotic overuse and suggests that educational efforts to narrow this communication gap will be important for improving antibiotic use.
Pulse Oximetry Saturations in the First 6 Hours of Life in Normal Term Infants
Authors: Reddy Vijaya K. , Holzman Ian R. , Wedgwood Josiah F.
Published: June 2007

The pulse oximetry saturation values and the average percentage of time that normal newborns spend at different saturation ranges in the first 6 hours of life were determined in a cross-sectional study. Pulse oximetry saturation values were measured for a single 20-minute period in 101 normal term newborns between 20 minutes and 6 hours of age. The 25th percentile saturation values in the first postnatal hour (range 91%-100%) were lower than those from the second postnatal hour (range 96%-100%) onward. There was no significant difference between the 50th percentile (range 96%-100%) and the 75th percentile (range 97%-100%) saturation values in all postnatal hours. The babies spent a majority of time with saturations?96% in all postnatal hours. A newborn more than 20 minutes old who does not achieve a pulse oximetry saturation value of 96% over several minutes of observation may need evaluation or continuous monitoring.
Capillary Refill Time in the Hands and Feet of Normal Newborn Infants
Authors: Raju N. Venkata , Maisels M. Jeffrey , Kring Elizabeth , Schwarz-Warner Laura
Published: June 2007

We measured capillary refill time (CRT) in a convenience sample of 137 healthy newborns between 1 and 120 hours of age and 36-42 weeks gestation in the well-baby nursery of a large community hospital. CRT was measured by applying moderate pressure to the dorsum of the right hand and right foot for 5 seconds. Pressure was released and the time for complete refilling of the blanched area noted. Each infant was studied only once. We also measured ambient temperature and the skin temperature of the dorsum of the hand and foot and tested interobserver agreement. Mean CRT was 4.23±1.47 s (SD) (range 1.63-8.78 s) in the hand and 4.64±1.41 s (range 2.15-9.94 s) in the foot (p=0.0001) and did not change significantly in the first 72 hours. CRT decreased with increasing temperature. Environmental temperature, axillary temperature, and temperature of the hand and foot were all significantly and indirectly related to CRT, the strongest relationship existing between CRT and the skin temperature of the hand (r=-0.59, 95% CI 0.69, 0.47 p<0.00001) and foot (r=-0.33, 95% CI 0.46, 0.16 p<0.0001). With triplicate measurements, there was a statistically significant, but clinically moderate, order effect, CRT decreasing with each successive measurement (p<0.0001). Interobserver agreement was fair, the correlation coefficient (r) ranged from 0.47 to 0.71. We conclude that CRT as measured in the hand or foot of a newborn infant in the first 5 days of life is a relatively subjective measurement with an endpoint that is not easy to define and a wide range of values in normal infants. It is influenced significantly by environmental, axillary, and skin temperatures. Since there is no accepted standard for measuring decreased perfusion in the newborn, it is impossible to document the clinical utility of CRT in this population. Further studies are necessary before CRT can be accepted as a useful measure of peripheral perfusion and circulatory status in the newborn infant.
Follow-up Imaging Studies in Children with Splenic Injuries
Authors: Shafi Shahid , Gilbert James C. , Irish Michael S. , Glick Philip L. , Caty Michael G. , Azizkhan Richard G.
Published: June 2007

We undertook a retrospective study of pediatric blunt splenic injuries treated nonoperatively at our institution from 1990 to 1995 (n=72) to assess the impact of serial computed tomography (CT) scans on the outcome. Median number of studies per child was three. The result showed that the appearance of the splenic injury remained unchanged or improved in 95% of the imaging studies obtained (116 of 122). Only one of five patients with an image suggesting a worsening splenic injury required operative intervention. There were no instances of missed injuries, delayed ruptures, or readmissions. We conclude that serial CT scans have limited follow-up value and should be used selectively.
Low Frequency of Meperidine-Associated Seizures in Sickle Cell Disease
Authors: Nadvi Samina Z. , Sarnaik Sharada , Ravindranath Yaddanapudi
Published: June 2007

Pain control measures in sickle cell diseases are not uniform. Most clinicians use parenteral morphine or meperidine for severe pain. Reports of seizures associated with meperidine have led to a growing reliance on intravenous morphine, usually with patient-controlled devices. Acceptance of morphine has been poor among patients, and many prefer meperidine. The aim of this retrospective study was to determine the incidence of meperidine-associated seizures in a large, mostly pediatric population with sickling disorders. The results suggest that the incidence of seizures with meperidine is extremely small (0.4% of patients; 0.06% of admissions). The risk of seizures should not dissuade clinicians from using this drug.
Bisphosphonates: From Grandparents to Grandchildren
Authors: Srivastava Tarak , Alon Uri S.
Published: June 2007

Bisphosphonates are synthetic analogues of pyrophosphate that inhibit bone resorption by their action on osteoclasts. Bisphosphonates have been extensively used in the elderly with primary and secondary osteoporosis, Paget's disease, and hypercalcemia of malignancy. In recent years, bisphosphonates have been used to treat children acutely for resistant hypercalcemia and chronically for various metabolic bone diseases. The theoretical concerns of possible adverse effects of these drugs on the growing skeleton have not been proven to be true. In the present review, we have critically analyzed the available literature on bisphosphonate therapy in both adult and pediatric clinical trials. Although not yet approved by the FDA for use in children, bisphosphonates, from published experience, demonstrate benefit to the child with no serious adverse effects. Based on the literature analysis the review furnishes detailed recommendations and practical guidelines regarding the use of oral and intravenous bisphosphonates in children. Bisphosphonates might be the first agents to provide the pediatrician with an opportunity to treat mineral and bone disorders of childhood, which until recently did not have satisfactory therapy.
Changing Partners: The Dance of Infant Formula Changes
Authors: Polack Fernando P. , Khan Nafees , Maisels M. Jeffrey
Published: June 2007

The purpose of the study was to establish the frequency of, reasons for, and outcome of formula changes in infants. In this survey, we interviewed a convenience sample of 100 parents in our pediatric outpatient clinic and 75 parents in private pediatric office practices regarding their baby's initial formula, changes in formula, age at change, reason for change, initiator of the change, and outcome. The infants were 30-210 days old. Sixteen of the 175 infants (9%) were started on nonstandard formulas at birth. Fifty-eight of the remaining 159 infants (36%) were changed from regular to nonstandard formulas. After using nonstandard formulas, only seven infants (4%) were ever challenged subsequently with regular formula and all did well. Colic and regurgitation were the main reasons for switching formulas. In 47% the decision to change the formula was made by the mother and in 44% by the pediatrician. Following the formula change, mothers reported improvement or complete resolution of symptoms in 80% of infants. Although published estimates of formula intolerance range from 2% to 7.5%, one in three infants experiences a formula change, suggesting that nonstandard formulas are used excessively by both mothers and physicians. Nevertheless, in the vast majority of cases, parents report that the changes result in improvement or resolution of symptoms. Thus, while this practice appears to be a simple and effective intervention, it produces a significant population of soy and other nonstandard formula-fed babies who should be drinking regular formulas. Such changes encourage a belief by parents that their infants are allergic or otherwise abnormal and could have a negative impact on subsequent child development.
Conceptualizing and Measuring Democracy
Authors: Munck Gerardo L. , Verkuilen Jay
Published: June 2007

A comprehensive and integrated framework for the analysis of data is offered and used to assess data sets on democracy. The framework first distinguishes among three challenges that are sequentially addressed: conceptualization, measurement, and aggregation. In turn, it specifies distinct tasks associated with these challenges and the standards of assessment that pertain to each task. This framework is applied to the data sets on democracy most frequently used in current statistical research, generating a systematic evaluation of these data sets. The authors’ conclusion is that constructors of democracy indices tend to be quite self-conscious about methodological issues but that even the best indices suffer from important weaknesses. More constructively, the article’s assessment of existing data sets on democracy identifies distinct areas in which attempts to improve the quality of data on democracy might fruitfully be focused.
Frozen Foods — Warehousing and Distribution
Authors: Beyer Milton
Published: June 2007

Centralized distribution centers are being es tablished across the country to meet the needs of the food service industry for simplified pur chasing, delivery, and financing of purchases. The warehousing and trucking of frozen foods requires high investment, so that the distributor providing a complete product line is in a better position to render service. This article, based on an address delivered by Mr. Beyer at Stage VI, Food Systems of the Future, is the case history of one well-known distributor. — Ed.
Disposable Ware for Food Service
Authors: Mannini Walter
Published: June 2007

New disposable tableware of various composi tions is being developed by numerous manu facturers. This article presents American Can Company's new disposable MiraWare and is based on an address given by Mr. Mannini at Stage VI of Food Systems of the Future and also at the Third Commercial Airline Food Service Seminar.
Handling Kitchen Clean-up Problems
Authors: Kleinfeld Ernest
Published: June 2007

This article is based on a presentation made by Mr. Kleinfeld to the Airline Food Service Sem inar, held in January 1968 at the School of Hotel Administration, Cornell University.
Freeze-Dried Foods
Authors: Jenkins R.L.
Published: June 2007

Freeze-dried foods may advance the institu tional food service industry from today's "frozen era" to a "dehydrated era" in the next few years. Advances in food processing technology have already enabled processors to place on today's market freeze-dried soups, salads, entrees, sauces, vegetables, and beverages.

Pioneering the quantity use of freeze-dried foods is the military, which used over 2,500,000 individual freeze-dried meat dishes in 1967. For 1968, they have awarded contracts for 8,500,000 items.

The disadvantages of freeze-dried foods today are the high cost of utilizing the products in our present operations, and the lack of users' knowl edge of how to prepare them. These disadvan tages, however, are expected to be overcome in the foreseeable future.

The major advantages of freeze-dried foods are: (1) the consistency of quality, (2) ease in storing, as no refrigeration is needed, (3) long shelf life, (4) lower transportation costs, be cause weighty liquids have been removed, and (5) menu variety can be achieved without ex tensive preparation facilities.

If the progress in the next few years equals or exceeds that of the past five, freeze-dried foods will soon play a major role in the institutional food service industry. — Professor Vance A. Christian, School of Hotel Administration.
Convenience Meats
Authors: Levie AL
Published: June 2007

The Institutional Foodservice Manufacturers As sociation ascertained at its 13th Annual Sales Conference held in May at the Conrad Hilton Hotel in Chicago that among the 700 industry representatives present the most crucial need of today is for qualified employees. There is, a panel of leaders pointed out, "a most urgent requirement for manufacturers to supply opera tors with products that are both easily used and enable strict cost control.... manufacturers can best assist by developing products that are 'people-free' — that eliminate all, or part of, on- premise preparation." Convenience meat, precut and portion-controlled, was cited as an example of a product that eliminates a major portion of on-premise preparation requiring skilled work ers. — Editor
Environment for Second Careers
Authors: May Siegmund H.
Published: June 2007

U.S. population past 65 years now numbers over 19 million and is expected to increase to 22 mil lion by 1975. Moreover, as the "baby boom" of the 1940's seeks well-paying jobs, executives and line workers will be encouraged to retire at 60 or younger. What then?

Proper housing and living environment are para mount in constructive "second careers" when the daily trek to the job is no longer necessary, re ports Dr. Siegmund H. May. This presents op portunities to developers, for whom Dr. May lists financing resources. — Ed.
Change Will Accelerate
Authors: Kilborn Paul C.
Published: June 2007

This address was delivered at the National Res taurant Association's seminar, "Outlooks and De cisions for 1969," held January 22 in Los Angeles and again on April 22 before the Pacific North- west Restaurant Convention and Exposition in Portland (Ore.).
Food Service Employment Practices
Authors: Westbrook James H.
Published: June 2007

This article is based on an address delivered by Mr. Westbrook at the National Restaurant Asso ciation's three seminars, held in January 1969 in Chicago, New York, and Los Angeles.
Why Mergers Will Continue
Authors: Kantor Martin E.
Published: June 2007

This article by Martin E. Kantor views mergers and acquisitions from the investment banker's approach in counseling company executives on the securities market. The February issue of this magazine presented three articles on mergers and acquisitions in the hospitality industry by senior partners of Laventhol Krekstein Horwath & Horwath dealing with organizational and ac counting concepts. The series was developed from addresses given at the Seminar on Mergers and Acquisitions in the Hospitality Industry, held in November 1969 under the joint spon sorship of Cornell's School of Hotel Administra tion and Laventhol Krekstein Horwath & Hor wath. — Ed.
Company Conferences in Hotels
Authors: Perrins Harlan
Published: June 2007

Some 200,000 company conferences are held each year, most of them in hotels and motels. These range from training and planning sessions to board of directors' meetings. Since the com pany holding the conference usually pays the bill for all in attendance, conferences mean lu crative business for hotels and motels. Many ac tively solicit company conferences to fill low occupancy periods without realizing their estab lishments and services do not measure up to requirements. This article tells what the con ference director wants from the place where he schedules his meeting.

Harlan Perrins, as executive director of the Man agement Institute at Rockland Community Col lege, schedules numerous conferences in the Northeast. Formerly, he was conference director for the New York State School of Industrial & Labor Relations at Cornell University, which has an outstanding conference center.
Design of Resort Condominiums
Authors: Riemer Herbert W.
Published: June 2007

This article, prepared by Morris Ketchum, Jr. and Associates in cooperation with the Condo minium Committee of the American Hotel & Motel Association, is the first of a series. Chap ter 1 deals with the basic fundamentals for plan ning resort condominiums for play and profit. Chapter 2 covers land site evaluation for the master plan.

Subsequent chapters will contain in detail con dominium design aspects and criteria, site plan ning, unit design with planned flexibility, con struction techniques, interior decor and main tenance, recreational facilities, and physical suit ability for management and operation. These basic fundamentals can be applied either to an entirely new development or to the expansion of an existing development.

Morris Ketchum, Jr. Associates utilize the team- work approach in executing total architectural, engineering and planning services — master planning, urban design, building and interior de sign, landscape development, styling and graph ics. Their projects have ranged from college campuses to government building groups, aquar iums and zoological parks, schools and housing projects, urban and suburban shopping centers, and recreational areas in the United States, Eu rope, and Africa.

Morris Ketchum, Jr. FAIA is an internationally known architect and was president of the Amer ican Institute of Architects in 1965-66. Herbert W. Riemer, AIA, is the partner who leads the home-based team, which has headquarters in New York.
Quallity as an Economic Force in the Food Service
Authors: Minor Lewis J.
Published: June 2007

"I had an excellent repast — the best repast possible — which consisted simply of boiled eggs and bread and butter. It was the quality of these simple ingredients that made the occa sion memorable. The eggs were so good that I am ashamed to say how many of them I con sumed.... it might seem that an egg which has succeeded in being fresh has done all that can reasonably be expected of it. But there was a bloom of punctuality, so to speak, about those eggs of Bourg, as if it had been the intention of the very hens themselves that they should be promptly served." — Henry James