bluuebunny/crossref_metadata_2025 huggingface dataset:
Théorie crip et études de la folie : intersections et points de départ
Authors: Thorneycroft Ryan
Published: December 2021

Les expériences des personnes crip et folles, tout comme les disciplines qui abordent ces enjeux, soit la théorie crip et les études de la folie, ont rarement été réunies de manière synthétisée. Dans cet article, je mets en relation la théorie crip et les études de la folie pour en explorer les similitudes, les intersections et les points de départ. L’article commence par un examen des expériences de vie similaires entre les corps crip et les corps fous. Nous abordons entre autres l’isolement familial, la honte, la culpabilité et l’essentialisme, les stéréotypes et la discrimination, les expériences et les taux de violence, le pouvoir des étiquettes de diagnostic ainsi que les phénomènes de « passing » et de « coming-out ». Ensuite, la discussion se tourne vers les chevauchements théoriques entre la théorie crip et les études de la folie, notamment l’essentialisme (stratégique) versus le constructionnisme, l’opposition aux normes, la subversion et la transgression comme outils politiques et la problématisation des binarités. L’article se conclut par une réflexion sur la combinaison des deux écoles de pensée afin de soutenir la création de stratégies collectives et par une interrogation sur les méthodologies politiques axées sur la centralisation des dialogues autour des théories crip (cripping) et de la folie (maddening).
Teaching Disability Studies Together: The Importance of Having Instructors with Labels of Intellectual Disabilities
Authors: Fialka-Feldman Micah , Gill Mike
Published: December 2021

This short commentary has two goals: 1) to share the unique co-teaching experience of two disabled instructors, one of whom has a label of intellectual disability, and 2) to discuss how we, as two white disabled men, try to incorporate the principles of disability justice in our efforts to disrupt bodymind hierarchies within and outside the university classroom and to share some of the resources we use.
The Causes and Consequences of the Neo-Brandeisian Antitrust Movement in the United States
Authors: Fiebig Andre , Gerber David
Published: December 2021

The recent appointments of Timothy Wu as Special Assistant to the U.S. President for Technology and Competition Policy and Lina Khan, a member of the U.S. Federal Trade Commission, two prominent advocates for a fundamental shift in U.S. antitrust policy, and the introduction of federal and state legislation to change how antitrust is applied signal a realistic possibility of a fundamental change of direction in the course of U.S. antitrust. The shift advocated by these self-described “Brandeisians” goes beyond the reform proposals advocated by the Post-Chicago School movement. Whereas the Post-Chicago School movement, which was based primarily on industrial organization theory, advocated for change while recognizing the primacy of economic theory in the application of antitrust law, the Neo-Brandeisians argue that economic considerations should only be part of the substantive antitrust analysis and not necessarily the determinative factor.

For many Europeans, and in particular Germans familiar with legal history, the ideas advanced by the Neo-Brandeisians will be familiar. Louis Brandeis, whose writings and opinions serve as the intellectual compass of the Neo-Brandeisians, was himself influenced by the Freirechtsbewegung and their skepticism of a wertfreie jurisprudence. Borrowing from post-modernist philosophy, the Neo-Brandeisians recognize that the dominant legal doctrines reflect the prevailing power structures in society. In their view, the fact that U.S. antitrust law relies heavily on economic theory does not allow it to claim value neutrality. The more radical members of this movement consequently argue that other values beyond economics should be considered in the application of U.S. antitrust law by the courts and antitrust agencies. In this article we attempt to introduce this movement to a European audience and assess its possible impact on the direction of U.S. antitrust.
Der kartellrechtliche Beseitigungsanspruch als verschuldensunabhängiger Schadensersatzanspruch
Authors: Lahme Rüdiger , Ruster Andreas
Published: December 2021

Kartellgeschädigte können von Kartellanten die Rückzahlung kartellbedingter Überzahlungen verlangen. Typischerweise stützen sie sich hierzu auf einen verschuldensabhängigen Schadensersatzanspruch. Vielfach kann die Rückzahlung aber auch als verschuldensunabhängiger Beseitigungsanspruch verlangt werden. Der Beitrag führt zunächst in die dem zugrundeliegende Rechtsprechung des Bundesgerichtshofs ein. Im Anschluss beleuchten die Autoren die Konsequenzen dieses Befundes, indem sie Gemeinsamkeiten und Unterschiede sowie Vor- und Nachteile des Beseitigungsanspruchs im Vergleich zum Schadensersatzanspruch herausarbeiten. Besondere Bedeutung kommt dabei den unionalen Wurzeln des Kartellprivatrechts zu, die in Gestalt der Kartellschadensersatzrichtlinie und der Kasuistik des Europäischen Gerichtshofs die nationale Rechtsanwendung zunehmend prägen.
Implementing Transitions for Youth With Complex Chronic Conditions Using the Medical Home Model
Authors: Kelly Anne M. , Kratz Barbara , Bielski Mary , Rinehart Peggy Mann
Published: December 2021

The concept of a medical home is endorsed as an effective model for implementing successful transitions for youth with complex chronic conditions. The U Special Kids program at the University of Minnesota is described as a medical home designed to improve service delivery for children and youth with complex medical conditions to help them achieve optimal health and functioning. Two case studies depict effective communication methods, including a concise written health history summary, that promote shared understanding of the adolescent’s and family’s strengths and their skills. Specific components of a transition plan are detailed with the recommendation that a formal assessment occur to develop an individualized transition plan. The individualized plan incorporates goals for the adolescent to gain independence and to obtain support in required areas.
Fertility Treatments and Craniosynostosis: California, Georgia, and Iowa, 1993–1997
Authors: Reefhuis Jennita , Honein Margaret A. , Shaw Gary M. , Romitti Paul A.
Published: December 2021

Objective. Craniosynostosis, a malformation caused by premature closure of 1 or more cranial sutures, is a rare birth defect usually of unknown cause; however, it is often associated with advanced maternal age. Because fertility treatments are also associated with increased maternal age, this study investigated the possible association between fertility treatments and craniosynostosis.

Methods. Data from the Birth Defect Risk Factor Surveillance study were used, which included infants who were delivered from 1993 through 1997 in California, Georgia, and Iowa. Cases were defined as infants who had nonfamilial, nonsyndromic craniosynostosis and were ascertained through existing birth defect surveillance systems. Controls, infants without birth defects, were selected from the same regions and time period.

Results. Mothers of 99 case infants and 777 control infants from the 3 study locations participated in this study by completing a telephone interview. Unadjusted analyses showed associations with craniosynostosis for mothers who had used clomiphene citrate (odds ratio[OR]: 3.8; 95% confidence interval [CI]: 1.1–12.3), artificial insemination (OR: 4.2; 95% CI: 0.8–9.4), or assisted reproductive techniques (OR: 4.2; 95% CI: 0.5–27.3).

Conclusions. This is the first study that has found associations between fertility treatments and craniosynostosis. However, the numbers are small; therefore, the results should be viewed with caution.
Prevalence of Breastfeeding in the United States: The 2001 National Immunization Survey
Authors: Li Ruowei , Zhao Zhen , Mokdad Ali , Barker Lawrence , Grummer-Strawn Laurence
Published: December 2021

Objective. To address key gaps in the annual monitoring of breastfeeding prevalence in the United States, 3 breastfeeding questions concerning the initiation, duration, and exclusivity of breastfeeding were added to the rotating modules of the National Immunization Survey (NIS) beginning in the third quarter of 2001. The present study examines the current prevalence of breastfeeding in the United States using NIS data from this initial quarter.

Methods. The NIS is a random-digit-dialing survey of households with children aged 19 to 35 months, followed by a mail survey of the eligible children’s vaccination providers to validate the child’s vaccination information. In the third quarter of 2001, a randomly selected subset of households interviewed in the NIS (N = 896) were asked questions about breastfeeding.

Results. Almost two thirds (65.1%) of children had ever been breastfed. At 6 and 12 months, 27.0% and 12.3%, respectively, were receiving some breast milk. Non-Hispanic blacks had the lowest rates of breastfeeding initiation and continuation. Exclusive breastfeeding rates were low in the United States with only 7.9% at 6 months.

Conclusions. Although breastfeeding initiation is near the national goal of 75%, breastfeeding continuation lags behind the national goals of 50% and 25% at 6 and 12 months, respectively. Strenuous public health efforts are needed to improve breastfeeding practices among blacks.
Epidemiology of Early Hearing Loss Detection in Hawaii
Authors: Prince Cheryl B. , Miyashiro Lloyd , Weirather Yusnita , Heu Patricia
Published: December 2021

Objective. Universal Newborn Hearing Screening began in 2 Honolulu hospitals in 1992, and by 1999, all 14 civilian birthing facilities in Hawaii were providing screening. Examination of 1998 Hawaii data indicated that approximately 13% of infants who did not pass initial hearing screening in the hospital did not return for the indicated follow-up. The purpose of this study was to determine the epidemiologic profile of infants who were born in 1999 and did not return for follow-up.

Methods. A population-based, cohort study of the hearing screening completion rates among the 13 civilian birthing facilities in Hawaii that provided data to the Department of Health was conducted. Analysis included a bivariate analysis of the demographic characteristics of infants who completed the screening/follow-up process compared with those who did not and logistic regression modeling to ascertain the demographic profile of infants at high risk for being lost to follow-up.

Results. Of 12 456 infants, hearing screening data could be linked to the birth certificate file, and a final disposition regarding completion of the screening/follow-up process was determined for 10 328 (83%). Less than 2% (n = 176) of the linked infants failed to complete the screening/follow-up procedures. Low birth weight and white infants and infants born to women who had not completed high school were approximately twice as likely not to complete the screening as were their normal birth weight or nonwhite counterparts.

Conclusions. Failure to complete the hearing screening follow-up may be related to cultural differences that have been previously reported in other maternal and child health studies of the diverse populations in Hawaii. The results of this study will allow the Hawaii Newborn Hearing Screening Program to target its efforts and limited resources toward infants who are at higher risk of not completing the screening and who may need special attention to encourage their mothers to complete the screening process, and to move quickly with rescreening infants whose initial tests are positive so that infants are not lost to follow-up.
Maternal Perceptions of Weight Status of Children
Authors: Maynard L. Michele , Galuska Deborah A. , Blanck Heidi M. , Serdula Mary K.
Published: December 2021

Objective. We quantified maternal misclassification of child weight status and examined determinants associated with maternal perceptions of child weight status.

Methods. Data from the Third National Health and Nutrition Examination Survey (1988–1994) were used. The sample included 5500 children (aged 2–11 years) with maternal interview data. Maternal perceptions of children’s weight status were compared with measured weights and statures from which body mass index (BMI; weight/stature2; kg/m2) percentiles and z scores were determined. Frequency analyses determined the percentages of mothers considering their child to be “overweight,” “underweight,” or “about the right weight.” Multivariable logistic regression analyses determined predictors of maternal misclassification of overweight children (≥95th BMI-for-age percentile) and those at risk for overweight (≥85th to <95th BMI-for-age percentile).

Results. Nearly one third (32.1%) of mothers reported their overweight child as “about the right weight.” Younger children and those with lower BMI-for-age z scores had significantly greater odds of maternal underclassification of child overweight status. For children at risk for overweight, 14.0% of mothers reported sons to be “overweight,” whereas 29.0% considered daughters to be “overweight.” Odds of maternal misclassification of at-risk children as “overweight” were significantly greater for daughters, older children, children with higher BMI-for-age z scores, and children whose mothers had a lower BMI. Race/ethnicity was not a significant predictor in either model.

Conclusions. Nearly one third of mothers misclassify overweight children as being lower than their measured weight status. Mothers are more likely to identify daughters who are at risk of overweight as being “overweight” than they are sons.
Diagnostic Evaluation
Authors: Bock S. Allan
Published: December 2021

The diagnosis and management of adverse food reactions is a challenge for pediatricians and other primary care providers. Children of all ages may present with a variety of symptoms that parents have attributed to constituents of the diet. An approach has been devised to aid pediatricians in the evaluation of these children. The process begins with a detailed history. This history may be used to classify the problem into categories of symptoms and possible mechanisms. When common food offenders are suspected of causing symptoms, it is reasonable to obtain in vitro tests that may then be used to decide whether elimination of certain foods is indicated and whether a referral to an allergist is needed. Using this approach, the physician may be able to identify children who are experiencing food-allergic symptoms and aid frustrated families in dealing with problems that have not had apparent solutions. The application of specific testing and the assessment of the results are discussed. Also reviewed are the techniques used by allergists so that pediatricians may help families understand procedures that will be recommended and performed.
Antibiotic Resistance: What Is the Impact of Agricultural Uses of Antibiotics on Children’s Health?
Authors: Shea Katherine M.
Published: December 2021

Antimicrobial resistance has reached crisis stage in human medicine. The rapid acceleration of multidrug-resistant bacteria in the past 2 decades has overtaken new drug development, and patients and clinicians are faced with the prospect of untreatable infections. Although much of the problem stems from overuse and misuse of antimicrobial agents in human medicine, large-scale use of antimicrobials in agriculture also contributes to the crisis. Agricultural uses of antibiotics produce environmental exposures in a variety of reservoirs, which select for resistant microbes and microbial genes. This article presents the major lines of evidence documenting the risks to human health of some of the agricultural uses of antimicrobials. A brief review of the microbiologic antecedents of resistance is followed by a discussion of agricultural uses of antimicrobials and a targeted review of the literature, which provides the background knowledge and evidence necessary for pediatricians and other clinicians to be informed and to advocate for judicious use of antimicrobials in all sectors.
Effect of Child and Family Poverty on Child Health in the United States
Authors: Wood David
Published: December 2021

The Issue. Poverty has been described as an economic state that does not allow for the provision of basic family and child needs, such as adequate food, clothing, and housing. However, the debate about the effects of poverty on the growth, development, and health of children is as much involved with the culture or general context of poverty as it is with the economics of poverty. This culture of poverty is in part mediated through environmental deprivations, such as failing schools, gangs, drugs, violence, and struggling families. Heclo1 described this sociocultural and environmental dimension of poverty as “a condition of misery, hopelessness, and dependency.” The subject of this article is to review the literature on the effects of poverty on US children as mediated through economic, ecologic, and family influences.
The Application of Social and Adult Learning Theory to Training in Community Pediatrics, Social Justice, and Child Advocacy
Authors: DeWitt Thomas G.
Published: December 2021

The Issue. Perhaps the greatest challenge we face today in medical education is how to establish a conceptual framework for conveying the context of community pediatrics and issues related to child health equity and social justice to practicing pediatricians and pediatricians in training. This will require a new infrastructure and approach to training to allow pediatricians to think and practice differently. The application of social and adult learning theory to the development and implementation of community pediatrics curricula will be necessary to succeed in these endeavors. In particular, we also will need to understand the educational processes required to motivate adult learners to acquire knowledge, attitudes, and skills outside the context and framework of their previous experiences and perceived professional needs.
The Maternal Phenylketonuria International Study: 1984–2002
Authors: Koch Richard , Hanley William , Levy Harvey , Matalon Kim , Matalon Reuben , Rouse Bobbye , Trefz Frederick , Güttler Flemming , Azen Colleen , Platt Larry , Waisbren Susan , Widaman Keith , Ning Jiaping , Friedman Eva G. , de la Cruz Felix
Published: December 2021

Objective. The purpose of this report is to review the obstetric medical, psychological, and nutritional aspects and outcome of the women and offspring enrolled in the Maternal Phenylketonuria Study, which was established to assess the efficacy of a phenylalanine (Phe)-restricted diet in preventing the morbidity associated with this disorder.

Methods. A total of 382 women with hyperphenylalaninemia (HPA) were enrolled in the study and completed 572 pregnancies. Outcome measures were analyzed with χ2, Fisher exact text, analysis of variance, t test, Wilcoxon nonparametric test, and multiple logistic regression. Outcome measures were stratified according to maternal HPA classification and the time when dietary control was achieved.

Results. Optimal birth outcomes occurred when maternal blood Phe levels between 120 and 360 μmol/L were achieved by 8 to 10 weeks of gestation and maintained throughout pregnancy (trimester averages of 600 μmol/L). Mothers with mild HPA achieved similar birth outcomes as mothers who were in control preconceptually and those in control by 8 to 10 weeks of pregnancy.

Conclusions. Before conception, counseling and early entrance into a prenatal care program is essential in achieving optimal fetal outcome in women with HPA. The achievement of pre- and periconceptional dietary control with a Phe-restricted diet significantly decreased morbidity in the offspring of women with HPA.
Pregnancy Experiences in the Woman With Mild Hyperphenylalaninemia
Authors: Levy Harvey L. , Waisbren Susan E. , Güttler Flemming , Hanley William B. , Matalon Reuben , Rouse Bobbye , Trefz Friedrich K. , de la Cruz Felix , Azen Colleen G. , Koch Richard
Published: December 2021

Objective. A major issue in maternal phenylketonuria (MPKU) has been whether maternal non-PKU mild hyperphenylalaninemia (MHP) is teratogenic. Such untreated pregnancies and their outcomes are presented on this report.

Methods. Enrolled pregnancies in which the untreated prepregnancy assigned phenylalanine level (APL) was no more than 600 μmol/L were included in the Maternal PKU Collaborative Study and were followed according to protocol.

Results. Forty-eight enrolled women with non-PKU MHP had mean APL 408 ± 114 μmol/L. They had a total of 58 pregnancies that resulted in live births. Fifty were untreated. Maternal phenylalanine (Phe) levels in the untreated pregnancies decreased during pregnancy for average Phe exposure of 270 ± 84 μmol/L, virtually identical to the level of 269 ± 136 μmol/L in the 8 treated pregnancies. Birth measurements in the 50 offspring from untreated pregnancies were within normal limits with z scores of −0.25 for weight, 0.28 for length, and −0.63 for head circumference, although birth head circumference was negatively correlated with maternal APL (r = −0.30). Only 1 offspring had congenital heart disease. Offspring IQ was 102 ± 15 compared with 96 ± 14 in the mothers with untreated pregnancies and with 109 ± 21 in control offspring.

Conclusion. Maternal non-PKU MHP no more than 600 μmol/L does not require dietary therapy. The naturally lower Phe level during pregnancy seems to protect against teratogenesis.
History and Description of the Neonatal Intensive Care Unit Network Neurobehavioral Scale
Authors: Lester Barry M. , Tronick Edward Z.
Published: December 2021

This article provides an introduction and background to the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS). First is a summary of the history of the field of infant assessment. This is followed by a description of the NNNS, including its basic features and how the NNNS differs from other examinations. We then describe the biobehavioral basis for the examination and review studies in which the NNNS has been used. Finally we discuss the developmental model on which the NNNS is based and consider the implications of using the examination.
Normative Neurobehavioral Performance of Healthy Infants on the Neonatal Intensive Care Unit Network Neurobehavioral Scale
Authors: Tronick Edward Z. , Olson Karen , Rosenberg Rebecca , Bohne Lisa , Lu Jing , Lester Barry M.
Published: December 2021

Descriptive statistics for the Neonatal Intensive Care Unit Network Neurobehavioral Scale summary scores are provided for a sample of 125 full-term, healthy 1- to 2-day-old infants. The study sample is described, including demographic characteristics and infant and maternal medical characteristics. Descriptive statistics and percentiles are provided for the Neonatal Intensive Care Unit Network Neurobehavioral Scale summary scores. These tables can be used as quasinorms for comparison with other infants of this age.
Providing a Medical Home: The Cost of Care Coordination Services in a Community-Based, General Pediatric Practice
Authors: Antonelli Richard C. , Antonelli Donna M.
Published: December 2021

Objective. To determine the cost of unreimbursable care coordination services for children with special health care needs (CSHCN) in 1 community-based, general pediatric practice.

Methods. A measurement tool was developed to quantify the precise activities involved in providing comprehensive, coordinated care for CSHCN. Costs of providing this care were calculated on the basis of time spent multiplied by the average salary of the office personnel performing the care coordination service. In addition, data were collected regarding the complexity level of the patient requiring the service, the type of service provided, and the outcome.

Results. During the 95-day study period, 774 encounters that led to care coordination activities were logged, representing service provision to 444 separate patients. When these encounters were examined on the basis of clinical complexity of the patient, the most complex patients constituted 11% of the population of CSHCN yet accounted for 25% of the encounters. In addition, care coordination activities for these clinically complex CSHCN engaged office staff 4 times as long when compared with less clinically complex CSHCN. Overall, 51% of the encounters were attributable to coordinating care for problems not considered typically medical and included activities such as processing referrals with managed care organizations, consulting with schools or other educational programs, and providing oversight for psychosocial issues. On the basis of national salary and benefits data, the annual cost of the time spent coordinating care for CSHCN in this medical home model ranged from $22 809 to $33 048 (representing the 25th and 75th percentiles, respectively).

Conclusions. The costs of providing care coordination services to CSHCN in a medical home are appreciable but not prohibitive. Standardization of care coordination practices is essential because it makes the medical home more amenable to quality improvement interventions. Mechanisms to finance unreimbursable care coordination activities must be developed to achieve the Healthy People 2010 objective that all CSHCN have access to a medical home.
Parents’ Discipline of Young Children: Results From the National Survey of Early Childhood Health
Authors: Regalado Michael , Sareen Harvinder , Inkelas Moira , Wissow Lawrence S. , Halfon Neal
Published: December 2021

Objective. To examine the use and predictors of different discipline practices by parents of very young children using data from the 2000 National Survey of Early Childhood Health (NSECH).

Methods. NSECH is a nationally representative telephone survey of 2068 parents of young children between the ages of 4 and 35 months conducted by the National Center for Health Statistics. The survey includes questions about parents’ use of 5 discipline practices: yelling, spanking, time out, toy removal, and explanations. χ2 analyses and logistic multivariate regression were used to examine associations between discipline practices and child, parent, and demographic factors.

Results. Among young children aged 19 to 35 months, frequent parental use of discipline strategies ranged from 26% (spanking) to 65% (taking away toy or treat), 67% (yelling), 70% (using time out), and 90% (providing explanations). In multivariate analyses, child age predicts reports of more frequent spanking and yelling, and child developmental risk is associated with increased reports of yelling. Parent frustration predicts frequent use of every discipline practice, including a greater inclination to use aversive practices. Lower parental emotional well-being is associated with reports of frequent yelling and spanking. Black ethnicity and maternal age predict more frequent spanking, and Spanish-speaking parents reported less frequent use of time out and taking away a toy.

Conclusion. Child age and developmental risk and parents’ ethnicity, emotions, and mental health are closely associated with discipline practices in the first 3 years of life. These factors are important for pediatricians to recognize in providing anticipatory guidance about discipline.
N.T.A. CELEBRATES 50TH ANNIVERSARY
Authors: HILL LEE FORREST
Published: December 2021

ON JUNE 6, 1904, approximately 100 persons met in Atlantic City and organized the National Association for the Study and Prevention of Tuberculosis (shortened in 1918 to National Tuberculosis Association). This year, from May 17 to 21, the Association is returning to Atlantic City for a Golden Jubilee meeting and celebration. Pediatrics is pleased to have this opportunity of paying tribute to the accomplishments of this great organization during its 50 year history.

Tuberculosis has been a tough foe of mankind for centuries. It has the dubious distinction of being the first specific disease to have a nation-wide group of men and women join together for the purpose of effecting its control and eventual eradication. In this combat between man and microbe the National Tuberculosis Association has played a leading role. Its original constitution stated its purposes to be "the study of tuberculosis in all its forms and relations; the dissemination of knowledge about the causes, treatment, and prevention and scientific treatment of tuberculosis."
ON THE PRESENCE OF POLIOMYELITIS VIRUS IN REGIONAL LYMPH NODES
Authors: Wenner Herbert A. , Kamitsuka Paul
Published: December 2021

Fifteen fatal human illnesses caused by poliomyelitis viruses were studied in an effort to evaluate the position of lymphatic tissue in the pathogenesis of poliomyelitis. Poliomyelitis virus was detected in various regional lymph nodes obtained from 12 of 15 fatal cases.

Evidence that poliomyelitis virus multiplied in lymphatic tissue was not obtained. The findings indicated that the quantity of available virus was significantly less in lymph nodes than in CNS tissues or in the contents of the gastrointestinal tract. The data obtained in 5 patients indicated that substantial amounts of virus were not bound in situ by homotypic antibody.
GLYCOGEN DISEASE OF THE LIVER (VON GIERKE'S DISEASE) WITH HEPATOMATA
Authors: Mason Howard H. , Andersen Dorothy H.
Published: December 2021

A case of glycogen disease of the liver (von Gierke's disease), followed from the age of 6 months to death at 10½ years, is reported. The child was dwarfed and mentally retarded. The diagnosis is supported by blood sugar concentrations following the administration of monosaccharides and following epinephrine injection as well as by post-mortem anatomical and chemical studies.

Hypoglycemia was controlled by frequent feedings which contained glucose or starch. Levulose and galactose were restricted because low tolerance tests suggested that these substances were rapidly removed from the blood by the liver; after phosphorylation and conversion in the liver their release as glucose was evidently blocked by the same mechanism that blocked the release of glucose from glycogen.

Blood lactic acid was consistently elevated, the degree of elevation bearing an inverse relationship to blood sugar levels. It is suggested that excess blood lactic acid contributes to the acidosis and so therapy of the acidosis with lactates would be illogical.

The concentration of total serum lipids was always high but fluctuated widely, reaching a peak of 7.45 gm./100 ml., higher during periods of prolonged hypoglycemia and probably reflecting the mobilization of body fat during these periods.

The terminal illness was marked by 2 unexplained complications: multiple hepatomata and congestive right heart failure.

The severity of the disease varies from patient to patient, in the present case appearing to decrease with advancing age.
PRELIMINARY REPORT ON THE DEVELOPMENTAL ASPECTS OF THE P-R INTERVAL IN THE ELECTROCARDIOGRAMS OF HEALTHY CHILDREN
Authors: McCammon Robert W.
Published: December 2021

ADVANCES in the diagnosis and treatment of cardiac disorders in children have focused the attention of many investigators on the electrocardiographic findings in childhood as a possible diagnostic aid. Standards in healthy children published from several centers are not in accord with each other, and dissatisfaction with the present standards has become quite widespread. The Child Research Council study of healthy children has included periodic electrocardiograms taken serially on the same children from the age of 1 month. This material is being analyzed but it will be some time before any inclusive results are available. It has been suggested that a preliminary report on the P-R interval might be valuable by giving a developmental picture of this electrocardiographic interval.
TOTAL BODY EXCHANGEABLE WATER, SODIUM AND POTASSIUM IN "HOSPITAL NORMAL" INFANTS AND CHILDREN
Authors: Corsa Leslie , Gribetz Donald , Cook Charles D. , Talbot Nathan B.
Published: December 2021

Total body exchangeable potassium is approximately 40 mEq./kg. of body weight in infants, children and young adults alike, in contrast to exchangeable water and sodium which are high per unit of body weight at birth and decrease to adult levels during the first 2 years of life.

"Cell potassium concentration" calculated from exchangeable water, sodium and potassium and serum sodium concentration changes little during the period of growth and development despite other large alterations in body composition.

These measurements are suggested as a further means of investigating cellular potassium status in vivo.
REVIEW ARTICLE
Authors: Smith Margaret H. D.
Published: December 2021

Man, alone of all animal species, seems susceptible to meningitis, probably because of the very large amount of blood which perfuses his brain, thereby increasing the opportunities for blood-borne infection. Infants and young children, before they have acquired immunity to the common bacterial pathogens, are particularly prone to meningeal infection. Since they outwardly display less characteristic signs and symptoms of meningeal irritation than do adults, diagnosis is often delayed and the chances for recovery correspondingly impaired. Cyanosis, fever, vomiting in the newborn; fever, drowsiness, jitteriness, tenseness of the fontanelle in older infants; headache, vomiting, and stiffness of the neck in children, and so-called febrile convulsions in patients of any age, should point to the possibility of meningitis. Examination of the spinal fluid obtained by lumbar puncture is the only completely satisfactory way to establish the diagnosis, unless petechiae are present from which an organism can be recovered on smear. All things considered, the best chemotherapeutic agent for patients with H. influenzae meningitis is crystalline chloramphenicol; for those with meningococcal meningitis sulfadiazine, and for those with pneumococcal meningitis penicillin and sulfadiazine. Only if the etiologic agent cannot be identified should resort be had to drug combinations such as penicillin, sulfadiazine, and chloramphenicol; or to Terramycin® which is optimal in no type of meningitis, but fairly good in all. Whatever the chemotherapeutic agent employed, the physician should always remember that the management of patients with meningitis consists of far more than deciding which drug to prescribe. Treatment must start immediately the diagnosis is made and should include proper provision for the patient's rest and comfort, for an adequate fluid intake, for a minimal amount of discomfort (in the form of injections and restraint). Medication should come to an end as soon as safe in order to avoid unpleasant side-reactions: within 2 or 3 days in meningococcal meningitis and usually within a week in influenzal meningitis. Only in pneumococcal meningitis does the relatively high incidence of relapse make prolonged periods of treatment advisable. While complications during convalescence are much less common than formerly, the presence of fever beyond a few days, persistent anorexia or vomiting, restlessness, or focal neurologic signs should suggest the possibility of an intercurrent infection involving the ears, lungs or sites of antibiotic injection; or a subdural effusion. Only by constant alertness to possibility of meningitis in young children and by meticulous attention to all of the details of management can the mortality from meningitis be kept below 10 per cent (influenzal and meningococcal meningitis) and 20 per cent (pneumococcal meningitis).
MULTIPLE SCLEROSIS IN CHILDREN
Authors: Low Niels L. , Carter Sidney
Published: December 2021

Reference to textbooks on pediatrics and neurology, individual case reports and review articles on multiple sclerosis showed that multiple sclerosis can occur in childhood in typical form and has been occasionally confirmed by necropsy.

During the past year 3 children were seen at the Neurological Institute in New York in whom the diagnosis of multiple sclerosis seemed reasonably certain. Four additional patients are presented in whom that diagnosis was suspected. In the latter group years of observation will be required for confirmation of the diagnosis.
EFFECT OF EXTRACTS OF HEMOPHILUS PERTUSSIS ON LEUKOCYTE COUNTS IN NORMAL AND SENSITIZED MICE
Authors: Bradford William L. , Scherp Henry W. , Tinker Mary R.
Published: December 2021

Mice, sensitized by intranasal infection with sublethal doses of H. pertussis, were injected intra-abdominally 3 weeks later with extracts of the organism in order to observe their leukocytic response compared with that of normal mice.

After injection of an extract prepared by sonic disruption of the organism, a significantly greater increase of the total leukocyte count, particularly of the polymorphonuclear cells occurred in the sensitized animals. A similar, though somewhat lesser, response followed injection of this extract previously freed of agglutinogen by absorption with a specific antibacterial rabbit serum.

No significant increase occurred after injection of the extract after heating, after heating and absorption, or after injection of physiological salt solution.

Under the conditions of the experiments leukocytosis, chiefly caused by an increase of the polymorphonuclear cells, appeared to be associated with the heat-labile component of the extracts tested.
EXCHANGE TRANSFUSION IN THE TREATMENT OF OIL OF WINTERGREEN (METHYL SALICYLATE) POISONING
Authors: Done Alan K. , Otterness Larry J.
Published: December 2021

A case of oil of wintergreen (methyl salicylate) poisoning treated by exchange transfusion is reported. This procedure resulted in the rapid removal of a relatively large amount of salicylate and in prompt clinical improvement.

The favorable results presented in this report suggest that the use of exchange transfusion deserves further evaluation in this and in other selected types of poisoning in infants and small children.
ENDOCARDIAL FIBRO-ELASTOSIS
Authors: Andersen Dorothy H. , Kelly Janice
Published: December 2021

The site and degree of endocardial fibrosis has been estimated and recorded in 129 hearts with relatively uncomplicated congenital malformations. The great majority showed endocardial thickening.

Mechanical factors, including increased pressure and abnormal currents of intracardiac blood, are of importance in the production of endocardial fibrosis, because the sites of fibrosis follow the same pattern in various examples of the same defect and occur where general increase in intracardiac pressure may be presumed to occur on where localized jets may impinge on cause vibration. The degree of fibrosis increases with age.

Deficiency of oxygen in the coronary blood supply is also of importance, especially in cases of severe aortic stenosis or atresia and in hearts with a coronary artery arising from the pulmonary artery.

A hypothesis is offered that the warty valvular vegetations occasionally seen with aortic stenoss represent the reaction of fetal valvular endocardium to mechanical factors combined with hypoxia.

Elastic tissue stains show that proliferation of elastic fibers occurs in association with proliferation of the collagen in the thickened endocardium found in congenitally malformed hearts and in other types of heart disease. It is concluded that elastic tissue is a normal component of endocardial fibrosis.
CONGENITAL ENDOCARDIAL FIBRO-ELASTOSIS
Authors: Kelly Janice , Andersen Dorothy H.
Published: December 2021

Seventeen cases of congenital endocardial fibro-elastosis without associated cardiac malformations or other known cause have been reported. Seventy-nine similar cases have been collected from the literature.

Evidence is presented that these cases represent a disease entity with the following characteristic features:

a. The disease is familial.

b. Nonspecific symptoms begin in the first 6 months of life in the majority of cases, consisting of failure to gain and cough, over a few days or weeks. A sudden attack of labored breathing and tachycardia with vomiting or abdominal pain may lead to death within 1 or 2 days or to recovery followed by repetition of similar attacks. Death within a day of onset of an attack occurs in half of the cases.

c. Bradycardia before birth and congenital heart block occurred in two cases.

d. The heart is grossly enlarged mainly because of dilatation and hypertrophy of the left ventricle.

e. The endocardial fibro-elastosis increases with age and is most marked in the left ventricle.

f. Non-cardiac malformations are rarely present.

A hypothesis is presented that the disease is based on a familial metabolic defect leading to myocardial weakness and that the endocardial changes are secondary.
CLINICAL CONFERENCE
Authors: Buchanan Douglas
Published: December 2021

(E.W., 63 07 34) This girl is 8 months old. She has a brother 2 years old. Her mother and father are young and have had no recognized illness. Her mother was well after the birth of her first child in November of 1953. She had no change in weight and no evidence of anemia, and took no medicine. During her second pregnancy she had no feverish illness and no rash. She believes that the patient moved in utero more than her first child, but with both children she could feel the movements of the different parts of their bodies. The patient was born at term after a spontaneous onset of labor. She was delivered head first after 2 hours without anesthetic or sedation. She breathed at once. She had no cyanosis, no jaundice, and no convulsions.

On the day of her birth her tongue was large and protruded, and in the 8 months of her life it has never been completely within her mouth. The muscles of her arms and legs were unusually distinct, not only because of their size, but also because of the lack of fat beneath the skin. Her skin was thin, and the blood vessels were easily seen. Her abdomen was distended. There was a separation between the two recti muscles and the liver was slightly enlarged. These physical peculiarities have not changed or disappeared.

On examination now at the age of 8 months the optic discs and the retina in both eyes are normal. The other cranial nerves are all normal in their action. There is no strabismus or limitation of movement of the eyes in any direction. The deep reflexes are present, symmetrical, and brisk. The plantar responses are extensor.
DEVELOPMENT OF THE PULMONARY VEINS
Authors: Neill Catherine A.
Published: December 2021

The examination of serial sections of human embryos between 24 and 34 days (3 to 11 mm) and the use of plastic reconstructions, showed that the common pulmonary vein develops as an outgrowth from the medial superior wall of the left auricle and unites with the angioblastic plexus of the developing lung bud. No evidence was found that the vein connects directly with the sinus venosus in the early stages, and later shifts in position as the atrial septum grows. Anomalous pulmonary venous drainage is classified in four main types, and theories of development are briefly discussed.
TRACHEO-ESOPHAGEAL FISTULA WITHOUT ESOPHAGEAL ATRESIA—CONGENITAL AND RECURRENT
Authors: Sieber William K. , Girdany Bertram R.
Published: December 2021

The clinical problems presented by 10 infants with congenital and recurrent tracheo-esophageal fistulas are discussed.

A roentgenographic technique of identification of tracheo-esophageal fistulas, using the aqueous solution Dionosil®, is described.

The intermittent patency of the fistula is stressed. Recurrent tracheo-esophageal fistula may be a complication in infants operated upon for esophageal atresia with tracheo-esophageal fistula.

The results in this series demonstrate the urgency of early recognition and prompt therapy.
HYPOCHROMIC MICROCYTIC ANEMIA OF INFANCY: IRON DEPLETION AS A FACTOR
Authors: Josephs Hugh W.
Published: December 2021

In this work the author has attempted to gain insight into the significance of iron depletion by the use of 4 simple calculations, justification for which is found in recent articles. These are: (a) iron with which the infant is born; (b) iron retained from the food; (c) iron being used by the tissues and therefore unavailable for hemoglobin, and (d) iron combined with the total mass of hemoglobin. With these 4 figures it is possible to estimate the iron still potentially available for use (the "reserves" or "stones"). When the difference between a + b and c + d has reached about zero, depletion is considered to exist.

The following characteristics of depletion may be emphasized:

Depletion is the result of gain in weight and maximum possible usage of iron. It is therefore a normal result of growth and need not be associated with anemia.

As soon as depletion has occurred, the organism is thereafter dependent on current absorption of iron. This is ordinarily sufficient, even with a diet of milk alone, to maintain an adequate concentration of hemoglobin after about 8 to 10 months of age.

Severe anemia due to depletion alone is practically confined to premature babies whose relative gain in weight is rapid.

Severe anemia in other than premature babies is the result of a number of factors by which iron becomes unavailable or is actually diverted from hemoglobin to storage.

Response to iron medication is considerably better in infants with depletion than in those in whom some factor is present that interferes with iron utilization, and which is not connected by the mere giving of iron.

The dependence on current absorption, whether the result of depletion or non-availability, introduces a certain precariousness which is apparently characteristic of this time of life. The organism gets along from day to day if nothing happens, but may not be able to meet an emergency, whether this appears as a rapid gain in weight, or a necessity to repair damage done by severe infection.

If we consider iron deficiency as the cause of anemia, we can think of deficiency as due to a number of factors of which depletion is only one. The development and characteristics of depletion have been considered in this paper; other factors in iron deficiency will be considered in subsequent papers.
MENTAL DEFICIENCY
Authors: KUGEL ROBERT B.
Published: December 2021

Pediatricians are becoming acutely aware of the need for better understanding of the problems of handicapped children. Sound programs for improving the care of these children must be based on clear concepts of their problems. The medical education of most physicians now in practice did not include an adequate treatment of either the physical or the psychologic aspects of chronic handicaps. Indeed, an adequate treatment could not have been presented, so meager has been the knowledge of these problems. A recent article gives an excellent analysis of the concepts behind the term "pseudo-feeblemindedness" which has appeared in the literature on mental retardation. Attention is directed to the confusion which often arises from the use of such a term. A more dynamic concept of mental retardation is brought forward.
REVIEWING OF MANUSCRIPTS
Authors: MAY CHARLES D.
Published: December 2021

THE Editorial Board of Pediatrics is faced with a heavy burden in reviewing the manuscripts submitted for consideration for publication in Pediatrics. This task is discharged faithfully and well and with a full realization of the need for an objective appraisal. Many factors must be considered in reaching a decision concerning the suitability of a manuscript. The opinions of others, not members of the Editorial Board, are frequently solicited. The invaluable assistance of the following persons during the year ending July, 1956 is gratefully acknowledged.