bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiology and Control of Acute Respiratory Diseases With Emphasis on Group A Beta-Hemolytic Streptococcus: A Decade of U.S. Army Experience
Authors: Brundage John F. , Gunzenhauser Jeffrey D. , Longfield Jenice N. , Rubertone Mark V. , Ludwig Sharon L. , Rubin Fran A. , Kaplan Edward L. 
Published: December 2021

Objective. To summarize the experiences of the U.S. Army regarding prevention and control, and frequencies, rates, trends, and determinants of febrile acute respiratory diseases (ARDs), particularly Group A beta-hemolytic streptococcus (GABHS).
Methodology. Since 1966, the U.S. Army has conducted routine surveillance of ARDs among basic trainees. Since 1985, all trainees with fever and respiratory tract symptoms have been cultured for GABHS. Field investigations were conducted when outbreaks of acute respiratory or GABHS-associated illnesses were detected. Mass plus tandem benzathine penicillin prophylaxis were used to interdict and control training center GABHS outbreaks.
Results. During the period 1985 to 1994, there were 65 184 hospitalizations for acute febrile respiratory illnesses among Army trainees. The crude hospitalization rate was 0.45 per 100 trainees per week. The rate consistently declined over the period. Incremental dedines were temporally associated with increased use of adenovirus immunizations and broader use of benzathine penicillin prophylaxis. During the period, 10 789 of 59 818 (18%) pharyngeal cultures were positive for GABHS. GABHS outbreaks were associated with diverse clinical manifestations including streptococcal toxic shock, acute rheumatic fever, and pneumonia. The emergence of mucoid colony morphology in clinical isolates was a consistent indicator of circulating virulent strains with epidemic potential. Outbreak-associated M types were M1, M3, M5, and M18. In response to six GABHS outbreaks, mass plus tandem benzathine penicillin chemoprophylaxis produced rapid and sustained GABHS control. ARD and GABHS recovery rates were lowest when benzathine penicillin prophylaxis was widely used.
Conclusions. ARD rates among Army trainees have consistently declined to unprecedented levels. GABHS has reemerged as an important threat to military trainees.
Why Use Homeopathic Doses of Phototherapy?
Authors: Maisels M. Jeffrey 
Published: December 2021

Phototherapy is used worldwide for the treatment of hyperbilirubinemia; it is safe and it works. Although there exists a vast body of literature of human, animal, and laboratory investigation dealing with the mechanisms of action, biological effects, complications, and clinical use of phototherapy (and there are several excellent recent reviews1-4), personal experience suggests that there is considerable misunderstanding about how phototherapy works, how its dose is measured, and how it should be administered. Furthermore, both the way we use phototherapy today and the indications for its use (particularly in full-term infants) have changed.1
In a bygone era, when healthy newborns remained in the hospital for at least 3 days, and hyperbilirubinemia was treated aggressively,5,6 large numbers of infants who became modestly jaundiced (serum bilirubin levels of 10 to 13 mg/dL) received phototherapy and remained in the nursery until the bilirubin levels declined.
Health Supervision for Children With Sickle Cell Diseases and Their Families
Authors:   Committee on Genetics
Published: December 2021

This set of guidelines is designed to assist the pediatrician in caring for the child in whom the diagnosis of a sickle cell disease (SCD) has been confirmed by hemoglobin electrophoresis. The SCDs include SS, SC, SB0 thalassemia (refers to β thalassemia mutations that do not produce any β-globin), SD, SE (the latter being noted after the influx of Southeast Asian immigrants), and others. Because some of these variants (eg, SC or SE) may be associated with minor symptoms, the information contained in these guidelines about complications, morbidity, and mortality may be overstated for these disorders. Therefore, this statement has been developed primarily for the health supervision and treatment of patients with SS disease. Because management issues may be complex, consultation, referral, and/or comanagement with a pediatric hematologist or comprehensive sickle cell program is advisable.
Medical treatment, home environment, patient and family support, and education can significantly affect the clinical outcome of children and adolescents with SCD and can facilitate their transition to adulthood. The following outline is designed to help the pediatrician in caring for children with SCDs and their families.
In addition to assuring compliance with the schedule, "Recommendations for Preventive Pediatric Health Care" of the American Academy of Pediatrics (AAP), the following areas require ongoing assessment throughout childhood and should be reviewed at each visit or periodically at appropriate ages (Table 1).
1. Establishment of baseline hemoglobin, white cell count, absolute neutrophil count, and reticulocyte count, which should be repeated periodically;
2. Monitoring growth parameters and nutritional status;
Clinical Outcomes of Children With Acute Abdominal Pain
Authors: Scholer Seth J. , Pituch Ken , Orr Donald P. , Dittus Robert S. 
Published: December 2021

Objective. To determine the prevalence, associated symptoms, and clinical outcomes of children presenting for a nonscheduled visit with acute abdominal pain.
Design. Historical cohort.
Setting. Inner-city teaching hospital.
Participants. A total of 1141 consecutive children, ages 2 to 12, presenting for a nonscheduled visit (clinic or emergency department) with a complaint of nontraumatic abdominal pain of ≤3 days' duration were identified through a manual chart review.
Measurements. Collected data included: 1) demographic characteristics, 2) presenting signs and symptoms, 3) records from the hospital record for all children who returned within 10 days for follow-up, 4) test results, and 5) telephone follow-up. A clinical reviewer used the data to assign a final diagnosis to each patient.
Results. The prevalence of children presenting with abdominal pain of ≤3 days' duration was 5.1%. The most common associated symptoms were history of fever (64%), emesis (42.4%), decreased appetite (36.5%), cough (35.6%), headache (29.5%), and sore throat (27.0%). The six most prevalent final diagnoses, accounting for 84% of all final diagnoses, were upper respiratory infection and/or otitis (18.6%), pharyngitis (16.6%), viral syndrome (16.0%), abdominal pain of uncertain etiology (15.6%), gastroenteritis (10.9%), and acute febrile illness (7.8%). Approximately 1% of children required surgical intervention (10/12 for appendicitis). Approximately 7% of children returned within 10 days for reevaluation of their illness; on return, 11 had treatable medical diseases and 4 had diseases requiring surgical intervention.
Conclusions. An acute complaint of abdominal pain in children occurs in 5.1% of nonscheduled visits, is frequently accompanied by multiple complaints, and is usually attributed to a self-limited disease. Close follow-up will identify the 1% to 2% who proceed to have a more serious disease process. This epidemiologic data will aid clinic-based physicians who manage children with acute abdominal pain.
Four Patterns of Response to Inhaled Nitric Oxide for Persistent Pulmonary Hypertension of the Newborn
Authors: Goldman Allan P. , Tasker Robert C. , Haworth Sheila G. , Sigston Paul E. , Macrae Duncan J. 
Published: December 2021

Objective. To determine the clinical role of inhaled nitric oxide (iNO) in the treatment of persistent pulmonary hypertension of the newborn (PPHN).
Study Design. Prospective open observational clinical study.
Setting. A regional cardiac and pediatric intensive care unit.
Methods. Twenty-five consecutive near-term neonates (&gt;35 weeks gestation) with severe PPHN (oxygenation index [OI]&gt; 25) were given a trial of iNO of 20 ppm for 20 minutes. Neonates who showed a greater than 20% improvement in Pao 2 as well as a decrease in the OI to below 40 were defined as responders and continued on this therapy.
Results. Four patterns of response emerged to the iNO therapy: Pattern 1 neonates (n = 2) did not respond to the initial trial of iNO—one survived. Pattern 2 neonates (n = 9) responded to the initial trial of iNO, but failed to sustain this response over 36 hours, as defined by a rise in the OI to &gt;40. Six survived, five with extracorporeal membrane oxygenation. Pattern 3 neonates (n = 11) responded to the initial trial of iNO, sustained this response, and were successfully weaned from iNO within 5 days—all survived to discharge. Pattern 4 neonates (n = 3) responded to the initial trial of iNO, but developed a sustained dependence on iNO for 3 to 6 weeks. All three died and lung histology revealed severe pulmonary hypoplasia and dysplasia. These neonates (pattern 4) not only required iNO for a longer period of time than did the sustained responders (pattern 3), but they required significantly higher doses of iNO during their first 5 days of iNO therapy.
Conclusions. Early responses to iNO may not be sustained. Neonates with pulmonary hypoplasia and dysplasia may have a decreased sensitivity and differing time course of response to iNO when compared with patients who have PPHN in fully developed lungs.
Experience in a Neonatal Intensive Care Unit Affects Pain Response
Authors: Johnston C. Céleste , Stevens Bonnie J. 
Published: December 2021

Objective. To determine the effect of being in the neonatal intensive care unit (NICU) on pain responses in infants of 32 weeks' postconceptual age (PCA).
Design. A cross-sectional comparative design was used.
Setting. Two level III NICUs, each in metropolitan, university teaching hospitals.
Patients. Infants of 32 weeks' PCA born within the past 4 days (the newly born group; n = 53) were compared with infants of the same PCA who had been born 4 weeks earlier (the earlier-born group; n = 36) and had spent that time in an NICU.
Outcome Measures. Heart rate, oxygen saturation levels, and facial actions were used as outcomes in a between-group repeated measures analysis of variance across the heel stick procedure. Background variables of Apgar, weight at birth and data collection, severity of illness, age group, and total number of invasive procedures were entered into a stepwise regression.
Results. The two groups responded differently to the heel stick: the earlier-born infants had less behavioral manifestations of pain than the newly born infants. The number of invasive procedures was the primary factor that explained those behavioral differences, with Apgar as a second explanatory factor. The earlier-born infants had higher heart rates and lower oxygen saturation than the newly born infants before as well as during the procedure. These physiological differences were explained by the perinatal factors of age at birth and birth weight.
Conclusion. Preterm infants who spend PCA weeks 28 through 32 in an NICU are less mature in their pain response than newborn premature infants of 32 weeks' PCA. Greater frequency of invasive procedures is associated with behavioral immaturity, whereas birth factors are associated with physiological immaturity.
Birth Weight Associated With Lowest Neonatal Mortality: Infants of Adolescent and Adult Mothers
Authors: Rees Jane M. , Lederman Sally A. , Kiely John L. 
Published: December 2021

Objective. We tested the hypothesis that survival is highest for infants born in the same weight range whether mothers are adolescent or adult, comparing the weights at which infants of these mothers achieve lowest neonatal mortality.
Methods. The relationship between birth weight and neonatal mortality was studied in births to 16.4 million women using the National Center for Health Statistics 1983-1987 national linked birth/infant death data sets. Neonatal mortality rates were calculated for 500 g birth weight categories. Births for maternal ages ≤15 years, 16 years, and 17 to 18 years were compared with births to adults 19 to 34 years of age, whites and blacks considered separately. The birth weight categories associated with minimum neonatal mortality and the weight range corresponding with greatest survival were determined for each age and racial group.
Results. Minimum neonatal mortality rates occurred at the same birth weights (3500 to 4499 g white and 3000 to 3999 g black) whether mothers of the infants were adolescents or adults. The most favorable range of birth weight, in which survival was greatest, commenced at 3000 g for all mothers, terminating at 3999 g for most black adolescents and black adults, 4499 g for most white adolescents, and 4999 g for white adults. Of infants born to mothers ≤16 years old, 33% were lighter and 1.5% were heavier than the favorable birth weight range.
Conclusion. The birth weight categories with minimum neonatal mortality and the birth weight range in which neonatal survival was greatest were comparable for infants of adolescents and adults. Lower birth weights, occurring more frequently in births to teenage mothers, were associated with higher neonatal mortality. Assisting adolescent mothers to bear infants with birth weights in the range corresponding with low neonatal mortality is an appropriate goal of clinical management.
Questions About Varicella Vaccine
Authors: LALLIER CHARLES 
Published: December 2021

I read with interest Dr Stanley Plotkin's commentary on varicella vaccine in the February 1996 issue of Pediatrics. A lot of his points are very good.
My main concern is the long-term immunity.
As a "local medical doctor," chickenpox is seen as an irritating but generally mild disease. Complications can occur, but I don't see them often. In 11 plus years of general pediatric practice, I have admitted two patients for chickenpox complications; one had cerebellar ataxia and vomiting, and the other had a cellulitis.
Introduction
Authors: Harvey Birt 
Published: December 2021

One of the ongoing objectives of the Johnson & Johnson Pediatric Institute is to provide pediatricians with practical information on issues that will improve the health of children. Each year the Board of Trustees selects a topic whose importance is just becoming clear, a topic that is not being addressed adequately in other forums or in the usual pediatric reference sources. Recent topics have included what the pediatrician can contribute toward violence prevention and how the pediatrician can thrive in the changing health care system.
The Board of Trustees chose community-based education for the pediatric resident as the 1996 topic. A variety of factors, including the dramatic increase in managed care during the past few years, has led to an increasing proportion of children's care being shifted from inpatient to outpatient settings and has augmented the need for pediatrician involvement in public health and community issues. Some necessary major changes in resident education are reflected in the new Pediatric Residency Review Committee requirements and in the Pediatric Education in Community Settings. A Manual, whose sponsors or supporters included the Ambulatory Pediatric Association, the American Academy of Pediatrics, and the Health Resources and Services Administration.
After the Board selected this topic for the 1996 conference, a planning committee—Errol Alden, Carol Berkowitz, Tom DeWitt, Lewis First, Alan Kohrt, and Ken Roberts—determined the structure, content, target audience, and possible faculty. Tom DeWitt and Ken Roberts, chosen as co-chairs, assumed the crucial and laborious tasks of developing the specifics of the program and of identifying the conference faculty and the invitees.
Głosić odważnie na rozstajach dróg. Zadania głosiciela słowa Bożego w środowisku zsekularyzowanym
Authors: Szewczyk Leszek 
Published: December 2021

Celem niniejszego opracowania jest prezentacja zadań stawianych współczesnym głosicielom słowa Bożego w kontekście dokonujących się procesów sekularyzacyjnych. Procesy te wymagają nie tylko przenikania głoszenia słowa Bożego pierwotną gorliwością i zapałem apostolskiego przepowiadania. Wśród najważniejszych zadań stojących przed kaznodziejami głoszącymi w środowisku zsekularyzowanym należy wymienić: głoszenie z posłania i w imieniu Kościoła, głoszenie słowa Bożego, mimo niesprzyjających okoliczności i zagrożeń, budzenie pragnienie Chrystusa w sercach słuchaczy oraz odważne głoszenie na rozstajach dróg. Ostatni punkt opracowania zawiera omówienie najważniejszych zagrożeń stojących przed współczesnymi głosicielami słowa Bożego.
Chlorin E6-photodynamic therapy basal cell carcinoma
Authors: Kapinus V. N. , Kaplan M. A. , Yaroslavtseva-Isayeva E. V. , Spichenkova I. S. , Ivanov S. A. 
Published: December 2021

Purpose of the study. Evaluation of the therapeutic efficacy of chlorin E6-photodynamic therapy (PDT) with photosensitizers (PS) photoditazine, photolone and photoran in patients suffering basal cell skin carcinoma.Materials and methods. The efficacy of chlorin E6-PDT was studied in 532 patients with basal cell skin cancer (BCC) aged 28 to 93 years. PhS Photoditazine was used in 72 (13,5 %) patients at a dose of 0.5-1.0 mg/kg, PhS Photolon - in 281 (52,8 %) patients at a dose of 1.1-1.6 mg/kg and PhS Photoran - in 179 (33,6 %) people at a dose of 1.1-1.6 mg/kg.Sessions of local irradiation of tumor foci were performed on a laser device "Latus-2" (662 nm) with a power density of 200-500 mW/cm2, light energy was applied to the tumors at a dose of 100-300-600 J/cm2.Results. During the follow-up period from 6 months to 5 years, 16.2 % of cases of relapse were diagnosed in the study group. When analyzing the results, it was found that the percentage of relapses was minimal when using all PhS in patients who underwent PDT for the first time established BCC of the initial stages (neoplasms up to 2.0 cm) and amounted to 2.2 % (4 patients out of 183), and with a prevalence of the process of more than 2.0 cm and up to 4.0 cm, 9.5 % (10 patients out of 105) of relapses were found. In the results of treatment of recurrent skin malignancies with PDT using derivatives of chloride E6, depending on the prevalence of the process, a similar trend was observed: with the size of tumor foci up to 2.0 cm, the percentage of repeated relapses was less and amounted to 17.1 % (18 patients out of 105) than in the treatment of neoplasms more than 2.0 cm and up to 4.0 cm (28.8 % of relapses - 21 patients out of 73).Conclusions. Chlorin E6-PDT makes it possible to effectively treat primary and recurrent BCC in an independent variant, and the results of treatment depend on a number of factors, including the prevalence of the disease and the presence or absence of previous treatment.
Screening Patterns in Abusive Abdominal Trauma
Authors: Alcaide Amador Doriann M. , Marine Megan , Karmazyn Boaz 
Published: December 2021

Background: Diagnosis of abusive abdominal trauma (AAT) is often clinically occult. Abdominal CT is the preferred method to diagnose abdominal injuries. However, due to risk of ionizing radiation, and cost, it is performed only in selected children. Recently, elevated liver enzymes were used to screen for occult AAT, but its accuracy is unknown due to inconsistent methodology and results.
Objective: To determine the accuracy of elevated liver enzymes (transaminases) in the diagnosis of AAT and if pancreatic enzymes and clinical findings help in patients’ selection for abdominal CT.
Methods:   A retrospective (2011-2020) study on children younger than 3 years suspected of child abuse. The study group included children that had abdominal CT for suspected AAT, while the control group included similar number of children randomized from 5208 children evaluated for child abuse without an abdominal CT. Patients who had an incomplete medical record, were evaluated for cardiac arrest, or had a CT without contrast were excluded.
Results:   AAT is rare 0.6% (30/5434) in children suspected of child abuse. Transaminases were obtained in 99.1% of the AAT patients and 55.3% of the control cases. 93.1% (27/29) patients with abdominal injuries had elevated transaminases. The specificity and sensitivity for the transaminases in detecting positive abdominal CT was 93.3% and 90.0%, respectively. Only one additional case was identified with elevated pancreatic enzymes and negative transaminases. There was no clinical or imaging findings that could differentiate between patients with negative and positive abdominal CT scans. Based only on elevated transaminases, 11 CT scans need to be performed for a single positive study.
Conclusion/Potential Impact: Transaminases have high sensitivity in predicting AAT. Universal use of transaminases in all children suspected of child abuse may result in 11 CT scans for one positive study. Therefore, more clinical judgement is necessary in selecting patients for CT.
Identifying Bladder Cancer Stage And Use Of Chemotherapy In The Electronic Medical Record: How Reliable Is Natural Language Processing?
Authors: Devanathan Nirupama , Haggstrom David , Cary Clint 
Published: December 2021

Background: Large automated electronic medical record (EMR) databases, together with natural language processing (NLP) algorithms, have the potential to be valuable tools in studying the patterns and effectiveness of treatment. Therefore, the current study sought to develop novel tools to identify bladder cancer cases, their clinical stage, and the chemotherapy they receive in electronic medical records.
Methods: EMR data were obtained from Indiana University Health hospitals from 2008 to 2015. We developed 2 novel algorithms using natural language processing (NLP) on unstructured data to identify (a) bladder cancer cases and clinical stage, and (b) chemotherapy names and line of chemotherapy. The sensitivity, specificity, PPV, and NPV for the clinical staging and treatment algorithm were calculated against the gold standard of manual chart review
Results: A total of 2,559 unique bladder cancer patients were identified and stratified using the clinical staging algorithm, defined as metastatic, muscle invasive, or non-muscle invasive. We identified 657 metastatic cases, 567 muscle invasive cases, and 604 non-muscle invasive cases. Further, we calculated the PPV for metastatic cases as 69.9%, muscle invasive as 80.4%, and non-muscle invasive as 79.1%. Next, the treatment algorithm was applied to metastatic patients to identify the type of chemotherapy received and 1st or 2nd line of therapy. The PPV for identifying the 1st and 2nd lines were 70.5% and 55.6%, respectively. The PPV for gemcitabine/carboplatin or cisplatin was 57.5%, but for methotrexate, vinblastine, doxorubicin, cisplatin, was 37.5%.
Conclusion and Potential Impact: The performance of the algorithm demonstrates the potential for NLP to identify cancer cases, stage, and presence of treatment. While providing meaningful information, the accuracy of the approach suggests that a hybrid method using both NLP algorithms and manual chart review remains the most robust approach. The low performance of the algorithm to identify line of therapy further highlights the need for further NLP development in this area and emphasizes the ongoing need for either human entry or review of structured data.