bluuebunny/crossref_metadata_2025_split huggingface dataset:
Metabolic Aspects of Myocardial Disease and a Role forl-Carnitine in the Treatment of Childhood Cardiomyopathy
Authors: Helton Edward , Darragh Robert , Francis Paul , Fricker F. Jay , Jue Kenneth , Koch Gary , Mair Douglas , Pierpont Mary Ella , Prochazka James V. , Linn Lawrence S. , Winter Susan C. 
Published: December 2021

Objectives.A multicenter retrospective study was conducted to investigate the possible metabolic causes of pediatric cardiomyopathy and evaluate the outcome of patients treated with l-carnitine.Methods.Seventy-six patients diagnosed with cardiomyopathy were treated with l-carnitine in addition to conventional cardiac treatment, and 145 patients were treated with conventional treatment only. There were 101 males and 120 females between 1 day and 18 years old. Cardiomyopathy diagnoses included dilated (148 patients), hypertrophic (42 patients), restrictive (16 patients), mixed diagnosis (11 patients), and 4 with an unknown type. Of 76 l-carnitine-treated patients, 29 (38%) had evidence to suggest a disorder of metabolism, and of 145 control patients, 15 (10%) were suspected to have a disorder of metabolism. These metabolic disorders were thought to be the cause for the cardiomyopathy of the patients. The duration of l-carnitine treatment ranged from 2 weeks to &gt;1 year. Information was collected on length of survival (time-to-event), clinical outcome, echocardiogram parameters, and clinical assessments. Data were collected at intervals from baseline to study endpoint, death, transplant, or last known follow-up visit.Results.l-Carnitine-treated patients were younger than control patients and had poorer clinical functioning at baseline, yet they demonstrated lower mortality and a level of clinical functioning and clinical severity comparable to control patients on conventional therapy by the end of the study. An analysis of the interaction between clinical outcome and concomitant medications unexpectedly revealed that the population of patients treated with angiotensin-converting enzyme (ACE) inhibitors (40% of patients) had significantly poorer survival (although their greater likelihood for poor survival may possibly have made them more likely to receive ACE inhibitors).Conclusion.Results suggest that l-carnitine provides clinical benefit in treating pediatric cardiomyopathy. There is a need for further exploration of potential explanatory factors for the higher mortality observed in the population of patients treated with ACE inhibitors.
The Health Profile of Incarcerated Male Youths
Authors: Forrest Christopher B. , Tambor Ellen , Riley Anne W. , Ensminger Margaret E. , Starfield Barbara 
Published: December 2021

Objective.
To identify the health needs of adolescent males incarcerated in a juvenile justice facility and to compare their health profiles with those of male adolescents in the community.

Methods.
Cross-sectional surveys were conducted of incarcerated (N = 202) and school (N = 379) samples of male youths. Questionnaires were self-administered and completed before admission health screens (incarcerated youth) or in classrooms (school sample). Health status was assessed by the Child Health and Illness Profile, Adolescent Edition, using scale and item means and by categorizing each youth's pattern of health into 1 of 13 mutually exclusive health profile types.

Results.
Compared with school counterparts, incarcerated male youths had significantly worse health status as demonstrated by poorer health and functioning scores in perceived well being, self-esteem, physical discomfort, acute, chronic, and psychosocial disorders, family involvement, physical activity, interpersonal problem-solving, risk behaviors, and academic performance. Three profile types—High Risks, High Risks/Low Resilience, and Worst Health—accounted for patterns of health for 69.8% of incarcerated youth versus 37.3% of an age-matched school sample. Just 6.4% of incarcerated males were in the Excellent/Good Health profile types, which contrasted with 34.2% of the age-matched school sample.

Conclusions.
The health profiles of incarcerated male youths were worse than those of male youths in school. Our results indicate that rehabilitation programs will need to address incarcerated youth's basic health needs as well as modifying their risk and antisocial behaviors.
Exploring Barriers to Utilization of Poison Centers: A Qualitative Study of Mothers Attending an Urban Women, Infants, and Children (WIC) Clinic
Authors: Kelly Nancy R. , Groff Janet Y. 
Published: December 2021

Objective.
Prior research regarding poison center utilization identified risk factors for underutilization including race/ethnicity and acculturation. The purpose of this study was to understand factors contributing to underutilization of poison centers by low-income and minority mothers.

Methods.
Focus groups were conducted with women attending an urban Women, Infants and Children clinic. Transcripts were analyzed for themes and key points.

Results.
Twenty-two English-speaking mothers and 21 Spanish-speaking mothers participated in 7 groups. Participants viewed poisoning as a serious problem to which all children are susceptible. English-speaking mothers had heard of the poison center but were unaware of services provided. They preferred to use the 911 system, which was viewed as immediate medical assistance and was an easy number to remember. Women questioned the credentials of the poison center staff. Spanish-speaking mothers had limited knowledge of poison centers and were concerned about language barriers.

Conclusions.
To increase utilization of poison centers, educational interventions must address these specific needs and misconceptions and should be produced in Spanish and English versions.
Variation in Hospital Discharges for Ambulatory Care-Sensitive Conditions Among Children
Authors: Parker Jennifer D. , Schoendorf Kenneth C. 
Published: December 2021

Objective.
Ambulatory Care-Sensitive Conditions (ACSCs), conditions for which ambulatory care may reduce, though not eliminate, the need for hospital admission, have been used as an index of adequate primary care. However, few studies of ACSC have focused on children. We estimated national hospitalization rates for ACSC among children and examined the behavior of the index between subgroups of children.

Methods.
We used data from the 1990–1995 National Hospital Discharge Surveys (NHDS), the US census, and the National Health Interview Survey (NHIS) to calculate hospital discharge rates. Rates were estimated as the number of condition-specific hospital discharges from the NHDS divided by the population at risk, as estimated from the US census and NHIS.

Results.
Predictably, ACSC hospitalization rates were significantly higher among children who were younger, black, had Medicaid insurance, and lived in poorer areas compared with their counterparts. However, the relationship between ACSCs and income and the distributions of conditions within the index varied significantly between children.

Conclusions.
ACSCs may indicate disparities in access and utilization of health care, however, the differing behavior of the index between subgroups suggests that inferences from examining rates of ACSCs may not be comparable for all children.ambulatory care-sensitive conditions, hospitalization rates.
IDIOPATHIC CELIAC DISEASE
Authors: DI SANT'AGNESE PAUL A. 
Published: December 2021

The mortality and course of the illness of 58 patients with celiac disease, previously reported, are described. Three patients died; the remaining 55 went on to clinical recovery. The greatest clinical gains were made by these cases in the 6 to 24 months following initiation of treatment, but the abnormal character of the stools persisted for months or years. Relapses were not uncommon during the early years of improvement following upper respiratory infections or dietary indiscretions.
The results of the follow-up study of 23 patients, 3 to 11 years after the original admission to Babies Hospital, are reported. It was found that despite remission of clinical symptoms, many abnormal laboratory and roentgenographic findings persisted (termed "latent phase of celiac disease"). It is reasonable to expect that some patients who have had severe celiac disease during infancy or early childhood may experience a recurrence of gastrointestinal symptoms in adult life.
Interpretation of Traumatic Lumbar Punctures: Who Can Go Home?
Authors: Mazor Suzan S. , McNulty Jennifer E. , Roosevelt Genie E. 
Published: December 2021

Objective. To determine whether a ratio of observed to predicted (O:P) cerebrospinal fluid (CSF) white blood cells (WBCs) after a traumatic lumbar puncture (LP) can be used to predict which patients do not have meningitis and can safely be discharged from the hospital.
Methods. A retrospective medical record review was performed on 2 cohorts of previously healthy children who had received an LP at Children’s Memorial Hospital in Chicago, IL. All children were older than 1 month and had a red blood cell (RBC) count in the CSF &gt;500/mm3. Cohort 1 consisted of children who were examined in 1990 through 1999 and had CSF cultures positive for a bacterial pathogen. Cohort 2 consisted of children who were tested during January through December 1999 and had a CSF culture negative for any bacterial pathogen. Exclusion criteria included patients who received antibiotics within 72 hours before evaluation, patients with a previous neurosurgical procedure or CNS bleed, and patients whose complete blood count was not done within 6 hours of LP. The predicted CSF WBC count was calculated using the formula CSF WBC (predicted) = CSF RBC × (blood WBC/blood RBC). The O:P ratio was obtained by dividing the observed CSF WBC by the predicted CSF WBC. The simple ratio of WBCs to RBCs was also calculated. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated to predict the absence of disease. Receiver operator characteristic curves were generated for the O:P ratio and the WBC:RBC ratio. Continuous variables were analyzed with Mann-Whitney U test.
Results. Among the 57 patients who fit all of the study criteria, 12 (21%) had positive CSF cultures for bacterial pathogens. The patients with meningitis were significantly older (median: 7.8 months; range: 1–106 months) than the patients without meningitis (median: 1.3 months; range: 1–139 months). The O:P ratio was significantly lower in the patients without meningitis (median: 0.064; range: 0.000054–1.09) as compared with patients with meningitis (median: 1.26; range: 0.045–4.72). The WBC:RBC ratio was significantly lower in the patients without meningitis (median: 0.001; range: 0–4.46) as compared with patients with meningitis (median: 1.98; range: 0.04–24.45). The specificity and positive predictive value of an O:P ratio ≤0.01 and a WBC:RBC ratio ≤1:100 were 100% predicting the absence of disease. The area under the curve for the O:P ratio (0.981) did not differ significantly from the area under the curve for the WBC:RBC ratio (0.970).
Conclusion. A WBC:RBC ratio of ≤1:100 (0.01) and an O:P ratio of ≤0.01 identified a large group of patients without meningitis. Using these methods in children younger than 1 month, the majority of patients without meningitis can be differentiated from those with meningitis despite the CSF abnormalities associated with a traumatic LP. However, the clinician should examine all clinical and laboratory information before opting not to treat a child after a traumatic LP.
Using Organizational Assessment Surveys for Improvement in Neonatal Intensive Care
Authors: Baker G. Ross , King Hannah , MacDonald Jeanne L. , Horbar Jeffrey D. 
Published: December 2021

Background. Problems with organizational culture, lack of or poor team communications, and conflict are often seen as barriers to improvement efforts.
Methods. A survey measuring aspects of organizational culture was administered twice to staff in neonatal intensive care units participating in the Neonatal Intensive Care Unit Quality Improvement Collaborative Year 2000 collaborative. The surveys provided comparative data on coordination, teamwork and leadership, conflict management, unit leadership and unit culture. These data were summarized and fed back to NICU teams with guidance on their use. Interviews on the use of the survey were held with 12 medical directors and patient care leaders in 9 different NICUs.
Results. The findings indicated that all the units contacted saw themselves as committed to undertaking the organizational survey and using the results. Some units shared the data widely and initiated changes. Other units limited the distribution of data to the unit leadership. There was no apparent relationship between scores on the survey and activities undertaken. Several respondents credited the survey with helping to promote discussions about organizational and team issues.
Conclusions. Future use of the survey should include additional materials to assist in disseminating the results to staff.
Evaluation and Development of Potentially Better Practices to Prevent Chronic Lung Disease and Reduce Lung Injury in Neonates
Authors: Sharek Paul J. , Baker Robin , Litman Fern , Kaempf Joseph , Burch Kelly , Schwarz Edward , Sun Shyan , Payne Nathaniel R. 
Published: December 2021

Objective. Despite increased knowledge and improving technology, chronic lung disease (CLD) rates in extremely low birth weight infants have remained constant for 20 years. One reason for this is an ineffective translation of research-proven improvements into practice. The Neonatal Intensive Care Quality Improvement Collaborative Year 2000 (NIC/Q 2000) was created to provide participating nurseries the tools necessary to effect change. The objective of this study was to develop and implement a process that uses quality improvement techniques to collaboratively improve CLD rates.Methods. Nine member hospitals of the NIC/Q 2000 collaborative formed a focus group aiming to decrease CLD rates. The focus group established goals and outcome measures, created a list of potentially better practices (PBPs) based on available literature, benchmarked and performed site visits, encouraged individual site implementation of PBPs, developed a database, and measured outcomes.Results. The goal “decrease CLD rates in extremely low birth weight infants” was established. Nine PBPs were identified, and 57 PBPs were implemented by the 9 participating sites. Twelve site visits were conducted, and a 435-patient database of infants with a mean birth weight of 789 g was established.Conclusions. Collaborative use of quality improvement techniques resulted in creation of a logical, efficient, and effective process to improve CLD rates. Group creation of PBPs, based on literature review and reinforced with site visits, internal data analysis, and improved individual site outcomes, resulted in accelerated and effective change, unlikely to occur if attempted outside of the collaborative.
Implementing Potentially Better Practices for Multidisciplinary Team Building: Creating a Neonatal Intensive Care Unit Culture of Collaboration
Authors: Brown Mark S. , Ohlinger Judy , Rusk Connie , Delmore Paula , Ittmann Patricia ,   on Behalf of the CARE Group
Published: December 2021

Objective. Part of the process of deriving and refining the CARE (communication, accountability, respect, empowerment) focus group’s potentially better practices (PBPs) for multidisciplinary teamwork was to evaluate and experience the PBPs through implementation.Methods. The 4 neonatal intensive care units (NICUs) in the CARE focus group each worked with implementation of the PBPs. The choice of initial PBP and method of implementation was left up to each NICU’s core team.Results. The experience of each of the PBPs that is reported was selected from only 1 of the NICUs. These are summarized and described in a plan-do-study-act type of format.Conclusions. There was no ideal PBP with which to start. The intertwined nature of all of the PBPs provided additional opportunities to implement other PBPs. A change seemed to be a matter first of vocabulary, then of tentative acceptance, followed by gradual integration into the culture. Change was facilitated when there was acknowledgment of a need to do things differently by the NICU leadership. Although the validity of the PBPs and their importance in cultural change have yet to be confirmed, once there was a persisting intent to change, the makeup of the NICU culture moved to embrace change as part of its culture.
SOME EFFECTS OF EXOGENOUS THYROID OR THYROXIN UPON PREMATURE INFANTS
Authors: STEVENSON STUART S. , WIRTH PATRICIA , BASTIANI RITA , DANOWSKI T. S. 
Published: December 2021

Forty-eight premature infants, whose condition seemed satisfactory at one week of age and whose weights approximated 1500 gm., were selected for this study. Even-numbered infants in the series were given daily doses of desiccated thyroid or thyroxin for periods averaging 3½ weeks; odd-numbered infants were given placebos of lactose according to the same schedule. The clinical progress of the infants was noted and weekly red cell counts, hemoglobin and serum protein-bound iodine levels were determined.
1. Daily doses of 60 to 120 mg. thyroid produced no significant effects upon clinical condition and progress or upon the protein-bound iodine level.
2. Daily doses of thyroid 180 mg. or thyroxin 0.2 mg. did not affect the caloric and fluid intake, the gavage incidence, the amount of vomiting, the skin color or the body temperature. Such dosage, however, decreased the weight gain, increased the pulse rate and increased the incidence of diarrhea. A higher percentage of infants so treated required blood transfusions and did not fare so well clinically. The level of serum protein-bound iodine was elevated. The administration of thyroid or thyroxin to premature infants selected as noted above is therefore without observable benefit and is sometimes harmful. The effects of daily dosage with thyroxin 0.2 mg. were at least as great as those with thyroid 180 mg.
3. The mean protein-bound iodine level of 32 untreated infants was 5.7±.47 at an average age of 9 days, and mean values for the control infants did not differ significantly from this figure during a subsequent five week period. These levels do not suggest that the premature infant is deficient in circulating thyroxin.
4. Thyroid doses exceeding 120 mg./day are necessary to produce pharmacologic effects in premature infants and in euthyroid children and adults. This implies that the thyroid gland of the premature infant produces and releases thyroxin in amounts comparable to those of normal, older human beings and approximating 120 mg. thyroid/24 hours. Medication of the athyrotic cretin should be adjusted with this in mind.
5. When caloric intake is adjusted by the desires of the premature infant, he ingests an average of about 150 calories/kg. body weight/24 hours. On such a regimen, his weight gain approximates that of his fetal colleague of the same gestational age and averages more than 30 gm./day.
URINARY WATER EXCRETION AND NEUROHYPOPHYSIAL FUNCTION IN FULL TERM AND PREMATURE INFANTS SHORTLY AFTER BIRTH
Authors: AMES ROSE G. 
Published: December 2021

In infants studied in the first month of life there was a gradual development of the ability to excrete excess water in a short period of time. When a water load was given according to body weight, orally or intravenously, no diuresis was observed in infants under 3 days of age. In comparison, all individuals tested over 3 days of age responded with a definite increase in water excretion. As early as 2 weeks of age and in all infants over one month of age the entire water load of 3 to 5% of their body weight was excreted in a three hour period following the administration of fluid. No difference in the diuretic response to a water load was apparent in full term and premature infants of comparable postpartum age.
Antidiuretic hormone whether produced endogenously following thirst, excitation or pain, or injected in the form of exogenous antidiuretic principle, caused a decrease in urine output only in infants who received a water load and who were responding to it with a diuresis.
When diuresis followed a water load, the degree of the renal response to antidiuretic hormone could not be compared in the various age groups studied, because of the inability to control a sudden release of endogenous hormone provoked by excitatory stimuli.
The hormone was detectable in the urines of infants under 3 days of age after fluid deprivation; this is assumed to be evidence of a functioning neurohypophysis.
ABNORMAL ELECTROLYTE COMPOSITION OF SWEAT IN CYSTIC FIBROSIS OF THE PANCREAS
Authors: DI SANT'AGNESE PAUL A. , DARLING ROBERT C. , PERERA GEORGE A. , SHEA ETHEL 
Published: December 2021

The electrolyte composition of sweat secreted in response to a standard mild thermal stimulus was found to be abnormal in 43 patients with cystic fibrosis of the pancreas. Sodium and chloride concentrations in sweat were 2 to 4 times as high as those found in 50 patients with a variety of other diseases. Sweat potassium levels were also increased in cystic fibrosis of the pancreas although not to the same extent. In contrast, the amount of sweat was not significantly different in patients with fibrocystic disease of the pancreas and control patients.
It was shown that pancreatic deficiency, chronic pulmonary disease and the administration of certain drugs do not per se affect the electrolyte composition of sweat. It was also demonstrated by metabolic studies that disturbances in renal and adrenal function are not responsible for the high sweat chloride and sodium in fibrocystic disease. The dissociation between increased electrolytes in the sweat and their very low levels in the urine during salt restriction are unique to this condition.
The fact that the sweat glands do not retain salt effectively in hot weather, during salt restriction or when DCA is administered, points to a disturbance in the sweat glands themselves. This abnormality may not be pathognomonic of cystic fibrosis of the pancreas, but it is an expected finding.
These disturbances in sweat composition together with preliminary observations of abnormal salivary gland secretion suggest that the secretory activity of many and perhaps all exocrine glands is affected in cystic fibrosis of the pancreas. The term "mucoviscidosis" does not seem justified in view of the fact that at least two nonmucus-secreting structures are affected in this condition.
Massive salt loss through sweating in hot weather accounts satisfactorily for the "heat casualties" in cystic fibrosis of the pancreas. The mechanisms are discussed and it is emphasized that the symptoms are initiated by pure salt loss and the consequent reduction in extracellular fluid volume. Since the condition may, if not treated, lead to fatal cardiovascular collapse, it should be regarded as an acute medical emergency.
Under the usual circumstances, serum electrolyte concentrations are normal in fibrocystic disease of the pancreas. In the presence of marked pulmonary dysfunction in this disease, the bicarbonate of the plasma is elevated and the chloride reduced in compensation. It is therefore necessary to demonstrate a lowered serum sodium as well as chloride to detect the massive salt loss which may occur in hot weather.