bluuebunny/crossref_metadata_2025_split huggingface dataset:
CLUSTERS PROBLEM
Authors: Student  
Published: December 2021

"The study could neither confirm nor deny a link between the leukemia incidents and proximity of nuclear power plants because such statistical studies, by their nature, cannot prove cause and effect." So many scientific papers end with these words. It is as if Sherlock Holmes were going out with a shattered magnifying glass and then assiduously reporting that he could not see anything.
The problem is not the intention, but the tool. A cluster is a mysterious grouping of disease, in place or time, possibly a fluke and possibly statistically "real"—that is, not due to chance alone. Statistics can determine the "real" clusters but not what the cause may be.
By definition, a statistical study sniffs at a cold trail.
CARNATION HALTS FORMULA CLAIMS
Authors: L. J. F. 
Published: December 2021

The Carnation Company agreed yesterday to drop several claims from advertisements for its infant formula after nine states had accused the company of falsely suggesting that the formula would not cause an allergic reaction. In the agreement, Carnation said it would stop describing the product, called Good Start H.A., as hypoallergenic.
Carnation, a subsidiary of Nestle S.A., also agreed to stop citing scientific evidence for its health claims and to pay the states a total of $90,000 to cover the cost of the investigation.
The states involved in the investigation are New York, California, Illinois, Iowa, Massachusetts, Minnesota, Missouri, Texas and Wisconsin.
EMBRYOS IN A DIVORCE CASE: JOINT PROPERTY OR OFFSPRING?
Authors: L. J. F. 
Published: December 2021

Maryville, Tenn.—Mary Sue Davis and Junior Lewis Davis are getting a divorce. That is a seemingly unremarkable fact in a nation where the divorce rate is climbing and where 1,183,000 couples dissolved their marriages last year.
But behind the routine talk of property rights and custody, there are large philosophical, ethical and legal questions as the Davises fight over seven frozen embryos, eggs from Mrs. Davis's body that were fertilized with Mr. Davis's sperm after other attempts at pregnancy failed.
When the trial begins in Blount County Circuit Court, the issues will be profound and troubling. When does life begin? Should an embryo be treated not as property but rather as potential life, if not life itself?
Mr. Davis maintains that the embryos, now in storage at the Fertility Center of Eastern Tennessee in Knoxville, are not alive and that the central issues are purely legal ones involving joint property of the marriage. His lawyer says the issue is simple: Mr. Davis does not want his wife to bear a child using the embryos after they are divorced.
BASIC CAUSES OF FAILURE
Authors: Barness Lewis A. 
Published: December 2021

The greatest boon to public education will come through an improvement in social conditions. Strange as it may seem, elimination of unemployment will help our schools immeasurably. Passage of a national health plan will improve the well-being of the pupils, mentally as well as physically. Well-nourished and healthy students will provide fewer discipline problems. Furthermore, a federal campaign to provide low-cost housing would help to ameliorate the deplorable conditions in which many children live. Plants cannot grow well in barren ground.
In short, our schools cannot improve until the nation as a whole emerges from poverty and desperation of deprived Americans.
ARE WE COMING FROM OR GOING TO?
Authors: Student  
Published: December 2021

William James observed that we live forwards but we understand backwards. He used this phrase to express his conviction that the creative, novelty-seeking surge of life comes first and that reflection, articulation, classification, analysis, and understanding come later.
Whether or not something constitutes progress depends not upon reaching some preexisting goal but upon the distance traveled from where we have been to where we are now. To understand something is to judge it in the light of already known criteria. In his book The Structure of Scientific Revolutions, philosopher Thomas Kuhn argues that we understand science better if we do not think of it as evolving toward anything. We need not see science "as the one enterprise that draws constantly nearer to some goal set by nature in advance." The success of science rests in how far it travels "from the community's state of knowledge at any given time."
PRACTICAL EPIGRAM OF APGAR SCORE
Authors: Butterfield Joseph 
Published: December 2021

Despite the value of the [Apgar] scoring system, experience has shown that it may be difficult to memorize the categories that make up the score and that [some] medical personnel are not familiar with it. The purpose of this communication is to describe an epigram (Figure) which embodies the basic components of the scoring system and implements its application. [SEE TABLE 1 IN SOURCE PDF.]
The epigram has not altered the essence of the Apgar scoring system. . . . It does afford a means of remembering it easily. This has been an effective adjunct in expanding the use of the Apgar Score in this medical center, and it may be of value to those physicians who are interested in furthering the employment of this scoring system in their hospitals.
Lessons From Long-Term Survivors of Childhood Cancer
Authors: Komp Diane M. 
Published: December 2021

Facing another birthday, it's not always easy to agree with Browning. New technical information mushrooms even as my grey-crowned synapses burn out. Authority and tradition, the twin domains of the experienced, are under fire as patriarchal, paternalistic, imperialistic, and whatever else fails to satisfy modern sensabilities. It surely looks as if the game is to the swift and the young. Yet my birthday this year was graced by an experience that younger clinicians cannot yet savor.
As I answered the phone's ring, I heard, "This is a voice from your past; this is Freddie" (Names have been altered to protect privacy). Although I have not seen him for 10 years, the voice was unmistakable. How can you forget the voice of the first patient with leukemia you were able to tell that he was cured? He was also the first of my longterm survivors of cancer to father children and provide me with "grandchildren" to brag about. My first "grandchildren" are already teenagers and there have been dozens more born since then to other patients who are long-term survivors of cancer.
Freddie and two other patients participated with their families in the last grand rounds I gave at my former academic post. He was seen first 20 years ago with leukemia as a teenager with a high white blood cell count and hyperuricemia. He is now 36 years old and a coal miner. At the time of his marriage, in his town only the mines provided employment with health benefits for someone with a prior history of malignancy.
ADVERTISEMENTS IN MEDICAL JOURNALS = HIGHER COST OF MEDICATION
Authors: Student  
Published: December 2021

[The] function of advertising within learned journals is not to inform but to make possible lower subscription rates for a privileged segment of our population and to support journals in a fashion to which they would otherwise have no opportunity to become accustomed.
It is no doubt true that subscription prices of some journals would be increased without advertising revenue; but this seems as slight a cost as truth has ever incurred. It is not much of a brave new world in which the costs of necessary information for physicians and scientists are made lower by higher prices of medications for the ill and in which impartial truth and shoddy contrivance rub shoulders in the heady atmosphere of intellectual work.
Status of Varicella Vaccine for Healthy Children
Authors: STARR STUART E. 
Published: December 2021

Many readers of Pediatrics have undoubtedly wondered about the status of varicella vaccine with regard to licensure. After all, Takahashi and colleagues carried out the first clinical trials with live attenuated OKA strain vaccine in 1973, and since then, the vaccine has been studied extensively, with largely favorable results, in both healthy and leukemic children.
In actuality, prelicensing studies were delayed because of the development of unacceptable reactions in leukemic children who received certain lots of vaccine. Rashes occurred more frequently than in earlier studies in which different lots of vaccine were used, and in four children moderately severe disease requiring hospitalization and treatment with acyclovir developed.
PREP Statement
Authors: ALDEN ERROL R. , Dow JEAN ,   PREP ADVISORY GROUP
Published: December 2021

The following statement was developed by the PREP Advisory Group as part of an effort to inform the Academy membership about plans currently underway for the future of the PREP program.
Planning is still in the early stages, but the Department of Education is enthusiastic about the projected changes, including 12 (instead of 10) issues of Pediatrics in Review, a new section in the journal devoted to practice management, and computerized diagnosis and management problems in addition to the Self-Assessment examination. Some of these changes will be phased in during the next 2 years; the new PREP program will actually be launched in January 1992.
Please "stay tuned"—as plans continue to develop, we will keep the membership informed. In the meantime, if you have questions, comments, or suggestions regarding PREP, we would be happy to hear from you. You may contact PREP, Department of Education, American Academy of Pediatrics, 141 Northwest Point Blvd, Elk Grove Village, IL 60009-0927.
In Reply: Status Epilepticus—Risks and Treatment
Authors: FREEMAN JOHN M. 
Published: December 2021

Dr Haruda's letter deserves a strong reply. His central point is embodied in the last lines.". . .this 25% risk of another seizure, which may have fatal complications, is far too great for me to expect the parents of my patients to accept, and neither would I if I were such a parent. It is my practice to treat seizures."
This response embodies what I term "the Mount Everest" approach to seizures: seizures are treated because they are there.
Drug Screening
Authors: SCHWARTZ RICHARD H. , TSESIS VLADIMIR 
Published: December 2021

To the Editor.—
We are writing to express our strong opposition to the recently published American Academy of Pediatrics' (AAP) position paper concerning drug screening of adolescents (Pediatrics 1989;84:396-398). The improved accuracy and widespread use of urine tests for drugs of abuse has been one of the most significant advances in the diagnosis and management of diseases of addiction. Tests for drugs of abuse furnish objective evidence of exposure to illicit drugs—evidence that is difficult or impossible to obtain by any other means.
Could Hypobilirubinemia Be Bad?
Authors: GARBAGNATI ERSILIA 
Published: December 2021

To the Editor.—
Recently, M. van de Bor et al1 have attempted to relate the degree of hyperbilirubinemia at birth to later poor neurologic development in a large number of low-birth-weight subjects. However, as occurred in previous studies, this research has taken into account only problems related to bilirubin toxicity without paying any attention to a possible biologic role of this pigment.
Bilirubin is a mysterious substance. It belongs to a large group of compounds, the so-called "bile pigments," that are widely distributed in the animal as well as in the vegetable kingdom.
The Extracorporeal Membrane Oxygenation Debate
Authors: SHORT BILLIE LOU 
Published: December 2021

To the Editor.—
I would like to thank Dr Dworetz and associates1 for their concern for the use of retrospective criteria in determining ECMO (extracorporeal membrane oxygenation) entry criteria, a concern that is common to all of us. It should be pointed out that a controlled trial comparing ECMO to hyperventilation was completed at Boston Children's Hospital2 showing an improved survival with extracorporeal membrane oxygenation. Even though the criteria of the Boston study were tested prospectively, a year after that study, we must deal with how to change the criteria to reflect new therapeutic modalities.
More Concerning Asthma and Exercise
Authors: FURUKAWA CLIFTON T. , MURPHY SHIRLEY , Eggleston Peyton , Rachelefsky Gary , Bahna Sami , Fischer Thomas , Katz Roger , Meltzer Eli , Ownby Dennis , Pearlman David , Tinkelman David 
Published: December 2021

In Reply.—
Dr Altenburger's letter asks us to go beyond our statement endorsing medical therapy for a child with exercise-induced asthma into a statement about what "schools should" and "should not" do about medications. It has always been difficult for the "little white clinic" to tell "the little red schoolhouse" how to handle health concerns. It should be recognized that in some communities there is very good communication and cooperation and that policy statements cannot assure such good practice.
Acquired Immunodeficiency Syndrome and Adolescence
Authors: PARKER JAMES E. 
Published: December 2021

To the Editor.—
Goodman and Cohall1 have provided a valuable survey regarding the adolescent attitude to acquired immunodeficiency syndrome.
In their final paragraph, however, they pose a question which I find disturbing, in that it appears to strike at the very root of medical philosophy. How do we respond to the suggestion that 21% of respondents claimed that they would commit suicide if they had a positive human immunodeficiency virus test? Is this a reason not to test, or should one say "Amen, so be it?" We must recognize that this threat is very real but that it nevertheless constitutes emotional blackmail.
Gas Embolism After Ingestion of Hydrogen Peroxide
Authors: RACKOFF WAYNE R. , MERTON DAVID F. 
Published: December 2021

Gas embolism to the portal venous system is a well-recognized radiographic sign in infants with necrotizing enterocolitis. It also has been seen after colonic irrigation with hydrogen peroxide solution.1,2 We present what we believe is the first reported patient with radiographic evidence of portal venous gas embolism after ingestion of hydrogen peroxide solution. This finding is important because gas embolism to the portal venous system after colonic irrigation with hydrogen peroxide has been associated with gangrenous and perforated bowel.1,2
CASE REPORT
A 2-year-old boy ingested an unknown amount of 3% hydrogen peroxide solution. The child was found with foam around his mouth.
An Unlucky Rabbit's Foot?
Authors: RYAN-POIRIER KATHLEEN , WHITEHEAD PETER Y. , LEGGIADRO ROBERT J. 
Published: December 2021

The diagnosis of tularemia, a bacterial disease, may not be considered because of its low incidence in the United States. A careful epidemiologic history, however, may offer the necessary clues to diagnosis.1 We describe two cases of tularemia in siblings presumably caused by contact with a rabbit killed by hunting dogs. Of special interest was the use of the rabbit's feet as good luck charms. Although appropriate measures can be taken to prevent this disease, such precautions are either not widely known or not strictly adhered to among those who hunt small game.
CASE REPORTS
An 8-year-old white boy (R. M.) from Memphis was referred to LeBonheur Children's Medical Center for evaluation of persistent fever.
Medical Staff Appointment and Delineation of Pediatric Privileges in Hospitals
Authors:   Committee on Hospital Care
Published: December 2021

Medical staff credentialing, including the delineation of clinical privileges for each staff member, represents a cornerstone in the hospital quality assurance program. The process involves the evaluation and verification of a practitioner's professional competence and conduct based on his/her education and training, previous professional experience, personal background, and peer assessment. Once the practitioner's credentials have been confirmed and approved, clinical privileges are extended by the hospital, matching the practitioner's documented competence and skills with the standards and resources of the institution.
Because of the many significant differences between individual hospitals (ie, size, services provided, geographic location, population served, organization of the medical staff, fiscal and administrative characteristics), no one method for credentialing is universally applicable. The medical staff of each hospital is therefore responsible for establishing its own procedures for credentialing. There are certain elements, however, required in each hospital's credentialing process:
1. It must be thorough, fair, and timely and involve unbiased and good-faith peer review. Any possible malicious use of the peer review process is not acceptable.
2. The etire credentialing process must be clearly described in the medical staff bylaws. Included inn this description should be mechanisms for appeal and guaranteed due process for disputes concerning disciplinary actions and for changes in or revocation of privileges. The medical staff bylaws should also incorporate provisions of the federal Health Care Quality Improvement Act of 1986 as well as reference provisions of applicable state laws, to help achieve or describe available immunities annd protections for the hospital and peer review committee members from various legal liabilities.
Fluctuating Blood Pressure and Intraventricular Hemorrhage
Authors: MIALL-ALLEN VIVIENNE 
Published: December 2021

In Reply.—
We would like to thank JM Perlman and JJ Volpe for their comments on our recent article.1 They were surprised that we did not observe the "excessive" levels of blood pressure fluctuation (coefficient of variation up to 30% or more) which they obtained for cerebral blood flow velocity in infants at greatest risk of developing IVH (Perlman et al2,3). We were surprised by this too; and, as we commented in the discussion, this disparity is difficult to explain.
Solar Intensity and Sun Protection
Authors: WEINSTOCK MARTIN A. 
Published: December 2021

In Reply.—
Drs Weyrauch and Boiko cite the examples of Charleston, SC (33 latitude and 862 BTU per day solar radiation in July) and Spokane, WA (48 and 1314 BTU) to illustrate that factors other than latitude affect the overall intensity of solar radiation. Other complexities are worth noting. Cloud cover affects the average intensity of solar radiation, but the peak intensity on sunny days may be particularly relevant for melanoma. Furthermore, it is likely that the short wavelength ultraviolet component of sunlight is primarily responsible for the ability of the sun to cause melanoma, and this component is more dependent than other wavelengths on latitude.1
Dangers of Arterial Catheters in Critically III Neonates
Authors: WEINBERG GERARD , BRION LUC P. , VEGA-RICHF CARLOS R. 
Published: December 2021

To the Editor.—
We read with interest the recent article in Pediatrics.1 The authors present a case of aortic thrombosis associated with umbilical catheterization in a newborn delivered to a cocaine-addicted mother. We agree with the authors that the presence of an arterial catheter is the most likely cause of the arterial thrombosis, whereas cocaine may have had an additional vasoconstrictive effect. It would be interesting to know whether any placental infarct had been noted at the time of delivery.
Protective Efficacy of Haemophilus influenzae Type b Polysaccharide Vaccine
Authors: Shapiro Eugene D. , Berg Anne T. 
Published: December 2021

There has been uncertainty and controversy about the protective efficacy of Haemophilus influenzae type b polysaccharide vaccine almost since it first was licensed in the United States. This article will briefly review the available epidemiologic data about the protective efficacy of this vaccine in children with no recognized underlying illnesses.
H influenzae type b polysaccharide vaccine was licensed in the United States in April 1985, based on the results of a randomized clinical trial that was conducted in Finland.1 That study indicated that the vaccine's protective efficacy was 90% against invasive disease caused by H influenzae type b in children 18 to 71 months of age. Authorities recommended that all children receive the vaccine at 2 years of age and that it be administered to children up to the age of 60 months.2,3 The Immunization Practices Advisory Committee also recommended that children at increased risk (such as those who attend group day care) receive the vaccine at 18 months and again at 24 months of age because of its inconsistent immunogenicity when administered to 18-month-old children.2
Soon after its licensure, however, reports of vaccine failures began to appear. In some instances the vaccine failure could be attributed to an identifiable immune deficiency.4,5 However, Granoff et al6 reported 54 apparently normal children who had received the H influenzae type b polysaccharide vaccine but subsequently developed invasive disease caused by H influenzae type b. The majority of these children had normal serum concentrations of total immunoglobulins, IgG2, hemolytic complement, and antibody to tetanus toxoid (a T-cell-dependent antigen).
Comparative Immune Responses to Haemophilus influenzae Type b Polysaccharide and a Polysaccharide-Protein Conjugate Vaccine
Authors: Kim Kwang Sik , Wong Victor K. , Adler Robert , Steinberg Evan A. 
Published: December 2021

Haemophilus influenzae type b is the most common cause of bacterial meningitis in children in the United States. Antibody to the capsular polysaccharide of this organism, polyribosylribitol-phosphate (PRP), is important in protecting against invasive disease. In 1985, H influenzae type b vaccine containing only PRP was licensed in the United States for use in children 24 to 59 months of age.
Studies conducted in the United States and Finland have shown that PRP vaccine is safe and immunogenic in children older than 18 months of age.1,2 In Finland, an efficacy of approximately 80% was obtained when PRP vaccine was used to prevent invasive disease caused by H influenzae type b in children older than 24 months of age.3 The immunogenicity of the PRP vaccine in children 18 to 23 months of age, however, was not clearly established. Reported rates of seroconversion after receipt of a single dose of PRP vaccine ranged from 20% to 75%1.3-5
The purpose of our studies was to evaluate the immunogenicity y of PRP vaccines and of conjugate vaccine (PRP-Neisseria meningitidis outer membrane protein complex [PRP-OMPC]) in children from the Los Angeles area.
First, we conducted a randomized, prospective study to compare the immunogenicity of the PRP vaccines produced by three manufacturers. A total of 147 healthy children between the ages of 18 and 58 months were recruited from Childrens Hospital of Los Angeles and Kaiser Foundation Hospital, Los Angeles, to receive, according to a prepared randomization schedule, 25 µg of the following PRP vaccines: Hib-Immune, lot 184-669, 190-654; Hib-Vax, lot 7L91071, 7D91043; or b-CAPSA I, lot M087BD, M068BC.