bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical and Pharmacokinetic Evaluation of Long-Term Therapy With Didanosine in Children with HIV Infection
Authors: Mueller Brigitta U. , Butler Karina M. , Stocker Vicki L. , Balis Frank M. , Pizzo Philip A. , Brouwers Pim , Husson Robert N. , Lewis Linda L. , Jarosinski Paul , Venzon David 
Published: December 2021

Background. Didanosine has demonstrated promising antiviral activity and a tolerable toxicity profile in short term studies. We describe a cohort of HIV-infected children who were treated for a prolonged period of time with didanosine.
Methods. Children (6 months to 18 years of age) with symptomatic HIV infection or an absolute CD4 count &lt; 0.5 x 109 cells/L, received oral didanosine at doses between 20 mg/m2 to 180 mg/m2 every 8 hours. Clinical, immunological, and virological parameters were assessed at least every 2 months. The pharmacokinetics of didanosine were evaluated in 85 patients.
Results. Previously untreated children (n = 51) and children who had received prior antiretroviral therapy (n = 52) were enrolled in the study (median time on study 22.6 months; range 2 to 48). The long-term administration of didanosine was well tolerated and no new toxicities were observed. The absolute CD4 count increased by ≥ .05 x 109 cells/L in 28 of 87 (32%) of patients after 6 months of therapy. Responses were also sustained in 41% of these children after 3 years of therapy. Children entering the study with a CD4 count &gt;0.1 x 109 cells/L (n = 51) had a marked survival advantage (P = .00002) with an estimated survival probability after 3 years of 80% compared to 39% for children with lower CD4 counts. Although the area under the curve of didanosine increased proportionally with the dose, there was considerable interpatient variability at each dose level. There was no apparent relationship between surrogate markers of clinical outcome and plasma drug concentration.
Conclusions. Didanosine was well tolerated with chronic administration, and toxicities were uncommon and usually reversible. In 41% of patients, the CD4 count increased and was maintained at the higher level even after years of treatment.
Guidelines for Expert Witness Testimony in Medical Liability Cases(S93-3)
Authors:   Committee on Medical Liability
Published: December 2021

The American Academy of Pediatrics joins with other medical organizations in emphasizing the obligation of objectivity when its members respond to requests to serve as expert witnesses in the judicial system. Regardless of the source of the request, such testimony ought to embody the relevant facts and the expert's knowledge, experience, and best judgment regarding the case. At the same time, the Academy reiterates that it cannot condone participation of its members in legal actions in which their testimony will impugn some performances that clearly fall within the accepted standards of practice or, conversely, will endorse some obviously deficient practices.
The role of an expert witness in a medical liability case is to testify to the standards of care in a given case, and to explain how the defendant did or did not conform to those standards. An expert witness may be asked to testify as to whether a deviation from the standard of care caused the injury. Expert witnesses are also called upon to help an attorney determine if a case has merit, and in several states attorneys are required by law to consult an expert before a suit is filed. Because experts are relied upon to help courts and juries understand the "standards of practice" as applicable to a given case, care must be exercised that such "expert testimony" does not narrowly reflect the experts' views about applicable standards to the exclusion of other acceptable and perhaps more realistic choices. The standards of care for generalists may not necessarily be the standards of care for subspecialists.
The Frequency, Level, and Distribution of Fecal Contamination in Day-Care Center Classrooms
Authors: Laborde Danielle J. , Weigle Kristen A. , Weber David J. , Sobsey Mark D. , Kotch Jonathan B. 
Published: December 2021

Children in day care are at higher risk of infectious diarrhea than those who remain at home.1,2 Diarrhea in day care centers (DCCs) is propagated through the fecal-oral route,3,4 a mode of transmission that is enhanced by fecal contamination. Knowledge of the pattern and degree of fecal contamination in DCC classrooms can identify important sources of enteropathogens to be targeted by hygienic interventions. This study was undertaken to qualitatively and quantitatively describe fecal contamination in DCC classrooms and to determine the relative stability of patterns of contamination across time.
Fecal coliforms occur in large numbers in human feces and can be presumptively identified on differential culture media. Each discrete colony represents a bacterial cell originally present on the surface that was sampled. In principle, the number of fecal coliforms rather than the frequency of positive samples reported in previous DCC studies5,6 should more accurately reflect enteropathogen characteristics of infectious dose and survival in the environment. Therefore, fecal contamination was measured by the number of viable fecal coliforms recovered from environmental surfaces and the hands of children and DCC staff members. The distribution of fecal contamination was described in terms of coliform presence and coliform density (counts) for individual classroom sites.
METHODS
Fecal contamination was measured during two prospective studies in North Carolina. In study 1, 13 Cumberland County DCCs served as controls during a hygienic intervention trial and were sampled from April 1989 to March 1990; in study 2, 25 Research Triangle Area DCCs were sampled between January and August 1991.
Managing Stress and Burnout at Work: A Cognitive Group Intervention Program for Directors of Day-Care Centers
Authors: Kushnir Talma , Milbauer Varda 
Published: December 2021

There is considerable epidemiological evidence that occupational stress contributes to the etiology and expression of a wide variety of health and behavior outcomes such as cardiovascular disease morbidity and mortality, immunological processes, psychosomatic impairment, and affective disorders.1 As much as 60% of absence from work may be stress related.2 Recently, occupational burnout was found to be correlated with health problems ranging in severity from increased frequency of upper respiratory infections2 to increased risk for cardiovascular diseases.3 Such findings constitute the rationale for including stress- and burnout-prevention efforts in many health-promotion models. This paper describes a stress- and burnout-prevention workshop focusing on psychological coping skills for directors of child day-care centers. As far as we could tell, this program, which took place in Israel in 1991, was the only reported program within this particular work setting.
Directing a day-care center is highly demanding, entailing full responsibility for the effective functioning and well-being of staff and children. In Israel, this may amount to about 20 care givers and as many as 140 infants and children under 4 years of age. The centers, often geared to cater for young newcomers from developing countries and children from socially deprived neighborhoods, are open 8 to 9 hours a day, 6 days per week. Because the director has educational and administrative functions, she is closely supervised by two supervisors who frequently issue conflicting instructions. She also coordinates routinely with many governmental agencies and maintains close contact with parents. The job thus requires intense involvement with people, a feature that has been recognized as a major source of occupational burnout.4
The Science Behind the American Public Health Association/American Academy of Pediatrics National Health and Safety Guidelines for Child-Care Programs
Authors: Aronson Susan S. 
Published: December 2021

THE DEVELOPMENT OF THE APHA/AAP STANDARDS
In 1992, the American Public Health Association (APHA) and the American Academy of Pediatrics (AAP) published the long-awaited Caring for Our Children—National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs.1 This publication was the product of a 4-year effort involving many experts in child health and safety and day-care providers. The standards document provides a national consensus on approaches to reducing diseases and injury and promoting prevention among children and providers in group-care settings.
Consumer protection initiatives are needed because market-place forces are inadequate to ensure a health environment for children in child care. Over the past two decades, a growing number of investigators have documented the increased occurrence of infectious diseases2-4 and injuries,5-7 and missed opportunities for health protection and promotion in child care.8 Despite the tendency to focus on reports of negative health outcomes, children and families thrive in early childhood programs that provide safe, nurturing care and developmentally appropriate education. Day-to-day excellence in child care depends on committed, well-educated care givers who work in a child-friendly and staff-friendly environment.
In the US, good child care is limited. Few parents can afford the full cost of care. Most lack the knowledge, skills, or objectivity to critically evaluate the care they choose for their children. Convenience, availability, and affordability motivate parents when they choose child care. Parents are pressured to meet occupational expectations, and tend to overlook significant risks in their children's child-care arrangements. Even parents who are pediatricians (who are expected to be well-versed in child development, health, and safety) ignore hazards and poor quality when rating convenient and available child-care arrangements (Aronson S, unpublished data).
Triglyceride and High-Density Lipoprotein Cholesterol: Predicting Disorders in Parents From Their Children
Authors: Polonsky Sheldon M. , Simbartl Loretta A. , Sprecher Dennis L. 
Published: December 2021

Objective. To determine whether lipid disorders can be predicted in parents after such disorders are identified initially in their children. Although this relation has been well determined for children with high cholesterol or low-density lipoprotein cholesterol (LDL-C), it has not been as well described for disorders involving triglycerides (TG) or high-density lipoprotein cholesterol (HDL-C), or their interaction with LDL-C.
Methods. Serum lipid values were obtained from 232 families in the comparison population of a large genetics study. Subjects were classified into four groups based on their lipid status: 1) isolated LDL-C disorder, defined by a high LDL-C level and normal TG and HDL-C levels; 2) isolated TG/HDL-C disorder, defined by either high TG, low HDL-C, or both, and normal LDL-C; 3) combined disorder, defined by high LDL-C in addition to either high TG, low HDL-C, or both; and 4) normal, defined by the absence of any of the above disorders. The frequencies of these disorders were noted in both parents and children, and logistic regression analyses were conducted to determine whether the presence of these disorders in at least one child in the family could predict similar disorders in the parents.
Results. Children with isolated LDL-C or TG/HDL-C disorder were more likely to have parents with the same disorder as themselves (P = .002 and P = .04, respectively). Children with the combined disorder were more likely to have parents with any lipid disorder (P = .009), but especially isolated LDL-C (P = .002) and isolated TG/HDL-C (P = .05).
Conclusion. A classification scheme defining disorders of TG and HDL-C, LDL-C, or a combination can be useful for predicting lipid disorders in parents after such disorders are identified initially in their children.
Serologic, Virologic, and Histologic Characteristics of Chronic Phase Hepatitis C Virus Disease in Children Infected by Transfusion
Authors: Matsuoka Suguru , Tatara Katsuyoshi , Hayabuchi Yasunobu , Taguchi Yoshiyuki , Mori Kazuhiro , Kuroda Yasuhiro , Honda Hirohito , Itou Susumu , Yuasa Yasuto 
Published: December 2021

Objective. We studied the time course of hepatic dysfunction, seropositivity to hepatitis C virus (HCV) antibodies, viremia, and histologic evidence of hepatic injury to evaluate the course of HCV infection in children infected by blood transfusion.
Patients and methods. Twenty-nine patients (ages 4 to 18 years) who underwent open-heart surgeries for congenital heart disease were grouped into three categories based on alterations in serum alanine aminotransferase (ALT) levels: Group A, acute infection; Group B, subacute infection; and Group C, chronic infection.
Results. In Group C, all 13 patients had detectable HCV RNA in serum. In contrast, all patients in Group A had no detectable HCV RNA. In Group B, one of nine patients had detectable HCV RNA and two of four patients examined had persistent chronic hepatitis by histologic criteria. Antibodies directed against C100-3 antigen or core-antigen were more useful than second-generation HCV antibody assays in determining the relationship between viremia and immunologic response. Infection with HCV genotype II and the presence of higher HCV RNA copy numbers were associated with histologic evidence of hepatic damage.
Conclusion. An abnormal ALT value is frequently associated with viremia, and biochemically resolved acute infection reflects clearance of HCV. However, a normal ALT does not always reflect an absence of hepatocyte damage and HCV replication in patients with subacute disease. The measures outlined in this study are useful indicators of disease activity during the chronic phase of post-transfusion HCV infection.
Reduction of Elevated LDL-Cholesterol Levels of 4- to 10-Year-Old Children Through Home-Based Dietary Education
Authors: Shannon Barbara M. , Martel Juliann K. , Achterberg Cheryl L. , Smiciklas-Wright Helen S. , Tershakovec Andrew M. , Cortner Jean A. , Stallings Virginia A. , Stolley Paul D. 
Published: December 2021

Objective. To assess the effects of a home-based, parent-child autotutorial (PCAT) dietary education program on the dietary knowledge, lipid consumption, and plasma low density lipoprotein-cholesterol (LDL-C) of 4- to 10-year-old children with elevated plasma LDL-C.
Methods. "At-risk" children (screening total cholesterol, (TC), exceeded 4.55 mmol/L and average LDL-C from two fasting samples was between 2.77 and 4.24 mmol/L for boys or 2.90 and 4.24 mmol/L for girls) were randomized to the PCAT program (N = 88), for dietary counseling with a registered dietitian (N = 86), or to an at-risk control group (N = 87). Dietary knowledge, diet, and LDL-C of these groups were assessed at baseline and after the educational period (3-month follow-up). The knowledge and diet of a not-at-risk (TC below 4.22 and 4.34 mmol/L for boys and girls, respectively) control group (N = 81) was also assessed and compared with that of the at-risk control group.
Results. At the 3-month follow-up, the PCAT children's knowledge scores had increased three times more than those of the counseling and at-risk control groups (P &lt; .001). Mean grams of total and saturated fat consumed by PCAT and counseling groups declined while that of the at-risk control group increased slightly; these differences were significant (P &lt; .05). The mean LDL-C decline of the PCAT group was significantly different (P &lt; .05) from the decline of the at-risk control group (0.26 vs 0.09 mmol/L), and approached significance (P = .07) when compared with that of the counseling group (0.26 vs 0.11 mmol/L). The at-risk control group's knowledge and diet did not differ from that of the not-at-risk group.
Conclusion. The PCAT program offers a mechanism for providing effective dietary education to children with elevated cholesterol and to their families.
Prenatal Detection of Neuroblastoma—A Noninvasive Approach
Authors: Morgan Elaine 
Published: December 2021

In the September 1993 issue of Pediatrics, Ho et al presented the experience of the Dana-Farber Cancer Institute in the management and outcome of 11 infants with neuroblastoma detected by prenatal ultrasound.1 Those patients demonstrated favorable biology and were managed with operative resection. One patient with progressive disease responded to chemotherapy. All patients had a good outcome.
I have similarly reported one patient with prenatally detected neuroblastoma managed at Children's Memorial Hospital in Chicago. This patient is being reported with two additional cases in association with Drs Saylors, Cohn, and Brodeur.2
Lidocaine Adrenaline Tetracaine Gel Versus Tetracaine Adrenaline Cocaine Gel for Topical Anesthesia in Linear Scalp and Facial Lacerations in Children Aged 5 to 17 Years
Authors: Ernst Amy A , Marvez Eduardo , Nick Todd G. , Chin Eric , Wood Edmond , Gonzaba W. Thomas 
Published: December 2021

Study objective. The purpose of the present study is to compare LAT gel (4% lidocaine, 1:2000 adrenaline, 0.5% tetracaine) to TAC gel (0.5% tetracaine, 1:2000 adrenaline, 11.8% cocaine) for efficacy, side effects, and costs in children aged 5 to 17 years with facial or scalp lacerations.
Design. Randomized, prospective, double-blinded clinical trial.
Setting. Inner-city Emergency Department with an Emergency Medicine residency program.
Patients or other participants. Children aged 5 to 17 years with linear lacerations of the face or scalp.
Intervention. After informed consent was obtained patients had lacerations anesthetized with topical TAC or LAT gel according to a random numbers table.
Measurements and main results. A total of 95 patients were included in the statistical analysis with 47 receiving TAC and 48 receiving LAT. Physicians and patients/parents separately rated the overall pain of suturing using a modified multidimensional scale for pain assessment specifically for children. Patients/parents also stated the number of sutures causing pain. The power of the study to determine a ranked sum difference of 15 was 0.8. Multidimensional rating scale results and number and percentage of sutures causing pain were compared using Wilcoxon's rank sum test. According to patients no difference could be detected in percent of sutures causing pain in the LAT versus TAC group (P = .51). Using the multidimensional scale, physicians and patients/parents found LAT statistically the same as TAC in effectiveness (P = .80 for physicians and P = .71 for patients). Cost per application was $3.00 for LAT compared to $35.00 for TAC. Follow-up was accomplished in 85 of 95 participants in the study with no reported complications for either medication.
Conclusion. LAT gel worked as well as TAC gel for topical anesthesia in facial and scalp lacerations. Considering the advantages of a noncontrolled substance and less expense, LAT gel appears to be better suited than TAC gel for topical anesthesia in laceration repair in children.
Letters to the Editor
Authors: Kattwinkel John 
Published: December 2021

Dr Schrager identifies a real black cloud that pervades the practice of medicine–the irresponsible expert witness. The testimony of such individuals, which may lead to the inappropriate destruction of a responsible physician's career, is all too frequently buried within the confines of a courtroom or the untranscribed records of an individual case and thus is seldom exposed. Such isolation tends to encourage the witness to testify yet again, perhaps even more irresponsibly.
Unfortunately, there are insufficient details to determine if Dr Schrager's case is an example of such irresponsibility.
Cost Implications of Event Recordings In Apnea/Bradycardia Home Monitoring: A Theoretical Analysis
Authors: Steinschneider Alfred , Santos Vicki , Freed Gary 
Published: December 2021

Objectives. To evaluate the financial impact of incorporating event recordings as an integral component of home apnea/bradycardia monitoring.
Study design. This theoretical analysis examines the cost of home monitoring when medical decisions are based on an evaluation of the cardiorespiratory wave-forms surrounding each apnea/bradycardia monitor alarm (documented monitoring) compared to those based on parental observations. Data for both approaches were obtained from 155 infants referred within the first 10 days of life, because a sibling died of sudden infant death syndrome. All were followed on an impedance type apnea/bradycardia monitor with an attached event recorder. The monitor settings were 20 seconds for apnea and 80 beats per minute (bpm) for bradycardia. Parents were taught how to use the equipment, resuscitative techniques, and to complete an alarm log. The clinical protocol provided for home monitoring until there were no "episodes" (prolonged apnea or prolonged bradycardia) for 16 consecutive weeks. A polysomnogram would be obtained if an "episode" occurred. For each infant two independent approaches were used to judge the occurrence of an "episode": (1) parental report of an apnea alarm occurring during sleep or a physiologic alarm associated with skin color change or resuscitative intervention and (2) apnea ≥ 20 seconds long or bradycardia ≥ 10 seconds. The cost was calculated assuming a 4-week monitor rental fee of $350, a 4-week waveform interpretation fee of $180, and a $600 fee for performing and interpreting a polysomnogram.
Results. Episodes defined from an interpretation of the cardiorespiratory waveforms resulted in fewer diagnostic studies, a shorter period of home monitoring, and lower per patient treatment costs.
Conclusion. Despite the increased monthly cost, incorporating event recordings as an integral component of home monitoring resulted in a lower average per patient cost.
What is a Grandmother? (Written by a 9-year-old)
Authors: Riess G. R. 
Published: December 2021

"A grandmother is a lady who has no children of her own, so she likes other people's little boys and girls. A grandfather is a man grandmother.
Grandmas don't have to do anything except be there. They're old, so they shouldn't play hard or run. It is enough if they drive us to the market where the pretend horse is and have lots of dimes ready. Usually grandmas are fat, but not too fat to tie kids' shoes. They wear glasses and they can take their teeth out and gums off! They don't have to be smart ... only answer questions like why dogs chase cats and how come God isn't married? They don't talk Baby Talk like visitors do because it is hard to understand and when they read to us they don't skip words or mind if it is the same story over and over again.
Everyone should try to have a Grandma especially if they don't have a television, because grandmothers are the only grownups who really ever seem to have any time for children!"
Driveway-Related Child Pedestrian Injuries: A Case-Control Study
Authors: Roberts Ian , Norton Robyn , Jackson Rodney 
Published: December 2021

Objectives. To examine risk factors for driveway-related child pedestrian injuries.
Design. A community based case-control study.
Setting. The Auckland region of New Zealand.
Participants. Cases (n = 53) were children killed or hospitalized as a result of a driveway-related pedestrian injury, in the Auckland region over a period of 2 years and 2 months. Controls (n = 159) were an age-matched random sample of the child population of the Auckland region.
Results. The absence of physical separation of the driveway from the children's play area was associated with a threefold increase in the risk of driveway-related child pedestrian injury (OR = 3.50; 95% CI 1.38, 8.92). Children living in homes with shared driveways were also at significantly increased risk (OR = 3.24; 95% CI 1.22, 8.63). The population attributable risk associated with the absence of physical separation of the driveway from the children's play area was 50.0% (95% CI 24.7, 75.3).
Conclusion. The fencing of residential driveways as a strategy for the prevention of driveway-related child pedestrian injuries deserves further attention.