bluuebunny/crossref_metadata_2025_split huggingface dataset:
SUING YOUR PARENTS
Authors: H. B. 
Published: December 2021

In a court battle beginning today, a judge will be asked for what is believed to be the first time to determine whether children have the right to take legal action on their own behalf.
At the heart of the dispute in a Lake County, Fla., courtroom is a small, bespectacled boy who claims his childhood has been destroyed and who is doing battle with two formidable adversaries: his parents and the U.S. legal system.
Gregory K., age 11, (his name is being withheld by the court) has taken the unprecedented step of filing a petition to divorce himself from his parents ...
Judge C. Richard Singeltary is being asked to decide whether Gregory has the right to divorce his parents. The court is also being asked to allow Gregory's foster parents—with whom the boy has been living for nine month—to adopt him.
Safety of Continuous Nebulized Albuterol for Bronchospasm in Infants and Children
Authors: Katz Robert W. , Kelly H. William , Crowley Mark R. , Grad Roni , McWilliams Bennie C. , Murphy Shirley J. 
Published: December 2021

Objective. To determine the incidence of cardiotoxicity in infants and children who receive continuous nebulized albuterol (CNA) for bronchospasm.
Design. Prospective, case series.
Setting. A university pediatric intensive care and pediatric subacute units.
Patients. Nineteen infants and children who received CNA for at least 24 hours.
Interventions. None.
Measurements. Creatinine phosphokinase (CK) was measured at the time of admission and then at 12,24,48, and 72 hours while the patient received CNA. Isoenzyme CK-MB fractions were measured if CK concentration was ≥250 IU/L. One electrocardiogram was obtained for each patient during CNA treatment. All patients had continuous cardiac monitoring during continuous nebulization therapy.
Main results. Creatinine phosphokinase levels remained within normal limits for 16 patients during CNA treatment. Three patients had elevated CK and in two CK-MB fractions were elevated at one measurement. None of the electrocardiograms showed evidence of ischemia and no arrhythmias were noted during CNA therapy, even in the patients with elevated CK-MB fractions.
Conclusions. Continuous albuterol therapy appears to be safe in our patient population as there was no significant evidence of cardiotoxicity. The significance of the transient elevation of CK-MB without other evidence of cardiotoxicity remains to be determined.
Glucocorticoid-Responsive Hypotension in Extremely Low Birth Weight Newborns
Authors: HELBOCK HAROLD J. , INSOFT ROBERT M. , CONTE FELIX A. 
Published: December 2021

The maintenance of normal basal secretion and the ability to produce a stress-induced rise in cortisol secretion are critical to homeostasis. Glucocorticoids have a multiplicity of effects, among which are maintenance of glucose homeostasis, facilitation of free water clearance, and maintenance of vascular tone. Patients with glucocorticoid deficiency manifest hypotension which is resistant to the effects of volume expansion and vasopressors. This form of hypotension has been attributed to (1) renin substrate deficiency, (2) a direct effect of glucocorticoids, and/or (3) the lack of cortisol inhibition of nitric oxide and/or prostaglandin I2 synthesis, both potent vasodilators.1,2
At birth, complex changes occur in both the secretion and metabolism of steroids; these result in maintenance of appropriate postnatal cortisol production.3
Prevention of Fetal Alcohol Syndrome
Authors: SCHYDLOWER MANUEL , PERRIN JAMES 
Published: December 2021

In Reply.—
Doctors Shoemaker, Alpert, and Zuckerman's comments on abstinence from alcohol during pregnancy and alcohol effect on intrauterine growth are appreciated. The statement developed by the American Academy of Pediatrics (AAP) Committees on Substance Abuse and Children with Disabilities did in fact note that evidence for harm to the fetus is much stronger with large amounts of maternal alcohol consumption, and there is controversy about the association between maternal consumption of smaller amounts of alcohol and possible damage to the fetus.1
School Bus Transportation of Children With Special Needs
Authors:   Committee on Injury and Poison Prevention
Published: December 2021

Many school-aged children with handicaps are transported in school buses. A recent amendment to the Individuals with Disabilities Education Act has established requirements for infants and toddlers to have access to developmental and rehabilitation facilities. This amendment, to Part H of the Individuals with Disabilities Education Act (enacted as part of Public Law 102-119), however, does not specify how these children are to be transported to these facilities, a responsibility that will be faced by many school systems.
FMVSS 222 (School Bus Passenger Seating and Crash Protection) established safety requirements for school bus interiors, but to date it only applied to able-bodied children. However, an amendment to FMVSS 222 becomes effective in January 1994 that applies to the securement of wheelchairs and their occupants in school buses. National recommended standards for special education school buses were revised in May 1990 by the Eleventh National Standards Conference on School Transportation.1
Wheelchairs are the primary mode of transport on the school bus for many children with special needs. They have not been developed as safety restraint devices, however, and are not currently subjected to any crash-testing requirements. Research,2-5 nevertheless, has provided a basis for recommendations concerning occupant securement for a wheelchair-dependent child and a child with special needs who is transported on a school bus:
1. Any child who can assist with transfer or be "reasonably" moved from a wheelchair, stroller, or special seating device to the original manufacturer's forward-facing vehicle seat equipped with dynamically tested occupant restraints or be "reasonably" moved to a child car seat complying with FMVSS 213 requirement should be so transferred for transportation to and from school.
Letter to the Editor
Authors: Hall Caroline Breese , Margolis Harold S. 
Published: December 2021

We appreciate the concerned letter of Dr Jacobs and his thoughtful questions arising both from his knowledge of the recommendations and public health issues, as well as those of private practice.
The cost of vaccines is an issue with which we must all be concerned. By highlighting the importance of childhood immunization the Clinton administration has engendered interest and, thus, optimism that efforts toward reducing the cost will be successful. However, we should remember that the many excellent studies that have analyzed the reasons why children are not being vaccinated have shown that cost is not the major factor, but access, difficulties, and obstacles, real and perceived, to obtaining immunizations are.
SEEDS OF MURDER EPIDEMIC: TEEN-AGE BOYS WITH GUNS
Authors: L. J. F. 
Published: December 2021

BOSTON, Oct. 18—A new study has found that while the number of adults arrested for murder has declined since 1985, there has been a stunning increase in the number of boys under 18 charged with homicide.
"Murder is plunging to a much younger age group," said James Alan Fox, dean of Northeastern University's College of Criminal Justice and a co-author of the report. "What is so dangerous about this is that a 15-year-old with a gun in his hand is a much more volatile individual than a 40-year-old or even an 18-year-old," Mr. Fox said.
The study, by the National Crime Analysis Project at Northeastern University, found that the number of 17-year-olds arrested for murder climbed 121 percent from 1985 through 1991, and the number of 16-year-olds arrested rose 158 percent. But the biggest increase—217 percent—was in the arrest of 15-year-olds. Even the number of arrests of boys 12 and under soared 100 percent in that time.
These figures are the clearest statistical confirmation of what had been just anecdotal evidence...
SUPERMAN TO BE KILLED
Authors: L. J. F. 
Published: December 2021

The news that Superman is about to die has provoked anger and surprise, much of it from people who haven't read his comic book adventures in decades. Closer readers may have suspected for quite some time that death was in the cards. It's a logical outgrowth of a humanizing process that started in the 1980's.
For 50 years, the Man of Steel moved planets without breaking a sweat and survived Armageddon-like battles with nary a scratch and every hair in place. But invulnerability became a bore. It bored the writers and editors at D.C. Comics. It bored the readers who'd become accustomed to more mortal heroes, like Spiderman, who risk their lives in every adventure. In other comic books, heroes had become morally ambiguous, at times even a little shady. But Superman had remamed very much a boy scout, in style and temperament.
Then, six years ago, D.C. Comics began to revise him. Now he gets insomnia, forgets to shave, even weeps at times of emotional distress. Gone is that super self-reliance: Clark Kent leans on his parents when there's a wrenching decision to make.
Superman is more physically vulnerable, too. That suit, previously impervious to rips and tears, goes to tatters when he fights...
Superman will die next month at the hands of Doomsday, an escapee from what seems to be a prison. The battle rages through seven episodes and wrecks the better part of America.
Exclusive Breast-Feeding for at Least 4 Months Protects Against Otitis Media
Authors: Heery Lee B. 
Published: December 2021

It is exciting to see such a large, well-controlled study1 showing the protective effects of exclusive breast-feeding against otitis media. The study has given breast-feeding some positive attention in the lay press as well. The study overcame problems seen in other studies of the benefits of breast-feeding in that it was large (&gt;1000 infants), data were collected prospectively, and breast-feeding was well-defined.
My main concerns with this study regard statistical significance and the discussion of the results.
SYPHILIS CASES AMONG NEWBORNS CLIMB WITH THE RISE IN CRACK USE
Authors: L. J. F. 
Published: December 2021

According to the Federal Centers for Disease Control and Prevention, medical authorities reported the births of 4,322 babies with syphilis last year, 3,272 in 1990, and 1,807 in 1989. In the early 1980's, there were fewer than 200 cases recorded annually nationwide...
"The overriding issue is that although every obstetrician is required to take blood to check whether the pregnant woman has syphilis, 60 percent of the mothers who have babies with syphilis have had no prenatal care," said Steven Rubin, acting director of the New York City Health Department's bureau of sexually transmitted disease control. "That's what we need to change."
GANG THAT COULDN'T GIVE SHOTS STRAIGHT
Authors: L. J. F. 
Published: December 2021

There has not been a social program in recent history so badly flawed as Vaccine for Children. The administration's initiative is based on misleading information about immunization levels in the US. It is determined to create an entitlement even though immunization rates are at record levels. At a time when local health officials have more free vaccine than they can use, it is spending money to set up a government-run delivery service of unknown cost and questionable utility. Ignoring calls to delay the program, the administration has arrogantly dug in its heels to carry out a campaign pledge.
Congress assumed and the administration said that private vaccine companies would distribute the government-supplied vaccine. But the price controls the government imposed on vaccines to meet the [Congressional Budget Office] estimate left no margin for paying delivery costs. Therefore, the Department of Health and Human Services decided to set up its own distribution system. The rush to fulfill a campaign pledge now threatens to compromise the nation's vaccine supply.
First, HHS wanted the Veterans Administration and the Defense Department to operate a vaccine depot system for the program. The offer was rejected: Both agencies were getting out of the vaccine and medical distribution business; two government studies showed that private companies distributed health care products more cheaply and efficiently.
Worst of all, the administration is diverting funds to the warehousing scheme at a time when public health officials insist they have plenty of free vaccine. State and local health officials such as F. E. Thompson of the Mississippi State Department of Health note: "We have enough vaccine... What we do not have enough of is nurses to give it, clerical staff to track the children, and outreach workers to bring them."
NURSES LOOK TO HEALTH-CARE REFORMS TO FLEX MUSCLE. DOCTORS FIGHT BACK
Authors: L. J. F. 
Published: December 2021

Nurses press the White House for a bigger role in primary care, including diagnosing patients and determining treatment, a move they say would save money. Due to the shortage of primary-care doctors, "a person who would see a nurse as a first-line provider would get better care," argues Virginia Trotter Betts, president of the American Nurses Association.
But the American Medical Association wants to keep nurses in supporting roles. "This is a quality of care issue," says AMA Chairman Raymond Scalettar. "We're not looking down on nurses at all, but this push is wrong and could be harmful to the public." Instead, the doctors' group wants to assure that all Americans have a primary-care physician.
Apolipoprotein E Phenotypes and Serum Lipids in Newborns and 3-Year-Old Children: The Cardiovascular Risk in Young Finns Study
Authors: Lehtimäki Terho , Nikkari Tapio , Porkka Kimmo , Viikari Jorma , Ehnholm Christian , Åkerblom Hans K. 
Published: December 2021

Background. Apolipoprotein E (apoE) phenotype is a genetic determinant of plasma total cholesterol and low density lipoprotein (LDL) cholesterol concentrations, that are classical coronary heart disease risk factors. ApoE appears in three major isoforms E2, E3, and E4, coded by corresponding alleles ∈2, ∈3, and ∈4. These give rise to six different phenotypes.
Objective. To study the associations of apoE phenotype with cord serum lipids (during minimal enteral nutrition), and with serum lipids of 3-year-old children.
Subjects and methods. We determined serum lipid levels and apoE phenotypes in 206 newborns and 259 3-year-old children in connection with a larger follow-up study of atherosclerosis precursors in children and young adults. ApoE phenotyping was done directly from plasma by isoelectric focusing followed by immunoblotting.
Results. The effect of apoE phenotype on serum total and LDL cholesterol was significantly different in newborns and 3-year-old children (two-way ANOVA, interaction between apoE phenotype and age group: P &lt; .001 for both). In 3-year-old children, the concentrations of serum total cholesterol and LDL cholesterol increased with apoE phenotype in the order of E3/2, E3/3, E4/3, and E4/4, in both males and females (P &lt; .0001). On the contrary, in neonates total cholesterol and LDL cholesterol concentrations were low and did not differ significantly between apoE phenotypes (P &gt; .05) either in males or in females. The mean serum levels of triglycerides and high density lipoprotein cholesterol did not differ between apoE phenotypes either in 3-year-old children or newborns.
Conclusions. The results show that the differences in serum total and LDL cholesterol levels between apoE phenotypes are formed after birth by the influence of environmental factors and suggest that both genetic and external factors influence the levels of serum cholesterol concentrations during the first years of life.
"Flat Heads" and the American Academy of Pediatrics' (AAP) Sleep Position Statements
Authors: BRAKELEY JOHANA KASHIWA 
Published: December 2021

Just over I year ago, the AAP recognized research studies that showed an increased incidence of sudden infant death syndrome associated with the prone sleeping position. In response to this information, the AAP changed its recommendation for infant sleeping position. Instead of the prone position for sleep, the AAP is now recommending that infants be placed on their side or back for sleep.
Since that time, I have noticed more and more babies with head asymmetry. Most often the right side of the back of the head is flattened.
Training To Ensure Healthy Child Day-Care Programs
Authors: Kendrick Abby Shapiro 
Published: December 2021

Training in child care assumes a number of forms. There is pre-service training (needed before entering the field); orientation training (received when first on the job, highlighting the most essential skills, tasks and knowledge needed to begin the job); and ongoing training (required by regulation or recommended periodically for current staff).
Despite the fact that training is known to have a positive effect on the field of early care and education, the current training system is fraught with problems. A 1991 national survey conducted by the Wheelock College Center for Career Development in Early Care and Education found that at least one of three key informants in 59% of states said "training is fragmented, random, scattershot, and not based on the needs of the field."1
The licensing system requires minimal training and experience. For teachers in child-care centers, five states require no training, four states require pre-service training, 29 states require only ongoing training, and 14 states require both pre-service and ongoing training. Few states require more than 10 hours of annual ongoing training for any child-care professionals. For family child-care providers, the numbers are even lower: 24 states require no training and only 12 states require annual ongoing training.1 If first aid and cardiaopulmonary resuscitation (CPR) certification are required, there is little time for any other training.
In addition to limited funds to support training and limited incentives for providers, administrators, on funders to invest in training, other well-known barriers to implementing systematic and coordinated training efforts include the following items:
ANNOUNCEMENT
Authors: Haggerty Robert J. 
Published: December 2021

The Executive Committee of the International Pediatric Association (IPA) has established an "Ihsan Dogramaci" IPA Medal and Prize, to be awarded triennially during the IPA International Congresses. This will consist of a medal and a US $10 000 prize. The award will be made to someone who has made a significant contribution to pediatric education at the national or international level. A selection committee will screen the candidates and make a proposal to the IPA Executive Committee for a final decision.
The Member Societies of IPA are invited to propose candidates, with their CVs and a description of their contribution to pediatric education, to reach the office of the Executive Director no later than December 31, 1994:
LIMIT ON HOURS FOR DOCTORS DRAWS CRITICS FROM ALL SIDES
Authors: L. J. F. 
Published: December 2021

Four years and nearly $1 billion after New York State adopted the nation's strictest limits on the hours worked by medical residents, it is unclear whether the changes have helped or hurt patient care, doctors and hospital administrators say.
In many hospital departments, the rules are simply ignored, meaning that residents are working well beyond the 80-hour-a-week limit imposed by the state and are potentially more vulnerable to exhaustion and mistakes.
And where they are being followed, strict enforcement of the rules is resulting in a time-clock approach under which, critics charge, residents leave in the middle of procedures or delay tests because it is time to go home.
Still others, including the author of the original regulations, argue that the rules have not gone far enough and still allow residents to continue exercising too much responsibility.
While there is little statistical scientific evidence evaluating the changes, which have cost more than $840 million so far, a few studies do exist ...
One study at New York Hospital suggests that a result of more frequent signouts may be confusion in ordering tests and procedures. The researchers compared the charts of 263 patients who were discharged from that hospital's general medicine service in October 1988, before the new rules took effect, with the charts of the same number of patients discharged from the same hospital a year later, four months after the shorter hours were instituted.
The study found virtually no differences in the medical outcomes of the cases. But the patients treated under the new rules suffered more frequent in-hospital complications and more frequent delays of tests.
TEACHER TENURE
Authors: L. J. F. 
Published: December 2021

". . . a special education teacher in New York City was arrested, convicted, and sent to prison in 1990 for selling $7000 worth of cocaine to undercover police, and school officials thought it would be easy to dismiss him.
Not so. While the teacher, Mr Dubner, served his sentence in Sullivan Correctional Center in upstate New York, he collected his teacher's pay, and, after 5 years and more than $185 000 spent by the Board of Education on disciplinary proceedings, Mr Dubner has prevailed. He still has his job.
The story of New York City's failed effort to dismiss Mr Dubner underlines how difficult it has become for school boards to get rid of tenured employees, even in extreme cases."
Letter to the Editor
Authors: Vohr Betty R. 
Published: December 2021

I appreciate the opportunity to respond to the article by Drs Bess and Paradise1 in the February 1994 issue of Pediatrics in which they debate the justification of the National Institutes of Health Consensus Statement recommendations for universal hearing screening using transient evoked otoacoustic emissions (TEOAE) and brainstem auditory-evoked response (BAER).2
One of the components of screening with which the authors take issue is the specificity and positive predictive value of the TEOAE/BAER screen, a two-stage screen approach.
Letter to the Editor
Authors: Jacobs Jennifer , Gloyd Stephen S. 
Published: December 2021

Reply to Dr. Layton—We agree with Dr Layton that Pediatrics should continue to look thoughtfully at studies in areas that have previously been considered without merit. It is only through rigorous, well-controlled trials that efficacy of some of these treatment modalities can be evaluated.
Reply to Drs Duggan and Kleinman—This letter raises several important points. We agree that it would have been preferable to have precise information about both the nutritional management of these children as well as the stool output in grams or milliliters per kilogram body weight.