bluuebunny/crossref_metadata_2025_split huggingface dataset:
Der Digital Markets Act und die Regulierung von Ökosystemen
Authors: Kühling Jürgen , Weck Thomas 
Published: December 2021

Zusammenfassung
Die Entstehung großer digitaler Ökosysteme ist eine große Herausforderung für den Wettbewerbsschutz: Auf der einen Seite stellen die Betreiber für viele das beste Angebot am Markt bereit, auf der anderen Seite können und wollen dann viele auch nicht mehr zu Alternativen wechseln. Je größer die Ökosysteme werden, um so unangreifbarer werden sie auch. Der von der Europäischen Kommission vorgeschlagene DMA setzt diesem Mechanismus eine starre Verhaltens- und Transparenzregulierung entgegen. Der Erfolg des DMA wird davon abhängen, ob er den Mechanismus der Ausbildung und Erweiterung digitaler Ökosysteme richtig erfasst und die damit verbundenen Wettbewerbsprobleme neutralisiert. Insoweit sind nach jetzigem Stand noch einige Fragen zu klären. Der vorliegende Beitrag enthält dazu Überlegungen auf Basis der Gutachten der Monopolkommission zur Digitalwirtschaft.
How Pediatric Educators Know What to Teach: The Use of Teaching Scripts
Authors: Marcdante Karen Wendelberger , Simpson Deborah 
Published: December 2021

Objective.
Expert clinical teachers in medicine use teaching scripts. The aim of this study was to determine whether pediatricians also use common components of teaching scripts.

Methods.
Seventy-three pediatric clerkship directors identified anticipated errors and teaching points in response to two short vignettes. The content analysis of responses, which we completed, was analyzed by rank and receipt of teaching awards.

Results.
Greater than 87% of respondents identified at least one of three anticipated learner errors and greater than 80% of respondents identified at least one of three to four teaching points. Teaching points related directly to anticipated errors in 60% of responses. Level of experience and receipt of teaching awards had no impact on response content.

Conclusions.
Consistent with findings on the use of teaching scripts, pediatrics' educators achieved high congruence on anticipated errors and teaching points on two teaching vignettes. These findings support the hypothesis that developing teaching expertise is associated with other script components. medical education, teaching scripts, clinical teaching, pediatrics.
Medical Evaluation of Overweight Children and Adolescents: Reports From Pediatricians, Pediatric Nurse Practitioners, and Registered Dietitians
Authors: Barlow Sarah E. , Dietz William H. , Klish William J. , Trowbridge Frederick L. 
Published: December 2021

Objective. The primary aim of this study was to determine how pediatric health care providers identify overweight in children and adolescents and how they evaluate obesity-related medical complications. This information can guide development of programs to help providers improve their evaluation practices. A secondary objective was to examine the association of certain provider characteristics with recommended evaluation practices.Methods. A random sample of pediatricians, pediatric nurse practitioners (PNPs), and registered dietitians received a questionnaire about their evaluation of overweight children and adolescents. Results were compared with published recommendations. Associations between respondent characteristics and adherence to published recommendations were examined.Results. A total 940 providers responded (response rate: 19%–33%). Among all 3 groups a majority frequently used clinical impression, weight-for-age percentile, weight-for-height percent, and weight-for-height percentile to assess degree of overweight. Nearly all pediatricians and PNPs routinely evaluated blood pressure, but a minority routinely looked for orthopedic problems, insulin resistance, and sleep disorders. Less than 10% followed all recommendations for history and physical examination. Two thirds of pediatricians and PNPs routinely tested for lipid abnormalities. Most providers asked about family history of overweight, hypertension, cardiovascular disease, and diabetes, but only one third asked about gallbladder disease. In general, the provider’s specialty, years in practice, gender, and body mass index were not associated with adherence to recommended practices.Conclusions. Medical evaluation of overweight children and adolescents fell short of recommended practices. These results point to the need for educational efforts to increase awareness of medical risks and for tools to facilitate more complete evaluation during office visits.
Treatment of Child and Adolescent Obesity: Reports From Pediatricians, Pediatric Nurse Practitioners, and Registered Dietitians
Authors: Barlow Sarah E. , Trowbridge Frederick L. , Klish William J. , Dietz William H. 
Published: December 2021

Objective. The primary aim of this study was to identify interventions used by pediatric health care providers in treatment of overweight children and adolescents to identify provider educational needs. A secondary aim was to examine the association of certain provider characteristics with recommended evaluation practices.Study Design. A random sample of pediatricians, pediatric nurse practitioners, and registered dietitians (RDs) received questionnaires about their diet, activity, and medication recommendations for overweight patients and about referrals to specialists and programs. Results were examined for adherence to published recommendations and for associations with certain respondent characteristics.Results. A total of 940 providers responded (response rate: 19%–33%). The majority recommended “changes in eating patterns” and “limitations of specific foods.” Half or more used “low-fat diet” and “modest calorie restriction” in adolescents. Less than 15% used “very low-calorie diet.” Fewer RDs recommended more restrictive diets. More than 60% of all groups followed recommended eating interventions for school-aged children and adolescents. More than 80% followed recommended physical activity interventions for all age groups. In each group, about 5% sometimes recommended prescription medication and herbal remedies for adolescents. None recommended surgery. Two thirds of pediatricians and pediatric nurse practitioners often referred to RDs. Approximately 20% referred to child/adolescent weight programs, but for 27% to 42%, these programs or pediatric obesity specialists were not available. No consistent associations between respondent characteristics and adherence to recommended interventions were identified.Conclusions. The providers generally promoted healthy eating and activity with minimal use of highly restrictive diets or medication to control weight.
Response to Intravenous Immunoglobulin Predicts Splenectomy Response in Children With Immune Thrombocytopenic Purpura
Authors: Holt Derick , Brown Justin , Terrill Kelly , Goldsby Robert , Meyers Rebecka L. , Heximer Jody , Nordfors Beth , Slayton William B. 
Published: December 2021

Objective. Response to intravenous immunoglobulin (IVIG) has been shown to predict response to splenectomy in adults with immune thrombocytopenic purpura (ITP). However, reports in children have been inconsistent. We sought to determine whether response to IVIG is predictive of response to splenectomy in children.
Methods. Thirty-two assessable children were identified by a retrospective chart review. Response was graded according to previously published criteria as follows: “excellent” (platelets &gt;150 000 within 1 week), “good” (platelets between 50 000 and 150 000), and “poor” (platelets &lt;50 000). “Response” refers to both splenectomy and IVIG, and response to splenectomy was counted only when it was durable.
Results. Twenty-one of 23 patients who had a good or excellent response to IVIG also had an excellent response to splenectomy. Six of 9 patients who had a poor response to IVIG also had a poor response to splenectomy. Response to IVIG was a sensitive predictor of response to splenectomy in 88% of patients. Response to IVIG had a specificity of 75%, a positive predictive value of 91%, and a negative predictive value of 67%. Response to prednisone and length of time to splenectomy were not correlated with splenectomy response.
Conclusions. These results suggest that response to IVIG is predictive of response to splenectomy in children with chronic ITP. This correlation may be of value in deciding whether a splenectomy should be performed in children with chronic ITP.
Hepatitis B Surface Antigen Prevalence Among Pregnant Women in Urban Areas: Implications for Testing, Reporting, and Preventing Perinatal Transmission
Authors: Euler Gary L. , Wooten Karen G. , Baughman Andrew L. , Williams Walter W. 
Published: December 2021

Objectives. To estimate race/ethnicity-specific prevalence of hepatitis B surface antigen (HBsAg) in pregnant urban women and to evaluate factors associated with maternal HBsAg testing.
Methods. A multicenter, retrospective chart review was conducted of a racially/ethnically stratified random sample of maternal/infant charts of 10 523 women who gave birth to live infants during 1990–1993 in 4 urban areas in the United States. Data were collected on multiple variables, including demographic variables, HBsAg test dates and results, prenatal care type, and amount and source of payment.
Results. HBsAg prevalence among white non-Hispanics was 0.60% (95% confidence interval [CI]: 0.22–0.98), black non-Hispanics 0.97% (95% CI: 0.48–1.47), Hispanics 0.14% (95% CI: 0.01–0.26), and Asians 5.79% (95% CI: 4.42–7.16). HBsAg testing rates increased from 56.6% in 1990 to 78.2% in 1993. Factors associated with not being tested varied by urban area, but in the combined area model, they were having no or private prenatal care (odds ratios: 18.75 and 5.07, respectively) and being black (odds ratios: 2.08). Only 20.9% (95% CI: 19.1%–22.8%) of those not tested prenatally were tested at delivery. The expected number of infants born to HBsAg-positive study-area women was 3327 using study prevalence rates, compared with 1761 using national rates.
Conclusions. To help ensure that all urban infants who are born to HBsAg-positive women receive appropriate prophylaxis, health officials in urban areas should use urban-area prevalence rates to ascertain completeness of reporting maternal HBsAg positivity. Needed steps to increase maternal HBsAg testing rates include ensuring that more pregnant women receive prenatal care, promoting testing by private providers, educating providers about testing in all racial and ethnic groups, and reminding providers to test at delivery those women not tested prenatally.
Sleep Environment and the Risk of Sudden Infant Death Syndrome in an Urban Population: The Chicago Infant Mortality Study
Authors: Hauck Fern R. , Herman Stanislaw M. , Donovan Mark , Iyasu Solomon , Merrick Moore Cathryn , Donoghue Edmund , Kirschner Robert H. , Willinger Marian 
Published: December 2021

Objective. To examine risk factors for sudden infant death syndrome (SIDS) with the goal of reducing SIDS mortality among blacks, which continues to affect this group at twice the rate of whites.Methods. We analyzed data from a population-based case-control study of 260 SIDS deaths that occurred in Chicago between 1993 and 1996 and an equal number of matched living controls to determine the association between SIDS and factors in the sleep environment and other variables related to infant care.Results. The racial/ethnic composition of the study groups was 75.0% black; 13.1% Hispanic white; and 11.9% non-Hispanic white. Several factors related to the sleep environment during last sleep were associated with higher risk of SIDS: placement in the prone position (unadjusted odds ratio [OR]: 2.4; 95% confidence interval [CI]: 1.7–3.4), soft surface (OR: 5.1; 95% CI: 3.1–8.3), pillow use (OR: 2.5; 95% CI: 1.5–4.2), face and/or head covered with bedding (OR: 2.5; 95% CI: 1.3–4.6), bed sharing overall (OR: 2.7; 95% CI: 1.8–4.2), bed sharing with parent(s) alone (OR: 1.9; 95% CI: 1.2–3.1), and bed sharing in other combinations (OR: 5.4; 95% CI: 2.8–10.2). Pacifier use was associated with decreased risk (unadjusted OR: 0.3; 95% CI: 0.2–0.5), as was breastfeeding either ever (OR: 0.2; 95% CI: 0.1–0.3) or currently (OR: 0.2; 95% CI: 0.1–0.4). In a multivariate model, several factors remained significant: prone sleep position, soft surface, pillow use, bed sharing other than with parent(s) alone, and not using a pacifier.Conclusions. To lower further the SIDS rate among black and other racial/ethnic groups, prone sleeping, the use of soft bedding and pillows, and some types of bed sharing should be reduced.
Future Role of Large Neutral Amino Acids in Transport of Phenylalanine Into the Brain
Authors: Matalon Reuben , Surendran Sankar , Matalon Kimberlee Michals , Tyring Stephen , Quast Michael , Jinga Wei , Ezell Edward , Szucs Sylvia 
Published: December 2021

Objective. The treatment of phenylketonuria (PKU) in children and adults has been difficult because of erosion of dietary adherence, leading to poor school performance, impairment of executive functioning, loss of IQ, and deterioration of white matter in the brain. Mutant PKU mice produced by exposure to N-ethyl-N′-nitrosourea (ENU) were used to examine the effect of large neutral amino acid (LNAA) supplementation on brain and blood phenylalanine (Phe).
Methods. Mice with PKU, genotype ENU 2/2 with features of classical PKU, were supplemented with LNAA while on a normal diet. Two dosages of LNAA were given 0.5 g/kg and 1.0 g/kg by gavage. Blood Phe was determined in the experimental, control, and sham-treated mice. Brain Phe was determined by magnetic resonance spectroscopy after perchloric acid extraction. Branched-chain amino acid transferase (BCAT) was determined in brain as a marker for energy metabolism.
Results. Blood Phe was reduced in the LNAA-treated mice by an average of 15% (0.5 g/kg) and 50% (1.0 g/kg) in 48 hours. There was a sustained decrease in the blood Phe levels over a 6-week trial. The untreated mice and sham-treated mice maintained high blood Phe throughout the experiments. Brain Phe level determined by magnetic resonance spectroscopy showed a decline of 46% after the LNAA treatment. BCAT levels were lower (33%) in the ENU 2/2 mice compared with wild-type. The BCAT normalized in mice with PKU that were treated with LNAA.
Conclusion. The results suggest that giving LNAA lowered brain and blood Phe levels in mice with PKU. Energy metabolism generated from BCAT also improved in mice with PKU after treatment with LNAA. Data from the mice suggest that LNAA should be considered among the strategies to treat PKU in humans.
CONGENITAL ANOMALIES IN THE RAT PRODUCED BY EXCESSIVE INTAKE OF VITAMIN A DURING PREGNANCY
Authors: COHLAN SIDNEY Q. 
Published: December 2021

Excessive intake of vitamin A during pregnancy in the rat results in a marked litter failure. However, when litters are carried to term a variety of gross congenital anomalies are produced which include: encephaly, eye malformations, cleft palate, shortening of the mandible and maxilla, spina bifida with meningocele and hydrocephalus. Of 148 offspring of vitamin A-fed maternal rats, 77 exhibited gross malformations (an anomaly rate of 52%). There were no congenital anomalies observed in 1201 control young.
The 7th to 10th day of gestation was found to be the period critically susceptible to the teratogenic effect of vitamin A excess. The stage specificity of various environmental agents and the possible mechanism of action of the teratogenic effect of maternal vitamin A excess are discussed.
La Progénèse. Facteurs Préconceptionnels du Développement de L'Enfant
Authors: VILLEE CLAUDE A. 
Published: December 2021

This book, with chapters by 34 different authors representing pediatrics, genetics, biochemistry, anthropology, embryology, ecology and demography, is a detailed consideration of the conditions which, acting before conception occurs, may affect the qualities of the future human being. The list of contributors includes authorities from France, England, the Netherlands, Belgium, Sweden, and Denmark.
In the introductory chapter, Professor Turpin contrasts progenesis—the factors, both hereditary and environmental, operating before conception to influence the future zygote—with metagenesis, the factors which come into play only after the egg has been fertilized.
Our Blind Children—Growing and Learning with Them
Authors: ZAHL PAUL A. 
Published: December 2021

This book, addressed mainly to the parents of sightless children, is professional counsel— solid, straightforward, and wholesome. The author is superintendent of the California School for the Blind, Berkeley.
In regard to blind children of pre-school years, the approach is under such specific headings as: Learning to Eat, Toilet Training, Sleeping Habits, Learning to Dress, Learning to Walk, Learning to Talk....
The author proceeds to matters of schooling and educational placement, together with discussions of and answers to a host of questions that inevitably occur to the parents of blind children.
MATERNAL DEPRIVATION
Authors: Glaser Kurt , Eisenberg Leon 
Published: December 2021

The effects upon the child of separation from his mother (deprivation syndrome) have been critically reviewed. Effects of physical neglect or emotional rejection by the child's mother have not been included in this paper.
The results of maternal deprivation in the physical, intellectual and emotional areas have been described. They have been shown to vary in type, intensity and reversibility depending upon the age at which separation occurs, duration of separation and pre- and post-separation experiences of the child.
Preventive and therapeutic measures have been briefly discussed.
The Boke of Children
Authors: MAY C. D. 
Published: December 2021

A. V. Neale, M.D., Department of Child Health, University of Bristol, and Hugh R. E. Wallis, M.D., Bath, Somerset are the editors of this reprint of the first book on pediatrics ever written in the English language. Pediatricians of the English speaking world owe a debt of gratitude to them and to the publishers who have made this famous book available–and at a reasonable price.
The full text of The Boke of Children is provided along with addition of a valuable Introduction as well as a most helpful Glossary of terms, without which some of the text would be unintelligible to the modern reader.
Histamine, A Ciba Foundation Symposium held jointly with The Physiological Society and The British Pharmacological Society
Authors: FEATHERSTONE R. M. 
Published: December 2021

This book includes reports of two symposia on histamine held in honor of Sir Henry Dale, pioneer in this field of research. The first symposium, that of the Physiological foundation, was divided into three major parts, namely: The occurrence of histamine in the body, the release of histamine, and the origin and significance of histamine in the body, during which formal presentations were made to the 300 participants.
During the first part, the distribution of histamine, its relation to mast cells and intracellular particles, and its occurrence in free and bound forms were the primary points of discussion.
ADOLESCENCE
Authors: Gallagher J. Roswell , Heald Felix P. 
Published: December 2021

I BELIEVE that it will be profitable to begin our discussion of adolescence with a few remarks about the Adolescent Unit at the Children's Hospital in Boston: what it is and why it is. This Unit is a general medical clinic designed for the care and treatment of young people between the ages of 12 and 21. As there is often confusion in the minds of not only the physician but the laity as to whether this Adolescent Unit is a psychiatric clinic, I would like to stress that our Unit is a general clinic for all young people, whether their complaints be a backache, dysmenorrhea, acne, diabetes, seizures, or any other ailment which is either common or uncommon in adolescence. Our discussion will not be psychiatrically but rather psychologically oriented to this age group.
It has not been our intention to create a new specialty, but rather to give special care to this somewhat neglected age group. In our Adolescent Unit we have pediatricians, internists, and general practitioners working side by side in a common effort to provide over-all medical care for these boys and girls. Young people deserve a clinic of their own just as do little children and adults. They need a place where they can tell their own story to their own doctor, and where their doctor can talk to them about what they should do to care for themselves.
In addition to our primary function, which is to care for the adolescent and his or her ailment, the Unit also serves for the training of the physician in the care of these young people.
APPARATUS FOR COLLECTION OF URINE FROM FEMALE INFANTS
Authors: Heeley Ann H. , Talbot Nathan B. 
Published: December 2021

THE COLLECTION of complete, uncontaminated urine specimens from female infants up to the time when toilet training is established without resorting to the use of a catheter has long been a problem on pediatric services. The apparatus described here has been found helpful in alleviating this problem. [See FIG. 1. in Source Pdf.]
DESCRIPTION OF APPARATUS
As shown in Figure 1, this collection apparatus consists of a small, quadrangular piece of plastic material (Section A), shaped to fit the contour of the female perineum, to which is attached plastic tubing (Section B-D). This apparatus is placed over the patient's penineum and is held firmly in place by means of cotton straps (Section E.) The collection tubing may either be nun under the knee of the patient and over the side of the bed into a collection bottle or may be dropped through a hole near the center of a metabolic mattress if one is available. Elevation of the head of the bed on 2-inch-high shock blocks facilitates drainage.
When used for prolonged urine collections, irritation of the skin of the perineum can be avoided by releasing the straps and adapter every 6 to 8 hours just after a voiding. The perineal area can then be washed, dried and exposed to the air for a few minutes before reapplying the apparatus.
The quadrangular adapter can be cleaned and reused. The tubing remains watertight for about 4 days and is replaced as indicated.
COMMENTS
Extensive use of this apparatus over the past 4 years in a wide variety of situations indicates that it greatly facilitates the collection of single, uncontaminated urine specimens even in the presence of profuse, watery diarrhea.
RABIES PROPHYLAXIS IN MAN
Authors: Habel Karl 
Published: December 2021

IN SPITE of the fact that rabies has long been recognized as a virus disease, that more experimental work has been carried out on this disease than on any other human illness of virus etiology, and in spite of the existence of a prophylactic vaccine for the past 70 years, nevertheless there continues to be a rabies problem in most parts of the world including the United States.
Although the number of animals reported annually as rabid in this country varies between 6,000 and 10,000 it is estimated that those reported represent only a small proportion—perhaps only a third—of the actual number. However, with only 10 to 20 human deaths each year due to rabies it would appear that this disease is of minor importance among the health problems of our human population, yet as many as 50,000 individuals receive antirabies prophylaxis each year.
A long range program aimed at the elimination of rabies as a public health problem in any area is actually a veterinary and wildlife rather than a medical problem, because man represents the end of the line in the ecology and persistence of rabies. In other words, if rabies did not occur in animals there would be no medical problems as regards humans with this disease. The present situation in the United States concerning the prevalence and distribution of rabies and the detection of the animal reservoir is quite a bit different from what it was 25 on even 10 years ago. For years the dog has been the chief source of exposure of humans to rabies, and because of his unique relationships to man will probably continue to be so.