bluuebunny/crossref_metadata_2025 huggingface dataset:
Der Digital Markets Act und die Regulierung von Ökosystemen
Authors: Kühling Jürgen , Weck Thomas
Published: December 2021

Die Entstehung großer digitaler Ökosysteme ist eine große Herausforderung für den Wettbewerbsschutz: Auf der einen Seite stellen die Betreiber für viele das beste Angebot am Markt bereit, auf der anderen Seite können und wollen dann viele auch nicht mehr zu Alternativen wechseln. Je größer die Ökosysteme werden, um so unangreifbarer werden sie auch. Der von der Europäischen Kommission vorgeschlagene DMA setzt diesem Mechanismus eine starre Verhaltens- und Transparenzregulierung entgegen. Der Erfolg des DMA wird davon abhängen, ob er den Mechanismus der Ausbildung und Erweiterung digitaler Ökosysteme richtig erfasst und die damit verbundenen Wettbewerbsprobleme neutralisiert. Insoweit sind nach jetzigem Stand noch einige Fragen zu klären. Der vorliegende Beitrag enthält dazu Überlegungen auf Basis der Gutachten der Monopolkommission zur Digitalwirtschaft.
High-efficiency polymethine dyes for passive Q-switch and mode locking of neodymium lasers
Authors:   Institute of Organic Chemistry of the National Academy of Sciences of Ukraine, Kyiv, Ukraine, Ishchenko Alexander A. , Slominskii Yurii L. ,   Institute of Organic Chemistry of the National Academy of Sciences of Ukraine, Kyiv, Ukraine, Sharanov Illia P. ,   Institute of Organic Chemistry of the National Academy of Sciences of Ukraine, Kyiv, Ukraine
Published: December 2021

New polymethine dyes (PD) based on benzene [c, d] indole were synthesized. Their spectral and nonlinear optical characteristics in liquid and polymer media have been studied. It was found that the relaxation times τ of the excited state of the new PDs are approximately the same as those of the dye 3274y, which is widely used as a passive Q-switch of neodymium lasers with a generation lengthwave of 1.06 μm. The low sensitivity of τ to changes in the chemical structure of such PDs indicates that the main contribution to the deactivation of the excited state is made by the benzene [c, d] indole heterocycle. High values ​​of the cross section in the range of 1.05-1.08 μm at low relaxation times allow the studied PD to be easily bleached in lasers at low intensities (about 10 MW/cm2). It is established that the photostability of the new PD significantly exceeds that for the dye 3274y. This is because they contain a saturated six-membered ring in the polymethine chain, which is much less reactive than the corresponding five-membered ring of dye 3274u with respect to the photoinitiator of free radicals of UV irradiation. It is shown that the efficiency of Q-switching and mode locking of new passive laser shutters is higher than their analogues based on the dye 3274y.
Delicate lithium-manganese spinel LiMn2O4 of quasi-spherical morphology, obtained by hydrolysis of complex compounds, as cathode material for high-power current sources
Authors:   Joint Department of Electrochemical Energy Systems of the National Academy of Sciences of Ukraine, Kyiv, Ukraine, Kirillov Sviatoslav A. , Potapenko Anna V. ,   Joint Department of Electrochemical Energy Systems of the National Academy of Sciences of Ukraine, Kyiv, Ukraine, Lisnycha Tetiana V. ,   Joint Department of Electrochemical Energy Systems of the National Academy of Sciences of Ukraine, Kyiv, Ukraine
Published: December 2021

Precipitation of hydroxides and carbonates from solutions containing complex compounds is a valuable industrial process enabling one to synthesize electrode materials with high density particles of microspherical morphology and high tap density. As a complex formation agent, ammonia is almost exclusively used in this process. Aiming at the search of other complex formation agents and the detailed studies of complex formation at precipitation, we have first investigated the hydrolysis of solutions containing citric acid. Equilibria in solutions containing citrate complexes of manganese and carbonates are computed. It is found that in Mn(NO3)2 - хC6H8O7∙H2O - уNa2CO3 systems, a neutral Mn(HCitr) complex dominates up to pH=9.5 and precipitation of MnCO3 from carbonate containing solutions begins at рН~6.5. Experiments show that MnCO3 precipitates from these systems in the form of openwork quasi-spherical aggregates formed by nanosized crystals. The synthesis of LiMn2O4 from this precursor does not influence the morphology of the material, and the resulting product consists of aggregates of less than 4 mkm and nanocrystals of ~90 nm. Electrochemical tests evidence that for the best samples, the specific capacity of 103 mAh/g can be achieved at 1 C current. At 20 C current, they deliver ~25 mAh/g capacity. After high-rate tests, in control cycles with 1 C current, the samples demonstrate high capacity retention, returning up to 98% of their initial capacity. This signifies their good prospects for using in high-rate batteries.
Electrochemical synthesis of nanostructured super-alloys with valuable electrochemical, electrocatalytic and corrosion properties
Authors:   V.I. Vernadsky Institute of General and Inorganic Chemistry of the National Academy of Sciences of Ukraine, Kyiv, Ukraine, Kublanovsky Valeriy S. , Bersirova Oksana L. ,   V.I. Vernadsky Institute of General and Inorganic Chemistry of the National Academy of Sciences of Ukraine, Kyiv, Ukraine, Yapontseva Yulia S. ,   V.I. Vernadsky Institute of General and Inorganic Chemistry of the National Academy of Sciences of Ukraine, Kyiv, Ukraine, Maltseva Tetyana V. ,   V.I. Vernadsky Institute of General and Inorganic Chemistry of the National Academy of Sciences of Ukraine, Kyiv, Ukraine, Nikitenko Vasyl M. ,   V.I. Vernadsky Institute of General and Inorganic Chemistry of the National Academy of Sciences of Ukraine, Kyiv, Ukraine, Babenkov Eugen A. ,   V.I. Vernadsky Institute of General and Inorganic Chemistry of the National Academy of Sciences of Ukraine, Kyiv, Ukraine, Devyatkin Sergei V. ,   V.I. Vernadsky Institute of General and Inorganic Chemistry of the National Academy of Sciences of Ukraine, Kyiv, Ukraine, Kochetova Svetlana A. ,   V.I. Vernadsky Institute of General and Inorganic Chemistry of the National Academy of Sciences of Ukraine, Kyiv, Ukraine, Pysanenko Alexander D. ,   V.I. Vernadsky Institute of General and Inorganic Chemistry of the National Academy of Sciences of Ukraine, Kyiv, Ukraine, Bogdanovich Lyudmila V. ,   V.I. Vernadsky Institute of General and Inorganic Chemistry of the National Academy of Sciences of Ukraine, Kyiv, Ukraine, Nechyporchuk Sergei V. ,   V.I. Vernadsky Institute of General and Inorganic Chemistry of the National Academy of Sciences of Ukraine, Kyiv, Ukraine
Published: December 2021

A study of the electrochemical formation of functional coatings by binary and ternary alloys M1M2, M1M3, M1M2M3 (where M1 is 3d6-8 metal of the iron subgroup: Fe, Co, Ni, and M2 is Mo, W; M3 is Re), from complex aqueous solutions and ionic melts. Such alloys are called "superalloys" due to a wide range of valuable physicochemical (corrosive, electrocatalytic) and functional properties and are designed to operate in extreme temperature and power modes with simultaneous exposure to an aggressive environment. The presence of rhenium in the alloy also simultaneously increases its strength and ductility (the so-called "rhenium effect"). A fundamentally new electrolyte (highly concentrated ammonia-acetate) has been developed for the formation of molybdenum alloys (NiMo, CoMo, FeMo) with a maximum content of a refractory component (about 85 at.%), such as those that exhibit a high electrocatalytic effect in the hydrogen evolution reaction (HER). The deposition of binary CoRe and ternary CoWRe alloys from a citrate electrolyte was carried out. The influence of the composition of solutions and electrolysis parameters on the chemical and phase composition, structure and properties of coatings has been established. The parameters of pulse electrolysis for obtaining multilayer CoMo and CoW coatings from carbamide melts containing cobalt and molybdenum / tungsten oxides have been determined.
Acetalization of glycerine at presence of acid-modified clinoptilolite, bentonite and tripolite from the domestic deposits
Authors:   A.V. Bogatsky Physico-Chemical Institute of the National Academy of Sciences of Ukraine, Odessa, Ukraine, Davtian Araksia S. , Levchenko Olha O. ,   A.V. Bogatsky Physico-Chemical Institute of the National Academy of Sciences of Ukraine, Odessa, Ukraine, Chikhichin Dmytro G. ,   A.V. Bogatsky Physico-Chemical Institute of the National Academy of Sciences of Ukraine, Odessa, Ukraine, Yaremov Pavlo S. ,   L.V. Pisarzhevsky Institute of Physical Chemistry of the National Academy of Sciences of Ukraine, Kyiv, Ukraine, Kamalov Gerbert L. ,   A.V. Bogatsky Physico-Chemical Institute of the National Academy of Sciences of Ukraine, Odessa, Ukraine
Published: December 2021

In recent years, the situation with glycerol (Gl) has changed dramatically due to rapid development of biodiesel industry, in production of which Gl is formed in large quantities. Cyclic acetals of Gl are used as additives to motor fuels, as well as intermediates in the synthesis of various mono derivatives of Gl, which are widely used in food and pharmaceutical industries, cosmetics, etc. On the examples of Gl interaction with acetone (Ac), benzaldehyde (BA) and formaldehyde (FA), authors revealed the prospects of nitric acid-modified samples of natural clinoptilolite (H-СPT), bentonite (H-BNT) and trepel (H-TRP) from Sokirnytsky, Dashukivsky and Konoplyansky deposits of Ukraine (respectively) as catalysts for Gl transformation into cyclic acetals. Factors that determine the optimal conditions for acid modification of raw material, providing maximum conversion of Gl and catalytic activity of obtained samples, have been identified. A characteristic feature of studied processes is need to change the reaction conditions when changing the carbonyl compound-partner of Gl. It was found that number of catalyst samples obtained on H-BNT basis, their activity is superior (or comparable) with cation exchange resin KU-2.
How Pediatric Educators Know What to Teach: The Use of Teaching Scripts
Authors: Marcdante Karen Wendelberger , Simpson Deborah
Published: December 2021

Objective.

Expert clinical teachers in medicine use teaching scripts. The aim of this study was to determine whether pediatricians also use common components of teaching scripts.

Methods.

Seventy-three pediatric clerkship directors identified anticipated errors and teaching points in response to two short vignettes. The content analysis of responses, which we completed, was analyzed by rank and receipt of teaching awards.

Results.

Greater than 87% of respondents identified at least one of three anticipated learner errors and greater than 80% of respondents identified at least one of three to four teaching points. Teaching points related directly to anticipated errors in 60% of responses. Level of experience and receipt of teaching awards had no impact on response content.

Conclusions.

Consistent with findings on the use of teaching scripts, pediatrics' educators achieved high congruence on anticipated errors and teaching points on two teaching vignettes. These findings support the hypothesis that developing teaching expertise is associated with other script components. medical education, teaching scripts, clinical teaching, pediatrics.
Inflammation in Childhood Asthma and Other Wheezing Disorders
Authors: Lemanske Robert F.
Published: December 2021

It has become clear in the last few decades that the primary underlying pathology of asthma is airway tissue inflammation. In asthma, airway remodeling occurs during chronic inflammation, even in very young children. One of the key goals in treating asthma is to identify those young children with an asthmatic phenotype and initiate early treatment to avoid irreversible airway remodeling. Distinguishing asthma from other conditions that induce wheezing is a daunting but critical step in the appropriate treatment of asthma. In some children, hallmark mediators of inflammation, such as increased eosinophil levels, may distinguish asthma from other causes of wheezing, such as viral infections. Although progress has been made in the differential diagnoses of asthma in young children, more research is needed to define unique markers for distinguishing asthma from other respiratory conditions that produce wheezing.
Medical Evaluation of Overweight Children and Adolescents: Reports From Pediatricians, Pediatric Nurse Practitioners, and Registered Dietitians
Authors: Barlow Sarah E. , Dietz William H. , Klish William J. , Trowbridge Frederick L.
Published: December 2021

Objective. The primary aim of this study was to determine how pediatric health care providers identify overweight in children and adolescents and how they evaluate obesity-related medical complications. This information can guide development of programs to help providers improve their evaluation practices. A secondary objective was to examine the association of certain provider characteristics with recommended evaluation practices.

Methods. A random sample of pediatricians, pediatric nurse practitioners (PNPs), and registered dietitians received a questionnaire about their evaluation of overweight children and adolescents. Results were compared with published recommendations. Associations between respondent characteristics and adherence to published recommendations were examined.

Results. A total 940 providers responded (response rate: 19%–33%). Among all 3 groups a majority frequently used clinical impression, weight-for-age percentile, weight-for-height percent, and weight-for-height percentile to assess degree of overweight. Nearly all pediatricians and PNPs routinely evaluated blood pressure, but a minority routinely looked for orthopedic problems, insulin resistance, and sleep disorders. Less than 10% followed all recommendations for history and physical examination. Two thirds of pediatricians and PNPs routinely tested for lipid abnormalities. Most providers asked about family history of overweight, hypertension, cardiovascular disease, and diabetes, but only one third asked about gallbladder disease. In general, the provider’s specialty, years in practice, gender, and body mass index were not associated with adherence to recommended practices.

Conclusions. Medical evaluation of overweight children and adolescents fell short of recommended practices. These results point to the need for educational efforts to increase awareness of medical risks and for tools to facilitate more complete evaluation during office visits.
Treatment of Child and Adolescent Obesity: Reports From Pediatricians, Pediatric Nurse Practitioners, and Registered Dietitians
Authors: Barlow Sarah E. , Trowbridge Frederick L. , Klish William J. , Dietz William H.
Published: December 2021

Objective. The primary aim of this study was to identify interventions used by pediatric health care providers in treatment of overweight children and adolescents to identify provider educational needs. A secondary aim was to examine the association of certain provider characteristics with recommended evaluation practices.

Study Design. A random sample of pediatricians, pediatric nurse practitioners, and registered dietitians (RDs) received questionnaires about their diet, activity, and medication recommendations for overweight patients and about referrals to specialists and programs. Results were examined for adherence to published recommendations and for associations with certain respondent characteristics.

Results. A total of 940 providers responded (response rate: 19%–33%). The majority recommended “changes in eating patterns” and “limitations of specific foods.” Half or more used “low-fat diet” and “modest calorie restriction” in adolescents. Less than 15% used “very low-calorie diet.” Fewer RDs recommended more restrictive diets. More than 60% of all groups followed recommended eating interventions for school-aged children and adolescents. More than 80% followed recommended physical activity interventions for all age groups. In each group, about 5% sometimes recommended prescription medication and herbal remedies for adolescents. None recommended surgery. Two thirds of pediatricians and pediatric nurse practitioners often referred to RDs. Approximately 20% referred to child/adolescent weight programs, but for 27% to 42%, these programs or pediatric obesity specialists were not available. No consistent associations between respondent characteristics and adherence to recommended interventions were identified.

Conclusions. The providers generally promoted healthy eating and activity with minimal use of highly restrictive diets or medication to control weight.
Response to Intravenous Immunoglobulin Predicts Splenectomy Response in Children With Immune Thrombocytopenic Purpura
Authors: Holt Derick , Brown Justin , Terrill Kelly , Goldsby Robert , Meyers Rebecka L. , Heximer Jody , Nordfors Beth , Slayton William B.
Published: December 2021

Objective. Response to intravenous immunoglobulin (IVIG) has been shown to predict response to splenectomy in adults with immune thrombocytopenic purpura (ITP). However, reports in children have been inconsistent. We sought to determine whether response to IVIG is predictive of response to splenectomy in children.

Methods. Thirty-two assessable children were identified by a retrospective chart review. Response was graded according to previously published criteria as follows: “excellent” (platelets >150 000 within 1 week), “good” (platelets between 50 000 and 150 000), and “poor” (platelets <50 000). “Response” refers to both splenectomy and IVIG, and response to splenectomy was counted only when it was durable.

Results. Twenty-one of 23 patients who had a good or excellent response to IVIG also had an excellent response to splenectomy. Six of 9 patients who had a poor response to IVIG also had a poor response to splenectomy. Response to IVIG was a sensitive predictor of response to splenectomy in 88% of patients. Response to IVIG had a specificity of 75%, a positive predictive value of 91%, and a negative predictive value of 67%. Response to prednisone and length of time to splenectomy were not correlated with splenectomy response.

Conclusions. These results suggest that response to IVIG is predictive of response to splenectomy in children with chronic ITP. This correlation may be of value in deciding whether a splenectomy should be performed in children with chronic ITP.
Hepatitis B Surface Antigen Prevalence Among Pregnant Women in Urban Areas: Implications for Testing, Reporting, and Preventing Perinatal Transmission
Authors: Euler Gary L. , Wooten Karen G. , Baughman Andrew L. , Williams Walter W.
Published: December 2021

Objectives. To estimate race/ethnicity-specific prevalence of hepatitis B surface antigen (HBsAg) in pregnant urban women and to evaluate factors associated with maternal HBsAg testing.

Methods. A multicenter, retrospective chart review was conducted of a racially/ethnically stratified random sample of maternal/infant charts of 10 523 women who gave birth to live infants during 1990–1993 in 4 urban areas in the United States. Data were collected on multiple variables, including demographic variables, HBsAg test dates and results, prenatal care type, and amount and source of payment.

Results. HBsAg prevalence among white non-Hispanics was 0.60% (95% confidence interval [CI]: 0.22–0.98), black non-Hispanics 0.97% (95% CI: 0.48–1.47), Hispanics 0.14% (95% CI: 0.01–0.26), and Asians 5.79% (95% CI: 4.42–7.16). HBsAg testing rates increased from 56.6% in 1990 to 78.2% in 1993. Factors associated with not being tested varied by urban area, but in the combined area model, they were having no or private prenatal care (odds ratios: 18.75 and 5.07, respectively) and being black (odds ratios: 2.08). Only 20.9% (95% CI: 19.1%–22.8%) of those not tested prenatally were tested at delivery. The expected number of infants born to HBsAg-positive study-area women was 3327 using study prevalence rates, compared with 1761 using national rates.

Conclusions. To help ensure that all urban infants who are born to HBsAg-positive women receive appropriate prophylaxis, health officials in urban areas should use urban-area prevalence rates to ascertain completeness of reporting maternal HBsAg positivity. Needed steps to increase maternal HBsAg testing rates include ensuring that more pregnant women receive prenatal care, promoting testing by private providers, educating providers about testing in all racial and ethnic groups, and reminding providers to test at delivery those women not tested prenatally.
Sleep Environment and the Risk of Sudden Infant Death Syndrome in an Urban Population: The Chicago Infant Mortality Study
Authors: Hauck Fern R. , Herman Stanislaw M. , Donovan Mark , Iyasu Solomon , Merrick Moore Cathryn , Donoghue Edmund , Kirschner Robert H. , Willinger Marian
Published: December 2021

Objective. To examine risk factors for sudden infant death syndrome (SIDS) with the goal of reducing SIDS mortality among blacks, which continues to affect this group at twice the rate of whites.

Methods. We analyzed data from a population-based case-control study of 260 SIDS deaths that occurred in Chicago between 1993 and 1996 and an equal number of matched living controls to determine the association between SIDS and factors in the sleep environment and other variables related to infant care.

Results. The racial/ethnic composition of the study groups was 75.0% black; 13.1% Hispanic white; and 11.9% non-Hispanic white. Several factors related to the sleep environment during last sleep were associated with higher risk of SIDS: placement in the prone position (unadjusted odds ratio [OR]: 2.4; 95% confidence interval [CI]: 1.7–3.4), soft surface (OR: 5.1; 95% CI: 3.1–8.3), pillow use (OR: 2.5; 95% CI: 1.5–4.2), face and/or head covered with bedding (OR: 2.5; 95% CI: 1.3–4.6), bed sharing overall (OR: 2.7; 95% CI: 1.8–4.2), bed sharing with parent(s) alone (OR: 1.9; 95% CI: 1.2–3.1), and bed sharing in other combinations (OR: 5.4; 95% CI: 2.8–10.2). Pacifier use was associated with decreased risk (unadjusted OR: 0.3; 95% CI: 0.2–0.5), as was breastfeeding either ever (OR: 0.2; 95% CI: 0.1–0.3) or currently (OR: 0.2; 95% CI: 0.1–0.4). In a multivariate model, several factors remained significant: prone sleep position, soft surface, pillow use, bed sharing other than with parent(s) alone, and not using a pacifier.

Conclusions. To lower further the SIDS rate among black and other racial/ethnic groups, prone sleeping, the use of soft bedding and pillows, and some types of bed sharing should be reduced.
Evidence of Effects of Environmental Chemicals on the Endocrine System in Children
Authors: Rogan Walter J. , Ragan N. Beth
Published: December 2021

Pollutant chemicals that are widespread in the environment can affect endocrine signaling, as evidenced in laboratory experiments and in wildlife with relatively high exposures. Although humans are commonly exposed to such pollutant chemicals, the exposures are generally low, and clear effects on endocrine function from such exposures have been difficult to demonstrate. Several instances in which there are data from humans on exposure to the chemical agent and the endocrine outcome are reviewed, including age at weaning, age at puberty, and sex ratio at birth, and the strength of the evidence is discussed. Although endocrine disruption in humans by pollutant chemicals remains largely undemonstrated, the underlying science is sound and the potential for such effects is real.
Health Systems in the United Kingdom and Their Role in Increasing Equity
Authors: Davidson Leslie
Published: December 2021

The Issue. This article describes the organization of the National Health Service with respect to the primary and secondary levels of care it offers children. It begins with a personal reflection from 17 years ago that is still relevant to the challenges confronting families in the United Kingdom today. It will discuss the basics of what is different and what is similar when comparing the UK health care system to that of the United States.
Inequity in Child Health as a Global Issue
Authors: Waterston Tony
Published: December 2021

The Issue. Poverty, violence, lack of education, abuse and exploitation, and refugee status are among the primary determinants of the health of children worldwide. There are 1.3 billion people living on less than US $1 per day. Half the world’s population, 3 billion people, live on less than US $1.30 per day. Of the 4.4 billion people who live in developing countries, 60% lack access to sanitation, 33% lack clean water, 20% have no health care, and 20% do not have enough dietary energy and protein.1 The world’s 225 richest people have a combined wealth equivalent to the annual income of the poorest 2.5 billion people, nearly half of the world’s population.1 This article describes a number of the social, political, and environmental factors impacting children in the developing (southern hemisphere) world and how these are affected by actions taken in the developed (northern hemisphere) world.
Training and Education as a Means of Increasing Equity in Child Health Teaching of Undergraduates
Authors: Blair Mitch
Published: December 2021

The Issue. Several primary sources of influence shape pediatric curricula in the United Kingdom and the United States. The national guidance given by the General Medical Council1 in the United Kingdom and by the Future of Pediatric Education2 document in the United States focus on developing a group of physicians who respond to the relevant needs of contemporary children. The competition among interest groups for time in curricula, including our interests in advancing community pediatrics, determines what is taught and the extent to which it is taught. Strategies to engage and motivate students so that they learn what we want them to learn ultimately will define our success in medical education and as medical educators. In approaching the above noted challenges, I have made 3 assumptions about learners. First, most students come from middle-class backgrounds and have little exposure to what life is really like for our patients and their families. Second, there is good evidence now that students’ learning styles are set from the time they enter medical school.3 Contemporary students are very assessment driven, and our residents are adopting these same sorts of attitudes. It is a protective mechanism for survival in a very crammed curriculum. The third assumption is that students have a wealth of experiences and creative energy, and there is much that we can do to harness them.
Resident Training and Education in the United States
Authors: Jenkins Renee R.
Published: December 2021

The Issue. Critical institutional and organization issues affect the education of pediatricians, influence their knowledge about child health disparities, and shape their attitudes and approaches to community pediatrics. Understanding the US graduate and postgraduate medical education system is necessary if critical and sustainable changes are to be made to ensure the capacity of pediatricians to respond to critical contemporary determinants of child health.
Research in Relation to Equity: Extending the Agenda
Authors: Stewart-Brown Sarah
Published: December 2021

The Issue. An appreciation of the role of social and emotional well-being in determining health outcomes is important in advancing the equity agenda.1 These aspects of health are adversely affected by inequity. They also are important as potential causal factors. Low levels of emotional and social well-being among the rich may be important in perpetuating health and social inequity. In the past, most research on inequity has focused on the negative end of the continuum of emotional and social health (eg, child abuse, conduct disorder, mental illness, drug and alcohol abuse) and concentrated on the problems of the poor, not the rich. The prevalence of emotional and social well-being has not been well studied. At the other end of the spectrum, emotional and behavioral problems now are the most important cause of disability in childhood,2 affecting between 10% and 20% of children.3 In between these 2 extremes, some children are socially competent, are liked by their peers, are resilient in the face of problems, know their own minds, are kind to others, and are able to handle conflict in a way that leads to resolution. Others are prone to aggression and deceit, are ostracized by their peer group, and create conflict and distress. These children may have very low self-esteem. They often are manifestly unhappy and anxious and certainly make others unhappy and anxious. This group may not meet the Diagnostic and Statistical Manual of Mental Disorders-defined criteria for emotional and behavioral problems; teachers therefore may be more aware of them and their impact on others than physicians. As a result, teachers and educational psychologists have been at the forefront of developing interventions to help this group.
Future Role of Large Neutral Amino Acids in Transport of Phenylalanine Into the Brain
Authors: Matalon Reuben , Surendran Sankar , Matalon Kimberlee Michals , Tyring Stephen , Quast Michael , Jinga Wei , Ezell Edward , Szucs Sylvia
Published: December 2021

Objective. The treatment of phenylketonuria (PKU) in children and adults has been difficult because of erosion of dietary adherence, leading to poor school performance, impairment of executive functioning, loss of IQ, and deterioration of white matter in the brain. Mutant PKU mice produced by exposure to N-ethyl-N′-nitrosourea (ENU) were used to examine the effect of large neutral amino acid (LNAA) supplementation on brain and blood phenylalanine (Phe).

Methods. Mice with PKU, genotype ENU 2/2 with features of classical PKU, were supplemented with LNAA while on a normal diet. Two dosages of LNAA were given 0.5 g/kg and 1.0 g/kg by gavage. Blood Phe was determined in the experimental, control, and sham-treated mice. Brain Phe was determined by magnetic resonance spectroscopy after perchloric acid extraction. Branched-chain amino acid transferase (BCAT) was determined in brain as a marker for energy metabolism.

Results. Blood Phe was reduced in the LNAA-treated mice by an average of 15% (0.5 g/kg) and 50% (1.0 g/kg) in 48 hours. There was a sustained decrease in the blood Phe levels over a 6-week trial. The untreated mice and sham-treated mice maintained high blood Phe throughout the experiments. Brain Phe level determined by magnetic resonance spectroscopy showed a decline of 46% after the LNAA treatment. BCAT levels were lower (33%) in the ENU 2/2 mice compared with wild-type. The BCAT normalized in mice with PKU that were treated with LNAA.

Conclusion. The results suggest that giving LNAA lowered brain and blood Phe levels in mice with PKU. Energy metabolism generated from BCAT also improved in mice with PKU after treatment with LNAA. Data from the mice suggest that LNAA should be considered among the strategies to treat PKU in humans.
Building Medical Homes: Improvement Strategies in Primary Care for Children With Special Health Care Needs
Authors: Cooley W. Carl , McAllister Jeanne W.
Published: December 2021

Families and professionals agree that children and adolescents need access to community-based medical homes. This is especially true for children with special health care needs (CSHCN). Most primary care practices are designed for children's routine preventive and acute care needs. CSHCN benefit from care that is integrated with well-child and acute care; coordinated and actively co-managed with specialists, therapists, and educators; and offered in a planned, anticipatory manner. As the primary caregiver and decision maker, families need to be supported in a culturally effective way. Families want community resources that are integrated with care processes. Primary care practices that serve CSHCN require a practical and effective improvement method to become fully realized medical homes. A change method, which blends improvement strategies with progressive measurement, must be perceived by practices as practical and helpful, and it must be supported. The Center for Medical Home Improvement has developed and tested an effective model of medical home improvement and tools to measure the status of a practice and its progress of change.
CHEMICAL HOMEOSTASIS IN THE NEWBORN INFANTS OF DIABETIC MOTHERS
Authors: LOWREY GEORGE H. , GRAHAM BRUCE D. , TSAO M. U.
Published: December 2021

With the increased incidence of diabetic women reaching the child-bearing ages and their fertility being improved as a result of the use of insulin, there will be an increase in the number of newborn infants of diabetic mothers. Except for better control of diabetes in the mother there is no known method to reduce the infant mortality rate, which remains very high, approximately 30%. Likewise there is at present no completely adequate explanation for this poor prognosis. The present study of the blood electrolyte balance was undertaken to elucidate certain points in the physiology of the newborn infant of a diabetic mother. The 11 infants studied had extremely variable plasma chloride and total base levels and a high proportion of these had an uncompensated acidosis with a lowered blood pH when compared to the normal newborn infant. The high plasma CO2 tension indicates that ventilatory control of this factor was lacking, whether the fault be central or pulmonary. Furthermore, there appears to be a direct correlation between the degree of acidosis and the severity of the abnormal clinical picture present. The exact cause of this acidosis is not at present clear.
CONGENITAL ANOMALIES IN THE RAT PRODUCED BY EXCESSIVE INTAKE OF VITAMIN A DURING PREGNANCY
Authors: COHLAN SIDNEY Q.
Published: December 2021

Excessive intake of vitamin A during pregnancy in the rat results in a marked litter failure. However, when litters are carried to term a variety of gross congenital anomalies are produced which include: encephaly, eye malformations, cleft palate, shortening of the mandible and maxilla, spina bifida with meningocele and hydrocephalus. Of 148 offspring of vitamin A-fed maternal rats, 77 exhibited gross malformations (an anomaly rate of 52%). There were no congenital anomalies observed in 1201 control young.

The 7th to 10th day of gestation was found to be the period critically susceptible to the teratogenic effect of vitamin A excess. The stage specificity of various environmental agents and the possible mechanism of action of the teratogenic effect of maternal vitamin A excess are discussed.
ARE HOME ACCIDENTS IN CHILDREN PREVENTABLE?
Authors: DENNIS JAMES M. , KAISER ALBERT D.
Published: December 2021

A series of 491 nonfatal home accidents involving children, occurring in a 10 month period in the City of Rochester, New York, is presented. These accidents were obtained from hospital emergency rooms and investigated by the authors and Public Health Nurses. Of these 491 cases, 284, or 58%, were judged to be preventable. Reasonable supervision by an adult, and the use of ordinary precautions against accidents, were outstanding as means of prevention. The statistically typical accident involved a boy under the age of 5 years, who was playing in the porch and yard in the afternoon, who fell from a height and cut his head. No mechanical factors were involved, and an adult was at fault. Methods of prevention of accidents are discussed.
La Progénèse. Facteurs Préconceptionnels du Développement de L'Enfant
Authors: VILLEE CLAUDE A.
Published: December 2021

This book, with chapters by 34 different authors representing pediatrics, genetics, biochemistry, anthropology, embryology, ecology and demography, is a detailed consideration of the conditions which, acting before conception occurs, may affect the qualities of the future human being. The list of contributors includes authorities from France, England, the Netherlands, Belgium, Sweden, and Denmark.

In the introductory chapter, Professor Turpin contrasts progenesis—the factors, both hereditary and environmental, operating before conception to influence the future zygote—with metagenesis, the factors which come into play only after the egg has been fertilized.
Stuttering in Children and Adults
Authors: SENN MILTON J. E.
Published: December 2021

The problem of stuttering is one which confronts the pediatrician frequently. Despite the vast amount of research in the area of speech pathology which has been carried on in the world, stuttering continues to be a mystifying and frustrating complaint. There continue to be sharp differences of opinion between the experts, with feelings running high on many occasions, because one considers the others too extreme. The book by Johnson et al. reports on the vast amount of work done on stuttering in research and clinical settings at the University of Iowa for over 30 years.
Our Blind Children—Growing and Learning with Them
Authors: ZAHL PAUL A.
Published: December 2021

This book, addressed mainly to the parents of sightless children, is professional counsel— solid, straightforward, and wholesome. The author is superintendent of the California School for the Blind, Berkeley.

In regard to blind children of pre-school years, the approach is under such specific headings as: Learning to Eat, Toilet Training, Sleeping Habits, Learning to Dress, Learning to Walk, Learning to Talk....

The author proceeds to matters of schooling and educational placement, together with discussions of and answers to a host of questions that inevitably occur to the parents of blind children.
MATERNAL DEPRIVATION
Authors: Glaser Kurt , Eisenberg Leon
Published: December 2021

The effects upon the child of separation from his mother (deprivation syndrome) have been critically reviewed. Effects of physical neglect or emotional rejection by the child's mother have not been included in this paper.

The results of maternal deprivation in the physical, intellectual and emotional areas have been described. They have been shown to vary in type, intensity and reversibility depending upon the age at which separation occurs, duration of separation and pre- and post-separation experiences of the child.

Preventive and therapeutic measures have been briefly discussed.
The Boke of Children
Authors: MAY C. D.
Published: December 2021

A. V. Neale, M.D., Department of Child Health, University of Bristol, and Hugh R. E. Wallis, M.D., Bath, Somerset are the editors of this reprint of the first book on pediatrics ever written in the English language. Pediatricians of the English speaking world owe a debt of gratitude to them and to the publishers who have made this famous book available–and at a reasonable price.

The full text of The Boke of Children is provided along with addition of a valuable Introduction as well as a most helpful Glossary of terms, without which some of the text would be unintelligible to the modern reader.
Histamine, A Ciba Foundation Symposium held jointly with The Physiological Society and The British Pharmacological Society
Authors: FEATHERSTONE R. M.
Published: December 2021

This book includes reports of two symposia on histamine held in honor of Sir Henry Dale, pioneer in this field of research. The first symposium, that of the Physiological foundation, was divided into three major parts, namely: The occurrence of histamine in the body, the release of histamine, and the origin and significance of histamine in the body, during which formal presentations were made to the 300 participants.

During the first part, the distribution of histamine, its relation to mast cells and intracellular particles, and its occurrence in free and bound forms were the primary points of discussion.
Allergy in Childhood
Authors: DEAMER WILLIAM C.
Published: December 2021

Most pediatricians will find this book, written by one with many years of experience in allergy, to be of helpful and practical aid in the management of allergic children. It gives, in great detail, information on the diagnosis and practical management of the most common allergic disorders: asthma, eczema and contact dermatitis, allergic rhinitis, and pollinosis. Practically all of the other proven or suspected manifestations of allergy are also commented upon in one or another of its 67 chapters.
Modern Methods of Feeding in Infancy and Childhood
Authors: HILL LEE FORREST
Published: December 2021

American readers will be interested in this English view of infant feeding as presented by two well-known pediatricians of that country. Basic concepts differ but little from those contained in similar publications in this country. Names of some of the foodstuffs used may, however, be unfamiliar. Among these are such terms as "rose-hip syrup," "black-currant" purée (orange juice substitutes) and "groats" (cereal). Brand names of dried milks are listed under the intriguing titles of Cow & Gate Full-Cream, Ostermilk, Dorsella, and Ambrosia Full-Cream.
ADOLESCENCE
Authors: Gallagher J. Roswell , Heald Felix P.
Published: December 2021

I BELIEVE that it will be profitable to begin our discussion of adolescence with a few remarks about the Adolescent Unit at the Children's Hospital in Boston: what it is and why it is. This Unit is a general medical clinic designed for the care and treatment of young people between the ages of 12 and 21. As there is often confusion in the minds of not only the physician but the laity as to whether this Adolescent Unit is a psychiatric clinic, I would like to stress that our Unit is a general clinic for all young people, whether their complaints be a backache, dysmenorrhea, acne, diabetes, seizures, or any other ailment which is either common or uncommon in adolescence. Our discussion will not be psychiatrically but rather psychologically oriented to this age group.

It has not been our intention to create a new specialty, but rather to give special care to this somewhat neglected age group. In our Adolescent Unit we have pediatricians, internists, and general practitioners working side by side in a common effort to provide over-all medical care for these boys and girls. Young people deserve a clinic of their own just as do little children and adults. They need a place where they can tell their own story to their own doctor, and where their doctor can talk to them about what they should do to care for themselves.

In addition to our primary function, which is to care for the adolescent and his or her ailment, the Unit also serves for the training of the physician in the care of these young people.
GIANT CELL PNEUMONIA
Authors: Adams J. M. , Imagawa D. T. , Yoshimori Miye , Huntington R. W.
Published: December 2021

In two fatal cases of measles the major pathologic finding was a pneumonia characterized principally by giant cells and inclusion bodies. The pattern was not dissimilar to that encountered in two cases of "primary pneumonitis with inclusion bodies," evidently not due to measles. The development of giant cells has been illustrated in tissue cultures infected with adenoviruses and measles viruses, and in ferrets infected with distemper viruses. Conspicuous giant cell production in the lung appears to be a rather general viral phenomenon, not peculiar to any one virus.
APPARATUS FOR COLLECTION OF URINE FROM FEMALE INFANTS
Authors: Heeley Ann H. , Talbot Nathan B.
Published: December 2021

THE COLLECTION of complete, uncontaminated urine specimens from female infants up to the time when toilet training is established without resorting to the use of a catheter has long been a problem on pediatric services. The apparatus described here has been found helpful in alleviating this problem. [See FIG. 1. in Source Pdf.]

DESCRIPTION OF APPARATUS

As shown in Figure 1, this collection apparatus consists of a small, quadrangular piece of plastic material (Section A), shaped to fit the contour of the female perineum, to which is attached plastic tubing (Section B-D). This apparatus is placed over the patient's penineum and is held firmly in place by means of cotton straps (Section E.) The collection tubing may either be nun under the knee of the patient and over the side of the bed into a collection bottle or may be dropped through a hole near the center of a metabolic mattress if one is available. Elevation of the head of the bed on 2-inch-high shock blocks facilitates drainage.

When used for prolonged urine collections, irritation of the skin of the perineum can be avoided by releasing the straps and adapter every 6 to 8 hours just after a voiding. The perineal area can then be washed, dried and exposed to the air for a few minutes before reapplying the apparatus.

The quadrangular adapter can be cleaned and reused. The tubing remains watertight for about 4 days and is replaced as indicated.

COMMENTS

Extensive use of this apparatus over the past 4 years in a wide variety of situations indicates that it greatly facilitates the collection of single, uncontaminated urine specimens even in the presence of profuse, watery diarrhea.
ENVIRONMENTAL RETARDATION (HOSPITALISM) IN INFANTS LIVING IN FAMILIES
Authors: Coleman Rose W. , Provence Sally
Published: December 2021

Case reports of two infants reared in their own families who became retarded developmentally due to inadequate maternal care are presented. Maternal deprivation is one of the causes of retarded development in infancy. The presence of the syndrome in family infants requires emphasis and wider recognition. The differential diagnosis includes retardation due to 1) central nervous system lesions, 2) secondary to acute or chronic involvement of organ systems other than the central nervous system, and 3) accompanying infantile psychosis. Diagnosis is made on history, physical examination, developmental tests and response to therapy. While not a common cause of retardation, its recognition is of importance because prognosis for future development is good if appropriate therapeutic measures can be instituted.
RABIES PROPHYLAXIS IN MAN
Authors: Habel Karl
Published: December 2021

IN SPITE of the fact that rabies has long been recognized as a virus disease, that more experimental work has been carried out on this disease than on any other human illness of virus etiology, and in spite of the existence of a prophylactic vaccine for the past 70 years, nevertheless there continues to be a rabies problem in most parts of the world including the United States.

Although the number of animals reported annually as rabid in this country varies between 6,000 and 10,000 it is estimated that those reported represent only a small proportion—perhaps only a third—of the actual number. However, with only 10 to 20 human deaths each year due to rabies it would appear that this disease is of minor importance among the health problems of our human population, yet as many as 50,000 individuals receive antirabies prophylaxis each year.

A long range program aimed at the elimination of rabies as a public health problem in any area is actually a veterinary and wildlife rather than a medical problem, because man represents the end of the line in the ecology and persistence of rabies. In other words, if rabies did not occur in animals there would be no medical problems as regards humans with this disease. The present situation in the United States concerning the prevalence and distribution of rabies and the detection of the animal reservoir is quite a bit different from what it was 25 on even 10 years ago. For years the dog has been the chief source of exposure of humans to rabies, and because of his unique relationships to man will probably continue to be so.