bluuebunny/crossref_metadata_2025_split huggingface dataset:
PKU and Beyond: When Do Costs Exceed Benefits?
Authors: Scriver Charles R. 
Published: December 2021

The "first law of screening" stresses that effective measures must reduce "costs." 1As in all ventures, those who pay the piper can expect to call the tune. Whether the concept of cost effectiveness should dominate all decisions about screening for hereditary metabolic disease has been challenged both by the pipers and by those who pay; but to ignore all together this position would be to live again in Hamelin town. Therefore, I will try to clarify several views of cost which are of interest to those who plan or engage in screening for genetic disease.2-5
THE ECONOMIC VIEW OF COSTS
Cost avoidance receives the principal emphasis because the benefits of screening are hard to price. The monetary costs resulting from screening and treatment are to be weighed against those incurred when such preventive practices do not take place. We could, indeed, avert the monetary cost to society of phenylketonuria (PKU) by eliminating chronic care institutions for the mentally retarded; at one time PKU patients comprised 1% of their residents. Thankfully, no one has considered this to be an acceptable option. Instead we are pleased to find that one dollar spent for the screening and treatment of PKU is more than balanced by a saving of $4 in institutional and other care which would otherwise be given to non-screened, untreated, retarded PKU patients.6
In the economic view, only real costs are considered. These include the specific cost of screening and treatment which prevents the full expression of the disease; this cost should be weighed against the specific life cost of traditional or new methods of dealing with the disease without screening.
Screening to Prevent Lead Poisoning
Authors: Moriarty Richard W. 
Published: December 2021

The absence of fully effective treatment for lead encephalopathy, and the suggestive evidence that lead poisoning may cause brain damage even in the absence of overt encephalopathy, have led to massive efforts to prevent such damage.
These preventive efforts have been directed toward screening to identify children who have absorbed an undue amount of lead from their environment, reducing their further exposure to lead, and removing already absorbed lead from those most in danger of developing ill effects. This approach has been codified in the Surgeon General's Report of 19701 which makes the following recommendations:
1. All young children who live in or visit old dilapidated buildings should have periodic blood lead determinations.
2. Any child with repeated blood lead levels over 40µg/100 ml whole blood should be considered to be at risk of lead poisoning, h ave current sources of exposure to lead investigated and corrected, and be followed closely to ensure that he does not develop higher blood lead levels or clinical symptoms.
3. All children with blood lead levels between 50 and 79µg/100 ml should have diagnostic tests for metabolic and clinical evidence of lead poisoning and be treated immediately if such evidence is present.
4. All children with blood lead levels over 80µg/100 ml should be hospitalized immediately and treated with chelating agents.
Many aspects of this approach are subjects of current controversey, and the last word will not be written until much better knowledge of the natural history and ecology of lead poisoning is available.
Photodistribution of Viral Exanthems
Authors: Gilchrest Barbara , Baden Howard P. 
Published: December 2021

Gilchrest B., and Baden, H.P.: Photodistribution of viral exanthems. Pediatrics, 54:136, 1974.
The legends for the two illustrations were reversed. Figure 1 is a patient with chickenpox and Figure 2 is a patient with echovirus 9 infection.
Pulmonary Interstitial Emphysema in a Newborn Infant Treated by Lobectomy
Authors: Fletcher Barry D. , Outerbridge Eugene W. , Youssef Sami , Bolande Robert P. 
Published: December 2021

A case of pulmonary interstitial emphysema in a premature newborn infant with hyaline membrane disease is reported. The interstitial emphysema at first involved both lungs, then became localized to the left upper lobe. There was an associated pneumopericardium which resolved spontaneously. The increasing amount of air in the interstitium of the left upper lobe resulted in severe respiratory embarrassment which necessitated surgical removal at 29 days of age. Pathologic examination of the resected lobe showed chronic pulmonary interstitial emphysema and dilated, thick-walled lymphatic vessels.
See Image in the PDF file
WHO INVENTED THE ESKIMO PIE?
Authors: Dickson Paul 
Published: December 2021

Taken together the Eskimo Pie, the Good Humor bar, and the Popsicle have had a tremendous impact on the ice cream industry. All three were invented between 1919 and 1924 and there has not been a significant new ice cream novelty since.
One afternoon in 1919 a young boy entered a candy store in Onawa, Iowa, and ordered an ice cream sandwich but then changed his mind and ordered a candy bar. Christian Nelson, the proprietor, asked the boy if he really knew what he wanted, to which he replied, "Sure I know—I want ‘em both, but I only got a nickel." The lad's comment prompted Nelson, a Danish-born schoolteacher who ran the candy store as a sideline, to conclude that there was probably a market for a confection that combined chocolate candy with ice cream. He experimented with the idea but got nowhere because he was unable to make chocolate stick to ice cream. Weeks later he learned from a candy salesman that cocoa butter improves the clinging ability of chocolate, and he tried again. He succeeded on the first try and dubbed his chocolate-covered creation the "I-Scream Bar." The first five hundred bars were taken to the Onawa Firemen's Tournament, and all were sold.
Convinced that his was a money-making creation, Nelson applied for a patent and set out to sell it in Omaha. In 1921, after months of failure during which he was reduced to racking balls in a pool hall for $20 a week, he met an Omaha ice cream company superintendent named Russell Stover who liked the idea, and a partnership was established.
Fatalism in Ghetto Adolescents
Authors: Kuhr Murray D. 
Published: December 2021

Fatalism is defined as "the doctrine that all things are preordained and predetermined by fate." A true believer would hold that his life and his actions are beyond his control. The doctrine has its origin in despair and serves to perpetuate failure and further despair. It is the purpose of this communication merely to identify a pathogenic agent, not to define its epidemiology or propose a therapy for it.
In the course of rap sessions with black ghetto adolescents a horrifying truth was discovered.
The Risks of Paracervical Anesthesia: Intoxication and Neurological Injury of the Newborn
Authors: Guillozet Noel 
Published: December 2021

Obstetrical pain during routine vaginal delivery has prompted many therapeutic approaches over the decades with agents gaining and losing favor. The risks of local anesthesia have seemed negligible and mishaps have seemingly been rare. Teramo and Widholm remarked in 1967 that paracervical block had become the most popular method of relieving obstetric pain during the first stage of labor over most of the world.1 It is now an even more popular choice in large and small hospitals in the United States, and the fact that it can be administered without an anesthetist by the obstetrician is certainly contributory.
The safety of local anesthetics in routine vaginal deliveries was questioned in a number of articles published between 1963 and 1968 describing paracervial block and epidural routes using several agents.2-5
GALEN ON WHY THE FEMALE IS MORE IMPERFECT THAN THE MALE
Authors: C. T. E. 
Published: December 2021

Galen (A.D. 131-201), one of the greatest figures in medicine, was the principal authority in the medical schools of medieval and Renaissance Europe. Galen was so venerated by his contemporaries that many regarded him as a God and even formed a religious cult for his worship.1
His biologic views concerning women were not seriously challenged until the seventeenth century. In the Oeuvres de Galen(Paris, 1854-1856) one reads this about women:
The female is more imperfect than the male. The first reason is that she is colder. if, among animals, the warmer ones are more active, it follows that the colder ones must be more imperfect . . . .
Just as man is the most perfect of all animals, so also, within the human species, man is more perfect than woman. The cause of this superiority is the [male's] superabundance of warmth, heat being the primary instrument of nature . . . .
The male's testicles are all the stronger because he is warmer. The sperm born there, on reaching the final degree of concoction, is the formative principle of the animal. From a single principle wisely imagined by the Creator— that whereby the female is less perfect than the male—follow all the conditions useful for the generation of animal: the impossibility for the female genitalia to emerge externally, the accumulation of a superfluity of useful nourishment, an imperfect sperm, a hollow organ capable of receiving perfect sperm.
In the male, instead, everything is the reverse: an elongated member suitable for copulation and emitting sperm, and an abundance of this same thick warm sperm . . . .
Lettrt To The Editor
Authors: Thompson Ian M. 
Published: December 2021

In reply to Drs. Say and Coldwell, six of our patients were female but there were no siblings or near relatives who were known to have this congenital abnormality from the family histories in these patients.
I think the comment is worthwhile and would refer the authors to Dr. David Innes Williams at the Great Ormond Street Hospital in London for his comment due to his large experience with this disorder.
Photodistribution of Viral Exanthems
Authors: Cherry James D. 
Published: December 2021

The recent paper on photodistribution of viral exanthems1 was of great interest to me and has stimulated the following comments.
1. Figures 1 and 2 are apparently reversed and the reference to viral size on the same page is off by a factor of 1,000.
2. A quick review of the literature on echo 9 viral exanthems reveals one patient whose rash was confined to areas of sunburn; after exposure to the sun it became much brighter in color.2
Citrobacter diversus Meningitis: A Case Report
Authors: Tamborlane William V. , Soto Emilio V. 
Published: December 2021

Citrobacter is a member of the Enterobacteriaceae family presently grouped with Salmonella and Arizona. Most reported isolates of these organisms have been in adults where they have been considered as either normal bowel flora, of indeterminate clinical significance, or as secondary invaders in mixed cultures in compromised hosts. Occasionally they have been isolated in adult patients in pure cultures in urine and blood. Positive cerebrospinal fluid cultures, on the other hand, have been restricted to the newborn period as a very rare cause of neonatal meningitis.
Recently Citrobacter diversus has been recognized as a distinct species in the larger group of hydrogen sulfide-negative Citrobacter by Ewing and Davis.1
The Timing of Elective Surgery on the Genitalia of Male Children With Particular Reference to Undescended Testes and Hypospadias
Authors: Kelalis Panayotis , Bunge Raymond , Barkin Martin , Perlmutter Alan D. , Friedman David B. , Work Henry H. , Lucas Alexander 
Published: December 2021

Psychologic considerations suggest that the optimal time for elective surgery on the genitalia is either the first 6 months of life or sometime during the fourth year. In the child with cryptorchidism, physiologic considerations are of paramount importance and the timing of treatment should be based on these considerations. Despite the conflicting views on the subject, there is suggestive evidence that early orchiopexy—during the first year of life or soon afterwards—may be the most optimal time for orchiopexy, but further investigation would be necessary to confirm this. Currently, timing of operation is based more on psychologic rather than physiologic factors (although both are taken into account), and should remain unchanged until further evidence accumulates.
The Committee feels that the later the orchiopexy after age 6, the more likely germinal epithelial failure will occur. However, it should be pointed out that 5 or 6 has not proven to represent optimal age in respect to germinal function but only the latest recommended age for orchiopexy.
In patients with hypospadias, technical considerations have the greatest bearing on timing, but, depending on the individual surgeon, the precise timing varies. The period after the third birthday is preferred by the majority; this certainly is consistent with psychologic considerations unless the correction of chordee justifies a separate cedure, which then should be corrected by age 2.
Familial Cryptorchidism
Authors: Pardo-Mindan F. J. , Torcal F. Vargas , Julian G. Garcia , Ruiz M. T. Vitro 
Published: December 2021

Familial cryptorchidism is a poorly understood and infrequently reported condition.
We have had the opportunity of studying three different families. In the first family, the father, his twin 3-year-old sons, and their 6-year-old sibling had undescended left testes. In the second family, left-sided cryptorchidism occurred in the father, his brother, and his 7-year-old son. In the third family, twin brothers, 2 years of age, had cryptorchidism on the left side. There was no family history of cryptorchidism. In all cases the testes were located in the inguinal canal.
Exercise, the School, and the Allergic Child
Authors: Ghory Joseph E. 
Published: December 2021

We have met the challenge! The poet of Ecclesiastes is turning over in his grave, conceding the fact that there is something new under this Seattle sun. This selected panel of world-wide experts has deliberated at length and exercised its best judgment in coming up with some positive answers to difficult questions pertaining to exercise and asthma. The duration of our exercise has left us panting, if not wheezing!
Our next challenge must be to communicate this information to the patient who needs help and to the responsible peopele involved in his care. This includes not only his personal physician but also his family, his school authorities, and his recreation leaders. The successful management of any recurrent or chronic illness demands education and understanding of the natural course of the disease, its etiologic factors, its treatment, and its long-term prognosis. This process of education must involve not only the patient himself but, in addition, all those entrusted with his care.
Just as his parent is the allergic child's most important person in his home, so his teacher is the most important person in his school. The parents must cooperate freely with their child's teacher in providing all the necessary information about his allergies. Similarly, the teacher, like the parent, must be alerted to warning symptoms of distress so that proper medications can be administered early. The schoolteacher should be provided with the telephone numbers of the mother's home, the father's business, and the child's physician, so that someone responsible can be contacted if a major problem arises.
Current Status of Ampicillin-Resistant Hemophilus influenzae Type b
Authors: Katz Samuel L. , Calderon Ernesto , Carver David H. , Cramblett Henry G. , Frothingham Thomas E. , Klein Jerome O. , Quie Paul G. , Steigman Alex J. , Stiehm E. Richard , Yow Martha D. , Krugman Saul , Mortimer Edward A. , Dull H. Bruce , Larke R. P. Bryce , Meyer Harry M. , Witte John J. 
Published: December 2021

At its meeting on April 16, 1975, the Committee on Infectious Diseases reconsidered the problem of ampicillin-resistant strains of Hemophilus influenzae type b. The following facts were noted:
(1) Strains of H. influenzae type b highly resistant in vitro to ampicillin have been reported from 20 states and the District of Columbia.1
(2) These strains were isolated from children with sepsis, meningitis, cellulitis, epiglottitis, suppurative arthritis, and pneumonia. Some of the children died when the resistance of the etiologic strain was not appreciated.
(3) The prevalence of these strains is still uncertain but appears to be at a low level in most communities. Epidemiologic studies, however, indicate these strains may infect many children in closed communities, such as day-care centers.2
The Committee believes a modification of its prior statement3 is warranted based on the wide-spread occurrence of these strains:
(1) Initial management of children with documented or suspected severe infection due to H. influenzae type b (including meningitis, epiglotitis and sepsis) should include a parenteral penicillin (penicillin G or ampicillin) and intravenous chioramphenicol.
(2) All strains of H. influenzae type b should be tested for susceptibility to ampicillin as early as possible.
(3) Ampicillin alone as initial therapy for children with severe infections that may be due to H. influenzae should be considered only in areas of the country where ampicillin-resistant strains of H. influenzae type b have not appeared and where active programs of bacterial surveillance and rapid laboratory diagnosis of susceptibility to antimicrobial agents are available.
The dosage schedules, rationale for combined therapy as initial management, and description of susceptibility tests for H. influenzae are given in the initial Committee Report.3
Food for inefficient thought
Authors: Levine Melvin D. , Liden Craig B. 
Published: December 2021

The notion that "even an unwholesome diet" may have an impact upon the function of the central nervous system has been a recurring theme in the history of medicine and the study of human behavior. In the current issue of Pediatrics, Conners et al.1 present an important exploration of a comtemporary hypothesis regarding this association. Ultimately, their and other studies on the subject may modify our approach to the inefficient school-age child, or, alternatively, such pursuits may form another unfulfilling flirtation in the on-going romance between behaviorists and food faddists.
THE POPULATION CONSIDERED
In recent years, there has been growing awareness that there exists a population of children whose performance in life is handicapped significantly by intrinsic or constitutional inefficiencies.
Disagreement on Two Points With Commentary on Hypertension
Authors: Fowler R. S. 
Published: December 2021

The commentary entitled "The Pediatrician and Hypertension"1 deals with a very important problem in pediatrics that has only recently come into prominence. The concluding paragraphs are particularly timely to practicing pediatricians, stressing the careful follow-up of blood pressure in children beyond the 95th percentile for age and early investigation of those with severe hypertension.
I disagree with two items in the commentary:
1. Cuff Size: In a recent editorial in the American Journal of Cardiology,2 Steinfeld et al. summarize their own experimental and clinical work and other work, indicating that the pneumatic bladder should completely encircle the limb.
Effect of Chronic Salt and Water Loading on the Tubular Defects of a Child With Fanconi Syndrome (Cystinosis)
Authors: Arant Billy S. , Greifer Ira , Edelmann Chester M. , Spitzer Adrian 
Published: December 2021

A male child discovered to have cystinosis and Fanconi syndrome at the age of 2 years 8 months was hospitalized repeatedly for episodes of hyponatremic, hypokalemic dehydration and acidosis. Attempts to correct the fluid and electrolyte abnormalities by increasing progressively the supplements of sodium chloride, sodium bicarbonate, and potassium chloride resulted only in an exacerbation of the symptoms.
Tests of discrete renal functions and metabolic balance studies disclosed that, although all disturbances were expressions of the primary disease, their severity was enhanced considerably by the extracellular volume expansion induced by the vigorous therapy. Restriction in water intake resulted in an improvement in the renal performance and in the clinical condition.
Air Lead and Blood Lead Levels in Children
Authors: Hower J. , Prinz B. , Gono E. 
Published: December 2021

We read with great interest the communication by F. J. deCastro and co-workers,1 indicating the influence of air lead on blood lead levels in children.
Azar et al.2 have shown that in taxi drivers there is indeed a correlation between air lead and blood lead levels. Similar results were obtained by Knelson and Bridbord.3
We are carrying out systematic investigations on the significance of lead emission for mother and neonates in the highly industrialized Rhine-Ruhr area.4
Knowledge About and Attitudes Toward Genetic Screening Among High-School Students: The Tay-Sachs Experience
Authors: Clow Carol L. , Scriver Charles R. 
Published: December 2021

High-school students (ages 15 to 18 years; No. = 930) taking biology in their curriculum were surveyed (the first survey), in the classroom, for their knowledge and attitudes about Tay-Sachs disease and other "public" issues in genetics. High-school students now constitute 38.9% of those screened for the Tay-Sachs gene in the Montreal program and the participation rate is 75% among eligible Jewish students. Knowledge and attitudes about the screening experience were also surveyed (the second survey) in a sample (No. = 120) containing equal numbers of carriers and noncarriers matched for sex and age. The response rate was 75% in the second survey.
The first survey revealed that the level of knowledge about Tay-Sachs disease is high among students, only 28% percent of whom were Jewish. Students have a very positive attitude toward genetic screening in general. These findings are associated with an effort to expand the human genetics content in the biology curriculum.
The second survey revealed a favorable attitude toward the screening experience and the self-knowledge obtained among screened students. The screening clinic in the schools, and literature provided by the screening authority, was an effective source of knowledge about the significance of Tay-Sachs heterozygosity. Carriers experienced initial anxiety; later attitudes were similar in carrier and noncarriers. Self-image was unchanged in 90% and diminished in 10% of carriers and enhanced in 10% of noncarriers. Heterozygous students perceive information about their genetic status as useful to themselves and 95% want to know the genotype of an intended spouse; 88.4% would marry a carrier and only 11.6% would "reconsider."
These findings encourage us to emphasise high-school screening as the preferred program in our community and to offer it as an effective aid to the physician faced with increasing demands in medical genetics. It is also an effective model for teaching some genetics and human biology in the schools.
EIGHTH CENTURY IRISH RULES REGARDING THE CARE OF A SICK PERSON
Authors: C. T. E. 
Published: December 2021

An early eighth century Irish manuscript contained the following sensible rules for the care of a sick person.
No games are played in the house.
No tidings are announced.
No children are chastised.
Neither women nor men exchange blows.
There is no fighting.
The patient is not suddenly awakened.
No conversation is held across him or across his pillow.
No dogs are let fighting in his presence or in his neighborhood outside.
No shout is raised.
No pigs grunt.
No brawls are made.
No cry of victory is raised. Nor shout in playing games.
No shout or scream is raised.