bluuebunny/crossref_metadata_2025_split huggingface dataset:
FORMER BLUE CROSS CHIEF DECLINES TO TESTIFY
Authors: L. J. F. 
Published: December 2021

Joseph P. Gamble, who led the Washington area Blue Cross plan down a financially disastrous path during the 1980s, said yesterday he would answer no questions from the Senate subcommittee looking into the management of the troubled insurance giant...
Gamble, who retired as chief executive officer of the National Capital plan in November, led the company into an ill-fated diversification strategy during the 1980s that led to more than $ 100 million in losses...
In six years, Gamble alone ran up $447,000 in travel expenses, and travel for him and two other top executives topped $ 1 million, the probe found.
Recent and Intended Drug Trafficking Among Male and Female Urban African-American Early Adolescents
Authors: Li Xiaoming , Feigelman Susan 
Published: December 2021

Objective. To investigate associations between recent and intended involvement in drug trafficking and perceptions of the social environment among high-risk urban African-American youths.
Methods. A multicomponent risk assessment survey was conducted among a convenience sample of 351 African-American youths 9 through 15 years of age residing in low-income communities. Both univariate analysis and logistic regression were performed to examine the association of youths' perceived social environment with recent and intended involvement in drug trafficking.
Results. Drug selling or delivering in the previous 6 months was reported by 6% of the youths; 12% expected to engage in these activities in the next 6 months. There was a strong association between drug trafficking and other high-risk behaviors, including drug use. Among both genders, perceptions that neighbors, friends, or family members were involved in drug trafficking were correlated with recent or intended drug trafficking. For boys, personal economic needs had a strong association with drug trafficking. For girls, personal feelings were more important correlates of intended involvement.
Conclusions. Efforts aimed at both drug-trafficking prevention and intervention need to be community-based and multifaceted. Programs should address the youths' perceived social environments and consider gender differences regarding correlates of drug-trafficking involvement.
Why are Children Hospitalized? The Role of Non-Clinical Factors in Pediatric Hospitalizations
Authors: Goodman David C. , Fisher Elliott S. , Gittelsohn Alan , Chang Chiang-Hua , Fleming Craig 
Published: December 2021

Objective. Pediatric medical discharge rates vary widely across hospital service areas, beyond differences explained by chance or disease incidence alone. This study examines the relationship between the characteristics of local medical services and the likelihood of hospitalization.
Design. Small area and population-based regression analysis.
Setting. The 72 hospital service areas of Maine, New Hampshire, and Vermont.
Study population. The 589 290 (1989) children of Maine, New Hampshire, and Vermont &lt; 15 years of age with 120 806 discharges during 1985 through 1989.
Measurement and main results. Using logistic regression and controlling for community income, we found that children residing in zip codes with high per capita bed supply (4.0/1000) had 9% more discharges (odds ratio: 1.09; 99% confidence interval: 1.07, 1.11) compared with children in areas with low per capita bed supply (1.9/1000). Children living 30 minutes from the nearest hospital had 15% fewer medical discharges (odds ratio: 0.849; confidence interval: 0.830, 0.867) than those living in a zip code with a hospital. Residence in one of the three academic medical center hospital service areas resulted in 32% fewer discharges (odds ratio: 0.68; confidence interval: 0.66, 0.70). Similar and statistically significant(P &lt; .01) results were noted for the most common nonperinatal diagnostic categories: asthma/bronchitis (diagnostic related group = 98) and gastroenteritis (diagnostic related group = 184). No effect was noted for femur fracture, a condition for which admission rates equal disease incidence.
Conclusions. The supply and character of medical care are important influences on the likelihood of hospitalization for pediatric medical conditions for which outpatient alternatives are available.
Evaluation of a Rapid Diagnostic Test for Respiratory Syncytial Virus (RSV): Potential for Bedside Diagnosis
Authors: Krilov Leonard R. , Barone Stephen R. , Harkness S. Hella , Lipson Steven M. , Kaplan Mark H. , Ciamician Zarui 
Published: December 2021

Objective. Rapid detection of respiratory syncytial virus (RSV) infection can assist clinicians in decisions regarding antiviral therapy with ribavirin as well as instituting infection control measures. The Abbott TestPack RSV is a rapid RSV detection immunoassay that can be performed on respiratory secretions in 20 to 30 minutes without special laboratory equipment The purpose of this study was to evaluate housestaff performance of the TestPack RSV at bedside as compared with laboratory testing of aliquots of the same specimen by tissue culture inoculation, direct fluorescent antibody (DFA) testing, and TestPack RSV.
Methods. During the 1991 through 1992 RSV season, 137 nasopharyngeal aspirates or washes obtained from pediatric patients &lt; 4 years of age suffering from acute respiratory disease were assayed by the Food and Drug Administration-approved TestPack RSV as well as conventional tube culture and DFA testing.
Results. 66 of 137 (48%) specimens were positive for RSV as defined by: isolation and DFA-positive (n = 48) and DFA testing positive with negative culture (n = 18); blocking assay experiments using TestFack RSV confirmed culture-negative DFA-positive specimens as positive in 8/8 instances in which material for retesting was available. Using these definitions, the sensitivity and specificity for the assays were: housestaff TestPack RSV: 92%, 93%; laboratory TestPack RSV: 97%, 98%; virus isolation: 72%, 100%.
Conclusion. From these data, it appears that the TestPack RSV EIA in the field setting is reliable, although laboratory confirmation of results is important.
Efficacy of Albuterol in the Management of Bronchiolitis
Authors: Gadomski Anne M. , Lichenstein Richard , Horton Lisa , King James , Keane Virginia , Permutt Thomas 
Published: December 2021

Objective. To examine the efficacy of albuterol (0.15 mg/kg per dose) in the management of bronchiolitis.
Design. Randomized, double-blind, placebo-controlled outpatient clinical trial utilizing four study groups: nebulized albuterol, nebulized saline, oral albuterol, and oral placebo.
Setting. Pediatric emergency department and outpatient clinic at University of Maryland in Baltimore.
Patients. Eighty-eight infants (median age 5.5 months) being treated for their first episode of wheezing were randomly assigned to nebulized albuterol (n = 22), nebulized saline (n = 23), oral albuterol (n = 19), oral placebo (n = 24).
Interventions. The nebulized groups received two nebulizations 30 minutes apart, whereas the oral groups received one oral dose.
Main outcome measures. Respiratory and heart rates, clinical score, oxygen saturation (Spo2), and the infant's state, ie, asleep, awake, or feeding, were recorded at baseline and at 30 and 60 minutes after treatment
Results. Randomization produced equivalent groups in terms of demographics and baseline measures. There were no statistically significant differences in any outcomes among the four treatments, except for oral albuterol, which produced an increase in heart rate (15 beats per minute, P = .005). No differences in the need for additional treatment or hospitalization were observed. Change in the state of the infant during the trial had significant effects on respiratory rate and clinical score.
Conclusions. Albuterol is as effective as oral placebo in the management of bronchiolitis. Past studies supporting the use of albuterol did not control for effects of change in state of the infant and did not use a truly inactive placebo group. This study underscores the importance of these design components in measuring the efficacy of albuterol in infants.
WHAT'S IN A NOM?
Authors: L. J. F. 
Published: December 2021

The French, who sometimes claim to have invented civil rights, are free at last to decide what first names they may give their children. No longer will their choice be subject to the whims of a junior official in the local mairie of the commune in which their child is born and registered, who until now has been able to reject any name deemed "contrary to the interests of the child."
Under a law dating from the 11th Germinal of the year XI of the French Revolution (in fact, April 1st 1803, but not intended as an April fool's joke), parents were obliged to choose their child's name from one of the various authorised calendars of names of Catholic saints, revolutionaries or historical figures who were real, not mythical, and had lived before the Middle Ages. Achille, Nestor and Vercingetorix were all right; Jupiter and Juno were not.
The law was supposed to ensure that French babies were given French names and to protect them from ridiculous or obscene ones. Yet, as so often when bureaucrats know better, the ridiculous is what appeared. For boys, Chien (dog), Injurieux (insulting) and Fou (mad) were acceptable. Ordinary Breton and Basque names were, until relatively recently, forbidden. Girls could be called Porcaire (piggy), but not Sue-Ellen.
Which Dogs Bite? A Case-Control Study of Risk Factors
Authors: Gershman Kenneth A. , Sacks Jeffrey J. , Wright John C. 
Published: December 2021

Objective. Dog bites cause an estimated 585 000 injuries resulting in the need formedical attention yearly and children are the most frequent victims. This study sought to determine dog-specific factors independently associated with a dog biting a nonhousehold member.
Methods. A matched case-control design comprising 178 pairs of dogs was used. Cases were selected from dogs reported to Denver Animal Control in 1991 for a first-bite episode of a nonhousehold member in which the victim received medical treatment. Controls were neighborhood-matched dogs with no history of biting a nonhousehold member, selected by modified random-digit dialing based on the first five digits of the case dog owner's phone number. Case and control dog owners were interviewed by telephone.
Results. Children aged 12 years and younger were the victims in 51% of cases. Compared with controls, biting dogs were more likely to be German Shepherd (adjusted odds ratio (ORa) = 16.4, 95% confidence interval (CI) 3.8 to 71.4) or Chow Chow (ORa = 4.0, 95% CI 1.2 to 13.7) predominant breeds, male (ORa 6.2, 95% CI 2.5 to 15.1), unneutered (ORa = 2.6, 95% CI 1.1 to 6.3), residing in a house with ≥1 children (ORa 3.5, 95% CI 1.6 to 7.5), and chained while in the yard (ORa = 2.8, 95% CI 1.0 to 8.1).
Conclusions. Pediatricians should advise parents that failure to neuter a dog and selection of male dogs and certain breeds such as German Shepherd and Chow Chow may increase the risk of their dog biting a nonhousehold member, who often may be a child. The potential preventability of this frequent public health problem deserves further attention.
TIME TO THROW IN THE TOWEL?
Authors: L. J. F. 
Published: December 2021

England must take the credit—or blame—for the reinvention of boxing. The sport was a popular part of the Roman games but had vanished by the 5th century. It returned some 1200 years later, when bare-fist prizefights began to be held in and around London. With help from the Marquess of Queensberry, boxing spread around the world, making money for a considerable number of boxing promoters and a smaller number of boxers.
It is appropriate, then, that the British Medical Association should be actively involved in examining the sport. In its latest report, The Boxing Debate, which was issued last week, it repeats its call for a ban on boxing and asks for an independent inquiry into its safety.
The briefest reading of the report should persuade even boxing's proponents of the need for an inquiry. In its appendix the report prints abstracts of recent research on what happens to boxers after they have been battered in the ring.
For professional boxers, several studies make unpleasant reading. One using computerised tomography found 87 per cent of boxers, in a sample of 18, showed evidence of brain damage. Another records that 15 out of 19 young boxers register as impaired on a battery of neuropsychological tests.
Particularly disturbing are three studies which show that changes found in the brains of ex-boxers are immunochemically similar to those seen in Alzheimer's disease. That raises the possibility that even boxers who retire from the ring healthy may pay the price in middle age with early onset of Alzheimer's disease.
Recombinant Human Erythropoietin in the Treatment of the Anemia of Prematurity: Results of a Double-Blind, Placebo-Controlled Study
Authors: Meyer Michael P. , Hann F. Mary , Sive Alan A. , Moller Geoffery , Malan Atties F. , Meyer Jill H. , Commerford Anita , Jacobs Peter 
Published: December 2021

Objective. To assess the efficacy of recombinant human erythropoietin (rHuEpo) in the treatment of the anemia of prematurity.
Methodology. A double-blind, placebo-controlled study was conducted on 80 preterm infants (≤32 weeks; postnatal age, 2 to 8 weeks; central hematocrit ≤35%). Patients were randomly assigned to receive subcutaneous rHuEpo (Eprex, 600 U/kg per week) or an equivalent volume of placebo, for up to 6 weeks. All patients received supplements of vitamin E (25 IU) and iron (3 mg/kg per day). The iron supplement was increased if declining serum ferritin measurements were noted.
Results. Treatment and placebo groups did not differ significantly with respect to mean gestational age, birth weight hematocrit, or reticulocyte count at study entry. Fewer transfusions were administered to those receiving erythropoietin (7 compared with 21; P = .002). Compared with the placebo group, the infants receiving rHuEpo had a higher mean hematocrit (32.3 ± 4% vs 29.3 ± 6.2%; P = .014) and absolute reticulocyte count (223 ± 73 vs 124.9 ± 73 x 109/L; P &lt; .001) at the end of the study. The mean neutrophil count was not significantly reduced at study exit (P = .8), nor at any other period during the trial in the rHuEpo group. Intercurrent events (mostly infections) were not increased in the treatment group, although there was one case of sudden infant death syndrome at age 4 months.
Conclusions. Using a dose of rHuEpo of 600 U/kg per week, this study has shown a clear reduction in the requirement for blood transfusion in preterm infants.
Care of the Child With Tympanostomy Tubes: A Visual Guide for the Pediatrician
Authors: Isaacson Glenn , Rosenfeld Richard M. 
Published: December 2021

More than 2 million tympanostomy tubes are placed annually in the United States, primarily in children with chronic or recurrent otitis media refractory to nonsurgical management (J.S. Reilly, personal communication, 1994). Traditionally, the operating otolaryngologist has had the responsibility of caring for these patients, including: confirming middle ear disease, assuring tube patency, controlling refractory otorrhea, and managing complications such as tympanic membrane perforation or cholesteatoma. In response to pressures from a changing health care system, pediatricians are less able to refer children back to the otolaryngologist for routine tube surveillance, and must therefore perform it themselves, often with incomplete instrumentation and training.
An approach is presented here for the care of the child with tympanostomy tubes based on the authors' combined experience with thousands of intubated children, and on available information from the pediatric and otolaryngic literature. With appropriate postoperative surveillance and follow-up care, the morbidity from tympanostomy tubes can be minimized. Although there are other ways of achieving the same goals, these time-honored methods are safe and effective. Because this is a visual guide, photographs are liberally interspersed to clarify and reinforce the written material.
NORMAL TUBE APPEARANCE
There are hundreds of different tube designs and materials and at least five different potential insertion sites in the tympanic membrane. This bewildering array of devices can be reduced to two general types: short-term tubes (intended to remain in the eardrum for 8 to 15 months) and long-term tubes (intended to remain in the eardrum &gt; 15 months) (Fig 1A and B).
Infant Walker-Related Injuries: A Prospective Study of Severity and Incidence
Authors: Chiaviello Christine T. , Christoph Richard A. , Bond G. Randall 
Published: December 2021

Objective. To determine the incidence and significance of walker-related injuries in infants.
Methods. During a 3-year, 8-month period, all infants who were brought to the University of Virginia Pediatric Emergency Department with a walker-related injury were prospectively studied. During the emergency department visit demographic and epidemiologic information were recorded. The annual incidence of walker-related injuries occurring in infants &lt;1 year of age that resulted in a hospital emergency department visit was calculated from the home zip codes of the injured patients and from the population of infants &lt;1 year of age living in Charlottesville and in Albemarle County.
Results. Sixty-five patients were enrolled in the study. The age distribution ranged from 3 months to 17 months, with 95% younger &lt;1 year old. Mechanisms associated with walker-related injuries included stairway falls in 46 infants (71%), tip-overs in 14 infants (21%), falls from a porch in 2 infants (3%), and burns in 3 infants (5%). These injuries predominantly involved the head and neck region (97%), with few injuries to the extremities (6%) and trunk (3%). Although the majority of injuries were minor, significant injuries occurred in 19 infants (29%). These injuries included skull fracture, concussion, intracranial hemorrhage, full-thickness burns, c-spine fracture, and death. After excluding the burned patients, all the serious injuries resulted from falls down stairs. The annual incidence of injuries occurring in infants &lt;1 year of age, related to the use of walkers, and resulting in an emergency department visit was 8.9/1000, and for serious injuries was 1.7/1000.
Conclusions. The incidence and significance of infant walker-related injuries in infants are unacceptably high.
Kernicterus in Premature Infants: Current Prevalence and Relationship to NICHD Phototherapy Study Exchange Criteria
Authors: Watchko Jon F. , Claassen Diana 
Published: December 2021

Objective. This study was undertaken to determine the current prevalence of kernicterus in premature neonates and to relate the occurrence of kernicterus to 1) the categorization of the infant as "at risk" by National Institute of Child Health and Human Development (NICHD) Phototherapy Study exchange transfusion criteria, and 2) the clinical management of the infant's hyperbilirubinemia.
Design. Retrospective review of postmortem and clinical records.
Setting. Magee-Womens Hospital, a University of Pittsburgh Medical Center affiliated hospital with approximately 10 000 deliveries per year and a Level III Neonatal Intensive Care Unit with about 1400 admissions annually.
Subjects. All neonates autopsied between January 1, 1984 and June 30, 1993 who were &lt;34 weeks gestation and who lived at least 48 hours; a total of 81 infants.
Results. Three infants had kernicterus resulting in a prevalence rate of 4%. These cases included: 1) a 33-week newborn with nonimmune hydrops and a peak bilirubin of 26 mg/dl; 2) a 25-week newborn with asphyxia, hyaline membrane disease, grade IV intraventricular hemorrhage, necrotizing enterocolitis, meconium peritonitis, sepsis, prolonged acidosis, and a peak bilirubin of 11.3 mg/dl; and 3) a 24-week newborn with asphyxia, hyaline membrane disease, grade III intraventricular hemorrhage, and a peak serum bilirubin of 18.5 mg/dl. Of the remaining 78 infants who did not have kernicterus, peak bilirubin ranged from 3.6 to 22.5 mg/dl and 56% had bilirubin levels greater than that suggested as a criterion for exchange transfusion by NICHD Phototherapy Study guidelines; yet all but three were managed with phototherapy alone.
Conclusions. We conclude that kernicterus is currently an uncommon event in preterm infants, even when bilirubin levels are allowed to rise above those previously thought to place the premature infant at risk.
Infant Sleep Position and Sudden Infant Death Syndrome Risk: A Time For Change
Authors: Hunt Carl E. 
Published: December 2021

I fully support a comprehensive professional and public intervention campaign in the US to establish supine as the standard sleep position. Although other preventive health objectives can be included, the emphasis needs to be clearly focused on sleep position. Achieving the lowest possible prone prevalence rate in the US is thus the first goal of this new campaign.
The second and equally important goal of the new campaign should be to utilize this opportunity to maximum advantage to enhance our knowledge regarding the epidemiological risk factors causally related to SIDS and their interactions, and the interactions between epidemiological and biological risk factors. In addition to quantifying changes in infant mortality and in infant sleep position, we will also need to characterize both the supine and the persistent prone infant groups in regard to all of the putative epidemiological risk factors for SIDS. This campaign can thus enhance our understanding of the epidemiological risk factors for SIDS as long as a significant decrease in prone prevalence can be achieved.
AFRICANIZED HONEY BEES FOUND IN ARIZONA
Authors: Hawthorne S. 
Published: December 2021

Washington, DC, July 13, 1993—Africanized honey bees have been found in Arizona, the second state where the "killer bees" have migrated into this country, according to the Agriculture Department.
A swarm was found in a state Department of Agriculture trap 2 miles north of Sasabe, AZ. The bees were destroyed.
The fierce and unmanageable bees are descendants of honey bees imported from Africa to Brazil in 1956. They have been spreading north and south from Brazil since their release in 1957.
They tend to sting with less provocation and in greater numbers than other honey bees.
They migrated for the first time into the United States in 1990, near Hildago, TX, in the Rio Grande Valley. They have also entered the country on ships.
‘KILLER BEES’ BLAMED IN TEXAS MAN'S DEATH
Authors: L. J. F. 
Published: December 2021

Harlington, TX, July 19 (AP)—Federal agricultural officials say that the honey bees that killed an 82-year-old rancher last week were the Africanized variety known as "killer bees."
"Our lab has confirmed that the bees are Africanized," said Kim Kaplan, a Spokeswoman for the Federal Department of Agriculture in Greenbelt, MD. Final autopsy results are not yet available, but the pathologist who did the autopsy listed the preliminary cause of death as acute fluid buildup in the lungs caused by insect stings.
If the cause of death is confirmed, the rancher, Lino Lopex, would be the first person killed by Africanized bees in the United States since the aggressive variety migrated into Texas in 1990. Harlington, TX, in South Texas, is about 15 miles from the Mexican border.
Mr. Lopez apparently tried to drive the bees out of a wall in an abandoned house by poking the hive with a stick wrapped with a burning burlap sack. He was dead on arrival at the hospital, with about 40 stingers still attached to his body, officials said.
Letter to the Editor
Authors: Merenstein Gerald B. 
Published: December 2021

We thank Drs Arroll and Thompson for their interest and comments on the American Academy of Pediatrics Vitamin K Task Force statement. They raise two concerns—the validity of the Golding1 paper suggesting an increased risk of cancer and the appropriateness of recommending the use of oral vitamin K.
In both the task force statement2 and in response3 to a previous letter to the editor, we have clearly stated that the risks of cancer from intramuscular vitamin K are unproven and unlikely.