bluuebunny/crossref_metadata_2025 huggingface dataset:
Utilizing direct-initiation of thiols for photoinitiator-free stereolithographic 3D printing of mechanically stable scaffolds
Authors: Kreuels Klaus , Bosma David , Nottrodt Nadine , Gillner Arnold
Published: December 2021

The automated production of artificial biological structures for biomedical applications continues to gather interest. Different fields of science are combined to find solutions for the arising multidimensional problems. Additive manufacturing in combination with material science provides one solution for the biological issues around 3D cell culture and construction of living tissues. Here, we present the photoinitiator-free stereolithographic fabrication of thiol-ene polymers with microarchitectures in the range of tens of microns for scaffolds up to the millimeter scale. Scaffolds composed of cubic unit cells were designed using computer-aided design (CAD) and subsequently 3D printed with a custom-made laser stereolithography setup. The process parameters were determined step by step with increasing complexity and number of parameters. Gained insights were applied to the fabrication of 3D printed test specimens. The quality of the 3D printed parts was evaluated by measuring the porosity and optical microscopy images. Furthermore, the mechanical properties of the scaffold structures were characterized using compression testing and compared with the bulk material revealing a lower capacity to bear load but higher flexibility. In this study, we demonstrate the advantages of combining the high-precision, freeform fabrication of stereolithography with a biocompatible material for the fabrication of complex microarchitectures for biomedical applications
Electrodermal Activity Based Emotion Recognition using Time-Frequency Methods and Machine Learning Algorithms
Authors: Rao Veeranki Yedukondala , Ganapathy Nagarajan , Swaminathan Ramakrishnan
Published: December 2021

In this work, the feasibility of time-frequency methods, namely short-time Fourier transform, Choi Williams distribution, and smoothed pseudo-Wigner-Ville distribution in the classification of happy and sad emotional states using Electrodermal activity signals have been explored. For this, the annotated happy and sad signals are obtained from an online public database and decomposed into phasic components. The time-frequency analysis has been performed on the phasic components using three different methods. Four statistical features, namely mean, variance, kurtosis, and skewness are extracted from each method. Four classifiers, namely logistic regression, Naive Bayes, random forest, and support vector machine, have been used for the classification. The combination of the smoothed pseudo-Wigner-Ville distribution and random forest yields the highest F-measure of 68.74% for classifying happy and sad emotional states. Thus, it appears that the suggested technique could be helpful in the diagnosis of clinical conditions linked to happy and sad emotional states.
Gestimmt sein
Authors: Griffero Tonino
Published: December 2021

The boom in new theories of resonance is most certainly due to an intellectual atmosphere closely linked to the so-called “affective turn” in the humanities. The paper compares some theories of resonance or responsivity such as Thomas Fuchs’ phenomenological-psychopathological analysis of resonance and Bernhard Waldenfels’ phenomenology of responsivity with a sociological research on resonance by which Hartmut Rosa aims at contrasting the capitalist dictatorship of the growth-acceleration-innovation triad and the resulting loss of bodily resonance in the modern age, and above all with Hermann Schmitz’s (neo) phenomenology idea of felt-bodily (leiblich) communication. My aim is to show that by providing a neophenomenological approach to atmospheric perception – viewed as an affective and pre-reflexive bodily communication triggered by a spatial feeling whose sounding board is our Leib – a pathic aesthetics can assign both a diagnostic and a therapeutic value to the concept of resonance. This furthermore means that a sociology also attentive to the bodily and pre-linguistic dimension and a phenomenology also attentive to situative and historical-collective dimensions, both being able to focus on the pathicity of everyday life, may find an unexpected but promising point of contact.
Edgar Zilsels „Sozialismus 1943“ im Kontext
Authors: Fleck Christian
Published: December 2021

In the summer of 1943 Edgar Zilsel resigned from his membership in the exile organization of Austrian Social Democrats, a political movement he had joined as a young man back in Vienna. Zilsel (1891–1944) is known as an innovative scholar bridging philosophy, history and sociology of science, and belonging to the so-called left wing of the Vienna Circle of Logical Emipricism. Details of his political convictions are less recognized. A recently detected manuscript illuminates his worldview: His resignation letter had been accompanied by a short exposition of his interpretation of socialism near the end of World War II. The article introduces Zilsel, his life and work and publishes for the first time Zilsel’s statement from 1943.
Frequency regulation of wind energy integrated power system using a novel optimized type II fuzzy tilted integral derivative controller
Authors: Sinha Sayantan , Mallick Ranjan Kumar , Panda Gayadhar , Nayak Pravati , Bhoi Ashok
Published: December 2021

The prime objective of the proposed research work is to study the frequency response of a wind plant integrated two area power system under sudden load disturbances when considered under deregulated market environment. The thermal power system has been modelled with suitable generation constraint and governor dead bands. Erratic behaviour of wind power makes the power system very sensitive to frequency deviations and proper frequency control is needed for stability. A new tilted integral derivative controller (TID) with type II fuzzy controller is considered as secondary controller for minimizing frequency fluctuations. The gains of the controller are set at an optimal value with the help of newly designed hybrid Dragonfly algorithm–Whale optimization algorithm for proper control action. System dynamic performance with and without renewable penetration is studied and robustness of the proposed controller is established under various market conditions and varying renewable power integration.
Kierkegaard: A Seducer Resorting to Irony, Comic Jest and Humor
Authors: Yaguri Tami
Published: December 2021

While the role of the comic in Søren Kierkegaard’s thought has been thoroughly studied by diverse scholars, in this paper I will ask whether humor in Kierkegaard’s religious sphere amounts to seduction or to temptation. By “seduction” I will mean a luring that can be viewed as positive or neutral, whereas by “temptation” I mean a negative seduction that takes advantage of the tempted fool, leaving him empty-handed. Irony, comic jest and humor are existential categories in Kierkegaard’s three spheres of existence. Irony and comic jest play a seductive role and can be regarded as neutral or even positive. In the religious sphere, humor can be assessed as temptation. Kierkegaard humorously lures the one who wishes to believe. With humor, one is readying oneself for a leap of faith. The leap may fail; one can fall, crash, and be left empty-handed.
Effect of antiblock and slip additives on the properties of tubular quenched polypropylene film
Authors: Melkar Ashwith , Kumar Ravi , Singh Vishwa Pratap , Singh Priyanka , Samanta Satyajit , Banerjee Saikat
Published: December 2021

In the present investigation, silica and talc were used as antiblock additives with slip additive to investigate their effects on tubular quenched polypropylene (TQPP) film properties. Polypropylene (PP) powder was compounded with additives in twin-screw extruder and subsequently processed through TQPP machine to prepare the films. Tear and tensile properties [in machine direction (MD) and transverse direction (TD)] and surface properties of the produced TQPP films were investigated in terms of optics and coefficient of friction (CoF). The effect of conditioning time on CoF was also studied. Addition of slip agent alone to PP did not show any significant change in tear strength, CoF and tensile properties, whereas CoF reduced drastically by adding both slip and antiblock agents in combination. Reduction in CoF values were found to be more pronounced in the presence of silica-based antiblock compared to talc-based antiblock. Film surface morphology was further examined by field-emission scanning electron microscopy. The tear strength and the gloss of TQPP film decreased slightly in presence of only antiblock agents, but the tensile strength was found to increase. It was also found that tensile properties of TQPP films were superior in silica-based formulation, whereas tear strength was better in talc-based formulation in MD and TD.
Improving the rheological properties of water-based calcium bentonite drilling fluids using water-soluble polymers in high temperature applications
Authors: Liu Jinliang , Zhou Fengshan , Deng Fengyi , Zhao Hongxing , Wei Zhongjin , Long Wenjun , Evelina Amutenya , Ma Cunfa , Chen Sinan , Ma Liang
Published: December 2021

Most of bentonite used in modern drilling engineering is physically and chemically modified calcium bentonite. However, with the increase of drilling depth, the bottom hole temperature may reach 180 °C, thus a large amount of calcium bentonite used in the drilling fluid will be unstable. This paper covers three kinds of calcium bentonite with poor rheological properties at high temperature, such as apparent viscosity is greater than 45 mPa·s or less than 10 mPa·s, API filtration loss is greater than 25 mL/30 min, which are diluted type, shear thickening type and low-shear type, these defects will make the rheological properties of drilling fluid worse. The difference is attributed to bentonite mineral composition, such as montmorillonite with good hydration expansion performance. By adding three kinds of heat-resistant water-soluble copolymers Na-HPAN (hydrolyzed polyacrylonitrile sodium), PAS (polycarboxylate salt) and SMP (sulfomethyl phenolic resin), the rheological properties of calcium bentonite drilling fluids can be significantly improved. For example, the addition of 0.1 wt% Na-HPAN and 0.1 wt% PAS increased the apparent viscosity of the XZJ calcium bentonite suspension from 4.5 to 19.5 mPa·s at 180 °C, and the filtration loss also decreased from 20.2 to 17.8 mL.
A sociolinguistic study of address terms in a Nigerian university’s staff club
Authors: Mensah Eyo O.
Published: December 2021

This article explores the sociopragmatic functions of address terms in social interactions at the University of Calabar Senior Staff Club. It takes into perspective the metalinguistic categories of address terms, their motivations, and the cultural and sociolinguistic parameters that determine their choice among Club members. The study is rooted in social identity theory and community of practice (CoP) analytical framework as are theorized in contemporary sociolinguistic literature. The study identifies nicknames, titles, acronyms, formulaic appellations, clipped personal names and extended personal names as the primary types of address terms in the Club, and articulates that the use of address terms is a social construction of identity that enacts intimacy, fosters collective belonging, and enhances solidarity. Conversely, address terms can also reinforce social division and inequality given the hierarchical structure of the Club which does not license reciprocal use of some address terms. The study concludes that address terms are a site of highly creative use of language which is reflexively framed through humour, clipping, lengthening, language play and other linguistic devices. Generally, address terms provide mechanisms for members to bond socially and adapt flexibly to the socio-academic environment of the Club.
Studies on nucleation and crystal growth kinetics of plutonium(IV) oxalatex
Authors: Li Chuanbo , Wang Bo , Li Xiang , Yan Taihong , Zheng Weifang
Published: December 2021

A new method is developed to calculate the dilution ratio N of the two reactant solutions during nucleation rate determination. When the initial apparent supersaturation ratio S

N
 = f(N) in the dilution tank is controlled between 1.66 and 1.67, the counted nuclei is the most, both nuclei dissolving and secondary nucleation avoided satisfactorily. Based on this methoed, Plutonium(IV) oxalate is precipitated by mixing equal volumes of tetravalent plutonium nitrate and oxalic acid solutions. Experiments are carried out by varying the supersaturation ratio from 8.37 to 22.47 and temperature from 25 to 50 °C. The experimental results show that the nucleation rate of plutonium(IV) oxalate in the supersaturation range cited above can be expressed by the equation R

N

 = A

N
exp(−E

a

/RT)exp[−B/(ln S)2], where A

N
 = 4.8 × 1023 m−3 s−1
, and E

a
 = 36.2 kJ mol−1, and B = 20.2. The crystal growth rate of plutonium(IV) oxalate is determined by adding seed crystals into a batch crystallizer. The crystal growth rate can be expressed by equation G(t) = k

g
exp(−E’

a

/RT) (c − c
eq)
g
, where k

g
 = 7.3 × 10−7 (mol/L)−1.1(m/s), E’
a
 = 25.7 kJ mol−1, and g = 1.1.
Mechanical property of octahedron Ti6Al4V fabricated by selective laser melting
Authors: Zhai Yun , He Sibo , Lei Lei , Guan Tianmin
Published: December 2021

The stress shielding effect is a critical issue for implanted prosthesis due to the difference in elastic modulus between the implanted material and the human bone. The adjustment of the elastic modulus of implants by modification of the lattice structure is the key to the research in the field of implanted prosthesis. Our work focuses on the basic unit structure of octahedron Ti6Al4V. The equivalent elastic modulus and equivalent density of porous structure are optimized according to the mechanical properties of human bone tissue by adjusting the edge diameter and side length of octahedral lattice. Macroscopic long-range ordered arrangement of lattice structures is fabricated by selective laser melting (SLM) technology. Finite element simulation is performed to calculate the mechanical property of octahedron Ti6Al4V. Scanning electronic microscopy is applied to observe the microstructure of octahedron alloy and its cross section morphology of fracture. Standard compression test is performed for the stress–strain behavior of the specimen. Our results show that the octahedral lattice with the edge diameter of 0.4 mm and unit cell length of 1.5 mm has the best mechanical property which is close to the human bone. The value of equivalent elastic modulus increases with the increase in the edge diameter. The SLM technology proves to be an effective processing way for the fabrication of complex microstructures with porosity. In addition, the specimen exhibits isotropic mechanical performance and homogeneity which significantly meet the requirement of implanted prosthetic medical environment.
»[E]ine Art Experiment in unserer Phantasie«
Authors: Shokri Diba
Published: December 2021

This essay1 documents the participation of the Würzburg professor for ›Literaturgeschichte‹ Hubert Roetteken in a series of experiments conducted by the psychologist Karl Marbe and published in 1901 as part of the research program of the so-called ›Würzburg school‹. It suggests that Rotteken’s Poetik from the following year was positively influenced not only by Marbe’s criticism of Ernst Elster’s poetics, but by his own first-hand account of Marbe’s experimental practice. The article demonstrates how this adaptation represents a change in Roetteken’s ideal of academic reading and the making of ›Literaturgeschichte‹ and contextualizes his position in the broader development of the relationship between ›Germanistik‹ and ›Psychologie‹ as evolving academic disciplines.
Los atributos personales como promesa de acción política: Cuando los imitadores les cobran la palabra a los políticos
Authors: Álvarez Fuentes Mario
Published: December 2021

Pese a su impacto, la lógica que guía la producción de imitación sátira de políticos y políticas es aún poco investigada en el campo de la comunicación política. Este artículo devela las ideas que estos artistas tienen sobre su trabajo y, a partir de ellas, busca enriquecer las nociones teóricas presentes en el campo. El estudio emerge de la observación del proceso de producción de Polònia, un programa de imitación de políticos transmitido semanalmente en Cataluña desde 2006. Se incluyen entrevistas con algunos imitadores y se analiza cómo se representó una negociación política para formar gobierno. Un elemento central de la producción satírica consiste en observar a los políticos desde sus rasgos más personales y, a partir de ellos, los actores y actrices se forman impresiones con las que construyen sus personajes. Luego, en los sketches, los sátiros de Polònia muestran si es que los políticos son o no consistentes con las impresiones que causan con su personalidad. Los sátiros exigen su propio tipo de accountability político: Si un político inspira una forma de ser con su performance personal, debe actuar así en el tráfago político diario. Lo personal es una promesa de acción política, que, si no se cumple, condena al político a la irrelevancia. Esta centralidad de lo personal es discutida en comparación a su tratamiento conceptual en el campo de la comunicación política.
ДІЯЛЬНІСТЬ ГЕРТРУДИ БЕЛЛ ПІД ЧАС ПЕРШОЇ СВІТОВОЇ ВІЙНИ
Authors: Лілія Щербін Єлизавета Коржук
Published: December 2021

У статті вивчено діяльність відомої англійської мандрівниці, альпіністки, експертки із Близького Сходу, письменниці, археологині, картографині Гертруди Белл у роки Першої світової війни, події якої мали значний вплив на її життя.

З’ясовано особливості діяльності Гертруди Белл під час Першої світової війни. Виділено два ета­пи: 1) 1914–1915 рр. – робота у Червоному Хресті; 2) 1915–1918 рр. – перебування на Близькому Сході, отри­мання офіцерського звання, вирішальна роль при створенні Іраку. Вона налагодила систему обліку по­терпілих під час війни у Товаристві Червоного Хреста, запровадила нову ефективну систему даних про загиблих, поранених та зниклих безвісти солдатів, використавши свій досвід аналізування та типологізації для створення бази даних. Проаналізовано роль Г. Белл у подоланні конфліктів на Близь­кому Сході, підтримці нових держав, Констатовано, що вона була посередником між арабськими шейхами та британським урядом.

Ключові слова: Гертруда Белл, Перша світова війна, Червоний Хрест, Т.Е. Лоуренс, Близький Схід.
Perinatal SARS-CoV-2 Infection and Neonatal COVID-19: A 2021 Update
Authors: Sankaran Deepika , Nakra Natasha , Cheema Ritu , Blumberg Dean , Lakshminrusimha Satyan
Published: December 2021

The coronavirus disease 2019 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has swept across the world like an indiscriminating wildfire. Pregnant women and neonates are particularly vulnerable to this infection compared with older children and healthy young adults, with unique challenges in their management. Unfamiliarity with the consequences of this novel virus and lack of high-quality data led to considerable heterogeneity in obstetrical and neonatal management early in the pandemic. The aim of the this review is to summarize the impact of SARS-CoV-2 infection on pregnancy and childbirth and to examine care and possible outcomes for neonates with Covid-19-positive mothers. A brief review of vaccines currently approved by the United States Food and Drug Administration for emergency use and their potential effects on pregnant and lactating women in included.
USE OF MESOXALYL UREA (ALLOXAN) IN TREATMENT OF AN INFANT WITH CONVULSIONS DUE TO IDIOPATHIC HYPOGLYCEMIA
Authors: TALBOT NATHAN B. , CRAWFORD JOHN D. , BAILEY C. CABELL
Published: December 2021

The case history of an eight-month-old infant with severe convulsions due to idiopathic hypoglycemia is described. Because of the poor prognosis and lack of other certain means of therapy, treatment of the hypoglycemia by means of mesoxalyl urea was undertaken with apparent success.

It is concluded that mesoxalyl urea, though a potentially dangerous drug, may be worthy of further cautious trial in patients of the type described here.
ON THE SUBJECT OF ORDERLY OR LAWFUL BEHAVIOR
Authors: ALDRICH C. ANDERSON
Published: December 2021

The problem of orderly and lawful behavior in young children has been faced realistically. It has been pointed out that infants and young children are influenced by two sets of codes: one, those prescribed by civilized man, and the other by their own inherent growth impulses. The characteristics of the two codes were mentioned, pointing out that the former were of recent origin, extremely variable in different geographic, cultural and even medical situations, and were imposed from without; and that the latter were of extreme antiquity, were on the whole consistent in every social set-up, and exerted their force from within the individual.

It was shown that when the two systems regulating child behavior conflict, it is necessary either to train the child to ignore his growth urges in an effort to conform to social dictates or to modify these requirements. The growth demands cannot be changed. The methods by which a child can be made to conform are by persuasion, including example and guidance, or by corporal punishment, neither of which is a perfect method.

Illustrations of many aspects of behavior in the young child in which conflict commonly is found were cited to give some idea of in how many respects young children may be confused or frustrated with resulting unapproved behavior. It was emphasized that much of this might be prevented by relatively unimportant changes in the man-made codes.

It should be emphasized again that the whole purpose of this discussion is to make conformity to our laws possible and to insist that no child today can grow up doing entirely as he pleases. The adjustments called for are often merely those of timing, of demanding conformity at a later, more reasonable developmental stage.
THE TREATMENT OF ACUTE TEMPORARY DYSFUNCTION OF THE KIDNEYS BY PERITONEAL IRRIGATION
Authors: BLOXSOM ALLAN , POWELL NORBORNE
Published: December 2021

The occurrence of an acute temporary dysfunction of the kidneys following incompatible transfusions, sulfonamide blockage, massive trauma,acute glomerulonephritis, surgical trauma, toxemia of pregnancy, mercury poisoning, and renal failure following an acute hepatitis, is associated with a tragically high mortality. Any method lending itself to the temporary disposal of the accumulation of toxic substances from the renal failure with the subsequent salvaging of the patient merits the additional report of the use of that method.

The method of treatment in the following case report is not original. The case is being reported solely as an addition to the very small series1,2 in the literature of patients salvaged by this form of treatment. However, it does represent the first successful treatment of uremia in a patient with an acute glomerulonephritis following scarlet fever by the application of peritoneal irrigation. Its use may be of value in similar cases.

CASE REPORT*

J.L.R., Jr., a white male aged 10 years, was admitted to the pediatric service of the St. Joseph's Hospital on April 28, 1947, with the complaint of“rapid breathing, swelling, and pain in his abdomen.” The child's mother stated that he became ill first on March 24, 1947, with scarlet fever. This infection lasted about two weeks. He was kept in bed most of this time and received treatment with sulfadiazine. At the end of the two weeks he returned to school for nine days. On April 23 he complained that he did not feel well. The mother noticed that he
INGESTION OF MERCURY AS A PROBABLE CAUSE OF ACRODYNIA AND ITS TREATMENT WITH DIMERCAPROL (BAL): REPORT OF TWO CASES
Authors: ELMORE SAMUEL E.
Published: December 2021

Two infants who received mercurous chloride (calomel) in teething powders developed typical acrodynia. Dramatic resolution of symptoms followed treatment with dimercaprol (BAL). Cause and effect relationship deserve further study.
Parenteral Alimentation in Surgery
Authors: COE HERBERT E.
Published: December 2021

The author of this monograph which was awarded the quinquennial Samuel D. Gross prize of the Philadelphia Academy of Surgery for 1945 has for many years been interested in the problems of protein metabolism and has contributed extensively to the literature. He presents in this volume an excellent survey and analysis of the progress of the parenteral method of supplying the nutritional requirements of the body not only for maintenance but also for meeting acute deficits. Each of the six nutritional substances—water, salts (electrolytes), protein, carbohydrate, fat and vitamins—is described separately, but their vital interdependence is emphasized. Brief historic surveys in the introduction, and preceding the detailed discussion in several of the chapters are full of interesting items.
VITAMIN A DEFICIENCY: CASE REPORT
Authors: CORNFELD DAVID , COOKE ROBERT E.
Published: December 2021

A case of vitamin A deficiency in a 5½ mo. old infant is presented. The multiple manifestations of vitamin A deficiency as noted in this case clearly resemble the signs of deficiency described in experimental animals. The need for adequate supplementation of synthetic diets is re-emphasized.
INTESTINAL OBSTRUCTION IN THE NEWBORN INFANT DUE TO AGENESIS OF THE MYENTERIC PLEXUS (Congenital Megacolon)
Authors: POTTS WILLIS J. , BOGGS JOSEPH D. , WHITE HARVEY
Published: December 2021

Agenesis of the myenteric plexus or congenital megacolon often manifests itself by intestinal obstruction in the newborn infant. Medical management in such cases is not effective. If the infant's condition warrants, immediate resection of the neurogenically abnormal bowel should be done. In the poor-risk infant sigmoid-colostomy is the procedure of choice.
OXALOSIS
Authors: CHOU L. YING , DONOHUE W. L.
Published: December 2021

A case is reported of renal failure in a boy subsequent to recurrent calcium oxalate urinary calculi. The post mortem disclosed widespread deposits in the tissues of calcium oxalate crystals. These were particularly prominent in the kidneys and bone marrow.

It is suggested that this is the end result of an "inborn error of metabolism" in which there was an excessive formation of oxalic acid.
Issues in the Transition From Childhood to Adult Growth Hormone Therapy
Authors: Allen David B.
Published: December 2021

The consequences of severe growth hormone deficiency (GHD) in adults and the beneficial effects of GH replacement therapy are clear. However, the majority of children who have a diagnosis of GHD and who are treated with GH do not have permanent GHD and will not require treatment during adulthood. Several issues must be considered in selecting candidates for adult GH treatment and transitioning their care from pediatrics to adult medicine. Counseling about possible lifelong treatment should focus on children with panhypopituitarism and those with severe isolated GHD that is associated with central nervous system abnormalities. When to terminate growth-promoting GH therapy should be guided by balancing the high cost of late-adolescent treatment with the attainment of reasonable statural goals. Retesting for GH secretion is appropriate for all candidates for adult GH therapy; the GH axis can be tested within weeks after the cessation of treatment, but confirming an emerging adult GHD state with body composition, blood lipid, and quality-of-life assessments may require 1 year or more of observation. Selecting patients for lifelong adult GH replacement therapy will present diagnostic, therapeutic, and ethical problems similar to those in treating childhood GHD. The experience and expertise of pediatric endocrinologists in diagnosing and treating GHD should be offered and used in identifying and transitioning appropriate patients to adult GH therapy.
Melanocytic Nevi in Children Treated With Growth Hormone
Authors: Wyatt David
Published: December 2021

There is concern that growth hormone (GH) therapy may influence the growth of melanocytic nevi. In a review of the experience of the National Cooperative Growth Study, we found no excess of skin cancer in children who were treated with GH. We also reviewed our experience in 90 children with GH deficiency and 24 with Turner syndrome. We found no difference in the nevi count between control subjects and children with GH deficiency, even after many years of GH therapy. Nor was there any relation between the duration of therapy and the nevi count. Children with Turner syndrome had more nevi, but there was no relation to the duration of GH therapy. These findings and the absence of a greater frequency of skin cancer in acromegaly are reassuring. It is unlikely that GH therapy has a significant influence on nevi count or the risk of skin cancer.
A National General Pediatric Clerkship Curriculum: The Process of Development and Implementation
Authors: Olson Ardis L. , Woodhead Jerold , Berkow Roger , Kaufman Nancy M. , Marshall Susan G.
Published: December 2021

Objective.

To describe a new national general pediatrics clerkship curriculum, the development process that built national support for its use, and current progress in implementing the curriculum in pediatric clerkships at US allopathic medical schools.

Curriculum Development.

A curriculum project team of pediatric clerkship directors and an advisory committee representing professional organizations invested in pediatric student education developed the format and content in collaboration with pediatric educators from the Council on Medical Student Education in Pediatrics (COMSEP) and the Ambulatory Pediatric Association (APA). An iterative process or review by clerkship directors, pediatric departmental chairs, and students finalized the content and built support for the final product. The national dissemination process resulted in consensus among pediatric educators that this curriculum should be used as the national curricular guideline for clerkships.

Monitoring Implementation.

Surveys were mailed to all pediatric clerkship directors before dissemination (November 1994), and in the first and third academic years after national dissemination (March 1996 and September 1997). The 3 surveys assessed schools' implementation of specific components of the curriculum. The final survey also assessed ways the curriculum was used and barriers to implementation.

Outcomes.

The final curriculum provided objectives and competencies for attitudes, skills, and 18 knowledge areas of general pediatrics. A total of 216 short clinical cases were also provided as an alternative learning method. An accompanying resource manual provided suggested strategies for implementation, teaching, and evaluation. A total of 103 schools responded to survey 1; 84 schools to survey 2; and 85 schools responded to survey 3 from the 125 medical schools surveyed. Before dissemination, 16% of schools were already using the clinical cases. In the 1995–1996 academic year, 70% of schools were using some or all of the curricular objectives/competencies, and 45% were using the clinical cases. Two years later, 90% of schools surveyed were using the curricular objectives, 88% were using the competencies, 66% were using the clinical cases. The extent of curriculum use also increased. Schools using 11 or more of the 18 curriculum's knowledge areas increased from 50% (1995–1996) to 73% (1996–1997).

Conclusion.

This new national general pediatric clerkship curriculum developed broad support during its development and has been implemented very rapidly nationwide. During this period the COMSEP and the APA have strongly supported its implementation with a variety of activities. This development and implementation process can be a model for other national curricula.
Guidelines for Expert Witness Testimony in Medical Malpractice Litigation
Authors:   Committee on Medical Liability
Published: December 2021

The interests of the public and the medical profession are best served when scientifically sound and unbiased expert witness testimony is readily available to plaintiffs and defendants in medical negligence suits. As members of the physician community, as patient advocates, and as private citizens, pediatricians have ethical and professional obligations to assist in the administration of justice, particularly in matters concerning potential medical malpractice. The American Academy of Pediatrics believes that the adoption of the recommendations outlined in this statement will improve the quality of medical expert witness testimony in such proceedings and thereby increase the probability of achieving equitable outcomes. Strategies to enforce ethical guidelines should be monitored for efficacy before offering policy recommendations on disciplining physicians for providing biased, false, or unscientific medical expert witness testimony.
PUBLIC HEALTH, NURSING AND MEDICAL SOCIAL WORK
Authors: WEGMAN MYRON E.
Published: December 2021

PREVIOUS discussions in this column have dealt with the problems surrounding adoption and the precautions and safeguards which should be used by all practicing physicians. The strong desirability of agency placement, to assure the kind of skilled social service necessary in adoptions, was emphasized. On the other hand, many physicians have not become reconciled to the long waiting periods and some of the other difficulties involved in working through agencies even though they are considered essential for full protection of the child, the natural parents, and the adoptive parents.

The Children's Bureau has recently released data indicating the extent to which, in 1951, the various methods were used in carrying out adoptions. Nearly half of the children adopted by persons not related to them were placed in adoptive homes independently of a social agency. Many of the children were very young and many of them born out of wedlock. This is the group particularly vulnerable to black or gray market practices. Even though there is no doubt but that some of these adoptions were successful, others were accompanied by difficulties and unhappiness for all concerned, difficulties which could easily have been avoided with proper planning.

The Children's Bureau report was prepared from data furnished by State Public Welfare are Agencies, 25 of which furnished substantially complete information for 1951.
Head Lice
Authors: Frankowski Barbara L. , Weiner Leonard B. ,   Committee on School Health,   Committee on Infectious Diseases
Published: December 2021

Head lice infestation is associated with little morbidity but causes a high level of anxiety among parents of school-aged children. This statement attempts to clarify issues of diagnosis and treatment of head lice and makes recommendations for dealing with head lice in the school setting.
Evaluation and Development of Potentially Better Practices for the Prevention of Brain Hemorrhage and Ischemic Brain Injury in Very Low Birth Weight Infants
Authors: Carteaux Patricia , Cohen Howard , Check Jennifer , George Jeffrey , McKinley Pamela , Lewis William , Hegwood Patricia , Whitfield Jonathan M. , McLendon Debra , Okuno-Jones Susan , Klein Sharon , Moehring Jim , McConnell Connie
Published: December 2021

Objective. Neonatal care providers from 5 institutions formed a multidisciplinary focus group with the purpose of identifying potentially better practices, the implementation of which would lead to a reduction in the incidence of intracranial hemorrhage and periventricular leukomalacia in very low birth weight infants.

Methods. Practices were analyzed, 4 benchmark neonatal intensive vare units were identified and evaluated, and the literature was assessed using an evidence-based approach. The work was also reviewed by a nationally respected expert.

Results. Ten potentially better clinical practices were identified. In addition, variability in cranial ultrasound practice, related to both procedural process and interpretation, was identified as a confounding problem in evaluating quality. Using the same process, potentially better cranial ultrasound practices were also identified.

Conclusions. Implementation of these practices will improve clinical outcomes as well as the reliability of sonogram interpretation, the basis for evaluating the quality of the team’s work.
Prenatal and Postnatal Environmental Tobacco Smoke Exposure and Children’s Health
Authors: DiFranza Joseph R. , Aligne C. Andrew , Weitzman Michael
Published: December 2021

Children’s exposure to tobacco constituents during fetal development and via environmental tobacco smoke (ETS) exposure is perhaps the most ubiquitous and hazardous of children’s environmental exposures. A large literature links both prenatal maternal smoking and children’s ETS exposure to decreased lung growth and increased rates of respiratory tract infections, otitis media, and childhood asthma, with the severity of these problems increasing with increased exposure. Sudden infant death syndrome, behavioral problems, neurocognitive decrements, and increased rates of adolescent smoking also are associated with such exposures. Studies of each of these problems suggest independent effects of both pre- and postnatal exposure for each, with the respiratory risk associated with parental smoking seeming to be greatest during fetal development and the first several years of life.
Air Pollution and Children’s Health
Authors: Schwartz Joel
Published: December 2021

Children’s exposure to air pollution is a special concern because their immune system and lungs are not fully developed when exposure begins, raising the possibility of different responses than seen in adults. In addition, children spend more time outside, where the concentrations of pollution from traffic, powerplants, and other combustion sources are generally higher. Although air pollution has long been thought to exacerbate minor acute illnesses, recent studies have suggested that air pollution, particularly traffic-related pollution, is associated with infant mortality and the development of asthma and atopy. Other studies have associated particulate air pollution with acute bronchitis in children and demonstrated that rates of bronchitis and chronic cough declined in areas where particle concentrations have fallen. More mixed results have been reported for lung function. Overall, evidence for effects of air pollution on children have been growing, and effects are seen at concentrations that are common today. Although many of these associations seem likely to be causal, others require and warrant additional investigation.
Immunocompetence and Allergy
Authors: McGeady Stephen J.
Published: December 2021

Developed nations are experiencing a marked increase in prevalence of the familial allergic diseases including asthma, allergic rhinitis, atopic dermatitis, and allergic gastroenteropathy, which are often called atopic diseases. No satisfactory explanation for this epidemic is known, but it has been proposed that some facets of modern life tend to bias immune responses away from the Th1 cellular immune responses that protect against many infections and toward Th2 responses that favor atopy. There are 2 hypotheses to explain why this epidemic is occurring now. Hypothesis 1 suggests that nutritional patterns have changed or that we are exposed to environmental toxicants that were not previously present. Hypothesis 2 holds that some aspects of modern lifestyles in affluent nations have minimized exposure to infectious agents or to their by-products, such as endotoxin. This feature of contemporary lifestyle, it is suggested, has favored the development of Th2 immune responses to environmental allergens and the development of the attendant atopic diseases. This latter theory has been designated the “hygiene hypothesis.” Although there is evidence both for and against both hypotheses, evidence for hypothesis 2 is stronger and more convincing.
Children’s Behavior and Physiology and How It Affects Exposure to Environmental Contaminants
Authors: Moya Jacqueline , Bearer Cynthia F. , Etzel Ruth A.
Published: December 2021

Infant, child, and adolescent exposures to environmental toxicants are different from those of adults because of differences in behavior and physiology. Because of these differences, there is the potential for quantitatively different exposures at various stages of development. Pediatricians are well aware of these behavioral and physiologic differences from a clinical standpoint—namely, food and water intake, soil ingestion, mouthing behavior, inhalation physiology, and activity level—as they relate to the ratio of these parameters between the adult and the child when considering weight and surface area. Pediatricians recognized the importance of pica as a cause of lead poisoning, the noxious effect of second-hand smoke, and the greater propensity for addiction during the adolescent years. For determining the differences in impact of many environmental toxicants between adults and children, research is needed to document where and whether these differences result in deleterious effects.
UNTOWARD EFFECTS OF ENEMATA IN CONGENITAL MEGACOLON
Authors: RICHARDS MARY R. , HIATT ROBERT B.
Published: December 2021

The problem of untoward reactions to enemata in cases of congenital megaclon has been discussed, and nine cases of such reactions presented. The evidence, although admittedly incomplete, seems to favor water intoxication as the basis of most of these reactions. Other possible etiologic factors are discussed.

A routine for the prevention of syncope by the use of isotonic enema solutions in cases of congenital megacolon is advocated. The use of tap water or soapsuds enemas or of solutions containing potentially toxic substances such as magnesium sulfate is contraindicated in congenital megacolon.
VESTIBULAR RESPONSES TO ROTATION IN THE NEWBORN INFANT
Authors: LAWRENCE MARGARET M. , FEIND CARL R.
Published: December 2021

Using a newly designed rotating apparatus with control of acceleration, deceleration and speed, the response of 64 full term newborn infants to rotation was studied.

While awake, all infants showed head and eye deviation opposite to the direction of rotation during acceleration and in the same direction during deceleration; all infants had a normal nystagmus during acceleration and for several turns of constant speed. Then followed a reversal of the nystagmus as soon as deceleration took place. The duration of postrotational nystagmus following 10 turns in 20 seconds varied from 3 to 35 seconds with an average of 13.1 seconds. There is no comparable adult group reported as the stimulus is not constant or controlled.

Sleeping infants had no response to rotation even though they gave normal responses while awake.

Associated postrotation reactions were: flushing, eructation and voiding.

The literature on vestibular responses to rotation in the newborn infant has been reviewed.
EFFECT OF AUREOMYCIN TREATMENT OF STREPTOCOCCAL SORE THROAT ON THE STREPTOCOCCAL CARRIER STATE, THE IMMUNOLOGIC RESPONSE OF THE HOST, AND THE INCIDENCE OF ACUTE RHEUMATIC FEVER
Authors: HOUSER HAROLD B. , ECKHARDT GEORGE C. , HAHN EDWARD O. , DENNY FLOYD W. , WANNAMAKER LEWIS W. , RAMMELKAMP CHARLES H.
Published: December 2021

A total of 1,009 patients with exudative tonsillitis or pharyngitis, predominantly streptococcal in etiology, was treated with aureomycin hydrochloride. A control group of 1,035 patients received no aureomycin.

An illness classified as definite or possible rheumatic fever subsequently developed in 20 patients who had received aureomycin and in 29 who had received no treatment. Data collected on rheumatic subjects indicated that when the interval between the onset of the observed attack of exudative tonsillitis or pharyngitis and the onset of rheumatic fever exceeded 35 days, an intervening streptococcal infection had occurred. Five patients in the treated group and 20 in the control group developed rheumatic fever within a 35 day interval. These data indicated that aureomycin therapy greatly reduces the subsequent occurrence of rheumatic fever.

Aureomycin therapy was also found to eradicate the streptococcus from the oropharynx in a large number of instances and to inhibit the formation of antistreptolysin. The degree of inhibition of antistreptolysin formation was shown to correlate with the eradication of the streptococci from the oropharynx. When bacteriologic relapse occurred following cessation of aureomycin therapy, the degree of inhibition of antistreptolysin production was low.

Aureomycin therapy of streptococcal infections was compared to penicillin therapy of such infections. It was shown that penicillin was more effective in eradicating streptococci, decreasing antistreptolysin formation, and preventing rheumatic fever. Penicillin, therefore, is the drug of choice.
THE PSYCHOLOGIC ASPECTS OF PEDIATRIC PRACTICE
Authors: BELL ANITA I. , LEVINE MILTON I.
Published: December 2021

What have we seen in the aforementioned cases? In both cases the parents were apprehensive about dirt, and extremely anxious about the period of time that elapsed between movements. Each child had gone through the usual routine of cathartics, enemas, etc. In requesting that the mother finger paint together with the child, we were doing two things. We were helping this mother to overcome her own feeling about being messy, and at the same time getting her to convey to the child that dirt need not be feared, nor must it be removed immediately. Interestingly enough, if we look at the finger painting when it is done by these mothers and children, although they have a choice of all the primary colors, in a majority of the cases the ultimate painting turns out to be brown, or greenish brown, a color so closely allied with feces.

It was equally interesting to hear some of the mothers say, "You know, it really can be fun to finger paint. At first I thought it would be so messy." Although in the cases described above, it was a little late to educate the parents against undue aggression toward the infant at the time of toilet training, however, with an understanding of the problem, came some sympathy toward the child, and a lessening of the parental aggression. This is very quickly sensed by children, and may, to some degree, be responsible for the improvement in the total situation of the parent-child relationship. Furthermore, one should not overlook the fact that the help of the pediatrician is of great importance to the parent. His is the voice of authority which enables the helpless and frustrated mother to overcome earlier emotional attitudes and assume a more tolerant parental role.

We do not presume to convey that every case of constipation is cured by resorting to finger painting. However, we have observed 22 cases which were treated by the method of reeducation of parental concepts plus finger painting, with positive results.

From the foregoing material, it is evident that there is a dire need for the pediatrician to fully understand the psychologic implications of fecal movements from the first day of birth on. It is the pediatrician who guides the mother, who relieves her anxiety when the child has no movements for several days, and who can explain to her the harmless composition of feces. It is he too, who can make her aware of the problems of toilet training and the more positive attitudes she can maintain to negotiate successfully this step without undue aggression.

Inasmuch as the period of life up to the age of approximately three or three and a half years is so fraught with incidents which could have been avoided with adequate understanding, it would be a pity to overlook the measures by means of which we could avoid as distressing an illness as what we term chronic constipation.
A NEW SYNDROME: PROGRESSIVE FAMILIAL INFANTILE CEREBRAL DYSFUNCTION ASSOCIATED WITH AN UNUSUAL URINARY SUBSTANCE
Authors: MENKES JOHN H. , HURST PETER L. , CRAIG JOHN M.
Published: December 2021

Four cases of a syndrome involving a rapidly progressive cerebral dysfunction and commencing during the first week of life are reported. In each of these cases the urine excreted had a peculiar odor resembling that of maple syrup. The pathogenesis of this condition is unexplained, although some anomaly of cerebral metabolism seems to be the most likely cause of the syndrome.