bluuebunny/crossref_metadata_2025_split huggingface dataset:
DOLLS FROM HELL
Authors: L. J. F. 
Published: December 2021

Wanna have a kid, kid? Baby Think It Over will make you think twice. . . On a May evening in 1993, Richard and Mary Jurmain watched a television documentary on teenage pregnancy. The camera followed students who were given bags of flour or eggs to carry around for several days. The idea was to teach teenagers how delicate infants are and how much care they require. The implied moral: Young people should think long and hard before becoming parents.
. . . Why not try to produce a realistic doll to teach teenagers about the responsibilities of parenting? . . . Jurmain produced his prototype doll. It weighed 6 pounds 8 ounces, measured 20½ inches long, and wailed like a real infant. He named the product Baby Think It Over.
Baby Think It Over dolls are usually assigned to students in a high school home economics or health class for a few days. Increasingly, teachers are introducing the dolls into junior high classrooms. The doll comes in white, black, Hispanic and Asian versions, and both sexes. The Jurmains also sell a "crack baby" model that simulates the violent shaking and incessant crying of a baby born dependent on drugs because the mother used them during pregnancy. The crack baby dolls are especially difficult to soothe.
Teachers say that a few students have stabbed their dolls, hurled them out of windows and ripped the electronic circuitry out in order to quiet the crying. These students flunk the assignment, of course, and are usually recommended for counseling.
Rick Jurmain updated the circuitry of the doll this fall so that a digital readout can now tell a teacher how much abuse—rough shaking, say, or dropping—the doll suffered . . . Jurmain says he's found a way to make the next generation of dolls wet.
The Changing Profile of Homozygous β-Thalassemia: Demography, Ethnicity, and Age Distribution of Current North American Patients and Changes in Two Decades
Authors: Pearson Howard A. , Cohen Alan R. , Giardina Patricia-Jane V. , Kazazian Haig H. 
Published: December 2021

Background. The age of patients with homozygous β-thalassemia is increasing because of better treatment and decreased births. A countering influence is immigration of ethnic groups with a high prevalence of thalassemia.
Methods. A questionnaire sent to 48 North American centers requested information about current patients with homozygous β-thalassemia: age, clinical severity, and ethnicity. An 83% response was obtained. Twelve reference hospitals that participated in similar surveys in 1972 and 1984 were included.
Results. Five hundred eighteen patients with homozygous β-thalassemia represent most North American patients. Four hundred forty-three (86%) of these had transfusion-dependent thalassemia major (TM); 75 (14%) had thalassemia intermedia (TI). Sixty-two percent were of Greek and Italian ancestry. There were approximately equal numbers of patients with TM in 5-year intervals between 0 and 25 years of age. Thereafter, the number of patients fell sharply. The mean age (±SD) of the patients with TM was 16.1 ± 9.2 years. Striking differences were seen in Italian and Greek patients compared with those of other ancestries. Sixty-six percent of the 271 Italian and Greek patients with TM were older than 16 years of age, whereas 77% of the 172 patients of other ethnic groups with TM were younger than 15 years of age. The mean age of the 75 patients with TI was greater than that of the patients with TM. Seventy-three percent of African-American patients with thalassemia had TI, compared with 0% of Southeastern Asian patients. Comparisons of patients with TM from the 12 reference hospitals for two decades show increasing mean ages of TM patients (1973, 11.4 ± 6.7 years; 1985, 14.2 ± 7.3 years; and 1993, 16.1 ± 9.2 years).
Conclusions. There are probably only 750 to 1000 patients with homozygous β-thalassemia in North America. Only about 15 to 20 new cases are diagnosed each year. The increasing mean age and age distribution indicate that modern therapies are effective, but immigration of non-Mediterranean ethnic groups with thalassemia has resulted in more, younger patients. TM is increasingly becoming a disease of young adults.
Pulmonary Administration of Vasoactive Substances by Perfluorochemical Ventilation
Authors: Wolfson Marla R. , Greenspan Jay S. , Shaffer Thomas H. 
Published: December 2021

Objectives. Therapeutic management of respiratory distress syndrome, pneumonia, and pulmonary hypertension includes delivery of biologically active agents to the neonatal lung. However, mechanical abnormalities of the lung, intrapulmonary shunting, ventilation-perfusion mismatching, and elevated surface tension impede effective systemic or intratracheal delivery of agents to the lung during conventional gas ventilation. The objective of this study was to test the hypothesis that perfluorochemical (PFC) liquid ventilation can be used for pulmonary administration of vasoactive drugs (PAD) and to compare these responses to those elicited with intravascular (IV) administration during tidal liquid ventilation.
Methods. Cardiovascular responses of 16 preterm and neonatal lambs to randomized doses of acetylcholine, epinephrine, and priscoline were studied. Physiologic gas exchange and acid-base balance were maintained using previously described tidal liquid ventilation techniques. In subgroups of animals, the distribution pattern of carbon 1- and choline 14-labeled dipalmitoylphos-phatidylcholine (14C-DPPC) in saline and the responses to priscoline after hypoxia-induced pulmonary hypertension and hypoxemia administered during liquid ventilation were studied.
Results. Dose-response curves for PAD and IV administration demonstrated progressive, dose-dependent, cholinergic responses to acetylcholine (decreased mean systemic arterial pressure [MAP] and heart rate), sympathomimetic responses to epinephrine (increased MAP and heart rate), and α-adrenergic blockade responses to priscoline (decreased MAP and mean pulmonary arterial pressure). Compared with IV administration, PAD of priscoline resulted in a significantly greater decrease in pulmonary relative to systemic arterial pressure; this response was potentiated by hypoxia, reduced pulmonary pressures to near normal values, and improved oxygenation. The 14C-DPPC in saline was distributed relatively homogeneously throughout the lung by PAD, with 80% of the lung pieces receiving amounts of 14C-DPPC with ±20% of the mean value.
Conclusions. This study demonstrates that vasoactive agents can be delivered to the lung directly by PAD during PFC liquid ventilation. The inherent advantages of this method relate to the physical properties of PFC liquid ventilation as a vehicle (respiratory gas solublity, low surface tension-enhancing distribution, and inertness precluding interaction) and physiological properties of the lung as an exchanger.
The Contribution of Missed Opportunities to Childhood Underimmunization in Baltimore
Authors: Holt Elizabeth , Guyer Bernard , Hughart Nancy , Keane Virginia , Vivier Patrick , Ross Alan , Strobino Donna 
Published: December 2021

Objective. To determine the community-wide incidence of missed opportunities to vaccinate, to describe the clinical settings in which they occur, and to estimate the impact of missed opportunities on immunization coverage.
Design and Methods. We abstracted outpatient medical records from a random, community-based sample of 2-year-old children whose residence was inner-city Baltimore. The date of each vaccine and the date, diagnoses, and temperature at each visit were collected for 502 children at 98 different provider sites.
Main Outcome Measures. Missed opportunities to vaccinate and up-to-date vaccination status.
Results. By 24 months of age, 75% of the children had at least one missed opportunity and only 55% were up-to-date for the 4:3:1 series. Missed opportunities occurred at more than one third of eligible visits for each vaccine, including &gt;20% of preventive care visits. Diagnoses commonly associated with missed opportunities were "well child," otitis media, upper respiratory infection, gastroenteritis, skin infection, and resolving illness. If no missed opportunities had occurred, 73% of the children would have been up-to-date by 24 months.
Conclusions. Missed opportunities occurred commonly at providers serving inner-city children in Baltimore and represent a major factor in underimmunization. Reduction of missed opportunities by accurate screening at all visits and adherence to the contraindication guidelines is a provider-based, low-cost method to increase immunization coverage.
Breastfeeding and the Working Mother: Effect of Time and Temperature of Short-term Storage on Proteolysis, Lipolysis, and Bacterial Growth in Milk
Authors: Hamosh Margit , Ellis Lorie A. , Pollock Darren R. , Henderson Theresa R. , Hamosh Paul 
Published: December 2021

Background. Women who breastfeed have to store expressed milk while at work for later feeding to their infants; however, storage conditions are often not optimal.
Objective. To assess microbial growth and stability of milk protein and lipid at 15°C to 38°C for up to 24 hours.
Methods. Sixteen healthy women who breastfed exclusively, either at home (n = 11) or who expressed milk for their infants (n = 5), were studied during early (1 month) or late (5 to 6 months) lactation. Expressed milk was stored at 15°C, 25°C, and 38°C for 1 to 24 hours for quantitation of pH, proteolysis, and lipolysis; bacterial growth was quantified at 0, 4, 8, and 24 hours of storage.
Results. Milk pH decreased 2 units by 24 hours of storage at all temperatures tested. Proteolysis was minimal during milk storage at 15°C or 25°C for 24 hours and was apparent only after 24 hours of storage at 38°C. Lipolysis was rapid, starting in the first hours of storage and progressing to 8% at 24 hours. Thus, while the greatest increment in proteolysis products was a 40% increase above baseline after 24 hours of storage at 38°C, free fatty acid concentration at this storage time was 440% to 710% higher than in freshly expressed milk. Bacterial growth was restricted mainly to nonpathogens, was minimal at 15°C throughout the 24 hours of storage, was low at 25°C for the first 4 to 8 hours, and was considerably higher at 38°C even during the relatively short period of 4 hours.
Conclusions. Storage of human milk is safe at 15°C for 24 hours, whereas at 25°C it is safe for 4 hours. Milk should not be stored at 38°C. Minimal proteolysis during storage suggests that milk proteins probably maintain their structure and function during short-term storage, while the marked lipolysis might slow bacterial growth during this time.
Protein Requirements of Infants and Children: Growth During Recovery From Malnutrition
Authors: Graham George G. , MacLean William C. , Brown Kenneth H. , Morales Enrique , Lembcke Jorge , Gastañaduy Arturo 
Published: December 2021

Objective. To evaluate the adequacy of protein intakes now recommended as safe for infants and toddlers.
Methods. Subjects were recovering malnourished infants, age 5.3 to 17.9 months, length age (LA) 2.5 to 6.4 months, weight age (WA) 1.5 to 5.2 months, weight/length (W/L) 78% to 100% of National Center for Health Statistics data; and toddlers age 11.4 to 31.6 months, LA 6.1 to 17.9 months, WA 3.9 to 12.0 months, W/L 79% to 99%. Infants were assigned at random to formulas with 5.5%, 6.7%, or 8.0% energy as 60:40 whey:casein protein. The 5.5% was based on FAO-WHO-UNU safe protein and average energy for ages 2.5 to 6.0 months. Toddlers received 4.7% (recommended for 6 to 18 months), 6.4%, or 8.0%. Identical concentrations (weight/kcal) of other nutrients were maintained; intakes were adjusted weekly to reach, in 90 days, the 50th percentile of weight for a LA 3 months greater than the initial one.
Results. Infants consumed 125 ± 11 (SD), 116 ± 10, and 126 ± 14 kcal and 1.7 ± 0.1, 1.9 ± 0.2, and 2.5 ± 0.3 g protein Kg-1· d-1; gained 2.4 ± 0.7, 2.9 ± 0.7, and 2.6 ± 0.5 months in LA, and reached a W/L of 105 ± 5, 103 ± 6, and 105 ± 5% of reference. Sum of four fat-folds (Σ FF) grew 13.1 ± 6.9, 10.4 ± 4.8, and 11.7 ± 5.3 mm to 32.5 ± 5.2, 31.7 ± 4.7, and 30.5 ± 5.5 mm; arm muscle areas (AMA) 57%, 51%, 70% to 1004 ± 109, 1017 ± 110, and 1004 ± 116 mm2, still low; arm fat areas (AFA) 93%, 66%, and 93% to higher-than-normal 598 ± 105, 610 ± 101, and 541 ± 116 mm2. Regression of intake on weight gain estimated energy for maintenance + activity to be 81.0 ± 7.5 (SEM) kcal · kg-1· d-1, and cost of gain (storage + metabolic cost) as 7.6 ± 1.7 kcal/g, with no significant effect of % protein.
Toddlers consumed 107 ± 9, 103 ± 12, and 105 ± 10 kcal and 1.3 ±0.1, 1.6 ± 0.2, and 2.1 ± 0.2 g protein kg-1 · d-1; gained 3.3 ± 0.7, 2.9 ± 0.6, and 3.3 ± 0.7 months in LA; to a W/L of 102 ± 1, 102 ± 3, and 101 ± 4%. Σ FF grew 9.2 ± 4.0, 7.4 ± 4.3, and 6.0 ± 3.8 to 28.9 ± 5.2, 30.5 ± 3.7, and 27.0 ± 2.7 mm; AMA 31%, 33%, and 34% to 1121 ± 115, 1124 ± 110, and 1117 ± 120 mm2; AFA 53%, 44%, and 45% to higher-than-normal 578 ± 106, 636 ± 99, and 569 ± 68 mm2. Cost of maintenance + activity was 70.8 ± 3.8 (SEM) kcal · kg-1 · d-1, that of weight gain 9.7 ± 1.35 kcal/g, with no effect of % protein.
Conclusions. Within age groups, there were no significant protein-related differences in growth. In both infants and toddlers, high-energy intakes resulted in mild obesity, with lean body mass still deficient. Protein intakes two SD below the means in the lowest protein/energy cells, 1.5 g · kg-1 · d-1 for infants and 1.1 g · Kg-1 · d-1 for toddlers, should still be safe for nearly all children of comparable biological ages.
Evaluating Intensive Family Preservation Programs: A Methodological Review
Authors: Heneghan Amy M. , Horwitz Sarah M. , Leventhal John M. 
Published: December 2021

Objectives. To determine the adequacy of evaluations of family preservation services (FPS), which are designed to support families and prevent out-of-home placements of children at risk of abuse or neglect, and to assess the effectiveness of FPS at reducing out-of-home placements of children.
Data Sources. References published from 1977 to 1993 were identified from a computerized search of databases for English-language publications using the key phrases "family preservation," "child abuse," and "family-based services." Unpublished references were identified by mail or phone from a listing of more than 200 programs in a national directory.
Selection of Studies. Of 802 references initially identified, 46 program evaluations were reviewed. Ten studies met the following inclusion criteria: (1) evaluated an intensive family preservation program, (2) included outcome data in the report, and (3) used a comparison group. Five were randomized trials, and 5 were quasi-experimental studies (nonrandomized).
Data Extraction. Descriptive information about the programs and evaluations was collected. To determine methodological quality, two independent raters used a 15- item questionnaire to examine the assignment of families to treatment groups, the interventions provided, and the outcomes assessed. A composite score of 11 or greater represented an acceptable study, 6 to 10 represented an adequate study, and 5 or less represented an unacceptable study.
Results. Only two studies were rated acceptable, four were adequate, and four were unacceptable. Methodological shortcomings included poorly defined assessment of risk, inadequate descriptions of the interventions provided, and nonblinded determination of the outcomes. Rates of out-of-home placements were 21% to 59% among families who received FPS and 20% to 59% among comparison families. The relative risk of placement was significantly reduced by FPS in only two studies (one randomized trial and one quasi-experimental study).
Conclusions. Despite current widespread use of FPS to prevent out-of-home placements of children, evaluations of FPS are methodologically difficult and show no benefit in reducing rates of out-of-home placements of children at risk of abuse or neglect in 8 of 10 studies. Consistent, methodologically rigorous evaluations are needed to determine the effectiveness of FPS and to guide social policy for high-risk children and their families.
The Relationship Between Idiopathic Mental Retardation and Maternal Smoking During Pregnancy
Authors: Drews Carolyn D. , Murphy Catherine C. , Yeargin-Allsopp Marshalyn , Decouflé Pierre 
Published: December 2021

Objectives. Smoking has been linked to small cognitive, achievement, and behavioral deficits but has not been associated with more severe cognitive impairments. This investigation evaluated the relationship between maternal smoking during pregnancy and idiopathic mental retardation (MR).
Methods. Data on maternal smoking during pregnancy were obtained during face-to-face interviews with the mothers of 221 children with idiopathic MR and the mothers of 400 children attending public school. All children had been born in the five-county metropolitan Atlanta area in 1975 or 1976 and were living in the area when they were 10 years of age. We used exposure odds ratios (ORs) to assess the relationship between maternal smoking and MR, controlling for sex, maternal age at delivery, race, maternal education, economic status, parity, and alcohol use.
Results. Maternal smoking during pregnancy was associated with slightly more than a 50% increase in the prevalence of idiopathic MR (adjusted OR, 1.6; 95% confidence interval, 1.0-2.4), and children whose mothers smoked at least one pack a day during pregnancy had more than a 75% increase in the occurrence of idiopathic MR (OR, 1.9;95% confidence interval, 1.0-3.4). This increase was neither accounted for by other sociodemographic risk factors for MR nor explained by an increase in the prevalence of low birth weight among the children of smokers.
Conclusions. Our data suggest that maternal smoking may be a preventable cause of mental retardation.
Treatment of Familial Hypercholesterolemia in Children and Adolescents: Effect of Lovastatin
Authors: Lambert Marie , Lupien Paul-J , Gagné Claude , Lévy Emile , Blaichman Shirley , Langlois Sylvie , Hayden Michael , Rose Vera , Clarke Joe T. R. , Wolfe Bernard M. J. , Clarson Cheril , Parsons Howard , Stephure David K , Potvin Diane , Lambert Jean ,   Canadian Lovastatin in Children Study Group
Published: December 2021

Objective. Familial hypercholesterolemia (FH), an inherited autosomal dominant disorder of lipoprotein metabolism, is associated with premature atherosclerosis. The recommended pediatric therapy consists of dietary intervention and, when necessary, treatment with bile acid-binding resins. However, compliance has been poor in many children. Therefore, our objectives were to determine the efficacy, safety, and tolerance of the short-term use of lovastatin, a 3-hydroxy 3-methylglutaryl coenzyme A reductase inhibitor, in the control of severe FH in a male pediatric population and to evaluate the dose-response relationship.
Methods. Sixty-nine male patients with FH 12.9 ± 2.4 years of age (mean ± SD) participated in this multicenter, randomized, double-blind trial. After a 4-week placebo period, the patients were allocated to four treatment groups (lovastatin 10, 20, 30, or 40 mg/d) for 8 weeks. Plasma lipid and apolipoprotein (Apo) concentrations were measured every 2 weeks. Clinical and laboratory evidence of adverse events was monitored periodically throughout the study.
Results. All lovastatin doses reduced total cholesterol (—17% to —29%), low-density lipoprotein cholesterol (—21% to —36%), and ApoB (—19% to —28%) concentrations. A dose-response relationship was seen, and between-group comparisons showed that results were significantly improved up to a dose of 30 mg/d. We observed a 7% increase in high-density lipoprotein cholesterol and a 4% increase in ApoA1 concentrations. The medication was well tolerated by all patients. No serious clinical adverse experience was reported. Lovastatin increased aspartate aminotransferase concentrations, but there was no evidence of a dose-response relationship, and no value exceeded two times the upper limit of normal. No significant change in alanine aminotransferase was observed. Three patients had marked (more than three times the upper limit of normal) asymptomatic elevations in their creatine kinase values, which returned spontaneously to normal, and no action was required regarding the drug.
Conclusions. Lovastatin is an effective therapy for severe FH in children and adolescents. It was well tolerated, and the occurrence of adverse experiences of clinical significance was very low. Long-term pediatric studies are indicated.
Letter To The Editor
Authors: May Duane L. 
Published: December 2021

The manufacturers of the Varivax vaccine include a warning which states that Varivax recipients should also avoid contact with susceptible high-risk individuals (newborns, pregnant women, immunocompromised persons). In contrast, our health maintenance organization recommends that family members of HIV-positive individuals should receive the Varivax vaccine with the obvious intent of preventing chickenpox within the family complex.
I would appreciate your comment as to the risk of immunizing a sibling when there is a newborn within the family complex, particularly if the mother of that newborn had chickenpox as a child, meaning the newborn would have passive immunity to chickenpox for a number of months.
Evaluation of Penicillins, Cephalosporins, and Macrolides for Therapy of Streptococcal Pharyngitis
Authors: Shulman Stanford T. 
Published: December 2021

Objective. To review recent clinical experience with treatment of acute streptococcal pharyngitis with penicillins, cephalosporins, and macrolide antibiotics.
Methods. Literature review and analysis.
Results and Conclusions. Oral penicillin V administered two to three times daily for 10 days is the treatment of choice for acute streptococcal pharyngitis and is the oral standard against which other treatments should be measured. A single intramuscular dose of benzathine penicillin also remains highly effective. Recent studies evaluating alternative oral agents given for less than 10 days or in once-daily regimens have yielded promising results. Studies should make efforts to exclude chronic streptococcal carriers with intercurrent viral pharyngitis because their inclusion in treatment trials substantially confounds the data. As issues of health care costs assume increasing importance, the cost of newer antimicrobial agents will deter their usage for acute streptococcal pharyngitis.