bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acquired Rectovaginal Fistula in Human Immunodeficiency Virus-Positive Children
Authors: Hyde George A. , Sarbah Steedman 
Published: December 2021

In 1990, at Harare Central Hospital, an unusual finding of acute acquired rectovaginal fistula, principally in young infants, was noted. These infants had a normal anorectal canal and most had a history of passing stool through the vagina for 1 to 2 months.
PRESENTATION
The first infant was seen in 1990 and both mother and child had evidence of acquired immunodeficiency syndrome (AIDS). Since then 17 girls have been admitted to the Pediatric Surgical Service with the same complaint, but no other mother has had obvious AIDS. All but one infant, who died of clinical AIDS before a test was obtained, were human immunodeficiency virus (HIV)-positive as determined by an enzyme-linked immunosorbent assay (ELISA) test.
Universal Screening for Infant Hearing Impairment
Authors: Nierenberg David 
Published: December 2021

In their article in the February issue of Pediatrics, Bess and Paradise perform a useful public service by highlighting the problems inherent in using otoacoustic emissions (OAE) technology to screen infants before hospital discharge.
The problem I have with the authors' analysis, however, is that their disappointments with a specific modality should not lead them to dismiss screening altogether. They apparently have not tested other competing modalities that do not suffer from the problems that make OAE inaccurate and noneconomic.
International Conference on Child Day-Care Health: Opening Remarks
Authors: Ching-Li Hu 
Published: December 2021

It is important to recall the definition of health embodied in the Constitution of the World Health Organization (WHO) over 45 years ago: "Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic, or social condition." Among the Organization's mandated functions is "to promote maternal and child health and welfare and to foster the ability to live harmoniously in a changing total environment." The challenge of that task is no less today than it was then.
Historically, societies have evolved various patterns of family structure for social and economic functions. In preindustrial societies there evolved a great concordance between these functions, with many of the health, developmental, and socialization functions taking place first within the family and then within the immediate community. The rapid social changes of both the industrial and information revolutions have changed drastically the functions of the family, and have shifted many of the health, developmental, and social functions to nonfamily institutions, from which families are often excluded or marginally involved.
Much of the international attention to child health in this last decade has been directed at simple interventions to prevent the nearly 13 million deaths each year of children under 5: universal child immunization; the control of diarrheal and acute respiratory diseases; and infant and young child nutrition, particularly breast-feeding.
Spanking Infants and Toddlers: Maternal Belief and Practice
Authors: Socolar Rebecca R. S. , Stein Ruth E. K. 
Published: December 2021

Objective. To describe maternal beliefs and practices of spanking infants and toddlers and the relations between factors affecting these beliefs and practices.
Design. Cross-sectional survey.
Setting. Site 1 was an inner-city teaching hospital pediatric clinic. Site 2 was a private pediatrician's office in a nearby suburban neighborhood.
Participants. Mothers of children less than 4 years old in the waiting area. Site 1: n = 104; site 2: n = 100.
Selection. Systematic sample of convenience.
Methods. Mothers were interviewed using a 20-minute structured questionnaire. Measures were constructed to assess beliefs (Cronbach's α = .90) and practices about spanking and approach to discipline (α &gt; .71).
Results. Belief in spanking correlated significantly (P &lt; .001) with belief in negative approach (r = .52) and with the practice (r = .46) and severity (r = .34) of spanking. Nineteen percent of the mothers believed that there are times when it is appropriate to spank a child less than 1 year old, and 74% believed this about children 1 to 3 years old. Forty-two percent reported that they had spanked their own child in the past week. Mothers believed more strongly in spanking for dangerous misbehaviors than for annoying ones (P &lt; .001). Belief in spanking and negative approach were stronger for older toddlers (P &lt; .001). Belief in and frequency of spanking were more common at the inner-city site (P &lt; .001).
Conclusions. The belief in and practice of spanking are prevalent in disciplining very young children. The context of the spanking affects beliefs and practices. The finding that belief and practice of spanking are highly correlated suggests that belief rather than impulse largely explains spanking of children less than 4 years old. The high correlation between spanking and negative approach toward discipline raises questions about whether negative consequences of spanking are the result of spanking per se, the negative approach toward the child, or both.
A Novel Cause of Error in Capnographic Confirmation of Intubation in the Neonatal Intensive Care Unit
Authors: Roberts William A. , Maniscalco William M. 
Published: December 2021

Failure to recognize esophageal intubation can result in hypoxia and may lead to permanent neurologic injury. Clinical criteria commonly used to comfirm endotracheal intubation can fail to identify esophageal misplacement.1-9 The risk of this error has been reduced in the operating room by using capnography, which is both sensitive and specific for correct endotracheal intubation.4,6,7,10-12 Capnography is able to identify errant tube placements more rapidly and specifically than clinical indicators alone.10 We report here a novel cause of error in the capnographic findings at intubation in a neonate.
CASE REPORT
A 26-week gestational age, 690-g neonate was accidentally extubated during routine care.
Letters to the Editor
Authors: Jacobs Jennifer 
Published: December 2021

Mr Shoultz's letter typifies the conventional knee-jerk response to homeopathic medicine—"We don't understand how it works, therefore it must be a fraud." This type of thinking is the antithesis of the scientific method. In science, one must observe what occurs in the universe, then set out to determine causality.
It is true that the mechanism of action of homeopathic medicines is not understood. Indeed, as Mr Shoultz points out, homeopathic theory is inconsistent with current scientific belief.
Diverting Managed Care Medicaid Patients From Pediatric Emergency Department Use
Authors: Gadomski Anne M. , Perkis Victoria , Horton Lisa , Cross Sheila , Stanton Bonita 
Published: December 2021

Objective. To evaluate the health outcomes of managed care Medicaid children with non-emergent conditions who were not authorized to be seen in the Pediatric Emergency Department (PED) by their primary care provider.
Design. Consecutive case surveillance from 6/29/92 to 2/2/93.
Setting. University based PED (17,500 visits/year) in inner city Baltimore.
Participants. Cases were MAC children denied authorization to be seen for non-emergent conditions in the PED. Age and complaint matched MAC children were selected from the university based Pediatric Ambulatory Center (PAC) and from non-emergent PED visits (PED-seen) in order to compare utilization rates after denial.
Intervention. The Maryland Access to Care (MAC) Medicaid program (started in 12/91) emphasizes primary care and appropriate health care utilization by incorporating the following elements of managed care: assignment to primary care provider, gatekeeping, mandatory enrollment and fee for service.
Methods. Consecutive case surveillance from 6/29/92 to 2/2/93 was used to evaluate the health outcomes of MAC children denied authorization for non-emergent care in a university based PED. One week following denial, a pediatric nurse practitioner contacted the patient's caretaker and the MAC provider to ascertain health outcome. Medicaid claims data was used to compare the six month health care utilization of the denied group to age and complaint matched children seen in the PED (PED-seen) or in a primary care clinic (PAC).
Results. 216 MAC patients were not authorized for a PED visit by their MAC providers. 123 (57%) saw their MAC provider within one week of the denied PED visit. 40 (18%) were not seen because their presenting complaint had resolved completely. No adverse health outcomes occurred because of delay in health care delivery. The subsequent ER utilization rate of the denied group was the same as the PED-seen comparison group, and significantly higher than that of the PAC group (P = .002). The denied group was hospitalized at a significantly higher rate relative to these comparison groups (P = .003).
Conclusions. Diverting Medicaid children classified as non-emergent in an ER to their MAC providers can be a safe practice short-term. However, denial of a PED visit has no impact on subsequent ER utilization by Medicaid participants and may be associated with higher hospitalization rate. Gatekeeping in this setting does not necessarily change the health care seeking behavior of these patients.
Biological Rhythmicity in Preterm Infants Prior to Discharge From Neonatal Intensive Care
Authors: Glotzbach Steven F. , Edgar Dale M. , Ariagno Ronald L. 
Published: December 2021

Objective. The study of biological rhythms and the influence of environmental factors in the timing and synchronization of different rhythmic events have important implications for neonatal health. Preterm infants in the neonatal intensive care unit (NICU) are deprived of the patterned influences of maternal sleep, temperature, heart rate, and hormonal cycles. The impact of the NICU and nursing interventions on the development of the circadian system was studied in 17 stable preterm infants in the Intermediate Intensive Care Nursery at Stanford University for three consecutive days at about 35 weeks postconceptional age.
Outcome measurements. Rectal temperature, abdominal skin temperature, heart rate, and activity were simultaneously recorded at 2-minute intervals during each 3-day study by a small microcomputer (Vitalog).
Results. Very low amplitude circadian rhythms were found for rectal and skin temperatures (maximum range 36.8 to 37.0°C); population mean values for heart rate (158 bpm) and activity (3.5 counts per 2-min bin) did not differ significantly as a function of time of day. Rectal temperature, averaged in 6-hour bins over the 24-hour day as a function of both postconceptional age and postnatal age, was significantly higher during the first part of the circadian cycle. In all infants, rhythmicity in each variable was dominated by ultradian periodicities that were coincident with feedings and related interventions; moreover, several physiological variables charted during feeding differed significantly from values obtained during periods in which caregiving interventions did not occur.
Conclusion. Quantitative data on the preterm infant circadian system may facilitate evaluation of factors that improve therapeutic responses, recovery, and outcome of neonatal intensive care patients.
Pediatric Adenoidal Hypertrophy and Nasal Airway Obstruction: Reduction With Aqueous Nasal Beclomethasone
Authors: Demain Jeffrey G. , Goetz David W. 
Published: December 2021

Objective. Pediatric adenoidal obstruction of the nasal airway is associated with significant morbidity and is a frequent indication for surgery. Because efficacious medical alternatives to adenoidectomy are lacking, we assessed the potency of standard-dose topical nasal beclomethasone in reduction of adenoidal obstruction of the nasal airway.
Methods. Seventeen children, 5 to 11 years of age, exhibiting chronic obstructive nasal symptoms and a group mean (±SE) adenoid/choana ratio of 91 ± 1% on rhinoscopic examination, completed an 8-week, double-blind, placebo-controlled crossover study of standard- dose aqueous nasal beclomethasone (total 336 µg/day) in the treatment of adenoidal hypertrophy. In a 16-week, open-label, follow-on study, subjects received beclomethasone 1 spray in each nostril twice daily (168 µg/day).
Results. Over the initial 4 weeks, improvements in the mean adenoidal obstruction of the choanae were significantly greater in the group receiving beclomethasone than in the group receiving placebo (right, -14.0% vs. + 0.4%, P = .0002) (left, -15.0% vs. -2.0%, P = .0006). In the subsequent crossover 4 weeks, a significant beclomethasone carryover effect resulted in further adenoid size reduction in both treatment groups. All patients demonstrated a decrease in adenoid size with beclomethasone treatment, compared with a mixed response to placebo. Over the full 8-week crossover study, the mean (±SE) obstructive symptom score after beclomethasone treatment (20.5 ± 3.0) was significantly improved compared to patients' initial (43.1 ± 2.9) and placebo scores (31.1 ± 4.2, P ≤ .05), despite the active drug carryover effect into the placebo treatment period. Significant improvements in adenoidal obstruction and symptom scores over the 8-week crossover study were enhanced in the subsequent 16-week open-label period (P = .0001). By 24 weeks, an 82% reduction in group mean nasal obstruction symptom score accompanied a 29% mean reduction in adenoid/choana ratio. No clinical or demographic characteristic predicted a patient's degree of response to treatment.
Conclusions. Properly administered aqueous nasal beclomethasone in standard doses can significantly reduce adenoidal hypertrophy and nasal airway obstructive symptoms in children.
THE ESSENCE OF BEING A DOCTOR HAS CHANGED
Authors: L. J. F. 
Published: December 2021

Disability coverage ... is going through some rehabilitation of its own these days.
... the changes are being prompted by a record number of claims from physicians, among the biggest buyers of individual disability insurance. The surge, which partly reflects declining job satisfaction among doctors, is resulting in deteriorating profits—and, in some cases, losses—for insurers. Many now are moving toward a major overhaul of such coverage.
Individual disability insurance, which generates $3 billion a year in premiums for the insurance industry, provides replacement income for people unable to work as a result of accident on illness. The length of coverage under the policy can range from short-term to indefinitely. Many companies provide their workers with some type of disability insurance, but self-employed people, primarily doctors and lawyers, have to buy their own coverage.
Doctors have long been among the most favored customers of disability insurers because their job satisfaction generally translated into short absences from work as a result of accident or illness. Insurers viewed them as extraordinarily profitable bets for replacement-income insurance.
But lately, many doctors, especially specialists, have lost enthusiasm for their work, according to insurers and industry analysts. A big reason, they say, is that managed-care organizations, concerned with controlling costs, monitor doctors more closely and squeeze their incomes.
"There's no question oven the last year and a half the essence of being a doctor has changed," says Elaine Rosen, a senior vice president at Unum. The job isn't as entrepreneurial as it used to be. "It's a phenomenon in the world of disability-income insurance that people will tough it out and go to work everyday if they are satisfied and motivated, but if satisfaction starts to "dwindle" they're more inclined to opt for the disability rolls," she says.
Evaluation of An End-Tidal CO2 Detector During Pediatric Cardiopulmonary Resuscitation
Authors: Bhende Mananda S. , Thompson Ann E. 
Published: December 2021

Objective. To determine the utility of a disposable colorimetric end-tidal CO2 detector during pediatric cardiopulmonary resuscitation (CPR) for (1) confirming endotracheal tube (ETT) position, and (2) assessing the relationship between end-tidal CO2 recorded by this method and outcome of pediatric CPR.
Design/setting. Prospective observations during CPR in a university children's hospital.
Participants. Forty children (28 male, 12 female) aged 1 week to 10 years (25 children aged ≤1 year, mean age 27.2 months, median 7 months), weighing 2.5 to 40 kg (31 children weighing ≤15 kg, mean 10.94 kg, median 7 kg) who underwent a total of 48 endotracheal intubations during CPR.
Methods. After intubation, ETT position was verified by usual clinical methods including direct visualization. The device was attached between the ETT and ventilation bag, the patient was manually ventilated, and a first reading was obtained. Any color change from purple (Area A, end-tidal CO2 &lt; 0.5%) to tan or yellow (Area B or C, end-tidal CO2 ≥ 0.5%) was considered to be positive for airway intubation. CPR was conducted as pen Pediatric Advanced Life Support guidelines. A second reading was obtained when the decision to discontinue CPR was made.
Results. All nine esophageal tube positions were correctly identified by the detector. Thirty-three of 39 tracheal tube positions were correctly identified (P &lt; .001). For verifying ETT position, the device had a sensitivity of 84.6%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 60%. Readings were obtained at the end of CPR in 25 patients. All 13 patients who regained spontaneous circulation and survived to ICU admission had a second reading in the C range, while none of the 12 patients with a second reading in the A or B range survived. Both the first and second end-tidal CO2 readings in the C range correlated significantly with short-term survival (P = .01 and P &lt; .001, respectively). Two patients were eventually discharged from the hospital.
Conclusions. During CPR a positive test confirms placement of the ETT within the airway, whereas a negative test indicates either esophageal intubation or airway intubation with poor or absent pulmonary blood flow and requires an alternate means of confirmation of tube position. The detector may be of prognostic value for return of spontaneous circulation and short-term survival.
CHEATERS BEATING SYSTEM PROFS: VIOLATORS ESCAPE PENALTIES
Authors: L. J. F. 
Published: December 2021

Although it's unclear whether cheating is on the rise on Vermont campuses, the process of going after offenders is so time-consuming and unwieldy that many offenders go unpunished, professors say.
According to University of Vermont Sociology Professor Steve Berkowitz's 1990 survey of more than 800 randomly chosen UVM studtents, 16.5% of them have cheated on one or more academic assignments.
Chemistry Professor Bill Meyer, however, calls the judicial process "laughable." He said he wishes for a return to the times when professors were allowed to discipline those caught cheating.
"The thing that turns people off is, if someone wants to fight it, even though it's pretty abundantly clear they are guilty, they spend a lot of time, money and effort, and escape," Meyer said. He likened professors' experiences to those of rape victims who then have to go on trial to prove their character.
"It's often the professors that come in red-faced and nervous," said Cooke, a mathematics and statistics professor. "The students come in angry and confident, as if they know it's the professor who's on trial."
PAYING GERMANS TO HAVE GERMAMS
Authors: L. J. F. 
Published: December 2021

Many experts believe that over-population is one of the greatest threats facing humanity and the earth on which we live. Governments around the world are seeking ways to stop population explosions that threaten to overwhelm their economies and social structures.
Germans, however, have precisely the opposite concern. Women have all but stopped having children, especially in states carved from the former East Germany. The birth rate in Brandenburg has fallen by more than two-thirds since 1989—the state had 38 000 births that year, 12 000 last year—and the drops in other eastern German states are almost as dramatic.
Last week, to encourage childbearing, Brandenburg announced plans to pay parents $650 for every baby they produce. At least two other eastern states are considering adopting the Brandenburg system of incentive payments.
Hockey Helmets, Face Masks, and Injurious Behavior
Authors: Murray Teena M. , Livingston Lori A. 
Published: December 2021

Objective. To educate physicians about factors that contribute to injurious behaviors in ice hockey and to propose that the medical community play a role in advocating change within the sport.
Methods. A review of relevant literature on the topic was conducted, with information drawn from scientific journal publications, conference proceedings, theses, and newspaper publications.
Results. The introduction of mandatory head and facial protection has been effective in virtually eliminating ocular, facial, and dental injuries in youth hockey, but it has also been problematically linked with an increase in catastrophic spinal injuries. Players adopt a false sense of security when donning the equipment, leading them to take excessive and unwarranted risks because of the protection they are supposedly afforded. The addition of these protective devices has also altered how officials perceive game situations, leading them to be more lenient in administering penalties. The net result has been an increase in illegal and injurious behaviors, such as checking from behind.
Conclusion. Physician advocacy may play an important role in effecting change within the sport.