bluuebunny/crossref_metadata_2025 huggingface dataset:
Cross Data Set Generalization of Ultrasound Image Augmentation using Representation Learning: A Case Study
Authors: Wulff Daniel , Mehdi Mohamad , Ernst Floris , Hagenah Jannis
Published: December 2021

Data augmentation is a common method to make deep learning assessible on limited data sets. However, classical image augmentation methods result in highly unrealistic images on ultrasound data. Another approach is to utilize learning-based augmentation methods, e.g. based on variational autoencoders or generative adversarial networks. However, a large amount of data is necessary to train these models, which is typically not available in scenarios where data augmentation is needed. One solution for this problem could be a transfer of augmentation models between different medical imaging data sets. In this work, we present a qualitative study of the cross data set generalization performance of different learning-based augmentation methods for ultrasound image data. We could show that knowledge transfer is possible in ultrasound image augmentation and that the augmentation partially results in semantically meaningful transfers of structures, e.g. vessels, across domains.
Needle insertion planning for obstacle avoidance in robotic biopsy
Authors: Gerlach Stefan , Neidhardt Maximilian , Weiß Thorben , Laves Max-Heinrich , Stapper Carolin , Gromniak Martin , Kniep Inga , Möbius Dustin , Heinemann Axel , Ondruschka Benjamin , Schlaefer Alexander
Published: December 2021

Understanding the underlying pathology in different tissues and organs is crucial when fighting pandemics like COVID-19. During conventional autopsy, large tissue sample sets of multiple organs can be collected from cadavers. However, direct contact with an infectious corpse is associated with the risk of disease transmission and relatives of the deceased might object to a conventional autopsy. To overcome these drawbacks, we consider minimally invasive autopsies with robotic needle placement as a practical alternative. One challenge in needle based biopsies is avoidance of dense obstacles, including bones or embedded medical devices such as pacemakers. We demonstrate an approach for automated planning and visualising suitable needle insertion points based on computed tomography (CT) scans.

Needle paths are modeled by a line between insertion and target point and needle insertion path occlusion from obstacles is determined by using central projections from the biopsy target to the surface of the skin. We project the maximum and minimum CT attenuation, insertion depth, and standard deviation of CT attenuation along the needle path and create two-dimensional intensity-maps projected on the skin. A cost function considering these metrics is introduced and minimized to find an optimal biopsy needle path. Furthermore, we disregard insertion points without sufficient room for needle placement. For visualisation, we display the color-coded cost function so that suitable points for needle insertion become visible.

We evaluate our system on 10 post mortem CTs with six biopsy targets in abdomen and thorax annotated by medical experts. For all patients and targets an optimal insertion path is found. The mean distance to the target ranges from (49.9 ± 12.9)mm for the spleen to (90.1 ± 25.8)mm for the pancreas.
Comparison of Geometrical Lung Models to Calculate Tidal Volumes during Spontaneous Breathing
Authors: Beck Simon , Laufer Bernhard , Moeller Knut
Published: December 2021

Demographic changes, increasing air pollution and the ongoing Covid-19 pandemic, causing virus-induced respiratory failures, monitoring of respiratory parameters is the focus of international interest. In this study, motioncapture- system data was used to get circumferences of the human thorax while executing different breathing patterns. Four geometric models were used to model tidal volumes of the tracked person while using spirometry data as a reference. The results show that all four introduced models can be used for tidal volume calculation based on changes in the thoracic circumference. In terms of accuracy, the use-case must be considered
Vitrectome with Integrated LED Illumination: Development and Testing
Authors: Sieber Nicole , Lingenfelder Christian , Götz Madeleine , Heine Pauline , Lichtner Leonie , Hessling Martin
Published: December 2021

Background: In current vitrectomy, the surgeon guides the vitrectome and a rigid fiber light guide with one hand each. It would be desirable to have a free hand for other surgical instruments and maneuvers. Methods: In the feasibility study presented here, a 20 gauge vitrectome is equipped with a miniature white LED that could eliminate the need for the separate light guide and therefore free one hand. The functionality of the system is proved in a ping-pong ball filled with agar and an ex-vivo porcine eye. Results: The brightness of the approach appears to be sufficient without any realistic phototoxic retinal hazard while the functionality of the vitrectome, in combination with the LED, is still given. Conclusion: The combination of a 20 gauge vitrectome with a LED illumination unit was successfully tested. The approach can be transferred to small vitrectomes in the future
Separating ventricular activity in thoracic EIT using 4D image-based FEM simulations
Authors: Stender Birgit , Blanck Oliver , Reinartz Sebastian D. , Dössel Olaf
Published: December 2021

One challenge in central hemodynamic monitoring based on electrical impedance tomography (EIT) is to robustly detect ventricular signal components and the corresponding EIT image region without external monitoring information. Current stimulation and voltage measurement of EIT were simulated with finite element porcine torso models in presence of a multitude of thoracic blood volume shifts. The simulated measurement data was examined for linear dependence on changes in stroke volume. Based on the results the EIT measurement information regarding stroke volume changes is sparse
Effect of carbon nanotubes on microstructure and corrosion resistance of PEO ceramic coating of magnesium alloy
Authors: Ma Qun , Wang Ping , Chen Xiaomin , Zhang Chunqing
Published: December 2021

Plasma electrolytic oxidation (PEO) ceramic coating modified by carbon nanotubes (CNTs) was prepared on Mg–Gd–Y alloy. The microstructure, hydrophobicity and corrosion resistance of the coating were investigated by SEM, contact angle meter and electrochemical test system. Carbon nanotubes (CNTs) are staggered in the ceramic coating and partially filled with plasma discharge micropores. To some extent, CNTs can promote the plasma discharge and improve the film formation rate. With the increase of the content of CNTs, the content of carbon nanotubes in the ceramic coating increases. CNTs can effectively improve the hydrophobicity of ceramic coating. With the increase of the content of CNTs, the corrosion potential E
coor and polarization resistance R

p
increase, the corrosion current i
coor decreases and the AC impedance |Z| increases, which leads to the decrease of corrosion rate.
Ohne-Tun und Selbstwandel
Authors: Heubel Fabian
Published: December 2021

In the text “The Principles of a Liberal Social Order”, Friedrich A. von Hayek quotes from Chapter 57 of the Daoist classicLǎozǐ老子 (alternative transliterations are Lao Tzu, Laotse, etc.; the text is also known under the titleDàodéjīngorTao Te King道德經). Appearing in a text devoted primarily to the concept of “spontaneous order”, the quote opens up questions regarding the relationship between liberalism and Daoism, which I address in this essay. The discussion comprises three parts. In the first part, I turn to the translation cited by Hayek and, by way of a commentary to the translation, I attempt to gain access to the motifs of “effortless action/without doing” (wúwéi無為), “self-transformation” (zìhuà自化) and “self-government” (zìzhì自治); the second part offers a hermeneutic commentary through which I discuss interpretative approaches found in the Chinese commentarial tradition; finally, the third part outlines transcultural correspondences which explore the political meaning of the Daoist “without doing” and the idea of “spontaneous order” in the context of the discursive struggle between the “democratic West” and “authoritarian China”.
Die karische Endung -τ
Authors: Simon Zsolt
Published: December 2021

Based on the contextual analysis of the Carian inscription from Hyllarima (C.Hy 1) this paper argues that the Carian nominal ending -τis neither genitive plural nor dative plural as previously proposed but ablative. This is supported both by its phonological history and its other attestions.
A learning based approach for designing extended unit cell metagratings
Authors: Panda Soumyashree S. , Hegde Ravi S.
Published: December 2021

The possibility of arbitrary spatial control of incident wavefronts with the subwavelength resolution has driven research into dielectric optical metasurfaces in the last decade. The unit-cell based metasurface design approach that relies on a library of single element responses is known to result in reduced efficiency attributed to the inadequate accounting of the coupling effects between meta-atoms. Metasurfaces with extended unit-cells containing multiple resonators can improve design outcomes but their design requires extensive numerical computing and optimizations. We report a deep learning based design methodology for the inverse design of extended unit-cell metagratings. In contrast to previous reports, our approach learns the metagrating spectral response across its reflected and transmitted orders. Through systematic exploration, we discover network architectures and training dataset sampling strategies that allow such learning without requiring extensive ground-truth generation. The one-time investment of model creation can then be used to significantly accelerate numerical optimization of multiple functionalities as demonstrated by considering the inverse design of various spectral and polarization dependent splitters and filters. The proposed methodology is not limited to these proof-of-concept demonstrations and can be broadly applied to meta-atom-based nanophotonic system design and in realising the next generation of metasurface functionalities with improved performance.
An Answer to a Question that Cannot Be Answered: A Pragmatist Approach to Viktor Frankl’s and Primo Levi’s Theoretical Perspectives on Humor
Authors: Hietalahti Jarno
Published: December 2021

This article offers a pragmatist approach to concentration camp humor, in particular, to Viktor Frankl’s and Primo Levi’s conceptualizations of humor. They both show how humor does not vanish even in the worst imaginable circumstances. Despite this similarity, it will be argued that their intellectual positions on humor differ significantly. The main difference between the two authors is that according to Frankl, humor is elevating in the middle of suffering, and according to Levi, humor expresses the absurdity of the idea of concentration camps, but this is not necessarily a noble reaction. Through a critical synthesis based on pragmatist philosophy, it will be claimed that humor in concentration camps expresses the human condition in the entirely twisted situation. This phenomenon cannot be understood without considering forms of life, how drastic the changes from the past were, and what people expected from the future, if anything.
The Reservations of the Funny: Ethics of Studying Funny Communication
Authors: Sills Liz
Published: December 2021

Studying the funny trends within historically marginalized populations has historically been used as a means of making them seem nonthreatening to dominant cultures. Scholars, furthermore, have often applied dominant-culture contexts toward reading minority artifacts without taking the time to understand the premises for other cultures’ funny enthymemes (Epp 2010; Price 1994). This paper proposes two solutions to the dilemma of recognizing the importance of representing marginalized populations’ humor in the scholarly canon but also studying those funny artifacts with a mind toward ethics, using Native American humor as a representative case study.
Removal of crystal violet from water by poly acrylonitrile-co-sodium methallyl sulfonate (AN69) and poly acrylic acid (PAA) synthetic membranes
Authors: S’Id Ely Cheikh , Degué Mohamed , Khalifa Chlouma , M’Bareck Chamekh
Published: December 2021

The current investigation is focused on the removal of crystal violet (CV) from water by adsorption process (bach method). To achieve this purpose, specific membranes were prepared from poly acrylonitrile-co-sodium methallyl sulfonate (AN69) and poly acrylic acid (PAA) blends. The adsorption of CV onto AN69/PAA membranes was studied under various conditions: membrane composition, pH, contact time, initial concentration and temperature. To understand the effect of membrane morphology on adsorption process, scanning electronic microscopy (SEM) was employed to determine the features of section and membrane’s surface. From isotherm results, it was found that: the maximum adsorption capacity Q

m
was 1250 mg g−1, the Langmuir separation factor R
L was lying between 0.33 and 0.76, the Freundlich intensity was higher than Unit (n = 1.25) and the adsorption process follows preferentially the Langmuir model (correlation constant R
2 = 0.99). The mechanism of adsorption is perfectly fitted by pseudo second order. The obtained results tend to confirm that the removal of dye molecules is due to the establishment of strong electrostatic interactions between cationic dye molecules and anionic membrane groups. The high adsorption capacity (1250 mg g−1) for the small dye molecules may open wide opportunities to apply these membranes in the removal of various hazardous pollutants commonly present in water.
Engagement markers in research project websites: Promoting interactivity and dialogicity
Authors: Mur-Dueñas Pilar
Published: December 2021

Scholars are currently not only required to produce primary output, i.e. peer-reviewed research articles, chapters or books, which constitutes certified and legitimised knowledge (Puschmann 2015), but also to disseminate such output, which is frequently carried out digitally and in English. In this context it is the aim of this paper to gain insights into scholars’ digital discursive practices by analysing academic websites of research projects funded under the European H2020 programme. More specifically, it explores the ways in which a potentially wide, blurred audience is addressed by means of engagement markers, particularly, reader pronouns, questions, and directives, including imperatives, obligation modals and adjectival phrases expressing necessity. Results indicate that the frequency of use of engagement markers varies across websites and that it may affect their degree of potential interactivity. They further show that some engagement markers are more common than others and that they tend to display specific rhetorical purposes. Differences on their use and function when compared to their use in RA writing are also shown. It is concluded that these interpersonality features have an important role in the potential promotion of dialogicity in this digital medium, and crafting an effective professional identity of the research teams.
Trato del telediario público a temas y líderes políticos (2014-2021)
Authors: Bandera López Noel
Published: December 2021

Ante la ausencia o retraso e incompletitud de registros de lo emitido en TV pública, se ofrece un estudio único, por su alcance (desde 2014 a 2021) y su novedoso método, sobre el Telediario de La 1 de Televisión Española. Se usa la herramienta Verba de la Fundación Civio, cuyo afán por la transparencia es presentado en la introducción, además de tratar la influencia de los medios en partidos políticos y agenda. El objetivo principal es evaluar dos tipos de elementos: 30 nombres de líderes políticos y 30 expresiones con incidencia política (los 15 principales problemas citados por la ciudadanía en el último CIS y otros 15 vinculados). El modelo se centra en las palabras pronunciadas y faltarían otros elementos audiovisuales del Telediario. Los resultados muestran un trato favorable a PSOE, PP y Ciudadanos y desfavorable a los partidos de izquierdas, los soberanistas y Vox. En cuanto a las palabras seleccionadas, se abusa de algunas, como “consenso” y sobre todo “polémica”, mientras lo social recibe menor atención que la expresada por la ciudadanía y lo relacionado con el sistema político o económico aparece aún menos. No existe proporcionalidad ni en la relevancia concedida a los problemas del CIS ni a los partidos de acuerdo con sus votos. Futuras investigaciones podrían aplicar la metodología afinándola para no contabilizar menciones no pertinentes.
Cambios en la programación televisiva en Andalucía debido a la pandemia por la COVID-19. El caso del Carnaval de Cádiz
Authors: Fernández Jiménez Estrella
Published: December 2021

Los medios de comunicación han sido el sector que no solo no ha parado su actividad, sino que la ha incrementado debido a la alta demanda de información por parte de la población para informarse y también para entretenerse. Nuestro objetivo principal es abordar cómo los medios de comunicación, en especial la televisión, se han adaptado a la nueva situación. En concreto la programación referida a la retransmisión del Carnaval de Cádiz. En 2021 las cadenas de televisión han tenido que generar ese contenido para cubrir la programación especial de esas fechas. En este trabajo mostramos una panorámica general analizando las parrillas de programación así como los contenidos generados por las televisiones. Mediante la observación participante, entrevistas en profundidad a agentes implicados en la dirección y desarrollo de los programas estudiados y análisis de las parrillas televisivas, observamos que, en esta ocasión, la creatividad ha surgido de los guionistas o directores de programas y no del producto cultural que es el Carnaval de Cádiz, como históricamente ha ocurrido. Sabemos que el contenido aquí estudiado puede quedar desfasado con rapidez debido a sus propias características, pero al ser un hecho excepcional debe ser estudiado como momento histórico que se suma a los diversos cambios y adaptaciones que la sociedad ha tenido que hacer debido a la pandemia.
Attention Differentially Affects Acoustic and Phonetic Feature Encoding in a Multispeaker Environment
Authors: Teoh Emily S. , Ahmed Farhin , Lalor Edmund C.
Published: December 2021

Humans have the remarkable ability to selectively focus on a single talker in the midst of other competing talkers. The neural mechanisms that underlie this phenomenon remain incompletely understood. In particular, there has been longstanding debate over whether attention operates at an early or late stage in the speech processing hierarchy. One way to better understand this is to examine how attention might differentially affect neurophysiological indices of hierarchical acoustic and linguistic speech representations. In this study, we do this by using encoding models to identify neural correlates of speech processing at various levels of representation. Specifically, we recorded EEG from fourteen human subjects (nine female and five male) during a “cocktail party” attention experiment. Model comparisons based on these data revealed phonetic feature processing for attended, but not unattended speech. Furthermore, we show that attention specifically enhances isolated indices of phonetic feature processing, but that such attention effects are not apparent for isolated measures of acoustic processing. These results provide new insights into the effects of attention on different prelexical representations of speech, insights that complement recent anatomic accounts of the hierarchical encoding of attended speech. Furthermore, our findings support the notion that, for attended speech, phonetic features are processed as a distinct stage, separate from the processing of the speech acoustics.

SIGNIFICANCE STATEMENTHumans are very good at paying attention to one speaker in an environment with multiple speakers. However, the details of how attended and unattended speech are processed differently by the brain is not completely clear. Here, we explore how attention affects the processing of the acoustic sounds of speech as well as the mapping of those sounds onto categorical phonetic features. We find evidence of categorical phonetic feature processing for attended, but not unattended speech. Furthermore, we find evidence that categorical phonetic feature processing is enhanced by attention, but acoustic processing is not. These findings add an important new layer in our understanding of how the human brain solves the cocktail party problem.
Synaptic Input and ACh Modulation Regulate Dendritic Ca2+Spike Duration in Pyramidal Neurons, Directly Affecting Their Somatic Output
Authors: Dudai Amir , Doron Michael , Segev Idan , London Michael
Published: December 2021

Nonlinear synaptic integration in dendrites is a fundamental aspect of neural computation. One such key mechanism is the Ca2+spike at the apical tuft of pyramidal neurons. Characterized by a plateau potential sustained for tens of milliseconds, the Ca2+spike amplifies excitatory input, facilitates somatic action potentials (APs), and promotes synaptic plasticity. Despite its essential role, the mechanisms regulating it are largely unknown. Using a compartmental model of a layer 5 pyramidal cell (L5PC), we explored the plateau and termination phases of the Ca2+spike under input current perturbations, long-step current-injections, and variations in the dendritic high-voltage-activated Ca2+conductance (that occur during cholinergic modulation). We found that, surprisingly, timed excitatory input can shorten the Ca2+spike duration while inhibitory input can either elongate or terminate it. A significant elongation also occurs when the high-voltage-activated Ca2+channels (CaHVA) conductance is increased. To mechanistically understand these phenomena, we analyzed the currents involved in the spike. The plateau and termination phases are almost exclusively controlled by the CaHVAinward current and the Imoutward K+current. We reduced the full model to a single-compartment model that faithfully preserved the responses of the Ca2+spike to interventions and consisted of two dynamic variables: the membrane potential and the K+-channel activation level. A phase-plane analysis of the reduced model provides testable predictions for modulating the Ca2+spike and reveals various dynamical regimes that explain the robust nature of the spike. Regulating the duration of the Ca2+spike significantly impacts the cell synaptic-plasticity window and, as we show, its input-output relationship.

SIGNIFICANCE STATEMENTPyramidal neurons are the cortex's principal projection neurons. In their apical tuft, dendritic Ca2+spikes significantly impact information processing, synaptic plasticity, and the cell's input-output relationship. Therefore, it is essential to understand the mechanisms regulating them. Using a compartmental model of a layer 5 pyramidal cell (L5PC), we explored the Ca2+spike responses to synaptic perturbations and cholinergic modulation. We showed a counterintuitive phenomenon: early excitatory input shortens the spike, whereas weak inhibition elongates it. Also, we demonstrated that acetylcholine (ACh) extends the spike. Through a reduced model containing only the membrane potential and the K+-channel activation level, we explained these phenomena using a phase-plane analysis. Our work provides new information about the robustness of the Ca2+spike and its controlling mechanisms.
Genetic Reduction of Mitochondria Complex I Subunits is Protective against Cisplatin-Induced Neurotoxicity inDrosophila
Authors: Groen Christopher M. , Podratz Jewel L. , Pathoulas Joe , Staff Nathan , Windebank Anthony J.
Published: December 2021

Chemotherapy-induced peripheral neuropathy (CIPN) is a prevalent side effect of widely used platinum-based anticancer agents. There are few predictable risk factors with which to identify susceptible patients. Effective preventive measures or treatments are not available. Here, we have used a model of CIPN inDrosophila melanogasterto identify genetic changes that confer resistance to cisplatin-induced neuronal damage but not in the rapidly dividing cells of the ovary. TheDrosophilastrainattP40, used as a genetic background for the creation of RNAi lines, is resistant to cisplatin damage compared with the similarattP2background strain.attP40flies have reduced mRNA expression ofND-13A, a component of the mitochondria electron transport chain complex I. Reduction ofND-13Avia neuron-specific RNAi leads to resistance to the dose-dependent climbing deficiencies and neuronal apoptosis observed in control flies. These flies are also resistant to acute oxidative stress, suggesting a mechanism for resistance to cisplatin. The mitochondria ofattP40flies function similarly to controlattP2mitochondria under normal conditions. Mitochondria are damaged by cisplatin, leading to reduced activity, butattP40mitochondria are able to retain function and even increase basal respiration rates in response to this stress. This retained mitochondrial activity is likely mediated by Sirt1 and peroxisome proliferator-activated receptor gamma coactivator-1α, and is key to cisplatin resistance. Our findings represent the potential for both identification of susceptible patients and prevention of CIPN through the targeting of mitochondria.

SIGNIFICANCE STATEMENTChemotherapy-induced peripheral neuropathy is a major, debilitating side effect of many platinum-based cancer drugs. There are few available screening tools to identify patients at risk, and there are no effective treatments. Here, we report a novel genetic change that confers resistance to cisplatin-induced neurotoxicity in aDrosophilamodel while preserving the toxic effect in rapidly dividing cells. This work has the potential to influence patient susceptibility testing and development of novel CIPN preventive treatments.
GROWTH KINETICS AND SURVIVAL OF LACTOBACILLUS ACIDOPHILUS IN BLACK RICE MILK
Authors: COŞANSU AKDEMİR Serap , TOUPAL Samin , ASLAN Özge
Published: December 2021

The growth kinetics of Lactobacillus acidophilus in black rice milk, white rice milk and MRS Broth were calculated by applying the experimental data to the Gompertz equation using DataFit software. The survival of L. acidophilus in black rice and white rice milk was monitored during storage (4°C, 20 days). The shortest lag phase duration (1.45 h) and the highest maximum population density (7.48 log CFU/mL) were in black rice milk (P <0.05). The generation time in black rice milk (1.31 h) was longer than in white rice milk (0.58 h) but shorter than in MRS Broth (2.22 h, P <0.05). L. acidophilus population declined in both milk at 4°C, but higher in black rice than white rice at the end of the storage period. It was concluded that black rice supports the growth of L. acidophilus compared to white rice and MRS Broth while contributing to its survival during cold storage.
Preeclampsia and Neonatal Neutropenia
Authors: Moallem Mohannad , Koenig Joyce M.
Published: December 2021

Neutropenia is a common hematologic disorder in the newborn intensive care unit, particularly in preterm neonates. Although its cause varies, a significant proportion of the episodes are associated with pregnancy complicated by preeclampsia. In this review, we provide a brief overview of preeclampsia and neonatal neutropenia, with a focus on the neonatal neutropenia associated with maternal preeclampsia. We discuss potential contributory mechanisms to and the natural history of this type of neutropenia, as well as reasonable management strategies in affected neonates.
TETRALOGY OF FALLOT: ESPECIALLY THE CARE OF THE CYANOTIC INFANT AND CHILD
Authors: TAUSSIG HELEN B.
Published: December 2021

A patient with a tetralogy of Fallot may be greatly improved by operation. Childhood is the ideal time for operation. In infancy the mortality rate is high and the long-time results are less satisfactory. Therefore, whenever possible it is wise to postpone operation until childhood.

An infant with a tetralogy of Fallot may not be cyanotic at birth. Difficulty in feeding may be the initial complaint. Digestion is difficult; small and frequent feedings are usually indicated.

Attacks of cyanosis and paroxysmal dyspnea are prone to occur as the ductus arteriosus undergoes obliteration. Paroxysmal dyspnea is best treated by placing the child in a kneechest position. If this does not give immediate relief, morphine should be used. A dose of 1.0 mg./5 kg. body weight is almost specific for the relief of paroxysmal dyspnea.

Anemia is treated by blood transfusions.

Cerebral thromboses when they occur in an infant with polycythemia should be treated with oxygen, venesection and the replacement of blood by plasma, 5% glucose or saline solution. Heparin may be a great help in the prevention of residual cerebral thrombosis.

If an infant is in great danger of dying of anoxemia, surgery holds the possibility of tremendous benefit. Two such cases are cited.
REVIEW OF PRIVATE PRACTICE: PEDIATRICIANS AND GENERAL PRACTITIONERS
Authors: HUBBARD JOHN P. , ZIBIT SAMUEL
Published: December 2021

THE preceding paper has described a composite picture of the total volume of medical service for children in eight selected states. This summary has induded medical care and health supervision given to children in hospitals, clinics, health conferences and by physicians in private practice. We may now examine in more detail one part of this total picture: private practice of pediatricians and general practitioners.

It should be kept clearly in mind that we are dealing only with physicians in private practice. Medical care rendered to children by those who are engaged in full-time academic positions is, for the most part, inseparable from hospital services; and, therefore, has not been included as a part of private practice. Excluded, also, are those physicians in administrative and research activities and those employed by federal, state and local health agencies.

For the purposes of this Study we have defined a pediatrician as a physician who says that he limits his practice to children. According to this definition, the Study listed 3,487 pediatricians in private practice in the United States; nearly one-half of these are members of the Academy, Table I. As of January 1947 the membership of the Academy within the United States was 1,909. Eighty per cent of this membership was engaged in private practice. An item which may be of considerable interest to the American Board of Pediatrics is the fact that of all pediatricians practicing in the country 51% are certified.

The distribution of pediatricians, indicated on a map of the United States (Fig. 1), shows a heavy concentration in the northeastern part of the United States. New York,[See Fig. 1 in Source Pdf] New Jersey and Pennsylvania combined account for 1,152, or approximately one-third of the pediatricians of the country. The concentration of pediatricians in urban centers is emphasized further by the fact that 75% of those in private practice are located in cities of 50,000 or more population.
ACUTE ATAXIA IN A TWENTY-MONTH-OLD FEMALE
Authors: KELLER MAURICE J. , KARELITZ SAMUEL
Published: December 2021

A case of probable encephalitis in a 20-month-old female infant with bizarre manifestations pointing primarily to involment of the mesencephalon and cerebellum is described. Similarities to the so-called electric chorea of Dubini and Bergeron, the myoclonic and the acute cerebellar forms of encephalitis are discussed.
A STUDY OF AN ENRICHED CEREAL IN CHILD FEEDING
Authors: URBACH CHARLES , MACK PAULINE BEERY , STOKES JOSEPH
Published: December 2021

The value of a special enriched breakfast cereal in feeding elementary school children was studied during the school year 1943 to 1944 and again during 1944 to 1945. The children used in the investigation were among those receiving a school lunch upon the advice of a physician or nurse in the school system of which the children were a part, because they had been found to be more than 10% underweight during the fall routine medical examination. Their home dietaries were inadequate, as shown by calculations and by medical and nutritional observations on the children themselves, and the school lunches failed to compensate for the poor home food intake. The duration of the study during each school year was seven months. None of the persons making the technical evaluations knew to which experimental group individual children belonged.

Methods of the Study

Experimental Subjects: During each of the two years during which the study proceeded, three groups of children constituted the experimental subjects, as stated; these averaged slightly over 11 years of age, and were matched initially as to age, sex, response to the medical observations and nutrition tests, family economic status, and type of school lunch received. The children were grouped as follows in this investigation: In addition to the school lunch, Group A received the enriched cereal; Group B received a common farina of equal caloric value; and Group C received no cereal at school. Of 55 children initially in each of the three experimental groups during the first
PENICILLIN THERAPY OF LATE CONGENITAL SYPHILIS
Authors: PLATOU RALPH V. , KOMETANI JOHN T.
Published: December 2021

Though no valid comparisons can be made until more patients have been treated and followed for a longer time, it seems to us that penicillin used alone is at least as effective as any other single agent for the treatment of late congenital syphilis. To what extent treatment or time alone contribute to improvements cannot yet be stated. Most of the clinical and serologic indications of healing developed rather slowly; in only a few patients with the most superficial lesions were there objective signs of improvement during therapy.

The treatment schedules we employed are similar to those previously recommended for infants. At present we advise a total dosage comprising at least 100,000 units commercial penicillin per kilogram body weight, divided into 100 equal intramuscular injections and given at two to three hour intervals around the clock for eight or more days. Therapeutic reactions, entirely febrile in nature, have all been transient and benign. There were no deaths. We believe that the simplicity, safety and convenience of these plans make them preferable to the more costly, hazardous, and time-consuming older methods; further-more, they effectively curtail the appallingly high delinquency rates formerly prevailing.

Results were significantly better for children treated under six years of age than they were for older children, and also for those who had normal spinal fluid before treatment; they were suggestively but not significantly better among those for whom the larger dosage schedules were used. Outcome was significantly worse in those who had received previous treatment of any sort. There were just three relapse—two defined only serologically, and one by a questionable recurrence of interstitial keratitis.

About a quarter of those with latent congenital syphilis have become seronegative. The poorest results ensued for patients with clinical neurosyphilis; two children from this group continued to exhibit definite deterioration. For interstitial keratitis, results were most gratifying in two patients treated within a month of onset. Seventy-two per cent of all patients with late congenital syphilis so far treated with penicillin and followed for more than two months are clinically well and have negative serologic reactions or progressively declining titers.
THE COMMITTEE FOR IMPROVEMENT OF CHILD HEALTH
Authors: WILSON JAMES L.
Published: December 2021

It seems to me that it is best this afternoon that I do not simply read to you the formal report of the Committee for Improvement of Child Health, since that has already been submitted to the Executive Board of the American Academy of Pediatrics, accepted by it, and will soon be published. I would rather spend this time to develop further the ideas that are stated there. I believe that whatever I say will represent the general consensus of the members of the Committee, but the formal expression of their views I leave, as I have said, to the printed report, and only I am responsible for the details of this afternoon's report.

As information resulting from the Academy's Study of Child Health Services became available, and as we grew in our understanding of the problems involved, it became more and more apparent that this work of the Academy concerned with the health of our nation's children could not stop with the end of the survey without great loss, particularly to the Academy itself. It was clear that the Academy was being projected into a position of great influence and authority because of the completeness and uniqueness of the information which it had gathered, but that this position of authority, with the influence it might give us towards directing future activities regarding child health in this country, could soon be lost.

Information such as we have obtained becomes quickly obsolete. Changes are going on constantly in our dynamic nation, and in a very short time any opinion which we might have based on this survey could be considered out-dated. It was apparent also that the demand for assistance by various organizations having common purposes with our own, the demand for technical and professional advice, would be greatly increased by the gradual dissemination of knowledge that would result from the survey and that we would be constantly approached for advice and for assistance, especially in the field of medical education with which the survey dealt most importantly.

This idea was transmitted to the Executive Board. The result was ultimately the formation of the Committee for Improvement of Child Health.
THE ROUTINE USE OF SEDATIVES IN INFANT FEEDING
Authors: ALDRICH C. ANDERSON
Published: December 2021

ON FEBRUARY 24, 1948, Dr. Stewart H. Clifford, Chairman of the Committee on Care of the Fetus and Newborn of the American Academy of Pediatrics, wrote me a letter as follows:

"On Ocober 15, 1947, . . . Health Officer, Department of Health, . . . Washington, wrote to the American Academy of Pediatrics through Dr. Grulee as follows: `Thank you for your opinion regarding the use of phenobarbital in the baby's feeding. As we gather more word of mouth information, it would seem that this is a common practice among certain physicians in this community, and is not based on individual problems but is established as a routine procedure.'

"At Dr. Grulee's suggestion Dr. . . . wrote to me on October 23, 1947, as follows: `Dr. Grulee, Secretary-Treasurer of the American Academy of Pediatrics, has suggested that we refer our question regarding infant sleeping habits to you.
THE PEDIATRICIAN AND THE PUBLIC
Authors: PARMELEE ARTHUR HAWLEY
Published: December 2021

I read with great interest Dr. Rothman's manuscript, "The Quality of Medical Care," published in your section of Pediatrics in February, 1952. I am an admirer of Dr. Rothman, and his discussion of medical education was certainly a scholarly one. I would, however, like to present a difference of opinion regarding some statements in one paragraph of his manuscript. In this paragraph, he decries the fact that internes have so much time off and are getting married and having families while still in training. He infers that medical education has suffered by this change. I would like to quote some of this paragraph: ". . . at the turn of the century, the house staff had little or no time off and very little or no financial remuneration. Living quarters were provided within the hospital; matrimony was postponed . . . towards the end of the decade preceding the second world war, it became customary in the majority of the hospitals for the house staff to have every other night off, and every other week end off. Coincident with this change, the yearly stipend increased, and what with the war and some unknown factor, marriage became the rule rather than the exception.
SOME EMOTIONAL PROBLEMS ASSOCIATED WITH RESPIRATORY INSUFFICIENCY IN POLIOMYELITIS
Authors: GRULEE CLIFFORD G.
Published: December 2021

EVERY physician who has cared for a patient acutely ill with poliomyelitis is necessarily impressed with the psychologic impact of this disease. Yet if a search is made for writings on this subject, little information is found. There may be several reasons for this. Poliomyelitis as an acute disease is of relatively short duration, and in a general sense the issue is promptly determined. As a consequence, the physician has little opportunity to collaborate with the psychiatrist, or to evaluate the emotional status of his patients with a view toward clinical investigation of the point. Probably of greater importance is the physician's knowledge that psychologic problems differ only in degree from those associated with other diseases. Stated another way, he is on familiar, though very difficult and perplexing ground.

Since poliomyelitis is an epidemic disease, it frequently follows that the work-load of the physician does not permit allocation of time necessary for proper handling of emotional problems. This becomes particularly true if the diagnosis automatically means admission to a "Polio Unit." Facilities in such units are primarily geared to specialized care of a few complicated and severe cases, but may become overcrowded and understaffed by the unselective and routine admission of any affected individual. Only the "don'ts" of dealing with social and psychologic problems can be recorded from such experiences.

In this discussion, interest is chiefly in the respiratory complications of poliomyelitis, but from the standpoint of the patient's emotional reactions we cannot disregard a compounding of anxiety-producing factors. First, we are dealing with a sick individual and the constellation of his family and community.
PRESSURE-TIME RELATIONS IN THE SAFE CORRECTION OF ATELECTASIS IN ANIMAL LUNGS
Authors: DAY RICHARD , GOODFELLOW ALICE M. , APGAR VIRGINIA , BECK GUSTAV J.
Published: December 2021

Observations on animal lungs have been made which support the following statements: Injury to lungs is caused by overdistention.

Distention is related to time as well as to the pressure exerted.

A certain minimum pressure must be exerted to correct atelectasis. To employ this pressure safely, its duration must be limited.

The combinations of pressure and time which produce satisfactory inflation in rat, rabbit and pig lungs are very similar to each other. Research is needed to find the combinations which are utilized by the normal newborn infant and which might be suitable in positive pressure resuscitation.

No practical application has so far been attempted of the methods of inflation which have been described. Small differences in the duration of each positive pressure inflation determine the safety of the procedure. Clinical application is a subject for future research.
IMPORTANCE OF EARLY SURGICAL TREATMENT OF CRANIOSYNOSTOSIS
Authors: MCLAURIN ROBERT L. , MATSON DONALD D.
Published: December 2021

One hundred and twenty children have been treated surgically for premature fusion of the cranial sutures in this clinic.

Thirty-six of these have been operated on in the first six months of life and constitute the material on which this report is based. These have included 19 instances of sagittal suture closure, 10 of coronal closure, 5 of multiple suture involvement and 2 miscellaneous cases.

The marked reduction in incidence and degree of mental retardation, the prevention of visual impairment, and the improvement in cosmetic appearance which can be achieved by recognition and surgical treatment of this lesion in early infancy are emphasized.

The operation of choice in this clinic is linear craniectomy parallel to the suture which is prematurely fused with insertion of polyethylene film over the bony margins to delay closure.

With proper precautions and supportive treatment this type of surgery is well tolerated and the complications are negligible during the first few months of life.
GIANT CELL PNEUMONIA WITH INCLUSIONS
Authors: WELLER RUSSELL W.
Published: December 2021

A case of giant cell pneumonia with inclusions is reported. Intracytoplasmic and intranuclear inclusions are present. Exhaustive search reveals no inclusions in viscera other than the lungs. The pulmonary cytologic picture is similar to that seen in canine distemper.
CENTRAL OFFICE—EVANSTON, ILL
Authors:   E. J. WIEDMAN & COMPANY
Published: December 2021

We have examined the books of account and records of the American Academy of Pediatrics, Central Office, for the fiscal year ended June 30, 1952 and, as a result thereof, we hereby certify that the above statement of cash receipts and disbursements correctly presents the cash balance of the Central Office of the Academy at June 30, 1952 and its cash transactions for the fiscal year ended on that date.
Metabolic Aspects of Myocardial Disease and a Role forl-Carnitine in the Treatment of Childhood Cardiomyopathy
Authors: Helton Edward , Darragh Robert , Francis Paul , Fricker F. Jay , Jue Kenneth , Koch Gary , Mair Douglas , Pierpont Mary Ella , Prochazka James V. , Linn Lawrence S. , Winter Susan C.
Published: December 2021

Objectives.

A multicenter retrospective study was conducted to investigate the possible metabolic causes of pediatric cardiomyopathy and evaluate the outcome of patients treated with l-carnitine.

Methods.

Seventy-six patients diagnosed with cardiomyopathy were treated with l-carnitine in addition to conventional cardiac treatment, and 145 patients were treated with conventional treatment only. There were 101 males and 120 females between 1 day and 18 years old. Cardiomyopathy diagnoses included dilated (148 patients), hypertrophic (42 patients), restrictive (16 patients), mixed diagnosis (11 patients), and 4 with an unknown type. Of 76 l-carnitine-treated patients, 29 (38%) had evidence to suggest a disorder of metabolism, and of 145 control patients, 15 (10%) were suspected to have a disorder of metabolism. These metabolic disorders were thought to be the cause for the cardiomyopathy of the patients. The duration of l-carnitine treatment ranged from 2 weeks to >1 year. Information was collected on length of survival (time-to-event), clinical outcome, echocardiogram parameters, and clinical assessments. Data were collected at intervals from baseline to study endpoint, death, transplant, or last known follow-up visit.

Results.

l-Carnitine-treated patients were younger than control patients and had poorer clinical functioning at baseline, yet they demonstrated lower mortality and a level of clinical functioning and clinical severity comparable to control patients on conventional therapy by the end of the study. An analysis of the interaction between clinical outcome and concomitant medications unexpectedly revealed that the population of patients treated with angiotensin-converting enzyme (ACE) inhibitors (40% of patients) had significantly poorer survival (although their greater likelihood for poor survival may possibly have made them more likely to receive ACE inhibitors).

Conclusion.

Results suggest that l-carnitine provides clinical benefit in treating pediatric cardiomyopathy. There is a need for further exploration of potential explanatory factors for the higher mortality observed in the population of patients treated with ACE inhibitors.