bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlations Between Appointment Keeping and Reorganization of Hospital Ambulatory Pediatric Services
Authors: Pearce Tola , O'Shea John S. , Wessen Albert F. 
Published: December 2021

Over a period of 13 months before and after a university-affiliated hospital's daytime ambulatory pediatric facility was upgraded from an episodic care clinic to a primary care unit, 260 subjects were interviewed in an attempt to predict compliance with return appointment scheduling. The parents of patients more than 10 years of age were the least compliant, but most of the differences in compliance appeared due to the subject's evaluation of the diagnostic ability, thoroughness, and sympathy of the physician at the initial visit. Although no changes were noted in the subjects' demographic characteristics or in their general opinions of ambulatory health care delivery or of attitudes desired of physicians, their evaluations of recent visits improved and the missed appointment rate declined by 46% in the course of the study. Moreover, the pediatric house officers, who evaluated the patients, demonstrated an increased ability to assess the characteristics the subjects found important in physicians.
Improvements are still needed, especially in the amount of communication between house officers, patients, and parents, but heeding clients' opinions about the provision of primary health care may help to make missed appointment rates negligible.
Metabolic Alkalosis in Infants with Cystic Fibrosis
Authors: Beckerman Robert C. 
Published: December 2021

Since submission of the article, "Hypoelectrolytemia and metabolic alkalosis in infants with cystic fibrosis," and, during the first eight months of academic practice, I have diagnosed six cystic fibrosis infants under 1 year of age, four of whom had documented episodes of hypoelectrolytemia and severe metabolic alkalosis. The data are included in the Table.
Cases 1 and 2 had recurrent episodes of metabolic alkalosis before the diagnosis of cystic fibrosis was made. Cases 2 and 4 are black infants, in whom the diagnosis of cystic fibrosis would not have been suspected, had not the association between cystic fibrosis and metabolic alkalosis of infancy been recognized.
Value of the Neonatal Neurologic Examination
Authors: Volpe Joseph J. 
Published: December 2021

The value of performing a careful neonatal neurologic examination frequently is questioned on the basis of two major contentions. The first is that the usual examination evaluates only function of subcortical structures, and the second, related in large part to the first, is that abnormal neurologic findings are poor indicators of subsequent neurologic abnormality. We consider neither of these contentions to be supported by available data and discuss each briefly below.
The usual support raised for the contention that the neonatal neurologic examination evaluates only function of subcortical structures relates to findings with hydranencephalic and anencephalic infants. Such infants often exhibit sleep-wake cycles, blink to light and sound, normal pupillary responses, and reflex extraocular movements.1,2
Legionnaires' Disease in a Child with Cancer
Authors: Ryan Michael E. , Feldman Sandor , Pruitt Bonnie , Fraser David W. 
Published: December 2021

Although Legionnaires' disease has only recently been recognized as a distinct clinical entity, serologic surveys of localized outbreaks of respiratory illnesses have indicated that its geographic distribution is wide.1-5 Most cases have occurred in clusters, but reports of sporadic cases are increasing.6 The disease appears to be most prevalent among elderly persons or adults undergoing immunosuppressive therapy; it has seldom been documented in children.1,7,8 We report a previously undetected case of Legionnaires' disease in a child with acute lymphocytic leukemia in remission.
MATERIALS AND METHODS
To determine whether Legionnaires' disease had occurred in a childhood cancer population with pneumonia, we reviewed the records of patients between 1 and 18 years of age for whom percutaneous transthoracic lung aspirates had been obtained between April 1970 and December 1977.
X-Rated Playgrounds?
Authors: Sweeney Theodora Briggs 
Published: December 2021

Safeguarding the primacy of the person in a technologic society will probably always be a challenge, especially in relation to its weaker members. Despite sincere efforts to anticipate and avoid it, chances are that a "humanization lag" will continue to exist between our devices and the modifications that make it possible to live comfortably with them. From aerosols to zeppelins, improvements are made in response to a felt human need.
Whether because children can't vote or because adults tend to view anything remembered from their own childhoods as sacrosanct, playgrounds and the equipment installed on them have for too long gone unexamined in terms of their suitability for human use.
The Right Not To Read Controversy
Authors: Lieberman Allan D. 
Published: December 2021

"The Right Not To Read" (Pediatrics 63:791, 1979) does a great disservice to the majority of pediatricians who do not have special training in the understanding and care of the academically underachieving child. I was surprised that the Editorial Board would accept for publication such a negative and misleading article.
One doesn't have a "right" to be sick and handicapped. One accepts a handicap, trying to get help to correct it or compensate for it.
Dyslexia: It's Real
Authors: Cobrinik Ralph 
Published: December 2021

Dr Levine's commentary1 is a disservice to children with dyslexia. While there are other reasons for learning problems, as he points out, many children suffer from this specific entity. It is of more than academic interest that dyslexia finally be recognized and accepted; failure to do so will serve to perpetuate the voo-doo "diagnoses" and "therapy" so many of these children are subjected to.
My definition,2 "A dyslexic child is one in whom there are no or almost no signs of neurological, intellectual, environmental, or primary psychological pathology, who has had adequate pedagogic exposure, and still is unable to read or spell with the same degree of success that he experiences in other areas," defines a large specific group of children who deserve to have their problems specifically addressed.
Valproate in Nonketotic Hyperglycinemia
Authors: MacDermot Kaye , Nelson William , Weinberg Joseph A. , Schulman Joseph D. 
Published: December 2021

Severe intractable seizures are frequent manifestations of nonketotic hyperglycinemia. Because levels of urinary and plasma glycine have been reported to be elevated by valproate in patients with seizures but no evidence of hereditary hyperglycinemia,1,2 it has been assumed that the agent is contraindicated for the therapy of convulsive states associated wtih nonketotic hyperglycinemia. This conclusion was recently stated, for example, at an international congress on human genetics.3
We regard this assumption as unwarranted. We have administered valproate to two nonketotic hyperglycinemic patients and monitored glycine levels in their cerebrospinal fluid. It is the elevated CSF glycine which has been postulated to result in the encephalopathy in nonketotic hyperglycinemia.4
Infant Automobile Restraint Systems: Beware of the Sun
Authors: Hankin Fred , Vermeulen Fred 
Published: December 2021

The use of infant safety seats in automobiles has become a standard recommendation of physicians, insurance companies, and various organizations. The efficacy of these devices in the prevention of serious motor vehicle trauma is well recognized.1-7 We report an adverse incident involving such a restraining device.
CASE REPORT
J.R. is a 12-week-old white female infant who was secured in such a restrainer seat in the recommended manner. The day of admission was an unusually sunny spring afternoon and the child was wearing only a T-shirt and a diaper. Persistent crying by the child for 15 minutes led to the discovery of a blister 3 cm in diameter on the exposed portion of the patient's anterior right thigh (Figure).
The Puzzling Epidemiology of Neural Tube Defects
Authors: Mortimer Edward A. 
Published: December 2021

Elucidating the cause of disease is often not easy and may require answers to many questions. Perhaps the most important questions have been rather simply stated in verse by Rudyard Kipling.1
I keep six honest serving men;
(They taught me all I knew)
Their names are What and Why and When and How and Where and Who.
In terms of neural tube defects, many of these servants of Mr Kipling have provided valuable epidemiologic clues as to the cause of neural tube defects (NTDs),2 but the specific mechanism responsible for this disabling birth defect has so far escaped definition.
Marijuana
Authors: Segal Sydney , Anyan Walter R. , Hill Reba M. , Kauffman Ralph E. , Mofenson Howard , Pruitt Albert W. , Shinefield Henry R. , Singer Harvey S. , Weinberger Miles M. , Ballin John C. , Catz Charlotte , Farchione Louis , Freeman Martha M. , Herrmann Arthur P. , Licata Sam A. , Oakley Godfrey , Sawchuk Steven , Schneider Jack M. , Soyka Lester F. 
Published: December 2021

In 1971 and 1975, the Committee on Drugs provided information about marijuana for the Academy membership.1,2 Since that time, marijuana use by children and adolescents has continued to increase. Investigations of the biologic effects of the agent have expanded, and there is justification for concern about frequent, chronic use by youth. In addition, marijuana use and experimentation with other drugs are now being promoted to children in subtle and insidious ways which need to be identified (Figs 1 to 5).
Pediatricians should be aware of the changing pattern of marijuana use in this country. Whereas occasional use by an adult may have little health consequence for the individual, frequent use by large numbers of children and adolescents raises different concerns. The National Institute on Drug Abuse (NIDA) conducts annual surveys of marijuana use in this country and reported in a recent publication3 that 10% of all high school seniors smoke marijuana daily. In the 12- to 17-year old group, 16% of those surveyed in 1977 used marijuana in the month preceding the survey. Even if the incidence figures are not entirely accurate, an increase in use by these two groups from 1976 to 1977, as determined by similar annual sampling techniques, is clear. Nationwide data since 1977 are not yet available, but in two states surveyed in 1978, 16% of high school seniors smoked marijuana daily (R. C. Peterson, PhD, personal communication, 1979). This information supports the conclusion that use in youth had increased each year since 1975. Extrapolation of additional data collected by NIDA revealed that in 1977 about 16 million Americans were current users of marijuana (ie, used the drug during the month preceding the survey).3
The Gynecologic Examination of the Prepubertal Child with Vulvovaginitis: Use of the Knee-Chest Position
Authors: Emans S. Jean , Goldstein D. P. 
Published: December 2021

Vulvovaginitis is a common complaint in the prepubertal child. The proximity of the vagina to the anus and the thin uncornified vaginal epithelium make the young child especially susceptible to vulvovaginal infection. Not only is hygiene often suboptimal in this age group, but pinworm infestations, bubblebaths, harsh soaps, and tight-fitting nylon tights can all contribute to the vulvar irritation. Because children are frequently sent to gynecologists, traumatized by a rectal examination as the first part of the evaluation, or sent for an x-ray of the vagina with the hope of excluding a radiopaque foreign body, we believed it would be useful to present our approach to the gynecologic evaluation of the prepubertal child in which the kneechest position is used for visualizing the vagina.
METHODS
The evaluation of a prepubertal child with vulvovaginitis in the Gynecology Clinic of Children's Hospital is done in the following order: (1) history; (2) inspection of the perineum with the child supine; (3) visualization of the vagina and cervix in kneechest position; (4) cultures; and (5) a rectal examination in girls with vaginal bleeding or abdominal pain.
The knee-chest position (Figure) provides a particularly good view of the vagina and cervix without instrumentation. The little girl is asked "to lie on her tummy with her bottom in the air." She is reassured that the examiner plans "to take a look" but "will not put anything inside her." The child rests her head to one side on folded arms and supports her remaining weight on bended knees (6 to 8 in apart).
Moderation, the Noblest Gift of Heaven
Authors: Barness Lewis A. 
Published: December 2021

Improving the outcome of pregnancy is a long sought goal of perinatologists. Observations that starvation during pregnancy could lead to disturbances in newborns, and in some cases to low birth weight infants, particularly if starvation occurrred late in the pregnancy, led to studies of food supplementation of pregnant women.
One of the most carefully designed studies is that of Rush and co-workers,1 part of which is described in this journal. They found that supplementing the diet of the pregnant woman, particularly with protein but also with calories, resulted in increased fetal wastage and few if any good effects. There was apparently a neutralization of some deleterious effects of smoking, an effect also recently observed in obese gravidas.2
Prenatal Nutritional Supplementation
Authors: Hegsted D. Mark 
Published: December 2021

My first reaction to this report (pp 683 to 697) is that something must be wrong and I assume many others will react the same way. If feeding pregnant women has an unfavorable effect upon the outcome of pregnancy we are really in a bad way! We need to examine possible reasons for this unanticipated result. I will comment on several of these.
First, the effect observed is small and if the distribution of four or five of the 823 outcomes of pregnancy had been different or distributed differently among the three groups, there would not be much to discuss or question.
Swimming Instructions for Infants
Authors: Flynn Thomas G. , Kennell John H. , McLeod Robert N. , Shaffer Thomas E. , Strong William B. , Thornton Melvin L. , Van Rooy Clemens W. , Burkett Lucille , Malacrea Richard , Wilkins Kaye E. 
Published: December 2021

Children less than 3 years old are most vulnerable to drowning, and organized efforts to reduce the toll are indicated.
Heretofore, swimming instruction has concentration on school-aged children, but in recent years some emphasis has been placed on teaching younger children to swim, even during the first year of life. Although it may be possible to teach young infants to propel themselves and keep their heads above water, infants cannot be expected to learn the elements of water safety or to react appropriately in emergencies. No young child, particularly those who are preschool aged, can ever be considered "water safe." Parents may develop a false sense of security if they feel their young child can "swim" a few strokes.
Additional problems may be associated with admission of infants to public swimming pools. Incontinent infants pose an aesthetic problem and make it difficult to maintain the effectiveness of chlorination.
The Committee recognizes the increasing populaity of swimming programs for infants and the enjoyment of the parent and child in this shared activity, and makes the following recommendations:
1. If a parent wishes to enroll his/her infant in a water adjustment and swimming program, it should be on a one-to-one basis with the parent or a responsible adult. Organized group swimming instruction should be reserved for children more than 3 years old.
2. Instruction should be carried out by trained instructors in properly maintained pools.
3. Infants with known medical problems should receive clearance from their physician.
4. Controlled studies clarifying the possible risks to infants from swimming programs should be carried out as soon as possible.
Human Milk Banking
Authors: Barness Lewis A. , Dallman Peter R. , Anderson Homer , Collipp Platon Jack , Nichols Buford L. , Walker W. Allan , Woodruff Calvin W. 
Published: December 2021

The experience of Finnish workers, as well as that of others, shows that the banking of heattreated and frozen human milk is a practical and safe means of feeding low-birth-weight newborn infants. The continuous and exclusive use of human milk is associated with a low incidence of infection and with a rate of survival which is among the highest reported.4 The rate of growth and weight gain is also considered satisfactory, although there is some controversy about whether weight gain is quite as rapid as in formula-fed infants.28 Long-term studies should be carried out to see if these infants grow and develop as well, or better than, those on formula feedings.
It is still uncertain whether banked human milk will prove sufficiently superior to formula with respect to its nutritional and immunologic characteristics to compensate for the difficulties of maintaining bacteriologic control and to warrant the cost of setting up and running a milk bank for premature infants. At this time, the Committee considers it optimal for mothers of low-birth-weight newborn infants to collect their milk for feeding their own infants fresh milk.29 Once home, the mothers can freeze the expressed milk and organize for transportation of samples on a regular basis. However, since this procedure will be impossible or impractical for many infants, bacteriologically safe milk from a donor seems a reasonable alternative for these infants.
Neonatal Hyperammonemia
Authors: Tollefsen Sherida E. , McCabe Edward R. B. , Goodman Stephen I. 
Published: December 2021

Goldberg et al1 described 12 infants with hyperammonemia in association with severe perinatal asphyxia, characterized by low Apgar scores and prolonged resuscitation, in premature, term, and postmature neonates. Ballard and colleagues2 reported five preterm infants with transient hyperammonemia and respiratory distress. We wish to summarize briefly the course of an infant who exhibited transient hyperammonemia without evidence of perinatal asphyxia or primary respiratory distress.
This 2,520-gm female infant was the product of an uncomplicated pregnancy in a 21-year-old primigravida.
A Restraint and Transillumination Device for Neonatal Arterial/Venipuncture: Efficacy and Thermal Safety
Authors: Curran John S. , Ruge Walter 
Published: December 2021

A different method of restraint together with technical details for construction demonstrating the use of reflected high intensity fiberoptic light is presented. Thermal data are presented demonstrating safety within recognized biologic skin temperature safety which permits utilization of a high intensity
See Images in the PDF File
light source for arterial or venous cannulation for prolonged periods of time extending to 20 minutes. This device presents a method to demonstrate visualization of blood vessels in the infant's extremity without risk of thermal burn associated with an adequate flexible restraint quick-release mechanism. Disposable polyurethane 5-mm pads (cut from sheets) were utilized to minimize pressure on bony prominences or nerves of the extremity. Neither thermal burns nor pressure alterations have been noted. Although not specifically evaluated, the use of a heat filter and CS-2-73 orange filter might further reduce heat buildup while using this device.
Value of the Neonatal Neurologic Examination?
Authors: Knight Philip 
Published: December 2021

The recent commentary on the "Value of the Neonatal Neurologic Examination" made two points: the logic examination of the newborn can evaluate cortical areas of the brain, and abnormal neurologic
See Images in the PDF File
examination of the newborn can evaluate cortical areas of the brain, and abnormal neurologic findings in the newborn can be good indicators of subsequent neurologic abnormalities.1 The data used to substantiate the latter contention came from the Collaborative Study for Cerebral Palsy carried out on 54,000 pregnant women between 1959 and 1966.2
Congenital Adrenal Hyperplasia Presenting with Posterior Labial Fusion Without Clitoromegaly
Authors: Marshall William N. , Lightner Elmer S. 
Published: December 2021

In females with congenital adrenal hyperplasia, 21-hydroxylase deficiency without salt loss is usually recognized in the neonate because of ambiguous genitalia (ie, clitoromegaly with or without labial fusion), or at a later age because of progressive virilization and/or accelerated linear growth. We are reporting the second case of posterior labial fusion without clitoromegaly as the presenting sign of congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Here, as in the prior case of Wolff et al,1 the absence of clitoromegaly postponed recognition of the patient's problem.
CASE REPORT
C.V. was born at term to a 25-year old, gravida 2, para 1, Mexican-American woman after a normal pregnancy; only vitamins were taken during the pregnancy.
More Contraindications to the Pill
Authors: Realini Janet P. 
Published: December 2021

I read with interest the excellent review by Drs Greydanus and McAnarney.1 Several of their points concerning combined oral contraceptives deserve discussion, however.
The relative potencies of the progestins and estrogens contained in oral contraceptives are controversial. Progestin potency is difficult to measure reliably, and comparisons among progestins can be misleading.2 While animal studies have suggested that mestranol is a weaker estrogen than ethinyl estradiol, a study of human ovulation inhibition suggested that ethinyl estradiol may be weaker than mestranol.3
Varicella Arthritis
Authors: Borgenicht Louis 
Published: December 2021

Varicella arthritis is a rare and usually self-resolving complication of chickenpox. The reports in the literature are few and far between.13 I have had the opportunity to observe a case of what I believe to have been varicella arthritis in my practice.
On June 26, 1978 a 5-year-old boy was seen with chickenpox. Four days earlier he had broken out with a typical varicella exanthem. One day earlier he had tripped, striking his left knee, but sustaining no major injury at the time. Over the next 24 hours the patient started to complain of progressive pain in his knee and on the morning he was seen, he was unable to bear weight on it.
ROBERT BURTON ON MATERNAL IMPRESSIONS (1621)
Authors: C. T. E. 
Published: December 2021

Robert Burton (1577-1640), author of the Anatomy of Melancholy (1621), one of the two books favored above all others by Sir William Osler, has ironically become one of the great entertainments among English writings. The irony, however, is accidental, because Burton, a joyful pessimist, wrote what has been called "undeniably one of the oddest, wittiest, and most learned books in English literature."1
Osler described the Anatomy as "the greatest medical treatise written by a layman."2 An example of Burton's views on the importance of maternal impressions, which would have been thoroughly approved of by the learned physicians of his day, follows:3
If she be over-dull, heavy, angry, peevish, discontented and melancholy, not only at the time of conception, but even all the while she carries the child in her womb, her son will be so likewise affected, and worse, as Lemnius adds, if she grieve over much, be disquieted, or by any casualty be affrighted and terrified by some fearful object heard or seen, she endangers her child, and spoils the temperature [temperament] of it; for the strange imagination of a woman works effectually upon her infant, that...she leaves a mark upon it, which is most especially seen in such as prodigiously long for such and such meats; the child will love those meats... and be addicted to like humours. If a great-bellied woman see a hare, her child will often have an hare-lip, as we call it. Garcaeus hath a memorable example of one Thomas Nichell, born in the city of Brandenburg, 1551, "that went reeling and staggering all the days of his life, as if he would fall to the ground, because his mother being great with child saw a drunken man reeling in the street."