bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigations of Surface Interactions between PEGDA-Polymer and Drug using Surface Plasmon Resonance
Authors: Lange Helge , Rekowska Natalia , Wulf Katharina , Grabow Niels , Eickner Thomas
Published: December 2021

For the development of combination products, the determination of the release kinetics of polymer-based drug delivery systems (DDS) is a central and often timeconsuming investigation. Classical methods are often unsuitable for large-scale screening of potential polymers for combination products. We present a rapid method based on surface plasmon resonance spectroscopy (SPR), using PEGDA700 (Poly(ethylene glycol) diacrylate, average molecular weight (Mn) 700) as an example. This method is capable of determinating the kinetics of drug association and subsequent release within minutes. The proportion of desorption and diffusion can be determined separately.

Surface plasmon resonance spectroscopy (SPR) is a label-free and very sensitive optical technique, which allows for real-time observation of surface interactions. The prepared SPR chips were spin-coated with PEGDA700 and crosslinked via photoinduced polymerization.

The association and dissociation kinetics of dexamethasone phosphate in swollen PEGDA700 have been studied at different concentrations. The maximum loading of the surface was also obtained by this method.

The study of PEGDA presented here identified the wellestablished SPR-based spectroscopy as a potential tool in the development of combination products.
Establishment of suitable parameters for laser machining based production of polymeric implants
Authors: Bohne Eric , Grossmann Swen , Dierke Ariane , Siewert Stefan , Grabow Niels , Schmitz Klaus-Peter , Stiehm Michael
Published: December 2021

Laser material processing enables precise machining of a wide variety of materials. In order to prevent an excessive heat input, which leads to irreversible material damage, the process parameters have to be adapted to the processed material. To keep the heat load as low as possible, the potential of femtosecond laser technology is exploited. The processing of semi-finished products using femtosecond laser technology is highly depending on the processed material. In this regard, we established a workflow and basic parameters for the processing of polymeric material. The performed parameter study varying cutting speed, cutting gas pressure and pulse energy to optimize the manufacturing process. Scanning electron microscopy (SEM) was utilized to analyze the cutting results, such as cut edge quality or possible melted areas. The established parameter set is also suitable for processing of very filigree material structures as used in innovative medical devices. The SEM analysis of the established parameter set showed that a homogeneous, nonwavy cut edge was created along the kerf.
Fixed Point Analysis Workflow for efficient Design of Convolutional Neural Networks in Hearing Aids
Authors: Klein Simon Christian , Kantic Jonas , Blume Holger
Published: December 2021

Neural networks (NN) are a powerful tool to tackle complex problems in hearing aid research, but their use on hearing aid hardware is currently limited by memory and processing power. To enable the training with these constrains, a fixed point analysis and a memory friendly power of two quantization (replacing multiplications with shift operations) scheme has been implemented extending TensorFlow, a standard framework for training neural networks, and the Qkeras package [1, 2]. The implemented fixed point analysis detects quantization issues like overflows, underflows, precision problems and zero gradients. The analysis is done for each layer in every epoch for weights, biases and activations respectively. With this information the quantization can be optimized, e.g. by modifying the bit width, number of integer bits or the quantization scheme to a power of two quantization. To demonstrate the applicability of this method a case study has been conducted. Therefore a CNN has been trained to predict the Ideal Ratio Mask (IRM) for noise reduction in audio signals. The dataset consists of speech samples from the TIMIT dataset mixed with noise from the Urban Sound 8kand VAD-dataset at 0 dB SNR. The CNN was trained in floating point, fixed point and a power of two quantization. The CNN architecture consists of six convolutional layers followed by three dense layers. From initially 1.9 MB memory footprint for 468k float32 weights, the power of two quantized network is reduced to 236 kB, while the Short Term Objective Intelligibility (STOI) Improvement drops only from 0.074 to 0.067. Despite the quantization only a minimal drop in performance was observed, while saving up to 87.5 % of memory, thus being suited for employment in a hearing aid
Clinical case study in acoustic-kinetic joint analysis: Synchronization and Evaluation of kinetic measurement data in AEA (Acoustic Emission Analysis) based diagnosis of arthritic knee joint defects
Authors: Subke Joerg , Schneider Benedict , Hanitz Fiona , Krüger Sabine , Junker Heinz-Otto , Schwalbe Hans-Joachim , Wolf Udo
Published: December 2021

: In patients with arthritic knee joint defects the course of movement, the application of muscle forces and the degree of freedom of the joints of the lower limbs differs significantly from the corresponding data of a healthy proband. The enhanced acoustic-kinetic joint analysis based on AEA, ground force reaction measurements and video enhanced gait analysis permits the correlation of force data, joint angles and acoustic emission significant of defective joint cartilage regions. This diagnostic procedure permits a quantifiable and detailed non invasive diagnosis of lesion patterns in the arthritic knee joint by means of a synchronization algorithm. The AEA shows lesion signals in the first and third knee bend of the patient. The lesion signals are assigned to the joint angles and ground reaction force. Comparing the kinematical data there is a shift between the curves of the hip and the knee angle. Overall the force data represent an imbalance between the left and the right leg during the knee bends. The presentation of the three measurement systems, the method, the synchronization of the data sets and their final assessment as well as the occurring difficulties during a case of a clinical study are discussed. This would be helpful regarding further patients of the clinical study
Automatic Hypercube Acquisition with high spatial and spectral resolution using a HSI Linescan Camera
Authors: Pape Robin , Patzke Stefan , Zaunseder Sebastian , Thiem Jörg
Published: December 2021

Push-broom HSI-cameras have a high spectral resolution but require scanning and stitching to get a correct spatial and spectral representation of a scene. The conventional approach is to calculate a scanning velocity that matches the camera’s frame rate so that the stitching becomes trivial. For this to work one needs to be able to apply the velocity steadily and know the distance between camera and subject. This contribution presents a feature-based approach that directly determines the distance the subject was moved between the images and uses it to correctly stitch the images. It is used in a self-contained environment consisting of a lightprotected box with a light source inside and a linear guide unit that moves the object under examination. The distance between camera and object can be altered to increase the spatial resolution for small objects. It is shown that our stitching approach works even if the velocity changes during scanning. If the distance of the camera is altered, e. g. to scan a larger object, the stitching is adjusted automatically without the need for manual intervention.
Hyperinsulinemic hypoglycemia in growth restricted convalescent preterm neonates: clinical characteristics and impediments to early diagnosis
Authors: Rodrigues Megan , Rana Pratibha , Lee Gene , Mahajan Chaitali , Nyp Michael , Pandey Vishal
Published: December 2021

Objectives

Describe clinical characteristics, course, and risk factors for hyper-insulinemic hypoglycemia (HIH) in preterm infants and identify impediments to early diagnosis.

Methods

Electronic records of infant–mother dyads were used to describe clinical characteristics, lab parameters, and course of HIH.

Results

All eight patients (gestational ages 26w0d–29w3d) had intrauterine growth restriction (IUGR) due to placental insufficiency, (4/8) were small for gestational age. All maintained normal glucose levels with glucose infusion during the first 48 h six of eight patients had cholestasis despite being on parenteral nutrition for short time (average 17 days). Four of eight patients were treated with diazoxide (average 22 days). Four of eight patients who recovered spontaneously (average 49 days after diagnosis) responded to continuous feeds and hydrocortisone for other clinical indications.

Conclusions

In IUGR preterms, HIH is asymptomatic, may be prolonged, requiring diazoxide treatment. Transient cholestasis is seen in majority of patients. Euglycemia should be demonstrated on bolus gavage feeds, off glucocorticoids before discontinuing blood glucose monitoring.
Internet Memes, Memory, and Orders of Repackaging
Authors: Korostenskiene Julija
Published: December 2021

The present study explores the construction of humor in internet memes along two dimensions. The external dimension is concerned with humor in internet memes as opposed to verbal humor on the one hand and as opposed to humor in comics and caricatures on the other. The perceptive differences, stemming from the workings of the human memory, and the medium are posited as the two main differentiating factors. On the internal dimension, we explore manifestations of humor in light of the communicative situation and taxonomic relations at both the intermedial and intramedial levels of internet memes, taking as an example a family of You Wouldn’t Get It image macros. Our analysis employs elements of intertextuality theory and the notion of orders of indexicality. The study aims to contribute to the growing theoretical and methodological framework for multifactorial analyses of internet memes.
Free-Range Philosophy: Modes of Philosophical Analysis across the Discipline … and across the Road
Authors: Gimbel Steven , Cisney Vernon
Published: December 2021

Philosophy’s richness comes in part from the wide range of conceptual frameworks from which meaning can be made of aspects of the world. Philosophy can be done from feminist, Marxist, positivist, or Freudian standpoints. The difference in the sorts of analyses produced by these different approaches can be tricky to explain to undergraduates. Contained here are short explanations of the nature of a collection of these frameworks and a fun example of each, an analysis of the chicken crossing the road joke to be used to give undergraduates a sense of the breadth of philosophical methodology.
Effect of infill density and pattern on the specific load capacity of FDM 3D-printed PLA multi-layer sandwich
Authors: Dobos József , Hanon Muammel M. , Oldal István
Published: December 2021

Three-dimensional (3D) printing settings allow the existence of differently filled sections together within a piece. That means the use of inhomogeneous internal material structure. Knowing the load capacity that 3D printed plastic parts can withstand leads to the reduction of the filling degree, thus the amount of the used material in certain places. This approach has two advantages during production: (i) less material use and (ii) reduced manufacturing time, both being cost-reducing factors. The present research aims to find the optimal proportions for fabricating a bending test piece with varying filling degrees. To achieve this goal, experimental tests were performed for obtaining tensile strength and modulus of elasticity using different pairs of infill density and pattern. This provided a basis for creating a working mechanical model based on accurate and realistic material properties. Hence, a series of virtual bending test experiments were conducted on a sandwich structure specimen employing Ansys Workbench software. By doing so, the optimal thickness (of the sandwich’s inner layer) with the highest specific load capacity for the given filling patterns and densities were determined. To the best of our knowledge, the current procedure of experiments and method of settings optimization were not discussed elsewhere.
Neuropeptide changes in an improved migraine model with repeat stimulations
Authors: Guo Yichen , Cheng Yawen , An Jiaqi , Qi Yi , Luo Guogang
Published: December 2021

Migraine is a medical condition with a severe recursive headache. The activation of the trigeminovascular system is an important mechanism. The neuropeptide calcitonin gene-related peptide (CGRP) plays a crucial role in the pathogenesis of migraine. Several other neuropeptides are also involved; however, their roles in migraine remain unclear. In this study, using a rat model of migraine induced by electrical stimulation of the trigeminal ganglia (TG) and an improved version induced with repeated stimulation, we observed the dynamic changes of these peptides in TG and blood. We demonstrated that the expression of CGRP, pituitary adenylate cyclase activating polypeptide (PACAP), neuropeptide Y (NPY), vasoactive intestinal peptide, and nociceptin in TG was significantly elevated and peaked at different time points after a single stimulation. Their levels in the blood plasma were significantly increased at 12 h after stimulation. The peptides were further elevated with repeated stimulation. The improved rat model of migraine with repeated stimulation of TG resulted in a more pronounced elevation of CGRP, PACAP, and NPY. Thus, the dynamic changes in neuropeptides after stimulation suggest that these neuropeptides may play an important role in the pathogenesis of migraine. Additionally, the migraine model with repetitive stimulation would be a novel model for future research.
Research on Experimental Properties of a Novel High-Performance Solidified Soil Material
Authors: Wu Chunying , Li Feng
Published: December 2021

The objectives of this study were to evaluate the properties of a novel high-performance solidified soil material, explore the potential value of the application that instead of the traditional cement-stabilized macadam in the base course. The results showed that the 7-d unconfined compressive strength of high-performance solidified soil increased two- to threefold and was greater than 60 % of that of cement-stabilized aggregates. The water-stability coefficient and compressive strength loss increased by 10–30 % and 12–22 %, respectively, which were close to cement-stabilized aggregates, as compared with conventional solidified soil. The novel high-performance solidified soil material has excellent mechanical, water resistance, and anti-frost performance and is advantageous to the base course of low-grade highway in the application aspect.
ВЗАЄМИНИ ЛЕВА БАЧИНСЬКОГО І КИРИЛА ТРИЛЬОВСЬКОГО: ВІД ДІАЛОГУ ДО КОНФРОНТАЦІЇ (кінець ХІХ – перша третина ХХ ст.)
Authors: Паска Ганна
Published: December 2021

Предметом статті є відносини Л. Бачинського і К. Трильовського в руслі українського націо­нально-визвольного руху кінця ХІХ – першої третини ХХ ст. Основу джерельної бази дослідження ста­нов­лять справи фондів ЦДІАЛ України, ЦДАВО України, Держархіву Івано-Франківської обл., автобіо­гра­фічні праці Л. Бачинського і К. Трильовського та матеріали тогочасної газетної періодики. Мето­до­ло­гічною основою статті є принципи об’єктивності, історизму, різноманітності джерельної бази. У ро­боті використано методи аналізу і синтезу, проблемно-хронологічний, біографічний методи для ви­вчення життя та діяльності історичної постаті, метод внутрішньої критики джерел. Автор статті приходить до висновку, що взаємини Л. Бачинського і К. Трильовського пройшли шлях від співпраці та дружніх відносин до відкритих конфліктів і політичної конфронтації. На рубежі ХІХ–ХХ ст. обидва політики були провідними діячами РУРП-УРП, а в 1907–1918 рр. стали послами австрійського парламенту. Початок суперечностей між двома радикалами було покладено після обрання Л. Бачин­ського головою УРП. Внаслідок загострення протистояння із К. Трильовським у 1910 р. Л. Бачинський змушений був залишити посаду керівника партії. Конфлікт отримав своє продовження в період ЗУНР, коли у 1919 р. К. Трильовський спричинився до розколу УРП та виокремлення із неї власної партії – СРП. Остання фаза протистояння між двома політиками відбулася у ході виборів до польського парламенту в 1928 р., коли з ініціативи К. Трильовського було засновано УСРП-лівицю. Конфлікт між двома політи­ками був фактором, який протягом більше двадцяти років відігравав негативну, деструктивну роль у радикальній течії західноукраїнського політикуму.

Ключові слова: Лев Бачинський, Кирило Трильовський, Русько-українська радикальна партія (Українська радикальна партія), Селянсько-радикальна партія, Українська соціалістично-радикальна партія-лівиця, “Громадський голос”.
ГОСПОДАРСЬКО-АДМІНІСТРАТИВНІ ПИТАННЯ УКРАЇНСЬКОГО НАСЕЛЕННЯ НА СЕСІЯХ ГАЛИЦЬКОГО КРАЙОВОГО СЕЙМУ (1908–1914 рр.)
Authors: Водославський Тарас
Published: December 2021

У статті висвітлено господарсько-адміністративні питання українців у діяльності послів Галицького крайового сейму в 1908–1914 рр., напередодні Першої світової війни. Автор поставив за ме­ту визначити основні господарсько-адміністративні проблеми населення Галичини, з’ясувати  кількість внесків, поданих послами-українцями, та їх результативність, розкрити загальну активність українсь­кого сеймового представництва та окремих політичних партій, найбільш активних депутатів і таких, що вели себе більш пасивно. Зокрема, у внесках представників української сеймової репрезентації пору­шувалися питання надання допомоги мешканцям для боротьби з наслідками природних лих, спорудження об’єктів інфраструктури, вирішення соціальних проблем, сприяння веденню сільського господарства, прийняття крайових законів у господарській сфері та внесення до них поправок, виділення нових адмі­ністративних і судових одиниць у межах краю. Проблематика роботи дозволяє дослідити найбільш нагальні потреби повсякденного життя галицьких українців, з’ясувати, наскільки швидко та ефективно вони вирішувалися  місцевою законодавчо-представницькою владою.

Ключові слова: Галицький крайовий сейм, посол, депутат, українці, поляки, господарсько-адмі­ністративні питання.
KAPOSI'S VARICELLIFORM ERUPTION; A PRIMARY INFECTION WITH HERPES SIMPLEX VIRUS
Authors: RUCHMAN ISAAC , DODD KATHARINE
Published: December 2021

Five cases of Kaposi's varicelliform eruption are reported of which three were children and two were adults. The patients had been exposed to one or more members of the immediate family who had herpes simplex infection. The virus of herpes simplex was recovered from two children and one adult. In all five cases the neutralization index of their sera against herpes virus, little higher than that of control serum during the acute phase of their illness, rose during convalescence. Corroborative evidence is obtained from a study of the above cases that Kaposi's varicelliform eruption is in all probability a manifestation of primary infection with herpes simplex virus in persons with eczema.
Researches on Normal and Defective Colour Vision
Authors: OGLE KENNETH N.
Published: December 2021

Because Wright is considered one of the authorities today in the field of color, this book warrants the attention of all interested in color physiology. The book describes and summarizes with unusual completeness the results of most of the recent experimental research, and points out the theoretical implications of those results with the emphasis placed on the physiology involved. Although the author describes the experimental works of others, he devotes most of the book to his own research or to that of the Imperial College of Science and Technology in London. The book is written in a technical lanuage.
Diseases of Children's Eyes
Authors: KENNEDY R. L. J. , PRAUGEN A. G.
Published: December 2021

This book should be useful to those interested in pediatric ophthalmology. The content of the book is largely the same as found in standard texts on ophthalmology. It is, however, well arranged, well illustrated, and condensed. Throughout the text the author has stressed the theme of the child as related to ophthalmology. The chapters on principles of examination, developmental and congenital anomalies, methods of treatment, and ocular welfare are handled in a practical manner and with much common sense.
Round Table Discussion
Authors: ZUELZER WOLF W. , WHEELER WARREN E. , LEONARD MARTHA F.
Published: December 2021

Chairman Zuelzer: Anemia happens to be one of the manifestations of erythroblastosis, but we intend to keep the purely hematologic aspects to a minimum and shall consider the disease as a whole, paying particular attention to its clinical features. The Rh factor which appears in the title of this discussion is likewise only of incidental interest to us. In recent years we have heard too much about Rh and too little about the clinical entity erythroblastosis fetalis which is our topic for today.

We have agreed for our purpose to define erythroblastosis as a disorder of fetal and neonatal life resulting from maternal sensitization against antigens of the Rh group present in the fetal cells. We exclude deliberately the still controversial cases of so-called erythroblastosis due to incompatibility in the O-A-B system of blood groups and will touch on this problem only in so far as it has a bearing on diagnosis.

Only a few words are needed in regard to the Rh antigens. The emphasis on the subtypes of Rh which are of interest mainly to the geneticist and immunologist have made the subject unpalatable to the clinician and the unnecessarily complex nomenclature has further beclouded a basically simple issue. For the clinician the original Rh antigen with a distribution of 85% in the white population is still by far the most important. In the simple language of the Fisher-Race theory we are chiefly concerned with the genes D and d, familiar to some of you as Rho and rh. The genetic background of maternal isoimmunization can be summarized by the simple statement that sensitization is possible only when a homozypous mother carries a heterozygous fetus. An heterozybous mother (Dd) cannot be sensitied since both antigens are present in her own cells. The homozygous fetus (DD or dd) cannot sensitize its mother because by definition it receives the same type of gene from both parents and must therefore be compatible with the mother. In the usual situation of erythroblastosis the mother is Rh negative (dd), i.e. homozygous, the Rh positive fetus is ipso facto heterozygous (Dd). Rarely a homozygous Rh positive mother may become sensitized to the c-d-e genes of a heterozygous fetus.

While the basic relationship of erythroblastosis fetalis to antigenic differences between mother and fetus is well established it seems only fair to say that we know as yet very little about the reasons why certain women become sensitized and others not.
THE PUBLIC HEALTH NURSE, THE PHYSICIAN'S ALLY
Authors: KAISER ALBERT D.
Published: December 2021

When schools for nurses were established in 1879 at Bellevue,New Haven and Massachusetts General Hospitals, the nursing profession was finally recognized in America as an important adjunct to the medical profession. Prior to that time nursing care of the sick was largely in the hands of incompetent and untrained women who were not highly regarded by physicians or the laity. During the first decade after the three training schools were opened the majority of the trained nurses were engaged in private practice in homes, usually in the homes of the rich. Later some were employed as private duty nurses in hospitals.

It was not until 1877 that the Women's Branch of the New York City Mission first sent trained visiting nurses into the homes of the sick poor to do bedside nursing; four years later the New York Ethical Society placed four nurses in the New York dispensaries to do not sick nursing but health nursing. The first visiting nurse association, founded for the purpose of sending trained nurses into homes, was started in Buffalo in 1885; and in 1886 similar associations were established in Boston and Philadelphia. Relatively few trained nurses devoted their energies to the public health field during the next two decades. However, private or non-official agencies interested in the control of tuberculosis, syphilis, acute communicable disease and maternal and child care played a strategic role in the development of professional public health nursing. These agencies, usually organized on a local basis, worked dosely with private
IMMUNIZATION WITH COMBINED DIPHTHERIA AND TETANUS TOXOIDS (ALUMINUM HYDROXIDE ADSORBED) CONTAINING H. PERTUSSIS VACCINE
Authors: MILLER JOHN J. , RYAN MARY LOUISE
Published: December 2021

A study of immunization against diphtheria, tetanus, and pertussis by means of two injections of a mixture of aluminum hydroxide adsorbed diphtheria and tetanus toxoids containing H. pertussis vaccine was reported by Miller et al1 in 1944. Two injections of 1.0 cc. each of this triple adsorbed mixture* were shown to lead to the production of unusually high levels of tetanus antitoxin and to uniform Schick negativity. On the other hand, the protection obtained against pertussis as gauged by estimations of serum agglutinins and by the results of clinical exposures was not entirely satisfactory. Two cases of pertussis following indoor exposure occurred in the group. It was therefore recommended that the total dose of 40 billion H. pertussis, contained in the 2.0 cc. of triple mixture injected, be augmented. This has been done, and in a second group of infants and children the original schedule of two injections of mixed adsorbed toxoids with vaccine, injected at a 12 week interval, was modified by an additional injection of a Phase I H. pertussis vaccine in saline*given midway between the above two injections (6 weeks after the first injection). Varying doses of vaccine were used for this additional injection—20 or 30 billion cells in the form of 1.0 or 1.5 cc. of a 20 billion per cc. saline suspension, and 40 or 60 billion cells in the form of a 1.0 or 1.5 cc. of a 40 billion per cc. saline suspension.

In the original study, herein referred to as Group
PROLONGED OBSTRUCTIVE JAUNDICE IN INFANCY
Authors: HSIA DAVID YI-YUNG , PATTERSON PAUL , ALLEN FRED H. , DIAMOND LOUIS K. , GELLIS SYDNEY S.
Published: December 2021

One hundred fifty-six cases of prolonged obstructive jaundice seen at the Children's Medical Center between 1940 and 1951 have been investigated and in 85% of the patients follow-up studies have been carried out.

Ninety-four (61%) were due to true biliary atresia.

Twenty-three (15%) were due to inspissated bile associated with erythroblastosis. All these patients are living and well and free of jaundice. The diagnosis of this condition can be made when the patient has (1) jaundice during the first two days of life with persistence of jaundice for over three weeks, (2) a high direct and indirect bilirubin compatible with obstructive jaundice, (3) negative flocculation tests, (4) blood-grouping studies consistent with erythroblastosis.

Thirty (19%) were due to inspissated bile of unknown etiology. Of these 6 are dead, 2 are alive but cirrhotic, and 18 are living and well and no follow-up was obtained on the four other cases. There appears to be some relationship between this condition and immaturity of the liver, small extrahepatic ducts, thickened secretions, and possibly dehydration.

Nine (6%) were due to miscellaneous causes, of which four cases were probably due to infectious hepatitis.
NEUROLOGIC MANIFESTATIONS OF INFECTIOUS MONONUCLEOSIS IN CHILDHOOD
Authors: KARPINSKI FELIX E.
Published: December 2021

Four cases of infectious mononucleosis with central nervous system involvement are presented.

The literature pertaining to the neurologic complications in infectious mononucleosis is briefly reviewed.

Recovery is usually relatively prompt and complete but permanent residual manifestations may occur.

Careful peripheral blood studies and tests for the heterophil agglutinins are essential in the etiologic diagnosis of the obscure diseases of the nervous system.
STUDIES ON THE METABOLISM AND DISPOSAL OF AMINO ACID MIXTURES GIVEN INTRAVENOUSLY
Authors: MULHOLLAND WILLIAM M. , BRIDGE EDWARD M. , FOX HELEN W.
Published: December 2021

The effects of continuous eight hour infusions of casein hydrolysate have been studied in normal fasting rabbits. At a rate of 1.0 gm. hydrolysate/kg./hr., approximately 5% of the infused material is lost directly into the urine as amino nitrogen. Another 1 to 2% remains in the blood stream during the infusions but is quickly dissipated when the injection is discontinued.

Deamination, as indicated by the accumulation and excretion of urea, increases steadily and proceeds at a rapid rate for approximately four hours after the infusion is discontinued. In all, 60 to 70% of the infused material may appear in the urine as urea, and another 10 to 20% in other forms. A relatively small amount is available for tissue use beyond four hours after the end of the administration.

Although retention of nitrogenous metabolites occurs during infusions at this rate and persists for several hours afterward, renal function is not impaired.

The respiratory quotient during continuous eight hour infusions was found to fall to the level of 0.72 to 0.74. The significance of this is uncertain.

It is suggested that relatively small amounts of complete amino acid mixtures administered continuously might supply the tissues more efficiently than when much larger amounts are given intermittently.
STOOL FREQUENCY OF NORMAL INFANTS IN THE FIRST WEEK OF LIFE
Authors: NYHAN WILLIAM L.
Published: December 2021

The stool frequency of 800 normal infants during the first week of life was studied statistically. The series was composed of 400 infants fed on a flexible regimen, of which 200 were breast-fed and 200 were bottle-fed; and 400 infants fed on the conventional four hour schedule, of which 200 were breast-fed and 200 were bottle-fed. Analyses were made from the points of view of number of stools and variability. The normal pattern was that of rise in both number of stools and variability up to the fifth day and a gradual fall. The peak for both number and variability occurred on days 3 through 6. The range of variation about the mean on each day was quite great and this fact seeemed to militate against a statistical diagnosis of diarrhea in this age group. The comparison among the various groups revealed fewer and smaller differences than the day-to-day comparisons. With regard to number of stools the bottle-fed babies had statistically greater numbers of stools than did the breast-fed babies regardless of feeding regimen, but only during those early days of life when it might be assumed that lactation had not begun. There were no differences between breast-fed babies on the two regimens studied. Bottle-fed babies on self-demand feeding had significantly greater numbers of stools than did those on scheduled feeding on two days. With regard to variability: bottle-fed babies on self-demand were most variable in number of stools per day. Breast-fed babies on self-demand were next most variable and bottle-fed babies on strict scheduling were least variable.
Round Table Discussion
Authors: GIBSON STANLEY , DEVEL LEON , VANCE WILLIAM C.
Published: December 2021

Chairman Gibson: For a good many years, it seems to me, we have been hashing over the same old problems of rheumatic fever without making much progress in our knowledge of the disease. Recently, however, I think there are hopeful signs that we are learning a little bit more about rheumatic fever and will be a little better able to deal with it.

As you all know, rheumatic fever is a disease with many varied manifestations. Some cases are so outright that even a junior medical student could make a diagnosis; other cases are so obscure that at a given time and in a given case one is quite unable to make a definite diagnosis. Yet within a wide scope of variations it seems to me that rheumatic fever does show a definite group of phenomena which, by careful study, one can usually evaluate in the course of time and thereby determine whether rheumatic fever is present.

I felt we might best handle the subject by dividing our discussion on rheumatic fever into 4 parts: etiology, recognition, prevention and treatment. At this time I want to introduce to you Dr. Edward C. Lambert, who is my associate in this Round Table discussion. He is at the University of Buffalo Medical School in Pediatrics and in charge of the Cardiac Children's Clinic.

Dr. Edward C. Lambert, Buffalo: About 50 years ago Dr. Osler defined rheumatic fever as an acute noncontagious febrile infection depending on an unknown infectious agent, characterized by multiple arthritis and a special tendency to involve the heart.
BAL THERAPY IN CHRONIC LEAD POISONING
Authors: GIANNATTASIO RUDOLPH C. , PIROZZI MICHAEL J. , BEDO ANDREW V. , JENNINGS KENNETH G.
Published: December 2021

Three cases of chronic lead intoxication have been presented which were treated with BAL in a dose of 4 mg./kg. body weight every four hours for 20 days. Cessation of symptoms were noted in every case. Resting urinary lead levels were increased three to sevenfold without exacerbation of symptoms of plumbism. BAL was found to be nontoxic in the dose used and acted as an effective deleading agent. The authors feel that this form of treatment merits use in both the chronic and acute phases of lead intoxication.
FERROUS SULFATE POISONING
Authors: BRANCH LEROY K.
Published: December 2021

A fatal case of ferrous sulfate poisoning in a 29 month old boy, with autopsy findings, is recorded. He died approximately 4½ hours after ingestion of about seventy-five 0.3 gm. ferrous sulfate tablets (1.87 gm./kg. body weight). Signs of severe gastrointestinal irritation were followed by cyanosis and peripheral vascular collapse. Hemorrhagic gastroenteritis with mucosal slough and submucosal venous thromboses were demonstrated post mortem. Prevention and measures for correction of shock were emphasized in discussion of treatment. This case report should re-emphasize the potential danger of iron poisoning.
ANOMALIES OCCURRING IN CHILDREN EXPOSED IN UTERO TO THE ATOMIC BOMB IN HIROSHIMA
Authors: PLUMMER GEORGE
Published: December 2021

A study was carried out on 205 4½ year old children who had been exposed to the atomic bomb blast during the first half of intra-uterine life. Eleven were exposed within 1200 meters of the bomb hypocenter, and the remaining 194 were beyond this distance.

Seven of these 11 children exposed within 1200 meters had microcephaly with mental retardation. This diagnosis was not made on any of the 194 children exposed at greater distances.

Correlation between head size and mental development of the child with distance from the hypocenter, symptoms of radiation effect and type of shielding of the mother is discussed.

The conclusion drawn from the present study is that central nervous system defects can be produced in the fetus by atomic bomb radiation, provided that exposure occurs within approximately 1200 meters of the hypocenter and that no effective shielding, such as concrete, protects the fetus from direct irradiation.
THE PEDIATRICIAN AND THE PUBLIC
Authors: LESSER ARTHUR J.
Published: December 2021

Your editor has asked a few physicians who have experience in the clinical, public health and educational aspects of some of the newer programs for handicapped children to prepare communications for this column. The first of these, Hearing Impairment in Childhood, is presented in this issue. The opportunities for helping children with impaired hearing which have been made possible by improvements in the vacuum tube, by specific therapy for middle ear infections, and by advances in speech training are among the most exciting in this decade.

A discussion of similar programs for children with epilepsy and with cerebral palsy are scheduled in future months.
Fever in Pediatric Primary Care: Occurrence, Management, and Outcomes
Authors: Finkelstein Jonathan A. , Christiansen Cindy L. , Platt Richard
Published: December 2021

Objective.

To describe the epidemiology, management, and outcomes of children with fever in pediatric primary care practice.

Patients.

A cohort of 20 585 children 3 to 36 months of age cared for in 11 pediatric offices of a health maintenance organization between 1991 and 1994.

Methods.

Using automated medical records we identified all office visits with temperatures ≥38°C for a random sample of 5000 children, and analyzed diagnoses conferred, laboratory tests performed, and antibiotics prescribed. We also determined the frequency of in-person and telephone follow-up after initial visits for fever. Finally, we reviewed hospital claims data for the entire cohort of 20 585 to identify cases of meningitis, meningococcal sepsis, and death from infection.

Results.

Among 3819 initial visits of an illness episode, 41% of children had no diagnosed bacterial or specific viral source. Of these, 13% with a temperature of 38°C to 39°C and 36% with a temperature of ≥39°C received laboratory testing. Almost half (43%) received some documented follow-up care in the subsequent 7 days. Among the 26 970 child-years of observation in the entire cohort, 15 children (56 per 100 000 child-years) were treated for bacterial meningitis or meningococcal sepsis. Five had an office visit for fever in the week before hospitalization, but only 1 had documented fever ≥39°C and received neither laboratory testing for occult bacteremia nor treatment with an antibiotic.

Conclusion.

The majority of febrile children in ambulatory settings were diagnosed with a bacterial infection and treated with an antibiotic. Of highly febrile children without a source, 36% received laboratory testing consistent with published expert recommendations, and short-term follow-up was common. Meningitis or death after an office visit for fever without a source was predictably rare. These data suggest that increased testing and/or treatment of febrile children beyond the rates observed here are unlikely to affect population rates of meningitis substantially.
Cost-Effectiveness of Childhood Immunization Reminder/Recall Systems in Urban Private Practices
Authors: Franzini Luisa , Rosenthal Jorge , Spears William , Martin Heather S. , Balderas Lorena , Brown Martha , Milne Gillian , Drutz Jan , Evans Donna , Kozinetz Claudia , Oettgen Barbara , Hanson Celine
Published: December 2021

Objective.

To assess cost and cost-effectiveness of immunization reminder/recall systems in the private sector.

Methods.

A manual postcard system (mail) was compared with a computer-based telephone system (autodialer) and control. Costs included time costs and the cost of equipment and supplies. The cost per child and the incremental cost of the intervention relative to control were computed. Cost-effectiveness ratios were computed for return visits and for immunizations delivered.

Results.

The average cost per child was $2.28 for the mail group and $1.47 for the autodialer group. The incremental visit cost relative to the control was higher for the mail group ($9.52) than for the autodialer group ($3.48). The autodialer was more cost-effective in delivering immunizations: $4.06 per extra immunization (autodialer) versus $12.82 (mail).

Conclusions.

Excluding start-up costs, the autodialer system was most cost-effective. Including autodialer equipment costs, the autodialer system is more cost-effective only for larger practices.
An Evaluation of an Innovative Multimedia Educational Software Program for Asthma Management: Report of a Randomized, Controlled Trial
Authors: Homer Charles , Susskind Oded , Alpert Hillel R. , Owusu MPM§; Celestina , Schneider Lynda , Rappaport Leonard A. , Rubin David H.
Published: December 2021

Background.

Asthma continues to be a substantial cause of morbidity in pediatric populations. New strategies are needed to provide cost-effective educational interventions for children with asthma, particularly those in the inner city.

Objective.

To assess the effectiveness of a multimedia educational software program about asthma.

Setting.

A hospital-based primary care clinic and an affiliated neighborhood health center.

Design.

Randomized, controlled trial.

Population.

Children 3 to 12 years old with physician-diagnosed asthma.

Intervention.

An interactive educational computer program, Asthma Control, designed to teach children about asthma and its management. Using a graphic display of a child going through simulated daily events, the game emphasizes: 1) monitoring; 2) allergen identification; 3) use of medications; 4) use of health services; and 5) maintenance of normal activity. Control group participants reviewed printed educational materials with a research assistant.

Outcomes.

Acute health care use (emergency department and outpatient) was the primary outcome. Secondary outcome measures included maternal report of asthma symptom severity, child functional status and school absences, satisfaction with care, and parental and child knowledge of asthma.

Results.

A total of 137 families were enrolled in the study (76 intervention, 61 control). Both intervention and control groups showed substantial improvement in all outcomes during the 12-month follow-up period. Aside from improvement in knowledge after use of the computer program, no differences were demonstrated between the 2 groups in primary or secondary outcome measures. Children reported enjoyment of program use.

Conclusions.

This trial of an educational software program found that it did not produce greater improvement than occurred with review of traditional written materials. Because both groups showed substantial improvement over baseline, computer-based education may be more cost-effective. Alternatively, improvements in illness severity over time may overshadow the effects of such interventions.

Rigorous comprehensive evaluations such as this are necessary to assess new interventions intended to improve management and outcomes of asthma.
Spirituality, Religion, and Pediatrics: Intersecting Worlds of Healing
Authors: Barnes Linda L. , Plotnikoff Gregory A. , Fox Kenneth , Pendleton Sara
Published: December 2021

Religious practices such as prayer represent the most prevalent complementary and alternative therapies in the United States. However, biomedicine has sometimes viewed faith and related religious worldviews as relevant only when they obstruct implementation of scientifically sound biomedical care. Recent efforts to arrive at a new synthesis raise challenges for pediatricians. This article reviews theories of child faith development, and models of child spirituality from different disciplinary perspectives. It provides sources illustrating how spirituality and religion may inform children's lives; play a part in children's moral formation, socialization, and induction into a sacred worldview; and provide the child with inner resources. It also suggests some of the positive and negative effects of spiritual and religious engagement. Second, this article examines aspects of spirituality and religion that parents may bring to bear in relation to their children's health. Third, this article addresses the spiritual and/or religious identity of the provider. These topics are discussed in the context of cultural competence and the related importance of religious diversity. The authors suggest 1) some approaches for appropriate inclusion of spirituality in clinical practice, 2) challenges for medical education, and 3) areas requiring further research.
Uninsured Children With Psychosocial Problems: Primary Care Management
Authors: McInerny Thomas K. , Szilagyi Peter G. , Childs George E. , Wasserman Richard C. , Kelleher Kelly J.
Published: December 2021

Objective.

Nearly 14% of children in the United States are uninsured. We compared the prevalence of psychosocial problems and mental health services received by insured and uninsured children in primary care practices.

Methods.

The Child Behavior Study was a cohort study conducted by Pediatric Research in Office Settings and the Ambulatory Sentinel Practice Network. Four hundred one primary care clinicians enrolled an average sample of 55 consecutive children (4–15 years old) per clinician.

Results.

Of the 13 401 visits to clinicians with 3 or more uninsured patients, 12 518 were by insured children (93.4%) and 883 were by uninsured children (6.6%). A higher percentage of adolescents, Hispanic children, those with unmarried parents, and those with less educated parents were uninsured. According to clinicians, uninsured children and insured children had similar rates of psychosocial problems (19%) and severe psychosocial problems (2%). For children with a clinician-identified psychosocial problem, we found no differences in clinician-reported counseling, medication use, or referral to mental health professionals.

Conclusions.

Among children served in primary care practices, uninsured children have similar prevalence of clinician-identified psychosocial and mental health problems compared with insured children. Within their practices, clinicians managed uninsured children much the same way as insured children.psychosocial problems, uninsured children, pediatrics, family medicine, primary care.
Exposure to Violence Among Urban School-Aged Children: Is It Only on Television?
Authors: Purugganan Oscar H. , Stein Ruth E. K. , Silver Ellen Johnson , Benenson Blanche S.
Published: December 2021

Objective.

To measure exposure to different types of violence among school-aged children in a primary care setting.

Design.

Child interviews using an instrument measuring 4 types of exposure (direct victimization, witnessing, hearing reports, media). Violent acts measured include being beaten up, chased/threatened, robbed/mugged, stabbed/shot, killed.

Setting.

Pediatric primary care clinic of large urban hospital.

Patients.

Convenience sample of 175 children 9–12 years old and their mothers. A total of 53% of the children were boys, 55% were Hispanic, and 40% received public assistance.

Results.

All children had been exposed to media violence. A total of 97% (170/175) had been exposed to more direct forms of violence; 77% had witnessed violence involving strangers; 49% had witnessed violence involving familiar persons; 49% had been direct victims; and 31% had witnessed someone being shot, stabbed, or killed. Exposure to violence was significantly associated with being male.

Conclusion.

Most school-aged children who visited a pediatric primary care clinic of a large urban hospital had directly experienced violence as witnesses and/or victims.
Health Care Supervision for Children With Williams Syndrome
Authors:   Committee on Genetics
Published: December 2021

This set of guidelines is designed to assist the pediatrician to care for children with Williams syndrome diagnosed by clinical features and with regional chromosomal microdeletion confirmed by fluorescence in situ hybridization.