bluuebunny/crossref_metadata_2025 huggingface dataset:
Precipitation Recycling Variability and Ecoclimatological Stability—A Study Using NARR Data. Part II: North American Monsoon Region
Authors: Dominguez Francina , Kumar Praveen , Vivoni Enrique R.
Published: March 2008

This work studies precipitation recycling as part of the dynamic North American monsoon system (NAMS) to understand how moisture and energy fluxes modulate recycling variability at the daily-to-intraseasonal time scale. A set of land–atmosphere variables derived from North American Regional Reanalysis (NARR) data are used to represent the hydroclimatology of the monsoon. The recycling ratio is estimated using the Dynamic Recycling Model, which provides recycling estimates at the daily time scales. Multichannel singular spectrum analysis (M-SSA) is used to extract trends in the data while at the same time selecting only the variability common to all of the variables.

The 1985–2006 climatological analysis of NAMS precipitation recycling reveals a positive feedback mechanism between monsoon precipitation and subsequent increase in precipitation of recycled origin. Recycling ratios during the monsoon are consistently above 15% and can be as high as 25%. While monsoon precipitation and evapotranspiration are predominantly located in the seasonally dry tropical forests in the southwestern part of the domain, recycling is enhanced northeast of this region, indicating a relocation of soil moisture farther inland to drier regions in the northeast. The three years with the longest monsoons in the 22-yr period present an asynchronous pattern between precipitation and recycling ratio. The longest monsoons have a characteristic double peak in precipitation, with enhanced recycling ratios during the intermediate dry period. This indicates that, even when large-scale moisture advection decreases, evapotranspiration provides moisture to the overlying atmosphere, contributing to precipitation. Through the negative feedback present during long monsoons and by relocation of soil moisture, precipitation recycling brings favorable conditions for vegetation sustenance in the NAMS region.
Reduced Stability of the Atlantic Meridional Overturning Circulation due to Wind Stress Feedback during Glacial Times
Authors: Arzel Olivier , England Matthew H. , Sijp Willem P.
Published: March 2008

A previous study by Mikolajewicz suggested that the wind stress feedback stabilizes the Atlantic thermohaline circulation. This result was obtained under modern climate conditions, for which the presence of the massive continental ice sheets characteristic of glacial times is missing. Here a coupled ocean–atmosphere–sea ice model of intermediate complexity, set up in an idealized spherical sector geometry of the Atlantic basin, is used to show that, under glacial climate conditions, wind stress feedback actually reduces the stability of the meridional overturning circulation (MOC). The analysis reveals that the influence of the wind stress feedback on the glacial MOC response to an external source of freshwater applied at high northern latitudes is controlled by the following two distinct processes: 1) the interactions between the wind field and the sea ice export in the Northern Hemisphere (NH), and 2) the northward Ekman transport in the tropics and upward Ekman pumping in the core of the NH subpolar gyre. The former dominates the response of the coupled system; it delays the recovery of the MOC, and in some cases even stabilizes collapsed MOC states achieved during the hosing period. The latter plays a minor role and mitigates the impact of the former process by reducing the upper-ocean freshening in deep-water formation regions. Hence, the wind stress feedback delays the recovery of the glacial MOC, which is the opposite of what occurs under modern climate conditions. Close to the critical transition threshold beyond which the circulation collapses, the glacial MOC appears to be very sensitive to changes in surface wind stress forcing and exhibits, in the aftermath of the freshwater pulse, a nonlinear dependence upon the wind stress feedback magnitude: a complete and irreversible MOC shutdown occurs only for intermediate wind stress feedback magnitudes. This behavior results from the competitive effects of processes 1 and 2 on the midlatitude upper-ocean salinity during the shutdown phase of the MOC. The mechanisms presented here may be relevant to the large meltwater pulses that punctuated the last glacial period.
Worldwide Measurements of Atmospheric CO2 and Other Trace Gas Species Using Commercial Airlines
Authors: Machida T. , Matsueda H. , Sawa Y. , Nakagawa Y. , Hirotani K. , Kondo N. , Goto K. , Nakazawa T. , Ishikawa K. , Ogawa T.
Published: March 2008

New automated observation systems for use in passenger aircraft to measure atmospheric carbon dioxide (CO2) and other trace species have been developed and are described in this paper. The Continuous CO2 Measuring Equipment (CME) is composed mainly of a nondispersive infrared analyzer, a datalogger, and two calibration cylinders for in situ CO2 measurements. The Automatic Air Sampling Equipment (ASE), on the other hand, is designed for flask sampling; the instrument, connected to a metal bellows pump, is made up of a specially designed control board and can accommodate 12 flasks. The CME platform can be used to conduct high-frequency measurements of CO2 for obtaining a detailed spatial observation over a wide area, while ASE, despite the limited flight frequency, can provide useful distributions not only of CO2 but also various trace gas species, as well as their isotopic ratios. ASE and CME are installed on the racks in the forward cargo compartment of the aircraft and the air bypass intake is mounted on the air-conditioning duct upstream of the recirculation fan. Both sets of sampling equipment are automatically controlled through input of relevant flight parameters from the aircraft data system. Their deployment in a Boeing 747-400 aircraft was approved by the aviation regulatory agencies in the United States and Japan through issuance of the supplemental type certificate (STC), while the approval for installation of CME in a Boeing 777-200ER was also obtained via STC. First measurement results of CO2 variations obtained by CME and ASE deployed on Japan Airlines (JAL) aircraft are reported herein.
Tropical Cloud Heating Profiles: Analysis from KWAJEX
Authors: Schumacher Courtney , Ciesielski Paul E. , Zhang Minghua H.
Published: March 2008

Diabatic heating (or Q1) profiles associated with specific cloud types are produced by matching synoptic cloud observations with a sounding budget analysis during the Tropical Rainfall Measuring Mission (TRMM) Kwajalein Experiment (KWAJEX), which took place in the Marshall Islands from late July through mid-September 1999. Fair-weather cumulus clouds produce up to 1 K day−1 of heating below 850 hPa and are associated with cooling throughout much of the rest of the troposphere. Cumulus congestus clouds produce heating on the order of 1 K day−1 up to 575 hPa and cooling in the mid- to upper troposphere. Cumulonimbus clouds produce heating through the depth of the troposphere, with a maximum of 3.7 K day−1 near 550 hPa. Cloud types indicating widespread rain (stratus or cumulus fractus of bad weather at low levels and nimbostratus at midlevels) have the largest and most elevated heating, with values >10 K day−1 above 600 hPa. Other mid- and high-level cloud types are shown to be consistent with area-averaged rain rates and Q1 profiles. Profiles of the divergence and apparent moisture sink (or Q2) for convective clouds are also analyzed and are shown to be consistent with the physics of the heating profiles just described.
Fanconi's Anemia: Clues to Early Recognition
Authors: Pochedly Carl
Published: March 2008

Fanconi's anemia may often be misdiagnosed as idiopathic aplastic anemia. Every child with unexplainable gradual bone marrow fail ure should be studied thoroughly for clinical or laboratory signs of occult clinical anomalies. Skin pigmentation, growth failure and minor chromosomal abnormalities are frequent concomitants.
Necrotizing Enterocolitis in Young Infants
Authors: Tan K.L. , Tan A.Y.O. , Wong T.T.T.
Published: March 2008

Necrotizing enterocolitis is a relatively rare disease occur ring in premature infants. "Greater awareness with earlier diagnosis and treatment may improve the survival rate."
Staphylococcal Pneumonia
Authors: Turner J.A. Peter
Published: March 2008

The reasons for the current decline in childhood staphylococcal pneumonia are not immediately apparent. Nevertheless, the clini cian must not forget the possibility of this disease, particularly with infants under one year of age. Adequate antibiotic therapy together with surgical drainage of the pleural space, if the lat ter is necessary, will result in complete resolution without se quelae. Such an infection may indicate an underlying cystic fibrosis.
Hemothorax in the Newborn
Authors: Sinniah Davendralingam , Nagalingam Iyngkaran
Published: March 2008

A three-day-old Orang Asli girl had umbilical bleeding and bruis ing as well as a left hemothorax was also present. A review of the literature reveals that hemothorax is a rare manifestation of hemorrhagic disease, and only five instances have so far been re ported. After treatment with vitamin K and transfusion of fresh blood, thoracentesis was performed. The chest became clinically and radiologically normal five days afer the onset of bleeding.
Mumps Associated with Coma or Exanthems
Authors: Balfour Henry H. , Hable Kathleen A. , Carlson Gary S. , Isenberg J. Nevin , Siem Robert A.
Published: March 2008

Mumps should be included in the differential diagnosis of a comatose patient, particularly when mumps is prevalent in the community. Mumps encephalitis sometimes occurs with normal CSF cell count and protein content.

Some exanthems associated with mumps may represent dual infections. That mumps virus alone may produce a rash is suggested by a report cited and by one patient in this series.
Poland's Syndrome
Authors: Mace J.W. , Kaplan J.M. , Schanberger J.E. , Gotlin R.W.
Published: March 2008

Seven cases of Poland's syndrome (absence of the sternal por tion of the pectoralis major with ipsilateral upper extremity anomalies) are compared with 48 previously reported cases.
Oculo-Cerebro-Renal Syndrome
Authors: Holinies Grace E. , Tucker Virginia
Published: March 2008

The clinical, anatomical and biochemical variations in this disease are well demonstrated in the family here described. The transmission of the syndrome in this family seems to be by means of an X-linked gene. The presence of lenticular opaci ties in all mothers of affected males may indicate an X-linked, partially dominant, or intermediate transmission pattern. The observed delay in the appearance of hyperaminoaciduria in one youngster is suggestive of a progressive renal tubular lesion.
The Sleep Patterns of Preschool Children
Authors: Healy Alfred
Published: March 2008

This article summarizes current understanding and insight con cerning sleep requirements, patterns and problems of young children which may be helpful to the practitioner caring for chil dren. Fundamental principles regarding children's sleep are indi vidually presented, followed by a brief discussion of each principle.
Pulmonary Aspergillosis in Childhood
Authors: Berger Ira , Phillips Walter L. , Shenker I. Ronald
Published: March 2008

An adolescent girl with aspergillosis is presented who demonstrated three different manifestations of the disease process. Therapy included the use of Amphotericin B and two pulmonary resections for aspergillosis. The patient has been stable for one and a half years without any evidence of recurrent disease, after a progressive course going back for some years.
Frequency and Prognosis of Coexisting Sickle Cell Disease and Acute Leukemia in Children
Authors: Jackson Rudolph E. , Short B. Joan
Published: March 2008

Among 58 black children with leukemia, seven had sickle cell trait and one was homozygous for Hb-S. Both of these rates are similar to those for the black population of the United States in general. The presence of sickle cell trait did not appear to influence the median age of onset, the median survival time, or the quality of survival in black children with acute leukemia. The single patient with sickle cell ane mia died a sudden, unexpected death with massive intravascular eryth rocytic sickling secondary to viremia while in a leukemic remission.
Early American Baby Rattles
Authors: Sturtz George S.
Published: March 2008

Part I of these descriptions of Early American Baby Rat tles appeared in last month's CLINICAL PEDIATRICS.
How to Shoot a Patient without Really Trying
Authors: Lee Henry F.
Published: March 2008

Dr. Henry F. Lee had an early interest in nuclear physics when it was a very young science and before he switched to medicine. His continuing interest is manifest in this article. He is an associate professor of pediatrics at the University of Pennsylvania, and Director of Pediatrics at the Chestnut Hill Hospital and has maintained a busy office practice in Philadelphia since 1947. Forthcoming in the near future is a book for parents based on his practice experience.
Dyke-Davidoff-Masson Syndrome
Authors: Parker Charles E. , Harris Nancy , Mavalwala Jamshed
Published: March 2008

A survey of five representative cases of an unusual congenital condition, having characteristic features but diverses causes as indicated by pathogenetic and dermatoglyphics studies.
The Pediatrician and Family Planning in a Very Poar Community
Authors: Hansen Christian M.
Published: March 2008

Family planning services should be of prime interest to all pediatricians because of their direct relationship to the health and well-being of mothers and children. Maternal and Child Health Services offer a natural starting place for introduc tion of family planning services. However, family planning should be a part of total family health care for better acceptance, rather than merely a categorical program.
Some Nutritional Considerations in Times of Major Catastrophe
Authors: Brown Roy E.
Published: March 2008

On a trip jointly sponsored by the Catholic Relief Services, the Americans for Children's Relief and The Mt. Sinai School of Medi cine of The City University of New York, Dr. Roy E. Brown spent 2-1/2 weeks in November 1971, in the Bangladesh Refugee Camps in India, observing the nutritional and general health status of children and infants in the camps. Dr. Brown has unique qualifications for this responsibility as an American- trained pediatrician who has worked for 8 years in many over seas countries including Haiti, Germany, Peru, Ethiopia, Uganda and the Ivory Coast. He has also made briefer trips serving as a pediatric nutrition consultant in Malawi, Biafra and Guyana.
Diagnosis of Down's Syndrome: Clinical vs. Laboratory
Authors: Lee Lynda G. , Jackson John F.
Published: March 2008

The art of simple physical examination is still valuable. Faced with a child suspected of having Down's syndrome, a lack of facilities for chromosome analysis, and anxious parents, the physician can often make the diagnosis with a high degree of accuracy by a thor ough physical examination, performed with the help of a check-list of frequently found signs. This paper compares the results of physi cal examination with those of chromosome analysis in 150 patients.
A View of the Drug Problem
Authors: Minkowski William L. , Weiss Robert C. , Heidbreder G.A.
Published: March 2008

"One purpose of this paper is to define, as precisely as possible, patterns of drug use in one subculture of the youthful population. Another of its purposes is to emphasize the distinction between "drug use" and "drug abuse." Among the patients in our clinic the taking of drugs is al most universal; abuse, on the other hand, is of a much lower order of magnitude. Admittedly, imprecisely defined criteria separate these practices. Furthermore, separation of drug use from drug abuse does not imply acceptance of the one and rejection of the other."
The Abuse of Drug Abuse
Authors: Kepler Milton O.
Published: March 2008

Drug abuse is abused in that current approaches largely fail to recognize drug abuse as a symptom of underlying disease. The concerns of medicine, religion, and the state have been to correct the symptom, rather than to attack its causes, as our rapidly changing technologic society progressively deprives us all of several needs basic to our well-being. One response has been drug abuse, often arising from the hunger for love, understanding, and a meaning to life in our increasingly dehumanizing culture. Essential ingredients in the development of identity are religion and ritualization; if healthy, normative sources are unavailable or unattractive, drugs may be chosen. "In this paper I should like to discuss some lesser-realized aspects of drug abuse in a special group of our youth, to stress some root causes of the problem." Medicine and religion must communicate with and educate our youth and ourselves, and become advocates of youth's plight and needs. Details are given.
Growth Comparisons of Urban and Rural Children in Southern Mexico with Randomly Selected California Children
Authors: Pryor Helen B. , Thelander Hulda E.
Published: March 2008

Growth studies which compare children from upper and lower socio-economic groups in the same population and geographic environment can offer an indication of optimal growth. Hence assessment of physical growth in children becomes an impor tant index of health and nutrition for a given population. But deviations from United States' standards should never be labeled as deviations from Normal, on the assumption that improved environmental factors would result in children from other countries reaching United States means for height and weight.
Penicillin-related Exanthems in Infectious Mononucleosis Identical to Those Associated with Ampicillin
Authors: Balfour Henry H. , Forte Francis A. , Simpson Richard B. , Zolov David M.
Published: March 2008

From personal observations and reports on record the authors point out that the same exanthem may be associated with penicillin as well as ampicillin, and sug gest that this may not be a persistent hypersensitivity.
Clinical Review : Acute Bacterial Meningitis in Childhood
Authors: Murray J.D. , Fleming P.C. , Anglin C.S. , Steele J.C. , Fujiwara M.W.
Published: March 2008

When acute purulent meningitis is treated as a medical emergency, the diagnosis made early and the correct medications started im mediately in the proper dosages and by the proper routes, the chances for recovery are excellent. For antibiotic therapy to be most effective, attention must also be directed to anticipating the many complicating hazards, and preventing them. Ampicillin is the antibiotic of first choice. For the child who is allergic to penicillin, chloramphenicol is recommended until the causative organism is identified. The concomitant administration of sulphonamides, streptomycin or other antibiotics is unnecessary and may be harm ful except in the neonatal period when it is recommended to commence therapy with ampicillin and gentamicin.

This report outlines in detail the authors' program for the specific and supportive treatment of bacterial meningitis and the preven tion and management of its major complications. The 100 cases most recently treated at The Hospital for Sick Children, Toronto, had a case fatality rate of 2.2 per cent.
Conditions that Simulate Epilepsy in Children
Authors: Snyder C. Harrison
Published: March 2008

"In general, a careful history is worth more than a bat tery of laboratory tests if one is to avoid the serious mistake of making an erroneous diagnosis of epilepsy."
Clinical Evaluation of an Epinephrine Suspension in the Treatment of Asthma
Authors: Lozano Jose , McLean Walter , Hannaway Paul , Mueller Harry
Published: March 2008

This study was carried out with 50 asthmatic children to evaluate the speed of action of Sus-Phrine,‡ which is epinephrine in a concentration of 1: 200, of which approximately 20 per cent is in solution for an immediate effect with the remainder in suspension for sustained action. The data indicated that Sus-Phrine is comparable to aqueous epinephrine in the rapidity of its bron chodilating effect. Because of its well-established prolonged action, this may be the drug of choice for the initial injection of epinephrine in acute asthma.
Management of CNS Leukemia in Childhood
Authors: Pochedly Carl
Published: March 2008

Progress in prolonging the lives of children with leukemia has resulted in a great increase in neurological complications. Exact diagnosis and intensive therapy are needed. Prophylactic CNS therapy offers bright new hope for prolonged survival or cure.
Intrafamilial Infection with Neisseria Meningitidis, Group C
Authors: Martin Gilbert I. , Degrinney Joseph T.
Published: March 2008

The family described below presented with meningococcal infections of several types: meningitis, nasopharyngeal carrier state, meningococcemia. Serum immunoglobins were within normal limits. Hemagglutination re sponses were based on the elaboration of IgG antibody. The organism isolated was Neisseria meningitidis, Group C, resistant to sulfadiazine.
The Contribution of Diaper Service Accreditation to Infant Health Care
Authors: Livesey Ruth P.
Published: March 2008

Setting up an accreditation system which establishes high standards can upgrade any industry that is willing to discipline itself for better service to the public.
A New Simplified Preschool Readiness Experimental Screening Scale (The Press)
Authors: Rogers W.B. , Rogers Robert A.
Published: March 2008

One of the challenges facing physicians today is to detect school learning prob lems as early as possible. As one possible approach, a screening scale was con structed which can be carried out by the physician while doing a physical exam on five-year-olds. This scale, the "Preschool Readiness Experimental Screening Scale," or "PRESS," was administered to 75 children along with a standard preschool readiness test and an IQ test. The results indicate the PRESS is a valid indicator of school readiness and does reflect IQ. The concept of pre school screening by physicians is tenable and we urge further studies in this area.
Paralytic Poliomyelitis Before and After Mass Vaccination
Authors: Kazemi Behrooz , Nourmand Aziz , Ziai Mohsen
Published: March 2008

In many countries in Africa, Asia, and Central and South America, where pre ventive vaccination is far from universal, the incidence of poliomyelitis is rising, and large outbreaks are being reported.1 In contrast, in the U. S. A., Canada, Australia, and New Zealand, the incidence has been falling steeply and progressively. In comparison with the years 1951-1955, the reduction by 1968 in these "developed" countries was 700-fold. The total number of reported cases in 1968 in all these countries together was only 62,1 and immunization cam paigns must be given the credit for reducing this morbidity and mortality.
Acute Splenic Sequestration Crises (ASSC) in Young Children with Sickle Cell Anemia
Authors: Seeler Ruth Andrea , Ziad Shwiaki M.
Published: March 2008

Acute splenic sequestration crises (ASSC) is a potentially life-threatening com plication in young children with sickle cell anemia. The clinical picture includes huge splenomegaly accompanied by signs and symptoms of acute circulatory insufficiency caused by profound anemia. The authors describe 20 such episodes in 14 children aged six to 55 months. Rapid transfusion of packed erythrocytes produced rapid and dramatic improvement. The spleens became nonpalpable in seven to ten days following transfusion. Four children died, four had one or more recurrences, four have splenic involution, and two were splenectomized. The recurrences were within four months of the previous ASSC. "Our current recommendation is to consider splenectomy only after at least two ASSCs."
Unusual Palm Creases and Unusual Children
Authors: Johnson Charles Felzen , Opitz Erica
Published: March 2008

Inspection of palm creases should be a routine part of the pediatric physical examination. Any variation in the basic configuration should be cause for concern, irrespective of the age of the child. Is the "nor mal" child with an SPC, SL, or other type C palm really normal? Will time or psychologic evaluation uncover an unsuspected abnormality? An otherwise normal infant with palmar crease abnormalities should be considered at risk of developmental problems appearing later.
Clinical Review : Peritoneal Dialysis in Children
Authors: Chan James C.M. , Campbell Robert A.
Published: March 2008

Peritoneal dialysis is no longer experimental; it has become a routine procedure which can be easily performed at home when desirable. It can be used in poison ings, acute renal failure, other metabolic derangements, and in the terminal uremic patient as a "holding action" while he waits for kidney homotransplant. The simplicity, economy, and efficiency of the procedure, together with recent advances in instrumentation and in our understanding of fluid and electrolytes, are helping to broaden the clinical usefulness of peritoneal dialysis. This com munication surveys current clinical applications of peritoneal dialysis, its techni cal aspects and hazards, and its promising potential for therapy and research.
Clinical Evaluation of the Anorexic Activity and Safety of 42-548 in Children
Authors: Sharma R.K. , Collipp P.J. , Rezvani I. , Strimas J. , Maddaiah V.T. , Rezvani E.
Published: March 2008

A double-blind study comparing the safety and efficacy of 42-548, a new, synthetic tricyclic appetite suppressant, with a placebo was started with 116 obese adolescent patients. All patients received a fixed daily dose of one tablet, one hour before the noon meal, for 12 weeks. A reduced caloric intake was prescribed initially and the patients were instructed to stay on this diet. 42-548 produced an average weight loss of 18.9 lb. at the end of the study, and the placebo a loss of 11.8 lb., a statistically significant difference. The medication was relatively well tolerated.
The Hyperactive Child
Authors: Schmitt Barton D. , Martin Harold P. , Nellhaus Gerhard , Cravens Jere , Camp Bonnie W. , Jordan Kent
Published: March 2008

Today's conference has three main objectives: first, to help physicians look at the hyperactive child in terms of subtypes rather than as a homogeneous group; second, to reaffirm that brain damage is the least common cause of hyperactivity and should be our last consideration; third, to put the drug approach to hyperactivity in some perspective.
Antibody Tests in Streptococcal Pharyngitis
Authors: Ofek I. , Kaplan Ophira , Bergner–Rabinowitz Sonia , Hornstein L. , Lapid A. , Davies A. M.
Published: March 2008

Antibody response to streptococcal antigens was measured by three conventional methods (ASO, AH, and ANADG) and by the new streptozyme test. Compared to the others, the streptozyme test showed a sensitivity of 73 per cent and a specificity of 90 per cent. It also detected additional cases missed by the other methods. In addition, the streptozyme test showed antibody rise earlier, after six to nine days in half of the cases. Thus, the streptozyme test is more sensitive and no less specific than any individual test and reveals antistreptococcal antibody rise earlier. These properties, together with its ease of performance and reproducibility, seem to make it the test of choice for estimation of antibody response to streptococcal infection in all circumstances where the performance of a battery of tests is impractical.
The Single Umbilical Artery and What it Means
Authors: Johnson Charles F.
Published: March 2008

The infant born with an SUA is a high-risk infant and should be treated accordingly immediately after delivery. The variety and multiplicity of congenital abnormalities associated with this finding call for a very thorough initial examination, continued close scrutiny throughout infancy and childhood, and prompt investigation of any developing symptoms or abnormalities. It is likely that the high death rate associated with the SUA could be lowered if steps are taken to uncover and correct such subtle abnormalities before they stir up difficulties.
Treatment of Fever in Burned Children
Authors: Noe Joel M. , Aber Robert C.
Published: March 2008

The protocol used clinically to treat high temperatures in burned children is presented. It is based upon the separation of fevers into two levels, with a different mode of therapy for each level. All treatments are modified according to the rate of rise of the temperature and the patient's tolerance to that temperature. The treatment of the fever should not obscure the search for its etiology.
Mesenteric Angiographic Studies in Children with Regional Enteritis
Authors: Genieser Nancy Branom , Madayag Manuel A. , Grosfeld Jay L. , Becker Melvin H. , Rothberg Murray
Published: March 2008

Mesenteric angiography in three children with active regional enteritis demonstrated arterial dilatation, a dense capillary phase, and early dense venous filling. These observations differ somewhat from angiography reports with older patients, and suggest a wide spectrum of findings depending on the age and activity of the disease state. When the usual small bowel barium studies are not diagnostic, and with recurrent disease in postoperative patients, mesenteric angiography may be a useful adjunct to diagnosis.
Glucose Intolerance in a Three-Year-Old Child With Cystic Fibrosis
Authors: Peden Virginia H. , Powell Keith R. , Rejent Anthony J.
Published: March 2008

Glucose intolerance preceding pulmonary disease in a child with cystic fibrosis is de scribed. After glucose intolerance was con trolled with tolbutamide, the pulmonary infec tion resolved. Early recognition and treatment of "diabetes" in children with cystic fibrosis is emphasized.
Psychosocial Problems of the Adolescent Patient with Epilepsy
Authors: Richardson Donald W. , Friedman Stanford B.
Published: March 2008

To evaluate the psychosocial problems in adolescent patients with epilepsy, 17 teen-agers and their parents were studied using interviews, a questionnaire, and group interviews. The main findings were: the existence of important psycho social problems in 13 of the 17 teen-agers and their families, the parents' recognition of be havior problems in the young person as their most frequent difficulty, and the teenagers report ing of problems with peers as their biggest psychosocial concern. This study has highlighted the areas of help parents need with the young person's behavior problems, and the help the teen-ager needs with peer relationships.
Gonadoblastoma Associated with Pure Gonadal Dysgenesis
Authors: Similä S. , Jukarainen E. , Herva R. , Heikkinen E.S.
Published: March 2008

A prepubertal girl with pure gonadal dys genesis and 46, XY karyotype is reported. Ex ploratory laparotomy was performed and bilateral gonadal streaks and a small left gonadal tumor were found at the place of the ovaries. The pathologic examination of this tumor revealed gonadoblastoma. The indication to laparotomy in patients with pure gonadal dysgenesis and 46, XY karyotype is discussed.
The Cryptophthalmos-Syndactyly Syndrome
Authors: Dinno Nuhad D. , Edwards William C. , Weiskopf Bernard
Published: March 2008

The cryptophthalmos-syndactyly syndrome is a rare disorder of which approximately 55 cases have been reported in the world literature. A few have been described in the American literature. It is the purpose of this paper to report another case and to stress the importance of early identification and of genetic counseling of the parents.
Cephalhematoma in the Newborn
Authors: Yasunaga Shig , Rivera Robert
Published: March 2008

A chart survey of 139 newborns with cephal hematoma showed the majority were associated with primiparity, forceps delivery, or prolonged labor. The complications included jaundice, central nervous system symptoms, localized in fection, anemia and subdural hematoma. Neo natal jaundice was frequently associated. Under lying skull fractures were found in 7.1 per cent of the 84 infants in whom skull x-rays were taken, a lower incidence than that reported by others.
Patterns of Pediatric Practice by the Same Physicians in a Prepaid and a Fee- for-Service Setting
Authors: Eisenberg John , Mackie Anita , Kahn Lawrence , Perkoff Gerald T.
Published: March 2008

A study is reported of the ambulatory services provided by four pediatricians who practice both in their own fee-for-service practice (FFS) and in an experimental prepaid group practice model (PPGP). Differences were noted in the two prac tices. There were more infants in the fee-for- service practice and more adolescents in the pre paid practice. Likewise, a nurse provided follow- up medical services in the prepaid practice but not in the fee-for-service practice. These factors explained some of the results observed. Even allowing for these practice differences, however, the same physicians prescribed more laboratory tests, consultations, and follow-up visits in the prepaid as opposed to the fee-for-service prac tice. This study suggests that observed differences in medical care utilization between PPGP and FFS are associated with the organizational, staffing, and financial aspects of prepaid practice contrasted to fee-for-service practice, rather than with physician differences per se.
Clinical Experiences with the Use of Cromolyn Sodium in Asthmatic Children
Authors: Leeks Harold I. , Kravis Lillian P. , Wood David W.
Published: March 2008

An eight-week, double-blind placebo-con trolled crossover trial was conducted with 105 patients in a multicenter study, to determine the efficacy of cromolyn sodium in the preven tion and adjunctive management of bronchial asthma in children. Statistical analysis disclosed significant differences in favor of cromolyn, with the patients indicating decreased wheezing and related respiratory complaints, decreased frequency and severity of acute exacerbations, lessening in the need for adjunctive medica tions, decreased time lost from school or work, and ability on the part of both patient and physician to distinguish the active from placebo therapy.

A second phase of the study involved a 19-to 33-month open trial conducted with 17 placebo-discriminating children in whom the double-blind investigation had indicated cromo lyn to be an effective agent in controlling their symptoms. All were chronically ill, consistently unresponsive to conventional therapeutic medi caments, and frequently in need of cortico steroid therapy. Six had a continuous, unremit ting steroid-dependent form of the disease; in the remaining 11, the asthma was episodic and remitting, and frequent steroids were required. Physician assessment indicated that 13 of the 17 children had a satisfactory response to cromo lyn. Eight patients who had been on intermittent steroid therapy were able to discontinue this completely, while three of the four who had been on continuous steroids were successfully switched to alternate-day therapy.

Eight of the children had at least a 50 per cent improvement in school attendance. Ability to participate in full activity was seen in two-thirds of the responding children. There was a reduc tion in the need for concomitant medication, particularly bronchodilators and steroids, a less ening in the number of isolated asthmatic at tacks and bouts of wheezing, and an increased bodily vigor and sense of well-being. However, the drug did not appear to be a barrier to infection.

Some of the factors that may play major roles in determining this drug's effectiveness include the site of the airway obstruction, the lumen size at that site, the reactivity of the bronchial tree, the strength of the stimulus applied to the air ways, the aerodynamics of aerosol administration, and patient cooperation.
The Case History of an Infant Born to an Amphetamine- Addicted Mother
Authors: Ramer Cyril M.
Published: March 2008

An infant born to an amphetamine-addicted mother had episodes of diaphoresis and agita tion alternating with episodes of lassitude, vom iting, miotic pupils, and glassy-eyed stare in the neonatal period. Development was somewhat slow for the first three months of life but thereafter proceeded normally. At two and a half years of age, she shows no neurologic or psychologic residues.
Hemophilus Influenzae Pericarditis Associated with Meningitis
Authors: Farooki Zia Q. , Henry James G. , Green Edward W.
Published: March 2008

An infant with Hemophilus influenzae meningitis and pericarditis was treated successfully with antibiotics and pericardiostomy. Review of the literature revealed 19 cases of Hemophilus in fluenzae pericarditis. Six cases were associated with meningitis.

The importance of early diagnosis combined with surgical drainage of purulent pericarditis is stressed.
The Frequency of Jaundice in Neonatal Bacterial Infections
Authors: Escobedo Marilyn B. , Barton Leslie L. , Marshall Richard E. , Zarkowsky Harold
Published: March 2008

Of 274 newborns with bacterial infections, only 16 were jaundiced, and in only six of the 16 was jaundice the initial single sign of the infection.
Hemophilus Influenzae Cellulitis
Authors: Bada Henrietta , Wright Stephen P.
Published: March 2008

Cellulitis is a complication of Hemophilus influenzae septicemia. Peak age incidence is 6 to 12 months. Onset is acute. The cheek is the most common site of involvement. Red or bluish discoloration is commonly noted. Re sponse to therapy with ampicillin or chlor amphenicol is dramatic.
Three Cases of Hemophilus Parainfluenzae Meningitis
Authors: Holt Roger N. , Taylor Charles D. , Schneider H.J. , Hallock James A.
Published: March 2008

Three cases of meningitis caused by Hemo philus parainfluenzae are reported. A review of the literature relating this organism to neonatal disease is presented. The importance of con sidering this pathogen in serious infections in neonates and children is stressed together with its differentiation from Hemophilus influenzae.
Reducing the Institutional Waiting Lists for the Mentally Retarded
Authors: Sells Clifford J. , West Margaret A. , Reichert Albert
Published: March 2008

Twenty-nine families who had children on the admission waiting list of a Washington State Institution for the retarded were studied. These parents and their retarded children had very little knowledge of possible outpatient services and had received little, if any, ongoing supportive primary care. Most parents were seeking institutionalization for their child to obtain relief for themselves and their family. Admission to the institution generally was not timed to meet either the needs of the individual or his family. Expansion of community services for the retarded can be important in reducing the number of candidates for admission to state institutions for the retarded.
Acrodermatitis Enteropathica Associated with Low Density Lipoproteins Deficiency
Authors: Wallis K. , Azizi E. , Kook A.J. , Herczeg E. , Julsary A. , Szeinberg A. , Zaidman J.L.
Published: March 2008

This study describes clinical, biochemical, and histopathologic findings in a three-month-old infant with acrodermatitis enteropathica. Com plete absence of low density lipoprotein frac tions in serum was found on paper and cellogel electrophoresis. This is the first known patient with acrodermatitis enteropathica in whom a- beta-lipoproteinemia was diagnosed. Despite treatment with fluids, special diets, antibiotics and diiodoquine, the infant died after two months of hospitalization..

A marked reduction in the levels of pre-beta and beta-lipoproteins was also observed in the serum of a sister of the propositus, one month following birth, born after propositus' death. At present, the sister is six months old. During this period, a constant increase in the d < 1.063 lipoprotein fractions in the sister's serum was observed. The propositus and the entire family have been studied and results are presented.
Eighty-One PNA's Later
Authors: Frank Donald J. , Chaney Patricia
Published: March 2008

A survey made of the activities and attitudes of nurses who have completed the Cincinnati Pediatric Nurse Associate Program showed, among other findings: most of the nurses are employed in public health settings; 80 per cent feel that there is excellent or good acceptance of their expanded role by physicians with whom they work; 75 per cent feel that there is ex cellent or good acceptance of their expanded role by nurse colleagues; 100 per cent feel that there is excellent or good acceptance of their expanded role by patients and families; 69 per cent feel that disease prevention, parent education, and screening assessment are the types of services most characteristic of their expanded role; 83 per cent feel that their ac tivities and accountability involve physicians; the role that PNA's like best by an overwhelming majority is the opportunity to provide counseling and anticipatory guidance; 60 per cent of the PNA's felt that parent education regarding mental and physical health and child rearing was the greatest unmet need of children in our present health care delivery system.
A Case of Somatic Expression of Family and Environmental Stress
Authors: Koch Charles R. , Minuchin Salvador , Donovan Woodrow M.
Published: March 2008

A child's behavior is caused by many factors. Some are "inside" the child, such as neurons and glands, memories and motivations. "Outside" the child are factors such as his parents, his siblings, his family's socioeconomic status, his house, his school, the hue of his skin, television, and many others.

The major theoretical systems in pediatrics and child psychiatry have always been concerned with the influence of both the internal and the external factors upon the development of the child. Particular emphasis has been put, in theory, on the importance of the family and the way the child, an organism with biologic and psychologic needs, negotiates those needs within the nurturing and socializing unit called the family.

The techniques of intervention which have been developed by pediatricians and child psychiatrists have been aimed almost entirely at the child as a separate organism. Though the theories have taken account of the importance of the family in the child's development and behavior, the techniques used to help the child have not.

Pediatricians acknowledge the significance of the family in the management of a child's illness, yet traditionally they examine the child but talk with the parents, mostly the mother.

A team of pediatricians and child psychiatrists at the Philadelphia Child Guidance Clinic and the Children's Hospital of Philadelphia have joined to explore the influence of the family in the development of psychosomatic and psychogenic symptoms in children and in the management of pediatric illness. Their researches in psychosomatic syndromes, supported by an NIMH grant (#21336-02), have been described in the bibliography at the end of the third article.

The three papers which follow illustrate how includ ing the family in the field of observation leads to a richer way of understanding and treating children's illnesses. —Salvador Minuchin, M.D.
The Unholy Trinity— Activity, Authority, and Magic
Authors: Rothenberg Michael B.
Published: March 2008

The pediatrician needs to ask and answer for himself: "What are the major psychosocial developmental milestones which an average child of my patient's age and cultural background has to achieve; what are the characteristic behaviors involved in such achievement; to what extent may his current illness interfere with these behaviors?" Other questions are in the mind of his patient (and the parents), whether or not they are expressed: 1) What do I have? 2) How did I get it? 3) Why did I get it? 4) What can be done about it? 5) When will I get well? With young children up to the age of four or five who require hospitalization there is the additional query: Why did my parents bring me to this place and why are they leaving me here?
Hypoactive Labyrinths and Motor Development
Authors: Rapin Isabelle
Published: March 2008

This study examines the relation of hypoac tive labyrinths to the achievement of motor milestones such as sitting and walking. Two children with genetic sensorineural hearing losses with vestibular dysfunction who walked very late did not show any evidence to suggest a diffuse neurologic cause for this delay at follow-up examinations. A review of electronys tagmographic (ENG) vestibular tests of 353 children under age ten years discovered 17 children who had been tested twice or more. There was disagreement between the two tests in four (24%), suggesting less than adequate relia bility of ENG test results in infants and chil dren. Forty-nine children had hypoactive labyrinths. The records of 22 of these were suitable for surveying the relation of the vestibu lar dysfunction to age at walking. Ten of the 22 children walked at 18 months or later, indicating that some, but not all children with vestibular dysfunction will be late walkers. Some of the children who walked at a normal age were described as having "weak necks" or "floppy heads," and some sat late. Accordingly, counsel ing of parents of deaf children who walk late should be delayed until vestibular testing has been carried out to avoid false diagnoses of associated brain damage or mental retardation. It is urged that all deaf children undergo vestibular testing, and that those with abnormal tests be retested to make certain of the results. Procedures to test vestibular function in infants and children need to be standardized, as shown by personal observations and a survey of the pertinent literature.
Vision Testing of Young and Retarded Children
Authors: Browder J.A. , Levy W.J.
Published: March 2008

Observations in a small population suggest that the Stycar system for vision testing is especially applicable to the evaluating of re tarded and other handicapped children func tioning at a young age level. Our experience suggests most children with mental ages above three years can be tested with this approach, despite their limitations of short attention span, distractibility, visual perceptual immaturity, and behavior problems. When adjustment is made for the children's mental ages, these difficulties seem minimized and success is probably equiva lent to that of other studies of preschool chil dren.
The Control of Rheumatic Fever
Authors: Shulman Stanford T. , Ayoub Elia M.
Published: March 2008

Not only does an attack [ of rheumatic fever] not confer immunity, but predisposes the subject to the disease. — Sir William Osler, The Principles and Practice of Medicine
Clinical Review: The Reading Miscue Inventory
Authors: Ramig Christopher J.
Published: March 2008

Reading Miscue Inventory—RMI—opens avenues of dealing with the reading process in a scientific and process-oriented fashion which can lead to further refining of the theoretical base upon which reading is founded as well as pro viding diagnostic information for use by reading specialists. From such information, reading specialists are able to develop remediation on an individualized basis. Appropriate materials, pro cedures, and practices are developed from the qualitative analysis of miscues rather than from the information provided by standardized achievement or diagnostic reading tests. Insights are gained regarding a child's ability to use the complex process of reading. Remediation of dis ability, at the appropriate place in the process, is based on assumptions regarding the inter relationship of thought and language.

Reading specialists are looking to psycho- linguists for theoretical bases upon which to build models of the reading process. Qualitative miscue analysis is based upon recently pro posed notions of the psycholinguistic nature of reading. Common concepts and understanding regarding reading and assessment of reading disability may facilitate learning disability teams in their diagnostic and remedial procedures.

Until recently, these discussions have occurred mainly in reading-related research and in educa tion circles, but learning disabilities teams are beginning to participate in the refining and clarifying of these notions of assessment and remediation. Regardless of the eventual outcome, the necessity for considering these views is basic to a fuller understanding of ways in which learning-disabled children may be helped.