bluuebunny/crossref_metadata_2025 huggingface dataset:
Automated vessel centerline extraction and diameter measurement in OCT Angiography
Authors: Viertel Bernhard K. J. , Naber Ady , Hoffmann Simon , Berwanger Daniel , Kessler Lucy , Khoramnia Ramin , Nahm Werner
Published: December 2021

Optical Coherence Tomography Angiography (OCTA) is a non-invasive imaging technique that enables the visualization of perfused vasculature in vivo. In ophthalmology, it allows the physician to monitor diseases affecting the vascular networks of the retina such as agerelated macular degeneration or diabetic retinopathy. Due to the complexity of the vasculature in the retina, it is of interest to automatically extract vascular parameters which describe the condition of the vessels. Suitable parameters could improve the diagnosis and the treatment during the course of therapy. We present an automated algorithm to compute the diameters of the vessels in en face OCTA images. After segmenting the images, the vessel centerline was computed using a thinning algorithm. The centerline was refined by detecting invalid pixels such as spurs and by continuing the centerline until the ends of the vessels. Lastly, the diameter was computed by dilating a discrete circle at the position of the centerline or by measuring the distance between both borders of the vessels. The developed algorithms were applied to in vivo images of human eyes. Certainly, no ground truth was available. Hence, a plausibility check was performed by comparing the measured diameters of two different layers of the retina (Superficial Vascular Complex (SVC) and Deep Vascular Complex (DVC)). Each layer exhibits a different characteristic vasculature. The algorithm clearly reflected the differences from both retinal layers. The measured diameters demonstrate that the DVC consists of more capillaries and considerably smaller vessels compared to the SVC. The presented method enables automated analysis of the retinal vasculature and forms thereby the basis for monitoring diseases influencing the vasculature of the retina. The validation of the method using an artificial ground truth is still needed.
Cardiopulmonary coupling analysis using smart wearables and mobile computing
Authors: Schüler Willi , Spicher Nicolai , Deserno Thomas M.
Published: December 2021

Cardiopulmonary coupling (CPC) analysis links heart and respiration rates to assess sleep-related parameters. Typically, the CPC is measured using multi-lead electrocardiography (ECG) and ECG-derived respiration (EDR). Novel textile shirts with embedded ECG sensors offer convenient and continuously monitored sleep at home. We investigate the feasibility of a shirt with textile sensors (Pro- Kit, Hexoskin, Quebec, Canada) for CPC analysis by mobile computing. ECG data is continuously transmitted from the shirt to a smartphone via Bluetooth Low Energy (BLE). We customize a CPC algorithm and use twelve whole-night recordings from four volunteers to perform qualitative and quantitative analysis. We compare EDR with respiratory inductive plethysmography (RIP). In average, EDR and RIP differ 17.22%. After one night, the batteries are reduced to approx. 70% (shirt) and 90% (smartphone). The run time for CPC processing is approx. 3 min. Hence, smart wearables in combination with mobile computing show technical feasibility for CPC analysis. Eventually, this could yield a useful solution for sleep analysis of non-expert users in a private environment.
Comparison of biphasic material properties of equine articular cartilage estimated from stress relaxation and creep indentation tests
Authors: Reuter Thomas , Hurschler Christof
Published: December 2021

Mechanical parameters of hard and soft tissues are explicit markers for quantitative tissue characterization. In this study, we present a comparison of biphasic material properties of equine articular cartilage estimated from stress relaxation (ε = 6 %, t = 1000 s) and creep indentation tests (F = 0.1 N, t = 1000 s). A biphasic 3D-FE-based method is used to determine the biomechanical properties of equine articular cartilage. The FE-model computation was optimized by exploiting the axial symmetry and mesh resolution. Parameter identification was executed with the Levenberg- Marquardt-algorithm. Additionally, sensitivity analyses of the calculated biomechanical parameters were performed. Results show that the Young’s modulus E has the largest influence and the Poisson’s ratio of ν ≤ 0.1 is rather insensitive. The R² of the fit results varies between 0.882 and 0.974 (creep model) and between 0.695 and 0.930 (relaxation model). The averaged parameters E and k determined from the creep model yield higher values in comparison to the relaxation model. The differences can be traced back to the experimental settings and to the biphasic material model.
PTT-based Contact-less Blood Pressure Measurement using an RGB-Camera
Authors: Wuerich Carolin , Rademacher Robin , Wiede Christian , Grabmaier Anton
Published: December 2021

Commonly used blood pressure measurement devices have noticeable limitations in accuracy, measuring time, comfort or safety. To overcome these limitations, we developed and tested a surrogate-based, non-invasive blood pressure measurement method using an RGB-camera. Our proposed method employs the relation between the pulse transit time (PTT) and blood pressure. Two remote photoplethysmography (rPPG) signals at different distances from the heart are extracted to calculate the temporal delay of the pulse wave. In order to establish the correlation between the PTT values and the blood pressure, a regression model is trained and evaluated. Tests were performed with five subjects, where each subject was recorded fifteen times for 30 seconds. Since the physiological parameters of the cardiac system are different for each person, an individual calibration is required to obtain the systolic and diastolic blood pressure from the PTT values. The calibration results are limited by the small number of samples and the accuracy of the reference system. However, our results show a strong correlation between the PTT values and the blood pressure and we obtained a mean error of 0.18 +/- 5.50 mmHg for the diastolic blood pressure and 0.01 +/- 7.71 mmHg for the systolic pressure, respectively.
KneTex – Improvements to a textile-integrated sensor system for feedback-supported rehabilitation after ACL surgery
Authors: Yavuz Sinan , Schlage N. , Cramer L. , Demmer J. , Mühlen A. , Kitzig A. , Naroska E. , Stockmanns G.
Published: December 2021

After surgery of the anterior cruciate ligament (ACL), unpredictable effects can occur in the patient’s gait patterns. Thus, patients often experience instability and uncontrolled buckling of the knee joint (“giving way” effect). The “giving way” effect is also difficult to measure due to the uncontrolled and rare occurrence. Within the KneTex project a smart textile-integrated sensor and actuator bandage system is developed to detect instability of the knee joint and actively support the rehabilitation process. Based on the sensor data the calculation of the knee angles as well as a recognition system is implemented. The bandage system can be controlled via a custom app which is developed as part of the project. This paper describes the recent developments and current status of the project. In addition, the results and steps for future work are described as well.
Impact of normalization, standardization and pre-fit on the success rate of fitting in electrochemical impedance spectroscopy
Authors: Pfeiffer Norman , Jechow Markus , Wachter Toni , Hofmann Christian , Errachid Abdelhamid , Heuberger Albert
Published: December 2021

Fitting the data of an electrochemical impedance spectroscopy (EIS) typically requires manual estimation of the initial values before regression algorithms such as complex nonlinear least squares (CNLS) can be applied. This makes the success rate of the fitting dependent on the user input. Furthermore, the Randles circuit consists of parameters with substantially differing magnitudes (e.g. capacitors and resistors), which can also strongly affect the success rate of the fitting due to numerical effects. The aim of this work is to investigate methods addressing the described limitations of fitting. Therefore, a Python implementation performing a fit for EIS is benchmarked with an equivalent open source library. The examined implementation optionally includes the normalization of the parameter values, the standardization of the impedances and a pre-fit. Applying the same equivalent circuit without additional signal processing steps and with fixed initial values defined by midpoints of the value ranges, both implementations were able to fit 46.50% of the simulated database with different spectra. Applying the normalization of the parameter values (76.25%) or the same method with additional pre-fit (97.75%) lead to a significant improvement of the success rate. The standardization of impedances did not affect the success rate.
Non-destructive analysis of drug distribution in nonwovens as drug-delivery systems for biomedical applications
Authors: Reske Thomas , Wulf Katharina , Illner Sabine , Eickner Thomas , Grabow Niels , Schmitz Klaus-Peter , Siewert Stefan , Khaimov Valeria
Published: December 2021

Analysis of the active ingredient distribution of medical devices is typically performed using Raman spectroscopy, a method that is fast and inexpensive [1]. In addition, it offers the advantage of non-destructive analysis without the need for special sample preparation. Assuming that all components are Raman-active and present in sufficient quantities, their distribution can be well represented. The drug distribution in dexamethasone-loaded polymer nonwovens was investigated in order to draw conclusions on the quality of the fleece batches and to make predictions for the release behavior. In the present study, dexamethasone (DMS), a glucocorticoid was used as the active ingredient. Qualitative and quantitative studies of the content of DMS in polymer films by means of Raman spectroscopy have already been carried out in the working group [2]. A representative square section was examined to describe the distribution of active ingredients. The required number of measurement points (spectra) was determined earlier [2].
Detection of Outdated Structural Priors in the Discrete Cosine Transformation-based Electrical Impedance Tomography Algorithm
Authors: Chen Rongqing , Moeller Knut
Published: December 2021

Morphological prior information incorporated with the discrete cosine transformation (DCT) based electrical impedance tomography (EIT) algorithm can improve the interpretability of EIT reconstructions in clinical applications. However, an outdated structural prior can yield a misleading reconstruction compromising the accuracy of the clinical diagnosis and the appropriate treatment decision. In this contribution, we propose a redistribution index scaled between 0 and 1 to quantify the possible error in a DCT-based EIT reconstruction influenced by structural prior information. Two simulation models of different tissue atelectasis and collapsed ratios were investigated. Outdated and updated structural prior information were applied to obtain different EIT reconstructions using this simulated data, with which the redistribution index was calculated and compared. When the difference between prior and reality (the redistribution index) became larger and exceeded a threshold, this was considered as an indicator of an outdated prior information. The evaluation result shows the potential of the redistribution index to detect outdated prior information in a DCT-based EIT algorithm.
Cardiovascular catheter stiffness – a static measurement approach
Authors: Brandt-Wunderlich Christoph , Grabow Niels , Schmitz Klaus-Peter , Siewert Stefan , Schmidt Wolfram
Published: December 2021

Catheters are widely used for therapeutic and diagnostic purposes in various medical applications. Along with frictional properties as well as the catheter profile the catheter stiffness mainly affects the deliverability and thus, the handling properties of the catheter. Within this study the bending stiffness of proximal and distal catheter samples was investigated with a custom made test setup. In particular, the influence of the catheter clamping length on the test results is discussed. Bending stiffness was calculated directly from the measured force, deflection and clamping length considering the test setup compliance. Measurements were performed three times at five positions in circumferential direction. Measured bending stiffness ranged from 629 ± 31 Nmm² to 733 ± 58 Nmm² for the proximal samples and from 30 ± 5 Nmm² to 98 ± 30 Nmm² for the distal samples, respectively. Bending stiffness varied depending on the free catheter length and the reaction force measured. The maximum reaction force decreased with increasing free catheter length leading to a higher measurement uncertainty. However, when considering the same free catheter length quantitative results were similar within the group of proximal and distal samples, respectively.
Investigation of an Active Measurement Method to Detect Inertial Cavitation and the Presence of Potential Drug Carriers
Authors: Helmerich Jan , George Benedikt , Rupitsch Stefan J.
Published: December 2021

Drug carriers, such as nanoparticles, are capable of releasing pharmaceutically active ingredients, which can be initiated by focused ultrasound via the effect of inertial cavitation. This effect of inertial cavitation is often verified by passive measurement methods that rely on the analysis of emitted acoustic signals caused by the implosion of bubbles. However, a major issue of such methods is their inability to detect the presence of potential drugs in human vessels, complicating the implementation of a closed loop control for future medical therapies. Therefore, this contribution introduces an active measurement method to determine both inertial cavitation and the presence of potential drug carriers in a tissue mimicking phantom
Agency Fluctuations and Identity Transformations in Chinese English-Majors on Their Learning Trajectories
Authors: Lin Qiuming
Published: December 2021

This paper explores agency fluctuations and identity transformations in Chinese English-majors and how they are related to the process of English learning. By tracing a group of students for four years in a Chinese university and conducting qualitative analyses to their oral narrations of learning experiences at different periods, the study has found that most participants started and ended their university life at relatively high levels of agency, with inevitable ups and downs in between. Agency fluctuations in the learners are the result of their identity positioning and repositioning within a complex and ever-changing context. Concordant or conflicting identities may co-exist within an individual learner and keep changing across different situations. Learner identities will cause increase or reduction in their investment in English learning, while their learning experience will in turn reinforce or undermine their identities. The study sheds light on the intricate relationships between agency, identity and language learning and therefore has important implications for English learning and teaching in China.
Linguistic Dimensions of Accentedness, Comprehensibility and Intelligibility: Exploring Listener Effects in American, Moroccan, Turkmen and Chinese Varieties of English
Authors: Wei Mei
Published: December 2021

The present study examines accentedness, comprehensibility, and intelligibility of American English, Moroccan English, Turkmen English, and Chinese English, from the perspectives of three groups of listeners: native speakers of English and Chinese speakers of English with or without international experiences. Of the 145 listeners, 38 had face-to-face interviews. These listener groups were asked to listen to the recordings of the four English varieties and fill in a cloze test. Results indicated that the three listener groups differed significantly in rating comprehensibility of American English, Moroccan English and Chinese English but they did not give Turkmen English statistically different ratings; there were no significant differences in accentedness ratings except for Chinese English; and there were significant differences in the intelligibility scores of the four English varieties. In addition, with respect to seven linguistic variables—speed, clarity, intonation, smoothness and fluency, vocal intensity, pause, vocabulary and grammar, there were significant differences in three listener groups’ rating of six variables in American English except the one of “speed”. By contrast, Chinese English received significantly different ratings only in “proper speed”. No differences were found in the ratings for Moroccan English and Turkmen English. Finally, unlike Chinese listeners without international experiences, native listeners and Chinese listeners with international experiences shared some similarities in correlations between the ratings of accentedness and comprehensibility and those of linguistic variables on Moroccan English, Turkmen English, and Chinese English. However, the results for American English from Chinese listeners without international experiences and native listeners seemed to be more alike. Linguistic variables correlating with accentedness and comprehensibility of American English showed a mixed profile. Qualitative data provided more variant elaborations on the pronunciations and language uses of the speakers.
„Auch die Natur wartet auf die Revolution.“
Authors: Hogh Philip
Published: December 2021

In this article, Herbert Marcuse’s nature-ethical considerations, which have to date been scarcely received, are used to develop perspectives on how the nature-ethical gap in contemporary Critical Theory could be closed. The central idea is that nature is tobe recognized as a subject in its own right without needing to anthropomorphize it in the process. The advocatory ethics of nature, which is outlined here, differs from current sustainability and environmental ethics primarily in that it maintains the tension between an anthropocentric and an ecocentric approach and does not resolve it in one direction. Marcuse’s so-called “liberation of nature” is understood as a means for the “liberation of humans”, but the latter can only succeed if the former is also carried out.
κέλῡφος and καλύπτω
Authors: Merritt Andrew
Published: December 2021

Though καλύπτω ‘cover’ is normally and correctly associated with *√ḱel- ‘cover’, the origin of the entire base καλυφ- remains unclear. The basis of clarification consists in an appreciation of the formally resemblant s-stem κέλῡφος, whose meaning ‘sheath, case, shell, husk, pod’ has invited comparison. The author therefore hypothesizes that the bases καλυφ- and κελῡφ- include related layers of nominal material. Starting from an originally adnominal *ḱel-ó- (> OIr. cel ‘death’), the author reconstructs the u-stem substantive *ḱó/él-u- ‘covering’, for which the evidence of Proto-Germanic *χlewa- ‘shelter’ and Greek κολεόν ‘sheath’ is adduced. The element in -φ- is then argued to reflect a nominalized form of *√bʰuhx- ‘become’ qua light verb of an anti-causative periphrasis whose originally acrostatic heavy member *ḱó/él-u- was employed as a predicative instrumental *ḱéluh₁ eventually fossilized as an indeclinable adnominal eligible for use as a First Compound Member (FCM) (> κέλῡφος). By comparison to the allomorphically archaic πόλις ‘city’ (gen. πόληος), the author finally argues for the paradigmatic renewal of *ḱó/él-u- (> > *ḱól-u- : ḱl̥-u̯- : ḱl̥l-éu̯) and the eligibility of its weak stem as first member of a compound from which was formed the *-i̯e/o- present ancestral to καλύπτω.
Chorioamnionitis has no impact on immunohistochemical expression of IL-6 in placental membranes of the late preterm delivery regardless of the membrane status
Authors: Benzon Zdeslav , Kuzmić Prusac Ivana , Zekić Tomaš Sandra , Vulić Marko , Vulić Luka , Benzon Sandra , Stefanovic Vedran
Published: December 2021

Objectives

To compare the immunohistochemical expression of IL-6 in placental membranes of late preterm delivery in women with histologically proven chorioamnionitis with and without preterm premature rupture of membranes (PPROM).

Methods

Fetal membranes were collected from 60 women who had late preterm delivery with histologic chorioamnionitis with and without PPROM (30 in each group). Immunohistochemistry for IL-6 was performed on formalin fixed and paraffin-embedded sections. The two groups were matched for age, body mass index and parity. SPSS Version 17.0 was used for statistical analysis.

Results

There was no difference in immunohistochemical expression of IL-6 in placental membranes of women with histologic chorioamnionitis regardless of the membrane status.

Conclusions

Chorioamnionitis has no impact on immunohistochemical expression of IL-6 in placental membranes of women with late preterm delivery despite the clinical presentation.
Ein preußischer Postbeamter oder ein postmoderner Provokateur?
Authors: Kroucheva Katerina
Published: December 2021

This article concerns itself with Gérard Genette’s reception in Germanophone literary study. Through an analysis of the rhetorical substrate from which Genette’s terminology draws its specific tension, the article determines that Genette is not only an excessive systematist, but also and simultaneously an author who battles received attempts at order and who foregrounds doubts about the idea of order. In this way, he displays a kinship with such theorists as Roland Barthes and Jacques Derrida. The receptions of the rhetorical construction of Genette’s texts and of the particular strategies of structuralism to which that construction refers did not occur synchronously in French, American, Russian, and German literary studies. The article demonstrates that, while German literary theory occasionally discusses Genette’s positioning within the field, there remains a general absence of the recognition that practically all of his books display a definite proximity to deconstruction, and that this proximity plays a central role in Genette’s enire theoretical edifice. This text is, last but not least, a call to read literary-theoretical texts in their aesthetic contexts.
Herramientas para el diseño de producción en videoclip 360 como modelo ante la necesidad de un producto audiovisual más inmersivo
Authors: Vegas Molina Francisco
Published: December 2021

La crisis sanitaria de 2020 y las restricciones de movilidad impuestas en cada territorio para frenar la propagación del SARS-COVID-19 han generado situaciones de aislamiento para un amplio sector de la población. Estas situaciones han creado la necesidad de experimentar de otra forma, mas inmersiva y participativa, los distintos productos culturales a disposición del público. De esta forma, la interacción de los usuarios con ciertas plataformas ha aumentado, así como con determinados tipos de formato más proclives a satisfacer tales necesidades, como el videoclip esférico o 360. Aunque esta modalidad de vídeo esférico ya disfrutaba de cierto recorrido desde 2015 en plataformas como Youtube, su popularidad no había sido la suficiente como para estandarizar su producción, no solo para profesionales del audiovisual, sino también para usuarios no profesionales o prosumers, siendo estos últimos los verdaderos responsables de la multitud de nuevas variables y tipologías dentro formato. Esta investigación tiene como objetivo estudiar las distintas herramientas de diseño de producción empleadas en un caso real: Efímera, de la banda española Love of Lesbian (2015), para arrojar luz sobre las particularidades de este tipo de producción, así como ofrecer las distintas herramientas concebidas para abordarlo.
Reliability of Neural Entrainment in the Human Auditory System
Authors: Cabral-Calderin Yuranny , Henry Molly J.
Published: December 2021

Auditory stimuli are often rhythmic in nature. Brain activity synchronizes with auditory rhythms via neural entrainment, and entrainment seems to be beneficial for auditory perception. However, it is not clear to what extent neural entrainment in the auditory system is reliable over time, which is a necessary prerequisite for targeted intervention. The current study aimed to establish the reliability of neural entrainment over time and to predict individual differences in auditory perception from associated neural activity. Across two different sessions, human listeners (21 females, 17 males) detected silent gaps presented at different phase locations of a 2 Hz frequency-modulated (FM) noise while EEG activity was recorded. As expected, neural activity was entrained by the 2 Hz FM noise. Moreover, gap detection was sinusoidally modulated by the phase of the 2 Hz FM into which the gap fell. Critically, both the strength of neural entrainment as well as the modulation of performance by the stimulus rhythm were highly reliable over sessions. Moreover, gap detection was predictable from pregap neural 2 Hz phase and alpha amplitude. Our results demonstrate that neural entrainment in the auditory system and the resulting behavioral modulation are reliable over time, and both entrained delta and nonentrained alpha oscillatory activity contribute to near-threshold stimulus perception. The latter suggests that improving auditory perception might require simultaneously targeting entrained brain rhythms as well as the alpha rhythm.

SIGNIFICANCE STATEMENTNeural activity synchronizes to the rhythms in sounds via neural entrainment, which seems to be important for successful auditory perception. A natural hypothesis is that improving neural entrainment, for example, via brain stimulation, should benefit perception. However, the extent to which neural entrainment is reliable over time, a necessary prerequisite for targeted intervention, has not been established. Using electroencephalogram recordings, we demonstrate that both neural entrainment to FM sounds and stimulus-induced behavioral modulation are reliable over time. Moreover, moment-by-moment fluctuations in perception are best predicted by entrained delta phase and nonentrained alpha amplitude. This work suggests that improving auditory perception might require simultaneously targeting entrained brain rhythms as well as the alpha rhythm.
Assessing the Economic Feasibility of Integrated Waste to Use Systems for Uganda
Authors: Agunyo Miria Frances , Kizza-Nkambwe Sarah , Bacwayo Kukunda Elizabeth
Published: December 2021

Waste and sanitation Management is a major challenge in urban areas in Uganda where waste is composed of atleast 70% organic content and is basically collected and disposed of in landfills. While 90% of the sanitation facilities used are onsite systems often requiring additional treatment of sewage and faecal matter sewage yet faecal and sewage sludge treatment plants are few. The projected population increase is expected to further influence urbanization, increasing the need for basic waste and sanitation services. Integrated Waste to Use systems that consider combined management of organic waste streams i.e. biowaste, animal waste, sewage and faecal sludge, could be a viable solution for the urban areas. The systems which consist of a combination of anaerobic digestion, composting, incineration and solar drying technologies promote resource recovery in the form of biogas, briquettes and organic fertilizer. The economic feasibility of the Waste to Use systems was carried out and the results indicated that the feasibility of the systems was positively influenced by the inclusion of the anaerobic digestion process, which allowed for recovery of biogas and digestate as organic fertilizer. Furthermore, a combination of low system investment costs, increased revenues from resource recovery, consideration of equity capital of at least 30%, interest rate of at most 10% and fugitive emissions less than 7 % would positively influence the economic feasibility of the system alternatives.
BRAIN TUMORS IN INFANCY
Authors: LEIBNER I. WALLACE
Published: December 2021

Seven cases of brain tumors occurring in infants are presented. Six occurred in males and one was in a female. Three of them arose in the cerebellum while the other four were supratentorial. The tumors included two medulloblastomas, one [See Table II in Source Pdf] spongioblastoma polare, one ependymoma, one astrocytoma and one hemangioblastoma. The seventh case probably was also one of medulloblastoma. One of the proven medulloblastomas was supratentorial, which is unusual so faras location is concerned. The hemangioblastoma arose in the cerebrum. The location of this tumor is also a rare one and to my knowledge, it is the first case of its type reported in an infant in whom full recovery occurred following removal of the tumor.

The diagnosis was unsuspected in four cases. Three of these infants were believed to be suffering from congenital hydrocephalus while the fourth was thought to be afflicted with encephalitis. The ways in which the correct diagnosis might have been made are discussed. Since bizarre clinical patterns are sometimes produced by brain tumors in infants and the diagnosis frequently overlooked, the possibility should be kept in mind by the pediatrician in considering the differential diagnosis of conditions producing signs referable to the nervous system.
FORMULA ROOMS FOR NEWBORN INFANTS IN LYING-IN HOSPITALS
Authors: WALLACE HELEN M. , ABRAMSON HAROLD , LOSTY MARGARET A.
Published: December 2021

This report comprises a preliminary discussion of certain conditions under which formulas are prepared for newborn infants in lying-in hospitals. The general picture is one of lack of proper supervision of formula room procedures and of the unskilled personnel usually assigned to the important process of formula preparation. The conditions disclosed by this study are not peculiar to New York City alone, but merely reflect the pressing nature of the problem throughout the country.

Until recently the study of formula preparation was a neglected field of investigation. A review of the literature emphasizes the lack of attention that has been paid to the problem in the past. Investigators now state unanimously that the entire procedure of formula preparation in hospitals requires revision. But the methods by which this change should be achieved are still open to study. The general opinion is that some means of terminal steam sterilization is necessary. But opinion is, however, divided as to the type of steam sterilization that is desirable, the optimal temperature that should be employed, and the time of application required. Opinions are not always substantiated by adequate bacteriologic data.

Asking those with practical experience to answer certain questions on terminal processing of formula led to no consistent conclusion. Opinions were based mainly on clinical experience and judgment. There was general agreement that subjecting formulas to high temperatures would destroy such vitamins as thiamin and ascorbic acid, and would cause appreciable caramelization of the formulas. It was thought that such changes would not have deleterious effect on the baby. Vitamin replacement therapy could be readily introduced.

It is the responsibility of hospital administrators, pediatricians, obstetricians, nurses, dieticians, and public health workers to devise safe and practical methods for preparing infant formulas and to plan the layout of the formula room. The methods recommended should be based on sound scientific data and be sufficiently simple to be carried out effectively by any person assigned to formula room duty.
THREE YEARS' EXPERIENCE WITH AN AFFILIATED RURAL RESIDENT TRAINING PROGRAM
Authors: CARSON MERL J. , POOLE BELLE DALE
Published: December 2021

FOR several years medical educators have given increasing consideration to the problem of extending medical teaching beyond the period of medical school and residency training, into the area of medical practice.

Dr. Edwards A. Park forcibly outlined this concept when he wrote, "Perhaps the greatest benefit which could be brought to pass in medical care in this country would result if the medical schools could be made to descend from their ivory towers—to use Dr. James Wilson's metaphor—and extend their educational facilities to the practicing physicians of the country and to assume the task of keeping them informed as a full part of their responsibilities."

A few months later a committee of the American Academy of Pediatrics reported, "In its report to the Executive Board at the Academy's Annual Meeting in Atlantic City, November 20-23, 1948, the Committee on the Improvement of Child Health gave due recognition to the great progress over the last half century in the medical care of children, but emphasized that the full benefits of modern medical care are not available to all children. The Committee's overall recommendations based on the findings are twofold:

"(1) To strengthen pediatric training in medical training in medical schools so that all doctors, not only specialists, may be thoroughly prepared to care for children, and

"(2) To develop systems of decentralized training and rural extension services so that better medical care for children may be available in outlying areas."

In view of the widespread interest in this concept and also in methods of developing a workable system of extending the services of a modern teaching center, it is felt that a description of the Children's Hospital-Imperial County Project might be of interest.
NUTRITIONAL RECOVERY SYNDROME
Authors: GÓMEZ FEDERICO , GALVÁN RAFAEL RAMOS , MUÑOZ JOAQUÍN CRAVIOTO
Published: December 2021

This paper presents clinical and laboratory data which indicate the development of a syndrome heretofore undescribed and still incompletely studied which appears in children during recovery from severe malnutrition.

The principal clinical findings are portal-intrahepatic hypertension beginning 20 to 40 days after treatment is instituted and lasting about a month.

Hepatomegaly, which is the first sign, is marked and progressive, affects particularly the left lobe and is inversely proportional to the degree of fatty infiltration of the liver, as is demonstrated by liver biopsies.

Along with the hepatomegaly there is distention of the abdomen, a thoraco-abdominal venous network and ascites.

Later phenomena (occurring after about 60 days of treatment) are hypertrichosis of the forehead, back and thighs, as well as a more or less marked eosinophilia not explained by intestinal parasites or allergy.

The most important chemical finding is the hyper-gamma globulinemia, the highest level of which coincides with the appearance of the portal hypertension; this is definitely statistically significant. At the same time a considerable elevation of total plasma proteins takes place and thymol turbidity tests become progressively more abnormal.
PSYCHIATRIC ASPECTS OF CHANGES IN INFANT AND CHILD CARE
Authors: BRUCH HILDE
Published: December 2021

DURING the last 2 or 3 decades child care has concerned itself with the question of how to raise children who would be emotionally secure and well-adjusted as well as physically healthy. A flood of advice has been directed toward parents as to the "best" psychologic methods of handling children.

I wish to draw attention to the problems involved in deliberately changing child-rearing customs, particularly when the advice goes from one extreme to the other. In contrast to the relative ease of teaching better physical care, parent education in the field of psychologic care has often resulted in dismal confusion. Such failure of the wonderful promise of better mental health due to better psychologic insight seems to be related to the contradictions inherent in different psychologic theories, their simultaneous and often mechanical application, and the neglect of some of the underlying problems.

Deliberately oversimplifying, I shall sketch the background of the various recommendations. Two main schools of thought can be recognized. According to one, children are more or less like blank pieces of paper and it is up to the parents to make the correct entries, or to "condition" a child to the correct way of life. The academic source is the psychologic teaching of behaviorism.

Translated into practice it implies child care in which everything is prescribed in exact terms. This trend was congenial to the thinking of scientific pediatrics. The combination resulted in a system of child care characterized by rigid schedules for feeding, toilet training and every other activity, that is, an over-all atmosphere of emotional sterility. This rigid school was the vogue from 20 to 30 years ago.

The opposed psychologic approach has its main source in psychoanalytic theories. It starts with the assumption that an infant is a bundle of intense emotions and instincts and that he "knows" in a mysterious way everything that is good for his future development. Hence the chief task is to satisfy to the fullest the child's instinctual demands and not to interfere with the unfolding of his drives.
Impact of Appointment Reminders on Vaccination Coverage at an Urban Clinic
Authors: Irigoyen Matilde M. , Findley Sally , Earle Beryl , Stambaugh Kevin , Vaughan Roger
Published: December 2021

Objective.

To test if appointment reminders blinded to immunization status improve kept-appointment and vaccination coverage rates.

Design.

Controlled trial.

Setting.

Pediatric clinic serving a low-income community in New York City.

Intervention.

Children ages 4 through 18 months (n = 1273) scheduled sequentially for clinic appointments were systematically assigned to 1 of 4 study groups: control (n = 346); postcard (n= 314); telephone call (n = 307); and postcard and telephone call (n = 306).

Outcome Measures.

Kept-appointment and vaccination coverage rates.

Results.

Children assigned to the postcard and telephone group were 1.75 times more likely to keep their appointments than controls (95% confidence interval [CI] = 1.2, 2.5). Children who actually received the postcard and telephone reminders were 2.3 times more likely to keep an appointment than controls (95% CI = 1.4, 3.7). Children who kept appointments were 2.3 times more likely to be up-to-date with their immunizations (95% CI = 1.7, 3.2). The reminders selectively increased vaccination coverage for the subgroup of children who were not up-to-date before the appointment (χ2 = 11.2). The cost of the reminders was $.67 for the postcard and $1.58 for the postcard and telephone. Assuming 5000 visits per year and $100 reimbursement per visit, the return on each dollar invested was $10 for the postcard and $7.28 for the postcard and telephone reminder.

Conclusions.

Appointment reminders blind to immunization status are a practical and cost-effective strategy to increase kept-appointment rates for all children, and, through this mechanism, reach and vaccinate children who are not up-to-date.appointment reminder, vaccination coverage.
DOMINANT INHERITANCE OF DIABETES INSIPIDUS
Authors: PENDER C. B. , FRASER F. CLARKE
Published: December 2021

The clinical features of diabetes insipidus are described in a family showing dominant inheritance of this condition. Forty affected individuals in six generations are listed. Two members of the family, investigated in hospital, showed no alteration of urinary flow in response to the intravenous injection of saline, but a marked reduction in flow following the injection of pitressin, thus confirming the diagnosis of diabetes insipidus due to pitressin deficiency. An exceedingly great urinary output is not necessarily a feature of the disease. The diagnostic value of the family history is emphasized.
Evidence-Based Approach to Change in Clinical Practice: Introduction of Expanded Nasal Continuous Positive Airway Pressure Use in an Intensive Care Nursery
Authors: Jackson Jodi K. , Vellucci Judy , Johnson Patrice , Kilbride Howard W.
Published: December 2021

Objective. Recent studies provide evidence that nasal intermittent positive pressure ventilation (NIPPV) may stabilize the airway of extremely low birth weight infants after endotracheal extubation. The objective of this project was to introduce the use of NIPPV into a busy level 3 intensive care nursery.

Methods. This report describes the process of NIPPV introduction using a series of rapid-cycle improvement projects, as proposed by the Vermont Oxford Network.

Results. In the first cycle, 7 (88%) of 8 infants were successfully extubated with NIPPV after meeting criteria for reintubation on nasal continuous positive airway pressure alone. Proper positioning of the prongs in the nasopharynx was found to be an important determinant of success. In a second cycle, shorter 2.5-cm nasopharyngeal prongs were more effective than standard 4-cm prongs in 12 recently extubated infants as assessed by objective measurements and subjective nursing reports. A third cycle confirmed the acceptance of this technique in our unit and demonstrated an associated decrease in markers of chronic lung disease in extremely low birth weight infants during the 22 months after its introduction.

Conclusion. This experience supports the role for the rapid-cycle change model in achieving effective evidence-based medical practices in a neonatal intensive care setting.
The Endocrine and Reproductive System: Adverse Effects of Hormonally Active Substances?
Authors: Greim Helmut A.
Published: December 2021

Chemicals that have the intrinsic property to modulate or even disrupt the endocrine system are present in the human environment. Because it is the potency of such chemicals that determines the toxicologic relevance, assessment of the risk to human health must consider both the endocrine disrupting potential and the potency. Usually in vitro assays are applied to detect the potential of a hormone-like effect, and such data are considered useful to set priorities for additional testing and for mechanistic studies. However, such data allow only determination of relative potency of a chemical as compared with other xenobiotics, natural compounds, or endogenous hormones. Relevant information on the endocrine-disrupting potency can be taken only from in vivo assays, eg, the Hershberger (male reproductive organs) and uterotrophic (female reproductive organs) assays, the updated versions of the 28- and 90-day toxicity studies in rodents, and the 2-generation studies in rodents. With the use of this information and the concentration of these chemicals in humans, the potency of the effect as compared with endogenous hormone activity can be estimated. So far, the relative potencies of chemicals tested in in vitro systems as compared with estradiol are several orders of magnitude smaller, whereas potency of the phytoestrogen, eg, isoflavones such as genistein or daidzein, can even exceed that of estradiol, especially in infants who are fed soy-based formula as a sole source of nutrition. Although there are still open questions regarding in utero or early postnatal exposure, the low potencies and concentrations of manmade chemicals as compared with the endogenous hormones in humans make it unlikely that adverse effects occur at common exposure.
Changing Requirements for Evaluation of Pharmacologic Agents
Authors: Chesney Russell W. , Christensen Michael L.
Published: December 2021

Children sadly have been excluded from some of the therapeutic advances that have marked pharmaceutical drug development during the past 100 years. Most drugs in use today lack Food and Drug Administration approval for use in children or are restricted to certain pediatric age groups, predominately older than 12 years. Only a few of the new drugs approved each year have pediatric indications and dosing guidelines described in the drug labeling information. However, many of these drugs are used in children. The lack of suitable information places children at risk for over- or underdosing, and there is a lack of suitable dosage forms, which can result in improper drug administration. This lack of information on the safe and effective use of drugs in the most vulnerable patients—infants and neonates—is of greatest concern. Recent changes in the regulations that govern drug development has dramatically increased the number of drugs that undergo testing in children. This article reviews new laws that govern drug testing in children and the use of children in therapeutic research.
RADIOIODINE UPTAKE IN THE STUDY OF DIFFERENT TYPES OF HYPOTHYROIDISM IN CHILDHOOD
Authors: SILVERMAN SAMUEL H. , WILKINS LAWSON
Published: December 2021

A method for demonstrating small uptakes of radioiodine by the thyroid gland has been described. The study suggests that in some cases of cretinism iodine-accumulating thyroid tissue may be completely absent while in others a small amount may be present. In cretins in whom a small amount of thyroid tissue can be demonstrated, the symptoms, even though appearing during the first year of life develop more insidiously. In cases of hypothyroidism developing later in childhood, small amounts of thyroid tissue capable of taking up iodine usually can be demonstrated.

In addition to the cases of hypothyroidism in which there is absence of the gland or marked diminution in the amount of thyroid tissue, two patients (Nos. 13 and 14) with definite hypothyroidism showed a normal uptake of I131. One of those patients had a thyroid gland of normal size, the other a moderately enlarged gland. They lived in regions in which there was no likelihood of deficient iodine intake (see Addendum).

One patient (No. 15) with acquired hypothyroidism took up no iodine when first studied but after injection of thyrotropic hormone showed a normal uptake. The problem of whether acquired hypothyroidism may be due to deficiency of thyrotropic hormone is discussed.
MAXIMUM BREATHING CAPACITY AND VITAL CAPACITY IN FEMALE CHILDREN AND ADOLESCENTS
Authors: FERRIS B. G. , SMITH C. W.
Published: December 2021

Expected mean values and a range of normal values (plus or minus twice the standard deviation) are presented for the vital capacity and the maximum breathing capacity of female children and adolescents.

Although multiple correlation does not demonstrate a particularly higher degree of predictability it is recommended that the above values be based upon the four attributes (age, height, weight, and body surface area) rather than upon a single attribute. This is especially important in the abnormally shaped individual.
DIABETES INSIPIDUS IN INFANCY RESISTANT TO PITRESSIN
Authors: KAO MARY YUN-CHEN , STEINER MATTHEW M.
Published: December 2021

The present authors have presented the report of a 6½ month old Negro male who, shortly after birth, developed polyuria, polydipsia, fever, vomiting, dehydration, constipation and failure to gain weight.

Investigations ruled out systemic infections as well as the common inflammatory and congenital renal diseases.

Under "control" conditions (average fluid intake) there was a persistence of the fever, vomiting and constipation; the values for nonprotein nitrogen, serum sodium and chloride were elevated above normal. The polyuria, which was characterized by low specific gravity, rose to a value of 1.011 during periods of marked dehydration.

During the "hydration test," a progressive increase of fluid intake above 2000 cc. daily resulted in normal temperature, absence of vomiting, increase of weight, and normal values for nonprotein nitrogen, serum sodium and chloride.

There was no antidiuretic response either to intravenous infusion of hypertonic saline (Carter-Robbins' test) or to 0.1 unit pitressin intravenously. A normal control showed prompt antidiuresis during and following the infusion of hypertonic saline.

Intramuscular administration of pitressin to the point of toxicity (4 units) had no effect on the volume or specific gravity of the urine.

It is postulated that this syndrome of diabetes insipidus in infancy, resistant to pitressin, is the result of a failure of end-organ response in the kidney.