bluuebunny/crossref_metadata_2025 huggingface dataset:
Nonfamilial Cutaneous Melanoma Incidence in Women Associated With Sun Exposure Before 20 Years of Age
Authors: Weinstock Martin A. , Colditz Graham A. , Willett Walter C. , Stampfer Meir J. , Bronstein Ben A. , Mihm Martin C. , Speizer Frank E.
Published: December 2021

Despite strong evidence that sun exposure causes malignant melanoma, the details of this relation remain unclear. A nested case-control analysis was conducted within the Nurses' Health Study cohort to examine the relation between timing of severe sun exposure and incidence of melanoma. The subjects were 130 white women aged 38 to 65 years with confirmed cutaneous melanoma (other than acral lentigenous) who reported no history of melanoma in first-degree relatives. The control subjects were 300 women matched by race, date of birth, and cycle of questionnaire who also reported no history of melanoma in first-degree relatives. We used conditional logistic regression to evaluate the relation of sun damage after 30 years of age and sun damage from 15 to 20 years of age to the incidence of melanoma. Blistering sunburns between 15 to 20 years of age were associated with risk of melanoma (relative risk = 2.2 for five or more burns vs none, 95% confidence interval 1.2 to 3.8). This association persisted when a history of burns after 30 years of age was controlled in the analysis. No material association was found between blistering sunburns after 30 years of age and melanoma. Similarly, a more equatorial latitude of residence between 15 and 20 years of age was positively associated with melanoma; latitude after 30 years of age was less strongly and not significantly related to melanoma risk. Sun exposure prior to 20 years of age is more closely associated with melanoma risk than sun exposure after 30 years of age.
Movement Disorder of Premature Infants With Severe Bronchopulmonary Dysplasia: A New Syndrome
Authors: Perlman Jeffrey M. , Volpe Joseph J.
Published: December 2021

A previously unrecognized, striking movement disorder has been observed in 10 premature infants with severe bronchopulmonary dysplasia. Chronic hypoxemia, hypercarbia, bronchospasm, and inadequate nutrition were present in all. The movement disorder developed from approximately the third postnatal month. The dominant movements involve the limbs, neck, trunk, and oral-buccal-lingual structures. The limb movements were most prominent distally and consisted of rapid, random, jerky movements (similar to chorea) and "restless" movements (similar to akathisia). Similar movements of the neck and face were observed; tongue movements had a "darting" quality. The oral-buccal-lingual movements were similar to the dyskinesia of older patients. Movements were exacerbated during episodes of respiratory failure and attenuated during sleep. All infants exhibited feeding disorders, largely due to tongue movements. In 3 infants treated with clonazepam, there was striking improvement in motor function, including feeding. The natural history was partial or complete resolution or a static course. Thus, of the 7 surviving infants, the movements were absent (without therapy) at 15, 18, and 30 months of age. In the remaining 4 infants (3 of whom receive clonazepam), the movements, though attenuated, persisted at 6, 12, 15, and 21 months of age, respectively. Neuropathologically, 1 infant showed neuronal loss with astrocytosis in caudate, putamen, globus pallidus, and thalamus. These data defined a previously unrecognized extrapyramidal movement disorder of infants with severe bronchopulmonary dysplasia; pathogenesis may be related to chronic hypoxemia.
Epidemiologic Aspects of Kawasaki Disease in a Manhattan Hospital
Authors: Ichida Fukiko , Fatica Nunzia S. , O'Loughlin John E. , Klein Arthur A. , Snyder Michael S. , Levin Aaron R. , Ehlers Kathryn H. , Lesser Martin L. , Engle Mary Allen
Published: December 2021

Epidemiologic and clinical features of Kawasaki disease in 106 patients seen between 1980 and 1986 at The New York Hospital in midtown Manhattan were compared with those in large series from the United States, Canada, and Japan. Dissimilarities in our Kawasaki disease experience included ethnic heterogeneity of our patients (50% white, 18% black, 16% Hispanic, and 16% Oriental) and, in comparison with the Japanese experience, an older mean age (3½ vs 1½ years) with fewer children less than 2 years of age (32% vs 50% to 60%). In comparison with the general population of the geographic urban and suburban referral area for our hospital and in comparison with our general pediatric population, Oriental children with Kawasaki disease were overrepresented (16% vs 2%). More families of children with Kawasaki disease were members of the upper and middle class (73%) than were the population seen in general pediatrics (31.7%) at our hospital. Personal interviews with 63 families of children with Kawasaki disease and 63 control families with children paired for ethnic group, sex, and age revealed no epidemiologic differences except for use of rug shampoo within 1 month of onset in 16 episodes in 15 children with Kawasaki disease in 14 families (22% of families) compared with two families of control children (3%) (P < .001).
ENDURING FAMILIES AT RISK
Authors: Student
Published: December 2021

A divorce-prone society is producing its first generation of young adults, men and women so anxious about attachment and love that their ability to create enduring families is imperiled.
Topical Skin Anesthesia for Venous, Subcutaneous Drug Reservoir and Lumbar Punctures in Children
Authors: Halperin Daniel L. , Koren Gideon , Attias Dina , Pellegrini Elizabeth , Greenberg Mark L. , Wyss Marinette
Published: December 2021

A new topical anesthetic ointment (EMLA, "eutectic mixture of local anesthetic" 5%) composed of eutectic mixture of prilocaine and lidocaine was studied in a double-blind, placebo-controlled trial to evaluate its efficiency in alleviating pain associated with venous, subcutaneous drug reservoir and lumbar punctures in children. Pain intensity was scored by the children themselves, using a visual analogue scale in which 0 corresponded to absence of sensation and 10 to the worst imaginable painful sensation. Venipunctures were performed on 18 children (6.1 to 12.2 years of age) equally divided in the study and control groups; EMLA cream was associated with lesser pain scores than those with placebo (means ± SD: 2.8 ± 2.4 vs 6.8 ± 2.1, P < .01). A crossover trial was used in the studies of subcutaneous drug reservoir and lumbar punctures, eight children (6.1 to 15.1 years of age) were tested for subcutaneous drug reservoir punctures; pain induced by this procedure was rated at 3.9 ± 2.2 with placebo compared with 1.2 ± 1.8 with EMLA cream (P < .04). In lumbar punctures (14 children studied, 5.5 to 15.3 years of age), EMLA cream was again associated with less pain (1.9 ± 1.9) than was placebo (5.6 ± 3.0, P < .01). It was concluded that the use of EMLA cream substantially reduces pain caused by venous, subcutaneous drug reservoir, and lumbar punctures in children and may therefore be offered to young patients, particularly those repeatedly submitted to such procedures.
Infant Mortality Among Moderately Low Birth Weight Infants in Alabama, 1980 to 1983
Authors: Hale Christiane B. , Druschel Charlotte M.
Published: December 2021

A previous study of postneonatal deaths among normal birth weight infants in Alabama indicated that rural residence increased the risk of postneonatal death, the magnitude of the excess risk in the black population, and the risk of death from preventable causes. To determine whether this pattern persisted in a group presumably at higher than usual risk of infant death, patterns of mortality among infants weighing 1500 to 2499 g at birth and born in Alabama between 1980 and 1983 were examined by race, residence, and cause of death. Neonatal and infant mortality rates were higher for white infants; postneonatal mortality rates were higher for black infants. Neonatal mortality was highest for white infants from the rural part of the state; postneonatal mortality was highest for black infants from the rural part of the state. There was little variation in the proportion of preventable postneonatal deaths by race or residence (17.6% for all) but almost twice as many white deaths were not preventable as black ones (39.0 vs 21.9%). It is posited that rural residence may actually be a surrogate measure for lack of access to health services.
Family Functioning, Temperament, and Psychologic Adaptation in Children With Congenital or Acquired Limb Deficiencies
Authors: Varni James W. , Rubenfeld Lori Ann , Talbot Darlene , Setoguchi Yoshio
Published: December 2021

Family functioning and child temperament variables were investigated as predictors of psychologic and social adaptation in 42 children with congenital or acquired limb deficiencies. Higher psychologic and social adaptation were seen when there was more family cohesion and moral-religious emphasis and organization, in combination with less family conflict. With regard to child temperament, more emotionality predicted greater internalizing and externalizing behavior problems and less social competence. In addition to the main effects of the family functioning and child temperament predictor variables, the interaction between family cohesion and child emotionality significantly predicted both internalizing and externalizing behavior problems. The findings are discussed in terms of the risk and protective effects of family functioning domains and temperament on the psychologic and social adaptation of children with visible physical handicaps.
Second-Generation Consequences of Small-for-Dates Birth
Authors: Klebanoff Mark A. , Meirik Olav , Berendes Heinz W.
Published: December 2021

This is the first reported study of birth outcomes of a group of women whose own birth weights and gestational ages had been previously recorded. Births occurring from 1972 to 1983 among 1154 Swedish women, born from 1955 to 1965, were studied. Women who were themselves small for gestational age (SGA) at birth were at increased risk of giving birth to a SGA infant (odds ratio = 2.21, 95% confidence interval = 1.41, 3.48). Women who had been SGA had an even greater increase in risk of giving birth to a preterm infant (odds ratio = 2.96, 95% confidence interval = 1.47, 5.94). Women who were preterm at birth were not at increased risk of giving birth to either preterm (odds ratio = 0.65, 95% confidence interval = 0.15, 2.74) or SGA (odds ratio 1.21, 95% confidence interval = 0.62, 2.38) infants. It is concluded that the long-term effects of intrauterine growth retardation may extend to the next generation; women who had been SGA should be considered at increased risk to give birth to both growth-retarded and preterm infants.
In Reply: Office-Based Medication Dispensing: Another Consideration
Authors: SHEA DANIEL W.
Published: December 2021

It would appear that the use of manpower resources of a local school of pharmacy to staff an on-site office pharmacy is a creative solution to an area of inadequate patient services. This model might be considered by others to be an excellent alternative to dispensing vs no provision of convenient medication services to patients.
Regaining Control of the Television Set
Authors: AGRE FRED
Published: December 2021

In response to Dr Strasburger's (Pediatrics 1989;83: 446-448) admonishment, I recently attempted to "regain control of the television set." Although the odds were against me, three teenagers to one parent, I was sure that his expert and righteous guidance would carry me to victory over the brain dead viewers.

It was a fierce battle. The "enemy" was dug in, unwilling to be moved from such impregnable positions as the sofa, the floor, and the chair. Only a frontal assault, requiring hand to hand combat, could win the day.
GLUT OF NEONATOLOGISTS AND NICU BEDS?
Authors: Student
Published: December 2021

[National Perinatal Information Center] survey figures reveal . . . there are about 2,021 neonatologists practising or between 37 percent and 60 percent too many subspecialty physicians in the field [U.S.]. . . . Between 1983 and 1985, births increased by 3.2 percent from 3,639,999 to 3,757,000. Nonetheless, the numbers of reported neonatal intensive care beds rose by 15.5 percent. . . . The analyses on manpower and beds point toward a system with excess capacity.
ICONOCLASTS AT WORK
Authors: Student
Published: December 2021

To assess the predictive value for perinatal brain damage of acidosis at birth, alone or in combination with the Apgar score at 5 minutes, a cohort of 982 liveborn infants delivered over the two months was studied prospectively.... Metabolic acidosis determined from the umbilical artery at birth [was] a poor predictor of perinatal brain damage.
BRITISH BARRISTERS FOR NO FAULT
Authors: Student
Published: December 2021

After years of inertia there are now almost daily developments on the issue of compensating those injured by medical treatment. Probably the most important recent development has been the support expressed for no fault compensaction by eminent lawyers at the annual bar conference. . . . Around the world—and particularly in the United States—lawyers have been one of the main forces obstructing the introduction of such schemes. The support expressed for introducing such a no fault scheme by the chairman of the Law Commission and the judge who made the first Lim award in a case of medical negligence must thus greatly increase the pressure on the government to act.
DEAF KIDS NEED TO BE TAUGHT ENGLISH
Authors: Student
Published: December 2021

Efforts to place deaf students in regular public schools have backfired, leaving many with an inadequate education, a government commission told a Senate panel.... The panel found that 95% of the nation's deaf students have had no hearing since birth or have been deprived of it in infancy; it recommended improvements in identifying these children and teaching them English.... Deaf students [need] access to special training programs other foreign-language students now receive.
Eye Injuries in Childhood: Demography, Etiology, and Prevention
Authors: Nelson Leonard B. , Wilson Thomas W. , Jeffers John B.
Published: December 2021

A 1-year survey was conducted of all children with eye injuries seen in the Wills Eye Hospital emergency room to determine demographic, etiologic, and prophylactic factors. There were 810 children with ocular trauma. Childhood ocular injuries are frequent, often resulting in serious visual impairment. Many of these injuries are preventable.
Increased Survival of Low Birth Weight Infants: Impact on the Incidence of Retinopathy of Prematurity
Authors: Valentine Priscilla H. , Jackson J. Craig , Kalina Robert E. , Woodrum David E.
Published: December 2021

Retinopathy of prematurity is a retinal vascular disease that occurs only in premature infants. Because of concern that the occurrence of this potentially blinding disease is increasing, a retrospective chart review was undertaken to compare the incidence of retinopathy of prematurity at the University of Washington during the years 1981 to 1984 with previously published data collected at the same institution during the years 1968 to 1980. During 1981 to 1984, there was an increase in the annual numbers of admissions and survivors weighing 1750 g at birth; the survival rate increased significantly (P < .000001). A trend toward an increased risk for proliferative retinopathy of prematurity (P = .057) during 1981 to 1984 period was noted, but the number of "excess cases" was calculated to be only 6 per year. The remainder of the additional cases, 19 annually, were due to increased survival of infants at risk. Thus, the "second epidemic" of retinopathy of prematurity is largely due to improved survival of low birth weight infants rather than to new iatrogenic factors. In infants with proliferative retinopathy of prematurity, there was a previously unreported association between increased severity of disease and lower birth weight (P = .015). There were four children with severe bilateral visual loss due to retinopathy of prematurity identified during the 1981 to 1984 period, whereas only one bilaterally blind infant was noted during the preceding 12.7 years.
Community Physician's Role in Case Management of Children With Chronic Illnesses
Authors: Liptak Gregory S. , Revell Gail M.
Published: December 2021

There is general agreement that case management should be provided to children with chronic illnesses, yet it is not clear who should provide this service. A survey of physicians and parents of children with chronic illnesses was conducted to evaluate the practice and views of pediatricians and compare their assessments with those of parents. Surveys were mailed to 360 physicians and 519 families with response rates of 39% and 63%, respectively. The majority of physicians (74%) thought that the primary care physician should provide case management. When compared with parents, physicians underestimated the parental need for information about the child's diagnosis (8% vs 52%, P < .001), treatments (3% vs 54%, P < .01), and prognosis (30% vs 78%, P < .01). They also overestimated parental needs for information regarding financial aid (70% vs 58%, P < .01), vocations (78% vs 54%, P < .01), and insurance (62% vs 51%, P < .05). Four services ranked by need by parents in the top 10 were not ranked in the top 10 by physicians. Rural physicians noted that services were more difficult to obtain than did those in nonrural areas. The physicians surveyed made several recommendations for steps that could be implemented to facilitate their role as case manageers. If primary care physicians are to be effective case managers, alterations in the current system of care will be required including continuing education related to chronic illness, information about community resources, reimbursement for the time required to perform case management, and better communication between physician and parents.
Superwarfarin Poisoning in Children: A Prospective Study
Authors: Smolinske Susan C. , Scherger Deborah L. , Kearns Pamela S. , Wruk Kathleen M. , Kulig Kenneth W. , Rumack Barry H.
Published: December 2021

This prospective study was undertaken to determine the incidence, severity, time of onset, and duration of coagulopathy in children following accidental ingestion of long-acting anticoagulant rodenticides, often called "superwarfarins." Of 110 children, who ingested superwarfarins and in whom one or more prothrombin time values were obtained, 8 had a prothrombin time ratio (patient to control) of ≥1.2, indicative of anticoagulation. Prothrombin time values obtained 48 hours after ingestion were more likely to be prolonged (6/34, 17.6%) than values obtained 24 hours after ingestion (2/104, 1.9%) (P < .005). The occurrence of an abnormal prothrombin time could not be predicted based on the history of amount ingested or on the presence of the characteristic green-blue product dye in or around the child's mouth. Acute toxicity was evidenced by transient abdominal pain, vomiting, and heme positive stools in 2 patients. The duration of prothrombin time prolongation could not be determined because of the few values obtained after 48 hours. To detect all possible abnormal prothrombin time values, 24-and 48-hour determinations are recommended after a child has ingested a superwarfarin.
Colic: Exasperating but Fascinating and Gratifying
Authors: CAREY WILLIAM B.
Published: December 2021

After more than 30 years of dealing with excessive crying in young infants, I would offer the seemingly inconsistent judgment that the problem is exasperating yet fascinating and gratifying. In this commentary, I shall explain this apparent contradiction and point out the extent to which the article by Barr and associates illustrates this view.

The exasperation of coping with "colic," or excessive crying, comes from several sources. The crying is unpleasant for the infant, for the family, and for those trying to help them. Most of the literature advising parents concerning this problem is not helpful, being usually pessimistic or inappropriately directed.
Systemic Lupus Erythematosus With Libman-Sachs Endocarditis in a 9-Month-Old Infant With Neonatal Lupus Erythematosus and Congenital Heart Block
Authors: JORDAN JOANNE MARIE , VALENSTEIN PAUL , KREDICH DEBORAH W.
Published: December 2021

Since the first report of a patient with a congenital discoid lupus erythematosus rash in 1954 by McCuistion and Schoch, multiple instances of neonatal lupus erythematosus have been described. It is now a well-described syndrome of congenital heart block, transient rash, or both, associated with transplacental passage of antibodies to Sjogren's syndrome A (Ro/SSA) from mothers with overt or latent connective tissue disease. The syndrome usually resolves when the infant is 6 months of age. Neonatal lupus erythematosus without congenital heart block is thus thought to be a transient, relatively benign, phenomenon. Even with congenital heart block, the prognosis can still be good, especially in the absence of structural cardiac abnormality.
Organized Athletics for Preadolescent Children
Authors:   COMMITTEE ON SPORTS MEDICINE,   COMMITTEE ON SCHOOL HEALTH
Published: December 2021

Each year in the United States, millions of preadolescent children participate in organized athletics. Some organized athletic programs are community based; others are school sponsored, either as extracurricula programs or as part of physical education classes. Most coaches in community-based programs are volunteers who have no formal training or expertise in coaching. The credentials and training of grade school coaches are highly variable. Therefore, many US preadolescents are involved in athletics without the benefit of specific program goals aimed at ensuring the most beneficial physical, psychologic, and recreational outcomes.

Coaches, officials, parents, and program designers all play critical roles in shaping the child's early athletic experience and the child's self-esteem. The goals of the program and the behavior of all of the adults involved should focus upon assisting the child to develop: (1) an enjoyment of sports and fitness that will be sustained through adulthood, (2) physical fitness, (3) basic motor skills, (4) a positive self-image, (5) a balanced perspective on sports in relation to the child's school and community life, and (6) a commitment to the values of teamwork, fair play, and sportsmanship. In addition, efforts must be made to make the sport as safe as possible.

Enjoyment of sports and fitness in childhood will increase the likelihood of a child pursuing these activities through adulthood. Children should be allowed to try a variety of sports and to choose sports that appeal to them. If children require more than gentle encouragement, then they are not ready for involvement. Unstructured free play should be encouraged to enhance enjoyment of sports, as well as to promote spontaneity and creativity.
Growth of Children With Cerebral Palsy
Authors: NOACK NELLENE G. , COURY DANIEL L. , BOYNE LINDA
Published: December 2021

Rempel et al, in their paper describing the growth of children with cerebral palsy who received a gastrostomy as part of their overall management, present important information concerning the management of children with these problems. Altered nutritional status in comparison to established norms is a common finding in this population. Its proper management is confusing, because there have been several theories as to the cause of poor growth in these children. As the authors point out, the presence of obesity does not facilitate care and can interfere with already limited motor skills.
Expert Testimony
Authors: HENDRICKS WILLIAM M.
Published: December 2021

I would like to commend the Committee on Medical Liability of the American Academy of Pediatrics (Pediatrics. 1989;83:312-313) for the development of sensible guidelines for expert medical testimony. In addition to these recommendations, I would suggest that expert witnesses obtain an affidavit from the plaintiff's attorney stating under oath that they have provided the complete medical records of their client. Furthermore, a copy of any "expert" medical opinion should be forwarded to the defendant physician.
Expert Testimony
Authors: DRY LAURENCE R.
Published: December 2021

I wish to comment on the American Academy of Pediatrics' guidelines for expert testimony (Pediatrics. 1989; 83:312-313). Although I applaud the efforts of the Committee on Medical Liability and believe that there should be a tightening of the definition of what constitutes an expert medical witness, guideline 6 goes too far: "The physician should be willing to submit transcripts of depositions and/or courtroom testimony for peer review." This guideline attempts to place sanctions on opinion testimony and thus limits free speech.
PRAYER FOR THOSE WHO CARE FOR SICK CHILDREN
Authors: Bowman C. Michael , Diaz Ruben P.
Published: December 2021

Lord, You called me to care for Your children when they are sick. Help me to do so gladly and joyfully. When I get discouraged, remind me of the value of what I do, and help me to do it to the very best of my abilities. Help me to see You in each of my patients, their families, and my coworkers. Help me to understand that I serve as the instrument by which You heal and bring comfort to Your children. Give me a smile and a gentle sense of humor and help me to use them to lighten the trying times.

I thank You for the many blessings You have given me, not only my medical understanding and skills, but also the opportunity to help others, as You taught us to do. May I always remember that giving of myself to others does not require that I totally deny my own needs or those of my family. Help me to continually strive for an appropriate balance between my vocation and my family. Help me to make my time with my family the highest in quality, especially when it is limited in quantity.

Lord, please give me a heart that listens carefully and patiently to others, particularly my patients, their families, my own family, my coworkers, and to myself. Help me to recognize the needs of each and give me the willingness, the strength, the courage and the resources to meet these needs, according to Your will. May I learn something new each day, not getting lost in my daily routine, and help me to persist in my commitment to help others. Amen.
PROFESSORS' PAY IN CHINA
Authors: L. J. F.
Published: December 2021

Beijing, April 7—The director of a research institute here made a novel proposal the other day: he suggested that full professors receive the same salary as waitresses at the nearby Shangri-La Hotel.

There is little chance that the Government will approve the proposal, which would involve huge pay increases for the professors. But his idea underscores the humble circumstances of teachers in China, contributing to what is widely perceived today as a crisis in education.

A professor in China averages $39.50 a month, a bit less than the average for employees in Chinese business enterprises, and much less than taxi drivers or waitresses at international hotels.
FACTORS AFFECTING BIRTH WEIGHT
Authors: Student
Published: December 2021

Maternal smoking, stress, and poor socioeconomic conditions during pregnancy have been linked with low birthweight babies. Is there any way of deciding which of these related potential causes is the most important? In an attempt to do that a research group. . . studied over 1500 pregnant women delivering at a district general hospital in inner London. They showed that the most important influence on fetal growth was smoking, which was associated with a 5% reduction in birth weight after adjustment for maternal height and parity, gestation, and the baby's sex. Of over 40 socioeconomic and psychosocial factors examined, only four were significantly related to a reduction in birth weight, and these became non-significant after adjustment for smoking. The authors conclude that any effects of stress and poor environment on fetal growth are small compared with the effect of smoking.
Kawasaki Disease in Families
Authors: Fujita Yasuyuki , Nakamura Yosikazu , Sakata Kiyomi , Hara Norihisa , Kobayashi Masayo , Nagai Masaki , Yanagawa Hiroshi , Kawasaki Tomisaku
Published: December 2021

The rate of second-case Kawasaki disease occurring among 1788 siblings of children with the disease was derived from data obtained from questionnaires mailed to the members of the Japanese Association of Parents of Children With Kawasaki Disease. Within 1 year after the onset of the first case in a family, the overall second-case rate was 2.1% for siblings, as compared to an overall incidence of approximately 0.19% in the general population of children 0 to 4 years of age in Japan in the epidemic year 1982. For siblings younger than 1 year of age, it was 8.4%, and for those between 1 and 2 years of age, it was 9.3%. More than half (54.1%) of the second cases developed 10 days or less after the first cases occurred.
Neck and Body Position Effects on Pulmonary Mechanics in Infants
Authors: Carlo Waldemar A. , Beoglos Aris , Siner Bonnie S. , Martin Richard J.
Published: December 2021

Pulmonary mechanics and ventilatory parameters were measured in 30 former preterm infants at a postterm age of 8 to 10 months. All subjects had required assisted ventilation in the neonatal period and 16 had a history of bronchopulmonary dysplasia. Each infant was studied in both supine and semisitting positions, and in each body position the infants were studied with neutral, flexed, and extended neck positions. Baseline measurements (body supine, neck neutral) and the responses to postural changes did not differ between infants who had had bronchopulmonary dysplasia and those who had not. Change in body position from supine to semisitting decreased total pulmonary resistance (P < .05) and increased specific lung compliance (P < .01). Neck flexion increased resistance (P < .0001) in both body positions but did not influence compliance. These postural effects are consistent with an increase in functional residual capacity in the semisitting position and a decrease in pharyngeal area during neck flexion. Thus, posture needs to be precisely controlled during pulmonary function testing in infants. Furthermore, optimal neck and body position may improve their clinical status.
Pediatric Organ Donor Maintenance: Pathophysiologic Derangements and Nursing Requirements
Authors: Kissoon N. , Frewen T. C. , Bloch M. , Gayle M. , Stiller C.
Published: December 2021

A retrospective chart review was conducted of 26 organ donors to determine hemodynamic and metabolic derangements encountered and nursing requirements for donor organ maintenance. There were 15 boys and 11 girls with a mean age 6.57 ± 5.46 years. Mean donor maintenance time was 10.5 ± 6.7 hours. Cardiorespiratory derangements included hypotension in 16, hypertension in 6, arrhythmias in 17 (premature ventricular contraction in 4, bradycardia in 8, paroxysmal atrial tachycardia in 3, and ventricular tachycardia in 2), asystolic events in 5, pulmonary insufficiency in 6, anemia in 8, and thrombocytopenia in 8. Metabolic and hormonal derangements included hyperglycemia in 18, hypokalemia in 20, hyperkalemia in 4, hyponatremia in 3, hypernatremia in 17, metabolic acidosis in 10, and diabetes insipidus in 15. Hypothermia (temperature 33.3°± 0.4°C, mean ± SD) occurred in 14 donors. The mean physiologic Stability Index score was 22.2 ± 4.7 and mean Therapeutic Intervention Score was 46.7 ± 5.8. Total number of nursing hours spent in donor maintenance was 424.5 hours. Therapies offered included diuretics in 10, sodium bicarbonate in 8, antibiotics in 6, insulin in 12, pitressin in 13, verapamil in 3, isoproterenol in 3, dopamine in 17, and intravenous potassium boluses in 14. Of the potential 26 donors, 46 kidneys, 8 hearts, 14 livers, 3 pancreas, and 9 corneas were retrieved in transplantable condition. With appropriate donor maintenance, organs suitable for transplantation can be retrieved despite significant pathophysiologic derangements. Physicians intending to provide donor support should be comfortable with invasive monitoring and cardiorespiratory support and be prepared to provide a nurse to patient ratio of 2:1 at the bedside.
THE IMPORTANCE OF CONTROLLED CLINICAL TRIALS DEMONSTRATED—ONCE AGAIN
Authors: Student
Published: December 2021

Two drugs used to treat heart rhythm irregularities in more than 200,000 Americans increased the risk of heart attack and death in a major clinical trial, Federal health officials said today.

The Food and Drug Administration said it was immediately advising doctors to stop prescribing the drugs, Tambocor and Enkaid, for mild or moderate heart rhythm irregularities, or arrhythmias.

The National Heart, Lung and Blood Institute said that more than twice as many patients getting the drugs suffered heart attacks or death as those taking dummy pills, making it necessary to suspend a major part of the test three years early.

"Absolutely, unequivocally, this trial was a success because we have identified two drugs of a type that are more dangerous than the disease they are supposed to treat," Dr. Killip said in a telephone interview.
HOW NOT TO EDUCATE YOUNG GIRLS—AS VIEWED IN 1853
Authors: C. T. E.
Published: December 2021

A commonly held view of mid-nineteenth century physicians, especially in New England, was that young schoolgirls should not be worked too hard and too long at their studies. The editorial below from a highly-respected medical journal is evidence of this unwarranted belief.

Every effort in the school now is to cultivate their minds at the expense of their bodies. They consequently have a sickly life, if perchance it is not cut off in early girlhood; they make poor mothers, are unable to nurse their children in many instances with a tendency to some of the most distressing complaints, and disease is propagated to their children. Much of this arises from the popular mistake that young misses must study algebra, chemistry, scientific botany, Latin, and perhaps Greek and Hebrew, by the time they are fifteen, in order to become ladies. They have no frolicking girlhood—because it is plebeian to romp out of doors with freedom, as nature intended in order to strengthen and perfect their delicate organization. A knowledge of domestic economy is decidely vulgar, and belongs to poor kitchen girls, whose red cheeks, round arms, splendid busts and fine health are perfectly contemptible. There is a kind of imagined gentility in always being under the care of a doctor, and jaunting through the country in pursuit of air, water, or expensive medical advice. Physicians deplore this wretched system, without being able to awaken public sentiment to its destructive character. Teachers are also aware of it, and exert themselves at times to counteract the evils which their every-day lessons exert on the frail, delicate pupils under their charge; but, alas, the poison and antidote are taken at once, and they exhibit the effects of their bad treatment, aided by silk hose in January, thin shoes, the impure atmosphere of crowded rooms and cold night air. Parents are the persons to blame and not the instructors of their children. Young girls are put to school too early and worked too hard and too long at their studies. More active play and fewer books, pudding-making in the place of algebraical equations, with a free exercise of their feet, which were actually designed for walking, would produce a race of women in our midst, such as cannot now be found, in regard to figure, capacity and beauty. What father has the moral courage to set the example, by allowing his daughters to become the angelic creatures they were designed to be, buoyant with spirit, vigor and health, fit companions of man, and the glory of an advanced civilization? Let them gambol in the open air, and, when indoors, act out the governing instincts of their nature in manufacturing rag dolls, till by means of bodily health and vigor, a foundation is laid for intellectual pursuits, and then and not before, may they with safety begin to be exercised in abstract, educational studies.
On the Relevance of Poor Judgment
Authors: WIDOME MARK D.
Published: December 2021

In this issue of Pediatrics, Dolan and colleagues compare the injured drivers of three-wheel all-terrain vehicles (ATVs) with those injured in four-wheel ATVs. Although it was surprising to learn that injuries sustained in four-wheel vehicles were as severe as those sustained in three-wheel vehicles, it is no surprise that deficiencies in personal judgment were among the most frequently identified contributing causes of injury. In the study, "immature judgment" was identified as a contributing cause in 15 of the 36 ATV injuries. Lack of parental supervision (ie, poor judgment on the part of an adult) was a contributing factor in 10 incidents and a possible factor in an additional 10 incidents.
Health Care for Children of Migrant Families
Authors:   Committee on Community Health Services
Published: December 2021

Migrant and seasonal/farm workers constitute a major portion of the labor force in the American food industry. By harvesting and processing farm crops, they contribute positively to agricultural communities and the American economy.

Currently, the office of Migrant Health estimates that nationwide there are between 3 and 5 million migrant and seasonal farm workers and dependents. The average annual income for migrant and seasonal farm workers is well below the poverty level (US Dept of Health and Human Services, unpublished data, 1988). Because health care insurance is invariably beyond the reach of migrant family budgets, and employers of farm workers rarely provide health care benefits for their employees, these families are usually uninsured. In some cases, these families lack US citizenship or are in this country illegally, which complicates obtaining health care for their children. Medicaid enrollment is also complicated by migration because aliens must meet eligibility requirements in each state to which they migrate, and only US citizens are eligible.

Because of their income and mobile life-style, migrant worker families often find that comprehensive child health care (health maintenance, anticipatory guidance, and preventive medicine) essentially is not available. Migrating families must seek health care whenever it is available. This results in a pattern of service that usually is fragmented and ad hoc. Migration not only interrupts continuity of care but it also contributes to a lack of knowledge about a community's health services and/or jeopardizes eligibility for these services by conflicting with residency requirements. Other problems that delay or prevent access to health care for the children of migrant families include language barriers and differences in culture.
Twenty-four Hour After-Treatment Lumbar Puncture: Should It Be Done?
Authors: LE CHINH T.
Published: December 2021

Drs Lebel and McCracken recently reported that delayed sterilization of the cerebrospinal fluid (CSF) during treatment of bacterial meningitis in infants and children was significantly associated with a complicated course (seizures, subdural effusions, and hemiparesis) and a higher incidence of neurologic sequelae. They suggested that a repeat CSF culture after approximately 24 hours of therapy should be done in selected cases for documentation of bacteriologic cure and prediction of prognosis. The authors' data also clearly indicated that (1) the younger age of the patient, (2) seizure before admission, and (3) lower glucose levels in the initial CSF specimen predicted delay in CSF sterilization (tables 3 and 4). It would have been interesting to look at these three parameters further and correlate them with hospital course and long-term sequelae, to determine whether they would be just as good as a repeat CSF examination in predictng outcome.
In Reply: Attention Deficit Disorders and Depression
Authors: KELLY PATRICK C. , ATKINSON A. W.
Published: December 2021

The differential diagnosis for attention deficit disorder with hyperactivity is broad and includes a large number of medical, behavioral, emotional, family, and educational disorders and/or dysfunctions. All of these, in addition to depression, must be considered as possible underlying or coexisting problems in children with behavioral concerns.

We agree with Drs Lord and Barthel regarding the need for consideration of depression and the importance of interviewing children in an approach to youngsters with behavioral problems.
Fire Setting and Klinefelter Syndrome
Authors: KALER STEPHEN G. , WHITE BEVERLY J. , KRUESI MARKUS J.P.
Published: December 2021

Miller and Sulkes' recently described an association between XXY sex chromosome aneuploidy (Klinefelter syndrome) and chronic fire-setting behavior. The association was noted in four individuals evaluated by them in Rochester, NY, during a 4-year peroid and was observed in 19% (6 of 31 persons) of XXY individuals reported by others. Following institution of testosterone replacement therapy, the 3 of their patients for whom follow-up was available had no evidence of additional fire-setting behavior.
AD CAMPAIGNS AND MEDICAL SCHOOLS
Authors: L. J. F.
Published: December 2021

As medical education has become something of a buyer's market, a Midwest medical school and a Texas university are resorting to advertising for students.

The Medical College of Ohio in Toledo has taken out ads in 23 Ohio college newspapers urging premed students to consider applying. Meanwhile, the University of Texas System, in a broader appeal, is running TV ads urging young Texans to choose health careers.

University of Texas officials hope their ad campaign will help stem a decline in enrollments in the state's medical and related schools, the same trend observed nationally for the past 15 years. Medical-school enrollments declined 37% nationwide between 1974 and 1988, according to the Association of American Medical Colleges.
CRICK ON FRUITFUL THEORIES
Authors: Student
Published: December 2021

The lesssons [Francis Crick] imparts contradict many of the cliches about science. A good model is one that does not account for all the data, he explains, for some of the data are bound to be wrong. Try to squeeze it all into a theory and you'll get a teetering architecture that is bound to fall.
IS ERROR FRAUD?
Authors: L. J. F.
Published: December 2021

Prof. David Baltimore of the Massachusetts Institute of Technology is under attack by Representative John Dingell of Michigan. Why should anyone outside of the Government or basic biomedical research care?

Dr. Baltimore's reputation is at stake, but the rest of us will be affected by the outcome of these investigations as well. What has come under a legislative cloud for the first time in a very long time, perhaps ever in this country, is the legitimacy of the scientific method itself. This is an immediate and serious threat to science and medicine.

The N.I.H. will have the last word on Dr. Baltimore's published research. But as I understand the Congressman's case, it is that published science must be free of error, and that error itself indicates bad faith and fraudulent intent. This is wrong. Published error is at the heart of any real science. We scientists love to do experiments that show our colleagues to be wrong and, if they are any good, they love to show us to be wrong in turn. By this adversarial process, science reveals the way nature actually works.

If we as a country make science a field for only those who enjoy a good lawsuit, we will have shut the door on our future as a technologically serious nation. Clearly Congress cannot wish to do this. I would welcome a Congressional initiative to deal with fraud as such, but I fear that the way Dr. Baltimore is being treated means that witch-hunts are in the offing.
DO SICK EX-LOW BIRTH WEIGHT CHILDREN UNDERUSE MEDICAL CARE?
Authors: Student
Published: December 2021

Low birth weight children were found to have more chronic conditions, more limitations of activity, poorer health status as perceived by parents, and more school days lost because of illness. However, numbers of physician visits were not different even for low birth weight children younger than 2 years, which is inconsistent with the higher proportions of multiple hospitalizations, chronic conditions, and other illness measures.
SMEAR
Authors: L. J. F.
Published: December 2021

Imagine that you won a Nobel Prize at age 37. That you've published some 400 papers on genetics and the human immune system. That you've built from scratch a highly respected scientific research center, the Whitehead Institute in Cambridge, Mass.

And then imagine that you wake up one morning and read in the hometown paper that you're accused of what "appears to be fraud and misrepresentation." The accusation is from a "Pete Stockton," whom you've never met, but who the paper says is a "staff member for Rep. John Dingell."

That's more or less what happened to David Baltimore a year ago. His experience since has taken him into the Kafka maw of "congressional oversight," Dingell-style. Readers of this space will recall that the last time we checked with Congress's grand inquisitor, Chairman Dingell was retreating from a botched attempt to smear a former federal prosecutor. Now he's assailing Dr. Baltimore and, to make the effort really worthwhile, American science.

The first time I met John Dingell I must admit to coming away with some respect for his intelligence and rough-hewn candor. But the more I've watched him and his investigators at work, the more it's clear that they are manning a runaway train. The arrogance bred of unchallenged power has stripped them of self-restraint and distorted their understanding of the public good.
Reducing Bedtime Tantrums: Comparison Between Positive Routines and Graduated Extinction
Authors: Adams Lisa A. , Rickert Vaughn I.
Published: December 2021

A total of 36 toddlers and preschool children exhibiting bedtime tantrum activity were randomly assigned to one of three groups: positive routines, graduated extinction, or control. Positive routines involved changing the child's bedtime to coincide with when he naturally fell asleep, as well as parent and child engaging in a series of four to seven enjoyable activities before the child being placed in bed. During the treatment period, bedtimes were systematically scheduled earlier such that the child went to bed at the time parents had originally used. Graduated extinction consisted of the parent putting the child to bed and ignoring the tantrum activity for increasingly longer amounts of time throughout the treatment. Children in these two treatment groups had tantrums less frequently and for shorter periods than control subjects during 6 weeks of treatment and during two follow-up observations 3 and 6 weeks after treatment. Although both treatments were more effective than waiting for the child to outgrow this problem, parents of the positive routine group reported significantly improved marital satisfaction, suggesting additional benefits of this treatment strategy.