bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlation of Black Blood MRI with Image- Based Blood Flow Simulations in Intracranial Aneurysms
Authors: Korte Jana , Marsh Laurel , Gaidzik Franziska , Pravdivtseva Mariya , Larsen Naomi , Berg Philipp
Published: December 2021

Intracranial aneurysms (IA) is not-uncommon pathology of cerebral vessels. Vessel wall magnetic resonance imaging can visualize the vascular walls of IAs. In some aneurysms, the wall-adjacent and a luminal hyperintense signal was detected. The signal was attributed to the inflammation and specific hemodynamic features of aneurysms. But, up to now, the studies investigating luminal enhancement combined with flow analysis are limited. Therefore, in this study, investigation of the luminal enhancement is further carried out by comparison to computational fluid dynamics. The latter provides the possibility of calculating hemodynamic parameters, which can give information such as velocity, pressure, and shear stress fields throughout a heart cycle. The data of the IAs is specific to each patient and builds the basis for the enhancement analysis and simulations. Specific hemodynamic parameters like kinetic energy and vortex formation evaluated in the simulations show a dependency to signal suppression recorded with vessel wall magnetic resonance imaging
ForeSight Approach to improve Privacy and Security in the Smart Living Domain
Authors: Bauer Jochen , Konrad Christoph , Hechtel Michael , Wichert Reiner , Weigand Christian , Dengler Simon , Holzwarth Martin , Franke Jörg
Published: December 2021

This contribution describes how to improve privacy and security for the Smart Living domain. Core elements of this approach adapt the Privacy by Design concept to the domain of smart living and extend it to enable artificial intelligence integration. To improve security, we created a minimum framework based on an existing information security management system to offer a holistic perspective on that topic. This, we think, is necessary, primarily if legacy Internet of Things devices should be supported
Visualizing the Knowledge Domain of Motor Speech Disorders: A Scientific Review (2000-2019)
Authors: Wang Huili , Zhang Shurong , Li Xueyan
Published: December 2021

This review visualizes the knowledge domain of motor speech disorders (MSDs) in linguistics between 2000 and 2019 by means of scientometric methods. With topic searches, the study collected 869 bibliographic records and 20, 411 references from Web of Science Core Collection (WoSCC) of Thomson Reuter. The clustered and visualized document co-citation network of the MSDs knowledge domain in CiteSpace identifies 15 research foci in different periods, including apraxia of speech, acoustics, children, technology, aphemia, childhood apraxia of speech, primary progressive aphasia, speech motor delay, Parkinson’s disease, amyotrophic lateral sclerosis, rhythm, foreign accent syndrome, phonation, phonological awareness, dose and speech perception. Revolving around linguistics, these foci could be divided into studies on speech characteristics of MSDs in terms of phonology and phonetics, remedies for MSDs in terms of neurolinguistics and acoustic phonetics, dysarthria secondary to neurological diseases based on pathological linguistics, subtypes of apraxia of speech, methods of MSDs based on auditory phonetics and a newly recognized subtype of MSDs. Meanwhile, the emerging trends of MSDs in linguistics are detected by the analysis of reference citation bursts, suggesting growing research in remedies for MSDs with the focus on assessments and effectiveness of treatments, speech characteristics and indexes of dysarthria secondary to neurological diseases and assistance to diagnose apraxia of speech. To sum up, the review has indicated that the acoustic measures to assess MSDs and acoustic remedies for dysarthria may not only be the past foci but also be future trends.
The Connections Between Founders’ Social Network and Human Capital in Technology-Based New Ventures
Authors: Zane Lee J. , DeCarolis Donna Marie
Published: December 2021

This research examines the relationship between a founding team’s social network and the acquisition of its critical human capital. First, explicitly dealing with technology-based firms, we disaggregate the founder(s) social network into four sub-networks: academic, industry, finance, and personal (family and community). Then, we detail the relationship between these individual sub-networks and the acquisition of both technical and business skilled human capital. Our results confirm that individual sub-networks have a differential effect on acquiring both technical and business human capital.
Methodology for the identification of economic, environmental and health criteria for road noise mitigation
Authors: D’Alessandro Francesco , Di Mascio Paola , Lombardi Lorenzo , Ridolfi Benedetta
Published: December 2021

The aim of the paper is to define a method for evaluating infrastructural interventions for the mitigation of noise generated by roads based on multi-criteria analysis which considers a series of parameters (environmental, social, economic and health) that could give broader evaluations than just economic convenience.

The research develops a guideline based on an already known methodology applied in other fields, which has been adapted to the above-mentioned topic: the multi-criteria analysis. The decision to use this method originates from an in-depth study of the state of the art regarding the issue of noise pollution related to transport infrastructures in Italy and at a European level.

The Multi-criteria Analysis proved to be the best solution both for completeness and versatility. In particular, the developed methodology uses the Analytic Hierarchy Process as a multi-criteria analysis method. Through its hierarchical structure, this method offers a comparison not only between possible interventions, but also between the same criteria taken into consideration for the choice of the best intervention. The model was validated by analyzing a real noise mitigation project on an Italian main road. The results showed how the model could represent a valid support to decision-making processes.
Some notes on central causal clauses in Venetian
Authors: Catasso Nicholas
Published: December 2021

The goal of this paper is to provide novel evidence in favor of an integration of Haegeman’s (2002) taxonomy of adverbial clause subordination by discussing some data from C-introduced causal constructs in Venetian, the Italo-Romance dialect spoken in the city of Venice. Haegeman’s model is based on a two-class categorization of adverbial structures into central clauses, in which matrix-clause phenomena (such as the licensing of some sentence-initial or sentence-final discourse particle-like items, XP-fronting) are excluded, and peripheral clauses, in which these phenomena are licit. The external-syntactic distinction predicted by this model, namely a semantic differentiation resulting from TP/VP-adjunction for central vs. CP-adjunction for peripheral adverbial clauses, has severe consequences for the internal syntax of the a/m constructions, the most striking being the absence of the upper projections of the Split CP of central constructs. The data presented in this paper, however, suggest that (at least) in Venetian, (some) main-clause phenomena may also be licensed in central adverbial clauses under specific circumstances. Additionally, it will be shown that the conclusions drawn from the observation of the Venetian data match the behavior of the same constructions in Standard Italian, as well as in other languages, under the very same conditions.
The dual of number sequences, Riordan polynomials, and Sheffer polynomials
Authors: He Tian-Xiao , Ramírez José L.
Published: December 2021

In this paper we introduce different families of numerical and polynomial sequences by using Riordan pseudo involutions and Sheffer polynomial sequences. Many examples are given including dual of Hermite numbers and polynomials, dual of Bell numbers and polynomials, among other. The coefficients of some of these polynomials are related to the counting of different families of set partitions and permutations. We also studied the dual of Catalan numbers and dual of Fuss-Catalan numbers, giving several combinatorial identities.
Nabû, the Avenger
Authors: Schwemer Daniel
Published: December 2021

B 158 is a Seleucid-period manuscript of the bilingual Balaĝ prayer Ukkin-ta eš-bar til-la. The tablet, which was found at Babylon in 1902 and is edited here for the first time, contains major portions of text that have hitherto been unknown. The prayer is suffused with first-millennium Nabû theology and contains a unique literary request for revenge against the enemy in the mountain lands. The findspot of B 158 may shed light on the provenance of the Late Babylonian kalûtu library of the Nanna-utu family.
Der Flussname Inn, Ockhams Rasiermesser und moderne Indogermanistik
Authors: Bichlmeier Harald
Published: December 2021

Some European hydronyms (among them also the river-name Inn) have sometimes been explained based on a root PIE “ *en‑/*on‑” (modern spelling: PIE *h₁en(H)-), which has usually been given the meaning ‘flow, river’ vel sim. This root cannot even be found in Pokorny’s Indogermanisches etymologisches Wörterbuch (1959). No real proof for that root has been found in the appellative lexicon of any Indo-European language. Moreover, there aren’t any sure continuations of that root in the onymic lexicons of those languages. All names put forward as arguments can either be explained based on a root PIE *pen-/*pon- ‘swamp, (standing) water’ (because they are Celtic) or based on a root PIE *h₂en- ‘haul (water)’. As long as no proof of an appellative use of a root PIE *h₁en(H)- can be offered, which alone might tell us, what that root actually meant, the application of ‘Occam’s razor’ leaves us no other choice but to explain all regarding names from the other two roots.
Metabolically healthy obesity was significantly associated with increased risk of gallstones
Authors: Man Sailimai , Gao Yongxiang , Lv Jun , Tong Mingkun , Yin Jianchun , Wang Bo , Ning Yi , Li Liming
Published: December 2021

Objective

The risk of gallstones among metabolically healthy obesity (MHO) individuals is largely unexplored. Therefore, the present study investigated the association between MHO and gallstones in a health check-up cohort of Chinese adults.

Design

A prospective cohort study.

Methods

Participants included 58 862 individuals from the MJ health check-up cohort aged ≥ 18 years without a history of gallstones at baseline. Gallstones were diagnosed using abdominal B-type ultrasound. Metabolically healthy was defined as not having any one of the components of metabolic syndrome. Obesity was identified by BMI and waist circumference (WC). Participants were cross-classified at baseline by metabolic health and obesity. Adjusted hazard ratios (HRs) and 95% CIs of gallstones across BMI or WC categories were estimated with Cox proportional hazard regression models.

Results

During a median follow-up of 3.0 years (interquartile range, 1.6–6.1), 1269 participants developed gallstones. Individuals with MHO (HR: 1.95, 95% CI: 1.23, 3.09 for BMI criteria; HR: 1.74, 95% CI: 1.37, 2.21 for WC criteria) had a significantly higher risk of gallstones than those with metabolically healthy normal weight. In metabolically healthy individuals, BMI and WC both displayed linear dose–response relationships with gallstones (P for non-linearity >0.05). The association between MHO and gallstones remained unchanged when using different criteria for metabolic health and obesity.

Conclusions

MHO was significantly associated with gallstones, suggesting that obesity can independently contribute to gallstones development, even among metabolically healthy individuals. These findings emphasize that metabolically healthy individuals may still benefit from maintaining normal body weight to prevent gallstones.
ВАСИЛЬ РЕГЕЙ (1915–1996): ЖИТТЯ ТА ДІЯЛЬНІСТЬ В УМОВАХ ТОТАЛІТАРНИХ РЕЖИМІВ
Authors: Микола ПОСІВНИЧ Василь ІЛЬНИЦЬКИЙ,
Published: December 2021

У статті на основі невідомих документів і матеріалів, мемуарів та наукової літератури цілісно реконструйовано біографію Василя Івановича Регея (1915–1996). Запропоновано увесь життєвий шлях Василя Івановича Регея можна поділити на декілька етапів: 1) 1915–1939 рр. – дитячі та юнацькі ро­ки, навчання у семилітній школі, німецькій гімназії (м. Станиславів), Варшавському університеті імені Йосифа Пілсудського; 2) 1939–1944 рр. – участь в українському визвольному русі – заступник повітового про­відника Сяноцького повіту (із одночасним обслуговуванням міста), учасник Південної похідної групи ОУН, провідник Дніпропетровського обласного проводу ОУН, водночас вчителювання; 3) 1944–1946 рр. – служба у радянській армії; 4) 1946–1951 рр. – науково-педагогічна праця у Дрогобицькому вчительсь­кому інституті; 5) 1951–1957 рр. – арешт, слідство, відбування покарання у виправно-трудових таборах;  6) 1957–1978 рр. – робота на лісопильному заводі с. Віхоровка; 7) 1978–1996 рр. – пенсія, повернення на Франківщину, активна участь у громадсько-політичному житті.

Методологія дослідження ґрунтується на принципах історизму, науковості, системності. У ро­боті використано біографічний та просопографічний підходи. Окрім цього автори застосували за­гальнонаукові (аналіз, синтез, узагальнення) та спеціально-історичні (історико-генетичний, історико-типологічний, історико-системний, документальної евристики) методи.

Ключові слова: Василь Регей, ОУН, Дрогобицький учительський інститут, репресивно-каральна система.
LITERARY AND THEOLOGICAL BACKGROUND OF THE SERMON ON LAW AND GRACE
Authors: МАЛМЕНВАЛЛ Симон
Published: December 2021

This article studies the literary and theological background of the Sermon on Law and Grace, a famous oration by Ilarion, the (future) Metropolitan of Kyiv, from the mid-eleventh century. The author of this article focuses also on potential patristic models for Ilarion’s theological and patriotic reflection on the recent East Slavic history in the light of the official adoption of Christianity under Volodymyr Sviatoslavich, Prince of Kyiv. The main feature of the mentioned (self-)reflection, relying on the notion of history as the history of salvation, is disregarding the Byzantine political and cultural superiority and, simultaneously, emphasizing the justice of God, who brings his grace equally to all peoples, thus positioning them on the same spiritual level. This kind of reasoning was not a peculiarity of the Rus’ culture but formed a wider phenomenon defined by apologetic attitu­de and was characteristic of the entire religious-literary tradition of the East Orthodox Slavs between the tenth and sixteenth centuries. While trying to construct a theological justification of the historical value of Kyivan Rus’, Ilarion adapted patristic patterns coming from Byzantium, for example, the explanation of (dis)continuity between the Law of Moses and Christ’s mercy, particularly following Gregory Nazianzen and Patriarch Nicephorus I, or perception of a polity led by a Christian ruler, particularly following Eusebius of Caesarea.

Keywords: Sermon on Law and Grace, Ilarion, Rus’ literature, history of salvation, patristic models
УЯВЛЕННЯ МИХАЙЛА МАКСИМОВИЧА ПРО АВСТРІЙСЬКУ ГАЛИЧИНУ ТА ЙОГО ВЗАЄМИНИ З КРАЯНАМИ
Authors: Райківський Ігор
Published: December 2021

У статті висвітлюється вплив М. Максимовича на національний рух в австрійській Галичині 30–70-х рр. ХІХ ст. В уявленні видатного українського дослідника-народознавця Галичина була не­від’ємною частиною русько-українського простору. Він зробив вагомий внесок в обґрунтування само­бутності та єдності української (“руської”, “малоруської”) мови і фольклорної спадщини обабіч авст­ро-російського кордону, спільності історичного минулого Галичини з підросійською Україною. М. Мак­си­мовичу так і не довелося особисто побувати в Галичині, але він підтримував багатолітні листовні сто­сунки з діячами “Руської трійці” І. Вагилевичем та Я. Головацьким, істориком Д. Зубрицьким. Ко­респон­денція мала інформаційно-науковий характер, охоплювала питання обміну книжками, відомостями про наукове й літературне життя. Галицькі народовці з 1860-х рр. використовували творчий доробок М. Макси­мовича у своїй видавничій діяльності для обґрунтування національної самобутності українського народу.

Ключові слова: Михайло Максимович, національний рух, народознавство, взаємини, діяч, Галичина.
ЩОДЕННИК ПІДПІЛЬНОГО ГРЕКО-КАТОЛИЦЬКОГО СВЯЩЕНИКА АНТІНА СІРЕЦЬКОГО (березень 1950 – грудень 1952 рр.)
Authors: Олег Єгрешій Оксана Сірецька,
Published: December 2021

Сучасна Церква (а йдеться не лише про священиків, але і про мирян) як ніколи гостро потребує прикладних чеснот. Імовірно, методологічно суперечливо оперувати поняттям “істо­рична Церква”, адже Церква, як зазначають богослови, створена Христом “відвіку і повсякчас” але це визначення, на наш погляд, має низку переваг. Водночас, в історичному минулому раз-у-раз шукаємо (і знаходимо!) відповіді на нагальні питання сьогодення. Не спроста ж про сучасну культуру фахівці говорять, як про “культуру гіпермаркету”, “культуру ницого сакрального”; йдеться про постхристиянську Європу, “light версію” християнства, етнографічне християнство тощо. На гадці висловлювання відомого релігійного діяча сучасності кардинала Римо-като­лицької Церкви, гвінейця Роберта Сара який нещодавно зауважив: “Церква вмирає, тому що священики бояться говорити правдиво та чітко. Ми боїмося засобів масової інформації, гро­мад­ської думки, своїх братів! Але добрий пастир віддає життя за своїх овець (...) Незабаром мене покличуть до Вічного Судді. Якщо я не передам правду, яку отримав, що я Йому скажу? Ми, єпископи, повинні тремтіти від думки про наше винне мовчання, наше поблажливе мовчання, наше поблажливе мовчання з навколишнім світом”
ЗАРАДИ ЮШКИ ТА ЗАРАДИ КНИГИ. ЖІНКИ-МІГРАНТКИ ЗІ СХОДУ ТА ПРАКТИКИ ТРАНСНАЦІОНАЛІЗМУ. Козенца: Пеллегріні Едіторе, 2018. 230 с. Рец. на монографію Стефанії Cальвіно
Authors: Алла Горбенко Петро Гаврилишин,
Published: December 2021

Сучасні міграційні процеси вже не одне десятиліття викликають чималий науковий інте­рес та гострі дискусії. Значна кількість українських досліджень присвячена трудовій мігра­ції українців до країн Західної Європи, зокрема Італії. Зростає інтерес до української імміграції і з боку італійських дослідників, оскільки вона є п’ятою, згідно книги, за чисельністю інозем­ною громадою та поступово набуває рис діаспори.

Суттєвим доповненням до існуючого  бібліографічного доробку є праця італійської дослідниці, спеціалістки з слов’янської лінгвістики та докторки соціології університету Калаб­рії Стефанії Сальвіно. Монографія “Заради юшки та заради книги. Жінки-мігрантки зі Сходу та практики транснаціоналізму” розглядає українську трудову жіночу міграційну групу в Італії у контексті глобального процесу транснаціоналізації міграцій. Такий підхід дозволяє більш точно зрозуміти як еволюціонує українське заробітчанство та динаміку інтеграції українців в Італії, вивчити особливості їхньої адаптації, побачити соціальний простір, в якому вони існують.
АРЕШТИ УКРАЇНСЬКОЇ ІНТЕЛІГЕНЦІЇ В 1965 р. НА ІВАНО-ФРАНКІВЩИНІ
Authors: Паска Богдан
Published: December 2021

Метою статті є комплексне дослідження арештів української інтелігенції в 1965 р. на тери­торії Івано-Франківської області. У контексті цієї мети виділені такі завдання: встановлення кіль­кісних масштабів арештів на території Івано-Франківщини, аналіз висунутих представникам інтелі­генції обви­нувачень, методів ведення слідства, поведінки заарештованих, дослідження судових процесів над іва­но-франківськими дисидентами. Основу джерельної бази становлять документи Галузевого державного архіву Служби безпеки України у м. Київ та матеріали самвидаву. Методологічною осно­вою дослідження є концепція Я. Секо про співіснування в українському русі спротиву 1950–80‑х рр. двох парадигм – націо­нально-визвольної (підпільні організації) та націоналізаційної (легальна діяльність інтелігенції із сере­до­вища “шістдесятників”). Автор статті приходить до висновку, що у ході хвилі репресій проти україн­ського шістдесятницького правозахисту у серпні-вересні 1965 р. було затримано п’ятьох представників інтелігенції Івано-Франківщини, із яких чотирьох осіб (В. Мороза, О. Заливаху, М. Озерного, В. Іванишина) було заарештовано. Основними пунктами обвинувачення були розповсю­джен­­ня забороненої літератури та бесіди про необхідність виходу України з СРСР, що було трак­товано як “антирадянська агітація і пропаганда”. Суворість покарання інакодумців значною мірою за­лежала від проявлення ними у ході слідства необхідних емоцій, які свідчили б про їх “розкаяння” і “пере­виховання”. У ході “першої хвилі арештів” Івано-Франківська область опинилась на третьому міс­ці за кількістю репресованих осіб після Львівщини та Київщини. Репресії завдали значного удару по осередках шістдесятницького правозахисту на Прикарпатті та місцевій мережі поширення самвидавної літератури.

Ключові слова: український дисидентський рух, радянський режим, “перша хвиля арештів”, самвидав, Комітет державної безпеки (КДБ), Валентин Мороз, Опанас Заливаха, Михайло Озерний.
The Problem of Cerebral Palsy Today
Authors: MUNNS G. F.
Published: December 2021

Dr. Perlstein presents the problem in the care of cerebral palsy patients as it confronts us today. The monograph is concise, well written, and reveals the author's comprehensive knowledge of the subject.

Part one is concerned with a general description of the problem and discusses the causes, types, prognosis, incidence and other pertinent information and observations. Our present facilities for care are outlined, and this picture is a sorry one indeed. Only about 10% of these unfortunate individuals receive adequate care at the present time.

Part two offers a well thought out and sensible plan to provide effective care. The proposed In-Patient Hospital-Schools and Out-Patient Clinic-Schools administered at state levels seem to offer a method of care far superior to any plan existing in most of our states today. There are a few states which have already inaugurated this or a similar plan.
Physiology of Man in the Desert
Authors: DARROW DANIEL C.
Published: December 2021

No one can read this book without gaining valuable knowledge concerning water metabolism. Adolph and ten associates summarize studies made for an Army contract on adaptation to the desert. The book is not written solely for physiologists but also for physicians and intelligent Army officers who have to use this knowledge. Since Adolph is one of the foremost physiologists working in this field, the book is authoritative. The style is clear and the index and arrangement of material permits ready reference.

The chief factor in the adaptation to a desert climate is dissipation of heat by evaporation of water. Heat is added from metabolism, from air warmer than the skin, and from radiant energy.
Yesterday a Learner, Today a Teacher Too: Residents as Teachers in 2000
Authors: Morrison Elizabeth H. , Hafler Janet Palmer
Published: December 2021

Resident physicians spend numerous hours every week teaching medical students and fellow residents, and only rarely are they taught how to teach. They can, however, be taught to teach more effectively. Teaching skills improvement initiatives for residents are taking a more prominent place in the educational literature. Limited evidence now suggests that better resident teachers mean better academic performance by learners. A small but important body of research supports selected interventions designed to improve residents' teaching skills, but not all studies have demonstrated significant educational benefits for learners. An increasing number of valid and reliable instruments are available to assess residents' clinical teaching, including objective structured teaching examinations and rating scales. In all specialties, rigorous research in evidence-based teacher training for residents will help prepare academic medical centers to meet the diverse and changing learning needs of today's physicians-in-training.resident physicians, medical students, fellow residents, teaching, graduate medical education.
A Trade-off Analysis of Routine Newborn Circumcision
Authors: Christakis Dimitri A. , Harvey Eric , Zerr Danielle M. , Feudtner Chris , Wright Jeffrey A. , Connell Frederick A.
Published: December 2021

Background.

The risks associated with newborn circumcision have not been as extensively evaluated as the benefits.

Objectives.

The goals of this study were threefold: 1) to derive a population-based complication rate for newborn circumcision; 2) to calculate the number needed to harm for newborn circumcision based on this rate; and 3) to establish trade-offs based on our complication rates and published estimates of the benefits of circumcision including the prevention of urinary tract infections and penile cancer.

Methods.

Using the Comprehensive Hospital Abstract Reporting System for Washington State, we retrospectively examined routine newborn circumcisions performed over 9 years (1987–1996). We used International Classification of Diseases, Ninth Revision codes to identify both circumcisions and complications and limited our analyses to children without other surgical procedures performed during their initial birth hospitalization.

Results.

Of 354 297 male infants born during the study period, 130 475 (37%) were circumcised during their newborn stay. Overall 287 (.2%) of circumcised children and 33 (.01%) of uncircumcised children had complications potentially associated with circumcision coded as a discharge diagnosis. Based on our findings, a complication can be expected in 1 out every 476 circumcisions. Six urinary tract infections can be prevented for every complication endured and almost 2 complications can be expected for every case of penile cancer prevented.

Conclusions.

Circumcision remains a relatively safe procedure. However, for some parents, the risks we report may outweigh the potential benefits. This information may help parents seeking guidance to make an informed decision.
Hawaii's Healthy Start Program of Home Visiting for At-Risk Families: Evaluation of Family Identification, Family Engagement, and Service Delivery
Authors: Duggan Anne , Windham Amy , McFarlane Elizabeth , Fuddy Loretta , MPH LCSW, , Rohde Charles , Buchbinder Sharon , Sia Calvin
Published: December 2021

Objective.

To describe family identification, family engagement, and service delivery in a statewide home visiting program for at-risk families of newborns.

Setting.

Six target communities of Hawaii's Healthy Start Program (HSP), which incorporates 1) early identification of at-risk families of newborns via population-based screening and assessment, and 2) paraprofessionalhome visiting to improve family functioning, promote child health and development, and prevent child maltreatment.

Design.

Cross-sectional study: describes early identification process and family characteristics associated with initial enrollment. Longitudinal study: describes home visiting process and characteristics associated with continued participation.

Subjects.

Cross-sectional study: civilian births in 6 communities (n = 6553). Longitudinal study: at-risk families in the intervention group of a randomized trial of the HSP (n = 373).

Measures.

Process: completeness and timeliness of early identification and home visiting activities; family characteristics: sociodemographics, child abuse risk factors, infant biologic risk.

Results.

Early identification staff determined risk status for 84% of target families. Families with higher risk scores, young mothers with limited schooling, and families with infants at biologic risk were more likely to enroll in home visiting. Half of those who enrolled were active at 1 year with an average of 22 visits. Families where the father had multiple risk factors and where the mother was substance abusing were more likely to have ≥12 visits; mothers who were unilaterally violent toward the father were less likely. Most families were linked with a medical home; linkage rates for other community resources varied widely by type of service. Half of families overall, but ≥80% of those active at 1 year, received core home visiting services. Performance varied by program site.

Conclusions.

It is challenging to engage and retain at-risk families in home visiting. Service monitoring must be an integral part of operations.
Effect of Method of Defining the Active Patient Population on Measured Immunization Rates in Predominantly Medicaid and Non-Medicaid Practices
Authors: Morrow Ardythe L. , Crews R. Clinton , Carretta Henry J. , Altaye Mekibib , Finch Albert B. , Sinn Jeffrey S.
Published: December 2021

Objective.

To examine the effect of patient selection criteria on immunization practice assessment outcomes.

Methods.

In 3 high- (50%–85%) and 7 low- (<25%) Medicaid pediatric practices in urban eastern Virginia, we assessed immunization rates of children 12 and 24 months old comparing thestandard criteria (charts in the active files excluding those that documented the child moved or went elsewhere) with 3 alternative criteria for selecting active patients: 1)follow-up: the chart contained a complete immunization record or the patient was found to be active in the practice through follow-up contact by phone or mail; 2) seen in the past year: the chart indicated that the patient was seen in the practice in the past year; 3) consecutive: patients that were seen consecutively for any reason.

Results.

Of the 1823 charts assessed in the high- and low-Medicaid practices, follow-up identified 61% and 83% as active patients; 78% and 95% were ever seen in the past year. At 24 months, mean practice immunization rates were lower for standard (70%) than all 3 alternative criteria (78%–86%). Immunization rate differences between standard and alternative criteria were greater in high- (17%–23%) than low-Medicaid practices (5%–13%).

Conclusion.

The standard for practice assessment should be based on a consistent definition of active patients as the immunization rate denominator.
Pediatric Deaths Attributable to Complex Chronic Conditions: A Population-Based Study of Washington State, 1980–1997
Authors: Feudtner Chris , Christakis Dimitri A. , Connell Frederick A.
Published: December 2021

Objectives.

Advances in medical technology and public health are changing the causes and patterns of pediatric mortality. To better inform health care planning for dying children, we sought to determine if an increasing proportion of pediatric deaths were attributable to an underlying complex chronic condition (CCC), what the typical age of CCC-associated deaths was, and whether this age was increasing.

Design.

Population-based retrospective cohort from 1980 to 1997, compiled from Washington State annual censuses and death certificates of children 0 to 18 years old.

Main Outcome Measures.

For each of 9 categories of CCCs, the counts of death, mortality rates, and ages of death.

Results.

Nearly one-quarter of the 21 617 child deaths during this period were attributable to a CCC. Death rates for the sudden infant death syndrome (SIDS), CCCs, and all other causes each declined, but less so for CCCs. Among infants who died because of causes other than injury or SIDS, 31% of the remaining deaths were attributable to a CCC in 1980 and 41% by 1997; for deaths in children 1 year of age and older, CCCs were cited in 53% in 1980, versus 58% in 1997. The median age of death for all CCCs was 4 months 9 days, with substantial differences among CCCs. No overall change in the age of death between 1980 to 1997 was found (nonparametric trend test).

Conclusions.

CCCs account for an increasing proportion of child deaths. The majority of these deaths occur during infancy, but the typical age varies by cause. These findings should help shape the design of support care services offered to children dying with chronic conditions and their families.
Counseling Families Who Choose Complementary and Alternative Medicine for Their Child With Chronic Illness or Disability
Authors:   Committee on Children With Disabilities
Published: December 2021

This Policy Statement was retired January 2018.

The use of complementary and alternative medicine (CAM) to treat chronic illness or disability is increasing in the United States. This is especially evident among children with autism and related disorders. It may be challenging to the practicing pediatrician to distinguish among accepted biomedical treatments, unproven therapies, and alternative therapies. Moreover, there are no published guidelines regarding the use of CAM in the care of children with chronic illness or disability. To best serve the interests of children, it is important to maintain a scientific perspective, to provide balanced advice about therapeutic options, to guard against bias, and to establish and maintain a trusting relationship with families. This statement provides information and guidance for pediatricians when counseling families about CAM.
CLINICAL DIAGNOSIS OF ENDOCARDIAL FIBROSIS
Authors: LAMBERT EDWARD C. , SHUMWAY CLARE N. , TERPLAN KORNEL
Published: December 2021

Evidence has been presented which indicates that endocardial fibrosis is a relatively common cause of death from heart disease in infancy and that a presumptive diagnosis of this condition can often be made during life. The salient features are: age under one year, marked dyspnea without persistent cyanosis, absence of a loud cardiac murmur on repeated examinations, enlargement of the heart, presence of femoral pulsations, and electrocardiographic evidence of left ventricular hypertrophy in the precordial leads. The chief conditions to be considered in the differential diagnosis are: aberrant coronary artery, interstitial myocarditis, and glycogen storage disease of the heart, all of which are much less frequent in the autopsy data. Four cases are presented in detail. In two of these the diagnosis was correctly made before death.
Symposium
Authors: COE HERBERT E. , BILL ALEXANDER H. , SWENSON ORVAR , KOOP C. EVERETT , HUDSON HENRY W. , WYATT OSWALD S.
Published: December 2021

At the Toronto meeting of the American Academy of Pediatrics it was suggested that the Surgical Section be responsible for a portion of the program at the next annual meeting, the presentations to be in the form of a symposium. Articles relating to surgical conditions in infants and children frequently appear in current medical literature presenting opinions which are often divergent, or even conflicting, and members of the Academy have often commented on this apparent confusion. It seemed timely, therefore, to select several of the more common of these conditions and assign each to a member of the Surgical Section for a discussion which might reasonably be expected to represent one of the views more generally accepted by surgeons primarily interested in children. Complete unanimity is of course not to be expected nor desired, as an honest difference of opinion promotes healthy discussion and progress.

Several of the comments on the presentations indicated that panel discussions on some of the subjects would be most interesting and might well be included in future programs.

The close attention and favorable reaction of the audience was most gratifying, and it was regrettable that Dr. Potts who planned and coordinated the Symposium was prevented by illness from acting as chairman. Illness also prevented Dr. Wilkinson from presenting his discussion on "Bronchiectasis" but fortunately his time could be made available for the Honorary Life President of the Surgical Section, Dr. William E. Ladd, whose excellent address will be long remembered by all who heard it.
Round Table Discussion
Authors: NEUHAUSER EDWARD B. D. , KNOTT PIERCE D. , STORTS BRICK P.
Published: December 2021

Chairman Neuhauser: I have been very much impressed with the pediatricians who know much more about diseases and abnormalities of the heart and lungs than they give themselves credit for, but the roentgen manifestations of abnormalities of the gastrointestinal tract do not appear to be as well understood. Many of the lesions that occur in the gastrointestinal tract, even the common ones, are overlooked. An understanding of the simple lesions and many of the more complicated ones is essential if the proper roentgen examination is to be carried out.

Most of the congenital malformations that occur have a rather simple embryologic explanation. There is defective recanalization of the fetal gut. When the fetal gut is first formed it is an open tube, but during the first few weeks of fetal life there is proliferation of the epithelial lining cells with obliteration of the lumen. Recanalization promptly ensues.

Many of the abnormalities occur during this process of recanalization. Stenosis, atresia, diverticular, duplication and many of the fistulas have their origin during this period of recanalization. The very simple lesions of stenosis and atresia are best demonstrated by lantern slides.

Tracheo-esophageal fistula without atresia or stenosis of the esophagus is not at all uncommon. Many are overlooked because the condition is not suspected; others may be overlooked because the roentgen examination is not properly carried out. Certainly a fistula between the esophagus and trachea running obliquely upward from the anterior aspect of the upper third of the esophagus to the trachea cannot be visualized if the patient is examined only in the supine or prone position.
Symposium
Authors: RATNER BRET , HARRIS T. N. , BOHROD MILTON G. , ROSTENBERG ADOLPH
Published: December 2021

This review will describe certain developments which have appeared recently in the immunologic literature involving the transfer of viable cells from one animal to another. In 1940 Landsteiner and Chase showed that it was possible to remove cellular exudates from guinea pigs sensitized with simple chemical compounds, wash these cells and transfer them to fresh guinea pigs and then to demonstrate in the recipient guinea pigs dermal sensitivity to the original compound. More recently, Dr. Merrill Chase sensitized guinea pigs with o-chlorobenzoyl chloride: paraffin oil had been injected intraperitoneally into these animals 48 hours before, in order to induce the necessary cellular accumulation. These cells were collected, washed and injected into a recipient guinea pig, which thereupon developed a positive reaction to the allergen.

Similar experiments were done with cells secured from lymph nodes of sensitized guinea pigs and in the case of heat-killed tubercle bacilli suspended in hydrocarbon as antigen.

The same phenomenon has been demonstrated by Metaxas with intradermally injected cells, and by Lawrence in the human species with leucocytes collected from blood and injected intradermally.

Tissue reactions of the immediate type of hypersensitivity have also been demonstrated by Chase as a function of transferred cells by the use of the Schultz-Dale technic, as well as by an adaptation of the PK type of reaction to the measurement of classical antibodies.

It was felt in our laboratory that this type of approach might provide more direct information on the mechanism of antibody formation in the cells involved. Accordingly, a study of such cells was undertaken, using largely bacterial cells as antigens and measuring the agglutinins produced thereto.
Evaluation, Development, and Implementation of Potentially Better Practices in Neonatal Intensive Care Nutrition
Authors: Kuzma-O’Reilly Barbara , Duenas Maria L. , Greecher Coleen , Kimberlin Lois , Mujsce Dennis , Miller Debra , Walker Donna Jean
Published: December 2021

Objective. The desire for evidence-based clinical guidelines for nutritional support of the preterm infant has been identified. Published evidence has not yielded clear guidelines about the best method of delivery, substrate use, or appropriate outcome measure to evaluate nutrition support. In addition, reports on research of nutrition support often fail to give the most rudimentary process necessary to improve quality in various unit settings.

Methods. The Vermont Oxford Network “Got Milk” focus group developed eight potentially better practices for nutrition support, implementation strategies for these practices, and a comprehensive appraisal process to measure nutrition outcome in preterm infants.

Results. After implementation of the potentially better practices, all participating institutions showed earlier initiation of nutrition support, earlier attainment of adequate energy intakes, reduced delay in reaching full enteral feeds, more consistent nutrition support practice, decreased length of stay, cost savings, and improved growth at time of discharge.

Conclusions. Development and implementation of evidence-based better nutrition support practices in neonates led to improved nutrient intake and growth with reduced length of stay and related costs. Consistent, comprehensive, multidisciplinary appraisal of practice is an integral component of improving nutrition outcomes in the neonatal population.
Development of Potentially Better Practices for the Neonatal Intensive Care Unit as a Culture of Collaboration: Communication, Accountability, Respect, and Empowerment
Authors: Ohlinger Judy , Brown Mark S. , Laudert Sue , Swanson Sue , Fofah Ona ,   on Behalf of the CARE Group
Published: December 2021

Objective. The Vermont Oxford Network (VON) CARE Group was formed in response to the need to create organizational cultures supportive of change and quality improvement.

Methods. The CARE Group consisted of team members from 4 participating neonatal intensive care units (NICUs). All CARE Group members chose to work on multidisciplinary teamwork for the duration of the Neonatal Intensive Care Quality Improvement Collaborative Year 2000. A questionnaire was developed by the CARE Group and administered to the 4 focus group NICUs. The survey focused on 6 domains of the organization: unit coordination, working in the NICU, leadership, management of disagreements, authority, and unit culture. Benchmarking visits were completed to supplement the information found in the survey and the literature.

Results. Seven potentially better practices (PBPs) were developed on the basis of the surveys, benchmark visits, and literature reviews. The PBPs include 1) a clear, shared NICU purpose, goals, and values; 2) effective communication among and between teams and team members; 3) leaders lead by example; 4) nurture a collaborative NICU environment with trust and respect; 5) live principled standards of conduct and standards of excellence; 6) nurture competent and committed teams and team members; and 7) commit to effective and positive conflict management.

Conclusions. The CARE Group successfully used quality improvement methods and collaboration to delineate principles and practices of multidisciplinary teamwork.
Behavioral and Developmental Effects of Preventing Iron-Deficiency Anemia in Healthy Full-Term Infants
Authors: Lozoff Betsy , De Andraca Isidora , Castillo Marcela , Smith Julia B. , Walter Tomas , Pino Paulina
Published: December 2021

Objective. To determine the behavioral and developmental effects of preventing iron-deficiency anemia in infancy.

Methods. Healthy full-term Chilean infants who were free of iron-deficiency anemia at 6 months were assigned to high- or low-iron groups or to high- or no-added-iron groups. Behavioral/developmental outcomes at 12 months of age included overall mental and motor test scores and specific measures of motor functioning, cognitive processing, and behavior. There were no differences between high- and low-iron groups in the prevalence of iron-deficiency anemia or behavioral/developmental outcome, and they were combined to form an iron-supplemented group (n = 1123) for comparison with the no-added-iron group (n = 534).

Results. At 12 months, iron-deficiency anemia was present in 3.1% and 22.6% of the supplemented and unsupplemented groups, respectively. The groups differed in specific behavioral/developmental outcomes but not on global test scores. Infants who did not receive supplemental iron processed information slower. They were less likely to show positive affect, interact socially, or check their caregivers’ reactions. A smaller proportion of them resisted giving up toys and test materials, and more could not be soothed by words or objects when upset. They crawled somewhat later and were more likely to be tremulous.

Conclusions. The results suggest that unsupplemented infants responded less positively to the physical and social environment. The observed differences seem to be congruent with current understanding of the effects of iron deficiency on the developing brain. The study shows that healthy full-term infants may receive developmental and behavioral benefits from iron supplementation in the first year of life.
Effects of Environmental Exposures on the Cardiovascular System: Prenatal Period Through Adolescence
Authors: Mone Suzanne M. , Gillman Matthew W. , Miller Tracie L. , Herman Eugene H. , Lipshultz Steven E.
Published: December 2021

Exposures to drugs, chemical and biological agents, therapeutic radiation, and other factors before and after birth can lead to pediatric or adult cardiovascular anomalies. Furthermore, nutritional deficiencies in the perinatal period can cause cardiovascular anomalies. These anomalies may affect heart structure, the conduction system, the myocardium, blood pressure, or cholesterol metabolism. Developmental periods before and after birth are associated with different types of risks. The embryonic period is the critical window of vulnerability for congenital malformations. The fetal period seems to have lifelong effects on coronary heart disease and its precursors. During the weeks immediately after birth, susceptibility to myocardial damage seems to be high. Exposure to cancer chemotherapy or radiotherapy in childhood raises the risk of long-term progressive left ventricular dysfunction and other cardiovascular problems. In childhood and adolescence, use of recreational drugs such as cocaine and tobacco poses cardiovascular dangers as well. Where evidence about environmental exposures is limited, we have included models of disease and other exposures that are suggestive of the potential impact of environmental exposures.
Environmental Pediatrics and Its Impact on Government Health Policy
Authors: Goldman Lynn , Falk Henry , Landrigan Philip J. , Balk Sophie J. , Reigart J. Routt , Etzel Ruth A.
Published: December 2021

Recent public recognition that children are different from adults in their exposures and susceptibilities to environmental contaminants has its roots in work that began >46 years ago, when the American Academy of Pediatrics (APA) established a standing committee to focus on children’s radiation exposures. We summarize the history of that important committee, now the AAP Committee on Environmental Health, including its statements and the 1999 publication of the AAP Handbook of Pediatric Environmental Health, and describe the recent emergence of federal and state legislative and executive actions to evaluate explicitly environmental health risks to children. As a result in large part of these efforts, numerous knowledge gaps about children’s health and the environment are currently being addressed. Government efforts began in the 1970s to reduce childhood lead poisoning and to monitor birth defects and cancer. In the 1990s, federal efforts accelerated with the Food Quality Protection Act, an executive order on children’s environmental health, the Agency for Toxic Substances and Disease Registry/Environmental Protection Agency Pediatric Environmental Health Specialty Units, and National Institute of Environmental Health Sciences/Environmental Protection Agency Centers of Excellence in Research in Children’s Environmental Health. In this decade, the Children’s Environmental Health Act authorized the National Children’s Study, which has the potential to address a number of critical questions about children’s exposure and health. The federal government has expanded efforts in control and prevention of childhood asthma and in tracking of asthma, birth defects, and other diseases that are linked to the environment. Efforts continue on familiar problems such as the eradication of lead poisoning, but new issues, such as prevention of childhood exposure to carcinogens and neurotoxins other than lead, and emerging issues, such as endocrine disruptors and pediatric drug evaluations, are in the forefront. More recently, these issues have been taken up by states and in the international arena.