bluuebunny/crossref_metadata_2025_split huggingface dataset:
Agammaglobulinemia, by Col. Ogden C. Bruton, MC, USA,Pediatrics, 1952;9:722–728
Authors: Buckley Rebecca H. 
Published: December 2021

A hitherto unrecognized entity manifested by complete absence of gamma globulin with otherwise normal serum proteins and recurrent pneumococcal sepsis is described in an 8-year-old male. The patient appeared to be normal in other respects and, after extensive study, no structural or functional change could be demonstrated in any body system. He was unable to produce antibody to the pneumococcus with the four antigenic substances used; a positive Schick test persisted despite numerous attempts to reverse it with diphtheria toxoid. No antibody could be demonstrated following administration of typhoid vaccine in the usual manner, and his serum was negative for complement-fixing antibodies of epidemic parotitis after he experienced a typical clinical picture of that disease.Gamma globulin could be demonstrated in his serum after concentrated immune human serum globulin was administered subcutaneously, and its gradual disappearance could be followed by electrophoretic analysis over a period of approximately six weeks. Concurrently, and following administration of human gamma globulin (3.2 gm. gamma globulin) at monthly intervals, he had been free of pneumococcal sepsis for more than a year, whereas he had experienced clinical sepsis at least 19 times in the previous four years. Eight different types of pneumococci had been recovered from blood cultures during 10 different episodes of sepsis.In the Discussion, [the author] concluded that there was a cause-and-effect relationship between the absence of gamma globulin and the repeated infections, based on the child's dramatic improvement after beginning gamma globulin therapy. [The author] proposed two possible causes–congenital or acquired. While [he] felt that the patient's good health for the first 4.5 years of life argued against a congenital cause, the persistence of the defect supported it.
Test for the Concentration of Electrolytes in Cystic Fibrosis of the Pancreas Utilizing Pilocarpine by Iontophoresis, by Lewis E. Gibson and Robert E. Cooke,Pediatrics; 1959;24:545–549
Authors: Chernick Victor 
Published: December 2021

Aim. To develop a method for stimulating sweating that is rapid, painless, and avoids the risk of heat stress.Background. Since the discovery that there is a high concentration of sodium and chloride in the sweat of patients with cystic fibrosis of the pancreas in 1953, the sweat test has been performed by placing the patient's body in a plastic bag with or without hot water bottles to stimulate sweating. This method is unsatisfactory because of complications such as hyperpyrexia and heat stroke. Direct injection of a cholinergic agent intradermally is painful and therefore not practical.Methods. A rheostat with a milliampere meter was constructed at a cost of ∼$7 that allowed the iontophoresis of pilocarpine into the skin using negative and positive (2-cm diameter) electrocardiography electrodes. The positive electrode was placed on the flexor surface of the arm over a filter paper soaked in 0.2 mL of 0.2% pilocarpine nitrate. Current (0.2 mA) was applied for 5 minutes and then sweat was collected onto a preweighed filter paper for 30 minutes. Sweat chloride was determined by a polarographic method. Sweat tests were performed on 25 patients with cystic fibrosis (CF), 17 asymptomatic relatives and 27 control patients. Patients with CF had sweat chloride concentration &gt;80 mEq/L; relatives, 32.5 mEq/L (highest 57 mEq/L); and control subjects, 21.1 mEq/L (highest 60 mEq/L).Conclusions. The iontophoresis of pilocarpine into the skin is a rapid, painless, safe, and reliable method for stimulating sweating and facilitating the determination of sweat chloride concentration.
A Controlled Trial of Antepartum Glucocorticoid Treatment for Prevention of the Respiratory Distress Syndrome in Premature Infants, by G. C. Liggins, MB, PhD, FRCOG, and R. N. Howie, MB, MRACP,Pediatrics, 1972;50:515–525
Authors: Avery Mary Ellen 
Published: December 2021

A controlled trial of betamethasone therapy was carried out in 282 mothers in whom premature delivery threatened or was planned before 37 weeks' gestation, in the hope of reducing the incidence of neonatal respiratory distress syndrome by accelerating functional maturation of the fetal lung. A total of 213 mothers were in spontaneous premature labor. When necessary, ethanol or salbutamol infusions were used to delay delivery while steroid or placebo therapy was given. Delay for at least 24 hours was achieved in 77% of the mothers. In these unplanned deliveries, early neonatal mortality was 3.2% in the treated group and 15.0% in the control subjects. There were no deaths with hyaline membrane disease or intraventricular cerebral hemorrhage in infants of mothers who had received betamethasone for at least 24 hours before delivery. The respiratory distress syndrome occurred less often in treated babies (9.0%) than in controls (25.8%), but the difference was confined to babies of &lt;32 weeks' gestation who had been treated for at least 24 hours before delivery (11.8% of the treated babies compared with 69.6% of the control babies). There may be an increased risk of fetal death in pregnancies complicated by severe hypertension–edema–proteinuria syndromes and treated with betamethasone, but no other hazard of steroid therapy was noted.We conclude that this preliminary evidence justifies additional trials, but that additional work is needed before any new routine procedure is established.
A Process Approach to Describing Mathematics Difficulties in Girls With Turner Syndrome
Authors: Mazzocco Michèle M. M. 
Published: December 2021

Objective. To expand on previous reports of mathematics difficulty in girls with Turner syndrome (TS).
Methods. Mathematics performance was examined by evaluating the types of errors made on mathematics achievement subtests by 29 girls with TS, 26 girls with fragile X syndrome (another genetic condition associated with mathematics difficulty), and 41 girls with neither disorder. Correlations between mathematics achievement scores and measures of IQ, attention, and visuospatial skills were also examined.
Results. Relatively low mathematics achievement was evident in girls with TS before 10 years of age, and a higher percentage of girls with TS made operation (57%) and alignment (48%) errors on a mathematics calculations test than did girls with fragile X syndrome (19% and 14%, respectively). No group differences were found for procedural or multiplication table errors. Girls with TS attempted more “unfamiliar” problems than did girls with fragile X syndrome or girls in the comparison group. Mathematics achievement scores in girls with TS were positively correlated with Judgment of Line Orientation and Wechsler Intelligence Scale for Children–Revised Third Factor scores; these correlations differed from those in the other groups.
Conclusions. The qualitative group differences observed further support the concept of specificity of the TS phenotype and illustrate the importance of a process approach to assessment.
Response to Growth Hormone in Attention Deficit Hyperactivity Disorder: Effects of Methylphenidate and Pemoline Therapy
Authors: Rao Jayashree K. , Julius Joanne R. , Breen Timothy J. , Blethen Sandra L. 
Published: December 2021

Objective. To determine whether treatment of attention deficit hyperactivity disorder (ADHD) with methylphenidate hydrochloride or pemoline diminishes the response to growth hormone (GH) therapy in patients with idiopathic GH deficiency (IGHD) or idiopathic short stature (ISS).Methods. The National Cooperative Growth Study database was used to identify patients between 3 and 20 years of age with IGHD or ISS and those within these groups who were treated with methylphenidate or pemoline for ADHD. Their growth in response to GH treatment (change in height standard deviation score [SDS]) was compared with that of patients with IGHD or ISS who were not treated for ADHD, by using a stepwise multiple regression analysis.Results. In the IGHD cohort, there were 184 patients who were being treated for ADHD and 2313 who were not. In the ISS cohort there were 117 patients who were being treated for ADHD and 1283 who were not. There was a higher percentage of males being treated for ADHD in both cohorts. In the IGHD cohort, the change in height SDS was positively associated with the number of years of GH treatment, parents' heights, body mass index, and GH injection schedule, and was negatively associated with height SDS at the initiation of GH therapy, age, and maximum stimulated GH level. The use of methylphenidate or pemoline had a negative effect on the change in height SDS, but the magnitude of the effect was small. Similar effects were noted in the ISS cohort, but body mass index and the use of methylphenidate or pemoline had no effect on the change in height SDS.Conclusions. Concurrent ADHD therapy is associated with a slight decrease in the change in height SDS during GH treatment in patients with IGHD but not in those with ISS. Even in IGHD, the magnitude of the effect is small and should not deter the use of such concurrent therapy.
The Role of Serial Sampling in the Diagnosis of Growth Hormone Deficiency
Authors: Diamond Frank B. , Jorgensen E. Verena , Root Allen W. , Shulman Dorothy I. , Sy Judy P. , Blethen Sandra L. , Bercu Barry B. 
Published: December 2021

We analyzed 12-hour serial sampling of growth hormone (GH) levels in two cohorts of short children: 96 children referred to a university endocrine clinic or studied on a research protocol and 825 children in the National Cooperative Growth Study of children treated with exogenous GH.
The mean 12-hour GH levels correlated with growth velocity in 60 children with normal height and growth velocity in the university study, and this correlation was stronger in the boys. The testosterone levels also correlated with growth velocity and mean 12-hour GH levels in the boys. The mean 12-hour GH levels were lower in a group of 36 children with idiopathic short stature than in the control subjects, as were the peak GH levels within 1 hour after the onset of sleep and the insulin-like growth factor I levels.
In the National Cooperative Growth Study cohort, pooled 12-hour GH levels were lower in the group with idiopathic GH deficiency (n = 300) than in the group with idiopathic short stature (n = 525), but the difference was not significant. The duration of GH treatment was the most significant predictor of change in the height SD score in both groups. Indices of spontaneous secretion of GH were not predictive of the response to GH treatment, nor were the results of provocative GH testing, the responses to GH treatment being similar in both groups over time.
We conclude that the results of GH testing must be interpreted for each patient and that several testing modalities may be helpful in finding GH insufficiency that originates at various levels of the somatotropic axis.
Influences on the Receipt of Well-child Visits in the First Two Years of Life
Authors: Freed Gary L. , Clark Sarah J. , Pathman Donald E. , Schectman Robin 
Published: December 2021

Objective.To determine demographic and health care system factors associated with children receiving an adequate number of well-child visits (WCVs).Methods.Information on 4385 children and their families was obtained via birth certificates, parent interviews, chart review of outpatient sites of care, and insurance records.Results.Only 77% of children received at least five WCVs by age 2. In regression analysis, the factors most strongly associated with children's total number of WCVs were delay in the initiation of prenatal care (odds ratio = 0.6) and receipt of all outpatient care in private physician offices (odds ratio = 4.2 to 5.6). Having an adequate number of WCVs was associated with being up to date for immunizations.Conclusions.Children of mothers who delay prenatal care are at high risk for not receiving adequate numbers of WCVs. Recognition of this marker can allow for targeted interventions that aim to ensure that children receive appropriate preventive care.
Children of Substance Abusers: Overview of Research Findings
Authors: Johnson Jeannette L. , Leff Michelle 
Published: December 2021

A relationship between parental substance abuse and subsequent alcohol problems in their children has been documented extensively. Children of alcoholics (COAs) are considered to be at high risk because there is a greater likelihood that they will develop alcoholism compared with a randomly selected child from the same community. COAs and children of other drug-abusing parents are especially vulnerable to the risk for maladaptive behavior because they have combinations of many risk factors present in their lives. The single most potent risk factor is their parent's substance-abusing behavior. This single risk factor can place children of substance abusers at biologic, psychologic, and environmental risk.
Since the turn of the century, many reports have described the deleterious influence of parental alcoholism on their children. A series of studies measured mortality, physiology, and general health in the offspring of alcoholic parents and concluded that when mothers stopped drinking during gestation, their children were healthier. Today, research on COAs can be classified into studies of fetal alcohol syndrome, the transmission of alcoholism, psychobiologic markers of vulnerability, and psychosocial characteristics. Each of these studies hypothesizes that differences between COAs and children of nonalcoholics influence maladaptive behaviors later in life, such as academic failure or alcoholism. This research supports the belief that COAs are at risk for a variety of problems that may include behavioral, psychologic, cognitive, or neuropsychologic deficits.
The vast literature on COAs far outweighs the literature on children of other drug abusers. Relatively little is known about children of heroin addicts, cocaine abusers, or polydrug abusers. Nonetheless, many researchers suggest that the children of addicted parents are at greater risk for later dysfunctional behaviors and that they, too, deserve significant attention to prevent intergenerational transmission of drug abuse. Most research on children of other drug abusers examines fetal exposure to maternal drug abuse.
The overview of the research on children of substance abusers points toward the need for better, longitudinal research in this area. Most studies on COAs or other drug abusers are not longitudinal; they examine behavior at one point in time. Given the studies reviewed in this article, it is unclear whether we see true deficits or developmental delay. Longitudinal studies will allow us to predict when early disorders and behavioral deviations will be transient or when they will be precursors to more severe types of maladaptive behavior. Longitudinal research also will enable us to explain specific childhood outcomes. Differences in outcome could be studied simultaneously to understand whether antecedents discovered for one are specific to it or are general antecedents leading to a broad variety of outcomes.
The Principles and Practice of Evidence-Based Neonatology
Authors: Soll Roger F. , Andruscavage Lisa 
Published: December 2021

Significant strides toward improving the outcome of newborn infants have been observed during the modern era of neonatal-perinatal medicine. One of the challenges that neonatologists and pediatricians face is deciding when to change current practices. New literature is abundant, but it must be critically reviewed and evaluated before changes in practice are made. The evidence-based medicine process can be used to help in changing practices or adopting new practices. It is based on five steps: 1) forming answerable questions; 2) searching for the best evidence; 3) critically appraising the evidence; 4) applying the evidence in practice; and 5) evaluating one's performance.This article reviews the five steps of the evidence-based medicine process. The various levels of evidence, including randomized, controlled trials and systematic reviews, are defined and discussed. An example of a critically appraised topic, a practical tool that can be used as an aid in addressing the first three questions of the evidence-based medicine process, is included. Once the evidence has been evaluated, the decision of whether or not to implement a change in individual practice or in institutional guidelines must be made. These decisions are difficult and require a variety of individual and societal factors to be taken into account.Examples of evidence-based medicine in neonatal and perinatal medicine include the use of antenatal corticosteroids for promotion of lung maturity, the use of surfactant replacement therapy for the treatment and prevention of respiratory distress syndrome, and prophylactic indomethacin for the prevention of intraventricular hemorrhage. Review of these examples provides insight into the strengths and weaknesses of evidence-based medicine.
Characteristics of Families Who Attend Free Vaccine Fairs
Authors: Hambidge Simon J. , Easter Sally A. , Martin Sharon , Melinkovich Paul , Brown Jeffrey , Siegel Carol D. 
Published: December 2021

Objective.To determine the health care resources and perceived barriers to care of families attending free vaccine fairs.Design.A cross-sectional survey.Setting.Twelve free vaccine fairs in Denver, Colorado, in 1994.Participants.A total of 533 consecutive parents or guardians of children receiving vaccine at the fairs.Interventions.None.Measurements/Results.Survey respondents reported that their children received regular health care through a private physician or health maintenance organization (HMO) (47%), a public clinic (20%), or a hospital-based clinic (14%); 18% had no regular site for health care. Twenty-seven percent of the families carried private insurance, although less than half of these plans covered children's vaccines: 9% were enrolled in an HMO or a preferred provider organization and 13% had Medicaid, whereas 50% had no health insurance. Families who received primary care at a private physician's office (OR: 1.7; 95% CI: 1.01–2.7) and those with no regular site for health care (OR: 2.0; 95% CI: 1.01–4.0) were more likely than those who went to a public clinic or hospital clinic to report free vaccine as the most important reason for attending a vaccine fair. Conversely, families who received well-child care at a hospital clinic were more likely to identify no appointment needed as the most important reason (OR: 2.7; 95% CI: 1.4–5.1). Families with private health insurance (OR: 2.3; 95% CI: 1.05–4.0) or no health insurance (OR: 2.3; 95% CI: 1.1–4.6) were more likely to identify free vaccine as the most important reason for attending a vaccine fair, whereas those enrolled in an HMO or preferred provider organization identified convenient time as the most important reason (OR: 3.2; 95% CI: 1.2–8.3). Families with Medicaid (OR: 3.2; 95% CI: 1.3–8.3) or with no insurance (OR: 2.1; 95% CI: 1.02–4.6) were more likely than were those with private insurance to identify no appointment needed as the most important reason for attending a vaccine fair.Conclusions.Most families attending free vaccine fairs have a regular source of health care. For families with private health insurance or with no health insurance, the availability of free vaccine is the major reason to bring their children to a vaccine fair, whereas for families whose insurance routinely covers the cost of childhood vaccine (HMO, Medicaid), convenience is the major determinant.
Structured Clinical Observations: A Method to Teach Clinical Skills With Limited Time and Financial Resources
Authors: Lane J. Lindsey , Gottlieb Ruth P. 
Published: December 2021

Objective.To develop and implement a methodology to teach clinical skills to medical students in busy clinical settings.Methods.The Structured Clinical Observation (SCO) program with guidelines and observation sheets for history-taking, physical examination, and information-giving skills was created. Faculty development preceded SCO implementation for pediatric clerkship students at Jefferson Children's Health Center. SCO observation sheets were tabulated and faculty and student questionnaires were administered.Results.The mean number of observations per student was 6, with 368 observations done for 63 students. SCOs were highly rated as an educational tool by faculty and students. The impact of the SCO program on faculty ability to perform clinical duties was initially minimal, but increased over the year. Observations were used primarily for feedback, but did influence outpatient clinical faculty's evaluation of two thirds of the students. Only 50% of students reported being observed in other rotations.Conclusions.SCOs are a feasible, inexpensive, qualitatively effective method of teaching clinical skills. The quantitative effect of SCOs on performance needs to be evaluated.
COMPARATIVE STUDY OF CANINE DISTEMPER AND A RESPIRATORY DISEASE OF MAN
Authors: ADAMS JOHN M. 
Published: December 2021

Clinical, epidemiologic, pathologic and serologic evidence has been presented which indicates a possible relationship of canine distemper and a respiratory disease of human beings.
Neutralization of distemper viral infection in ferrets has been accomplished experimentally; infection caused by this virus in living chick-embryos has been neutralized by human sera and by human gamma globulin. Both in vivo and in vitro methods were employed in these experiments.
Inclusion bodies are shown with the same morphologic and staining characteristics as well as similar tissue reactions to infection. The striking features of these changes are the proliferation and destruction of pulmonary lining epithelium, giant cell formation, and a predominant mononuclear reaction in the animal and human sections.
A review of the literature on a possible relationship between canine distemper and human illness has been presented. The former disease is now proved to be due to a specific virus.
PATTERN OF GROWTH OF SELECTED GROUPS OF BREAST-FED INFANTS IN IOWA CITY
Authors: PAIVA SILVIO L. 
Published: December 2021

The data of measurements of 21 male and 24 female breast-fed infants from birth to 6 to 7 months of age are presented. The infants were born of well fed mothers, coming from families of better than average income and intelligence.
The pattern of growth of these infants is compared with that of a larger group, the majority of whom were artificially fed infants of the same socio-economic status.
It is concluded that the pattern of growth of the breast-fed infants does not differ significantly from that of artificially fed infants of the same socio-economic group.