bluuebunny/crossref_metadata_2025_split huggingface dataset:
Introital Diameter as the Criterion for Sexual Abuse
Authors: HEGER ASTRID , EMANS S. JEAN 
Published: December 2021

During the past decade, interest in the medical diagnosis of the sexually abused child has dramatically increased. Sexual abuse of children is not a recent phenomenon, but in a society reluctant to believe that children are abused, medical professionals have often been placed in the position of being asked to validate the disclosure from the child solely on the basis of medical evidence.
In response to this pressure, physicians have attempted to establish standards of diagnosis by developing objective medical criteria. The legal system, accustomed to a general increase in medical knowledge and technology, has come to expect medical evidence to support an increasing number of cases of sexual abuse.
Daytime Urinary Frequency
Authors: ROBSON LANE M. , LEUNG ALEXANDER K. C. 
Published: December 2021

To the Editor.—
Zoubek et al1 reported on "Extraordinary Urinary Frequency" in children. This problem is likely more frequent than is appreciated presently. During the 14-month period from May 1989 through to June 1990, we observed 10 children with this problem. The Table shows the clinical data on these children. All 10 children had a previously normal daytime voiding pattern, a normal physical examination, and a negative urine culture. Seven of the ten children were boys.
`Ivory Tower' Fellowship Statement Challenged
Authors: NEWPORT MARY T. 
Published: December 2021

I have a number of questions related to the "Statement on Pediatric Fellowship Training" by the Federation on Pediatric Organizations.
The article did not list the authors of the statement. How many participants were involved in the development of this statement, what was the composition of the group, and, in particular, how many were subspecialists who practice clinical medicine in nonacademic settings?
The statement noted, with regard to the goals of training fellows, that "perhaps most important, graduates of regular and advanced training programs should be prepared to initiate independent research and to compete for peer-reviewed research funding."
Fatal Intentional Salt Poisoning Associated with a Radiopaque Mass
Authors: DOCKERY W. KEITH 
Published: December 2021

Intentional poisoning has become recognized more widely as a form of child abuse in recent years.1 Many substances have been reported as the agents used, including common table salt (sodium chloride).2-5 However, there is very little published information on the manifestations of salt poisoning when it is administered in large quantities in the undissolved, crystallized form. A case of fatal salt poisoning is reported which emphasizes two characteristics of crystallized salt that have not been described previously and which emphasizes once again that poisoning in young children may be a form of child abuse.
Case Report
A 5-year-old girl was brought to a local emergency department with seizures and hypernatremia.
BUTANOL-EXTRACTABLE IODINE IN THE SERUM OF INFANTS
Authors: MAN EVELYN B. , PICKERING DONALD E. , WALKER JAMES , COOKE ROBERT E. 
Published: December 2021

The difference between SPI and BEI in blood from the umbilical cord or from infants is no greater than the difference noted in the blood of adults. The average differences, SPI-BEI, in both are 0.4 to 0.5 gamma %.
SPI and BEI of cord blood do not differ significantly from those of the mother's blood taken during delivery and, therefore, cannot be used to measure the BEI of the infant during the first weeks of life. In contrast the concentrations of fatty acid and cholesterol of the serum from cord blood was only about one-third as great as that of maternal blood.
In the first days of life SPI and BEI rise sharply. In 12 of 13 infants 2 to 6 days old the BEIs were between 7.0 and 11.7 gamma %, values indicative of hyperthyroidism in adults.
Data on children from birth to 16 years of age suggest that the normal range may remain higher than that of adults for as long as seven years.
CHEMICAL GROWTH IN MAN
Authors: FORBES GILBERT B. 
Published: December 2021

From midfetal life to the period of young adulthood, chemical growth, as regards Na, K and H2O, proceeds in a manner which conforms to the differential growth equation, y = bxk.
Equations of this general form have been derived for each of the chemical constituents in question, from which mean total body content can be calculated for any normal subject of given body weight.
Retentions of Na, K and H2O resulting from normal growth can be anticipated by means of these equations.
PREMATURE INFANTS IN LATER LIFE
Authors: HOWARD PHILIP J. , WORRELL CALIER H. 
Published: December 2021

Physically: A few physical defects were found consisting of malnourishment, dwarfism, obesity, hypothyroidism, congenital absence of tooth buds, scoliosis and cryptorchidism. One child showed keratitis at birth. Eleven children were hyperopic. The condition of the eyes leads to the conclusion that the eyes of the premature may be frequently defective. Otherwise it is difficult to say that prematurity itself effects the physical growth.
Intellectually: The I.Q.'s of the 22 children studied ranged from two of the high grade moron group, upward, with a fair distribution, to two I.Q.'s in the very superior intelligence group. Prematurity per se seemingly has neither a beneficial nor detrimental effect on intelligence except that a more than average percentage of premature infants suffer intracranial hemorrhage as a result of being born prematurely. In these studies, one was definitely diagnosed as having brain damage at birth, and others were suspected of this damage. This seemingly appears in the I.Q. results with a higher than expected incidence of mild mental retardation. Using birth weight as a criterion there was no relation between the degree of prematurity and the resultant I.Q.
Emotionally: Personality test results in addition to the information gleaned from the psychologic interviews and the histories show that over half have made unsatisfactory or below average personality adjustment. Contributing factors were found including prematurity, overprotection by the parents, and poor physical endowment. Twelve of the 22 had personalities of the submissive passive type. Eight of the 22 showed unusual aggressive tendencies. Other behavior aberrations uncovered were nail biting, two cases of habit spasms and one case of chronic masturbation. It is suggested that study of premature infants who are necessarily deprived of immediate postnatal maternal tenderness may finally offer a basis for assessing the theory that such tenderness is necessary.
Urine Sodium Excretion in Response to an Oral Glucose Tolerance Test in Obese and Nonobese Adolescents
Authors: Finta Kathleen M. , Moorehead Catherine , Key Jane , Rocchini Albert P. , Katch Victor 
Published: December 2021

To determine if physiologic changes of insulin are capable of inducing sodium retention in insulin-resistant patients, we evaluated the ability of an oral glucose tolerance test to alter urine sodium excretion in 32 obese subjects (13.3 ± 1 years, weight 82 ± 5 kg, mean arterial pressure 89.3 ± 1.5 mm Hg) and 13 nonobese subjects (13.8 ± 2 years, weight 46 ± 4 kg, mean arterial pressure 74.5 ± 2.6 mm Hg).
After an overnight fast, subjects were placed in water diuresis and fasting insulin and glucose levels were drawn. Three 30-minute urine collections were obtained for baseline urine sodium excretion. The oral glucose tolerance test was administered with glucose and insulin levels drawn at 15, 30, 45, 60, 90, and 120 minutes. During the oral glucose tolerance test, four 30-minute urine collections were obtained for urine sodium excretion.
Serum glucose levels at baseline and throughout the glucose tolerance test did not differ between obese and nonobese subjects. Baseline insulin levels were elevated significantly in the obese (20 ± 3 µU/mL) compared with the nonobese (5 ± 0.7 µU/mL) subjects. Furthermore, insulin levels remained significantly elevated in the obese subjects compared with the nonobese subjects throughout the glucose tolerance test (118 ± 19 vs 49 ± 6 µU/mL, obese vs nonobese subjects at 1-hour post-glucose tolerance test). Prior to the oral glucose tolerance test, urine sodium excretion was not different between obese (249 ± 13 µEq/min) and nonobese (225 ± 28 µEq/min) subjects; however, during the oral glucose tolerance test there was a significant decrease in urine sodium excretion in the obese (158 ± 15 µEq/min) subjects, but no significant change in urine sodium excretion in the nonobese (221 ± 31 µEq/min) subjects.
The data support the hypothesis that, in the obese, changes in insulin associated with eating can result in sodium retention. This insulin-mediated sodium retention may participate in the development of hypertension in obese subjects.
Treatment of Theophylline Poisoning
Authors: SHANNON MICHAEL , WERN0VSKY GIL 
Published: December 2021

In Reply.—
We appreciate the comments of Strauss and Modanlou on the role of multiple-dose activated charcoal in the treatment of infants with severe theophylline intoxication. We are aware of both studies which they have published in this area and have also used multiple-dose charcoal in neonates.1-3 The infant in our case report was not considered a candidate for multiple-dose activated charcoal because of the absence of bowel sounds. He was also not a candidate for hemodialysis or hemoperfusion because of problems with vascular access which resulted from his complex congenital heart disease (including inferior vena cava occlusion and inaccessible subclavian veins).
The Biobehavioral Interface in Behavioral Pediatrics
Authors: Porges Stephen W. , Matthews Karen A. , Pauls David L. 
Published: December 2021

Behavioral pediatrics begins, as a discipline, with at least two important assumptions: (1) that all human experiences have psychosocial as well as biological or organic contexts; and (2) that the biological substrate with which the child is born is modifiable. Thus, behavioral pediatrics, by its own definitions and assumptions, initiates research questions at the biobehavioral interface.1 This paper attempts to delineate a number of research directions that may be used to investigate the complex relationships between behavioral and biological factors in behavioral pediatrics.
Research investigating biobehavioral processes can be approached on a number of different levels. The research can be organized in terms of the following specific causal assumptions relating behavioral and biological factors: (1) a parallel model; (2) a causal model in which behavioral factors influence biological factors; (3) a causal model in which biological factors determine behavior; and (4) a causal model in which there is bidirectional causality.
1. Parallels Between Behavior and Biology. This model assumes that there is no directional causality. Behavioral and biological factors represent parallel systems sharing a common underlying organization. Behavioral and physiological variables may be viewed as different levels of the same system, mediated by central nervous system processes. Various screening methods are based on this model. Research questions dealing with this model focus on indexing and predicting developmental outcome. Techniques such as the Neonatal Behavioral Assessment Scale2 or the identification of sleep patterns3 evaluate behavioral patterns and attempt to identify neurophysiological or neurological dysfunction. Similarly, physiological response patterns such as infant cry patterns4 or heart rate variability measures such as cardiac vagal tone5 have been used to predict developmental outcome when the behavioral repertoire is too limited to be useful in predicting subsequent behavior.
The Changing Role and Responsibilities of a Chairman—Letters
Authors: ZWELLING LEONARD A. 
Published: December 2021

To the Editor.—
I have just finished reading Dr Brent's article on chairmanships in the July issue of Pediatrics (1992;90:50-57). As someone who aspires to this role in the future, I found his advice invaluable. The reading list at the end was large and I wondered if he could prioritize it for me. Where should I start?
I would like to read some of the suggested books on academic administration that are listed. Please guide me to some of the best (and most available) of the ones that are listed.
The Changing Role and Responsibilities of a Chairman—Letters
Authors: TARNOWSKI KENNETH J. 
Published: December 2021

To the Editor.—
Just a quick note of congratulations to Robert L. Brent concerning his outstanding article on department chairmen which appeared in Pediatrics (1992;90:50-57). Without a doubt, the finest article I have encountered on the sociopolitical realities of department/medical school administration. Unfortunately, too many of the negative scenarios that were described were all too familiar.
Again, an outstanding piece of work. I do hope that the appropriate audience reads this piece. Moreover, I hope they are receptive to Dr Brent's sage advice.
The Use of Cow's Milk in Infancy
Authors: ROBSON WM. LANE M. , LEUNG ALEXANDER K. C. 
Published: December 2021

To the Editor.—
In June 1992, the Committee on Nutrition of the American Academy of Pediatrics recommended that if breast-feeding is not possible then an infant formula is the appropriate alternative, and that cow's milk is not suitable as an alternative to breast milk for the first year of life.1
We agree with this recommendation and with the rationale included in the June 1992 statement. In lieu of the recent evidence that cow's milk protein may be implicated in the pathogenesis of diabetes mellitus,2 we believe that the Committee on Nutrition should clarify whether cow's milk is ever appropriate for children and whether or not infant formulas that are based on cow's milk protein are appropriate alternatives to breast milk.
Anaphylaxis at School: Etiologic Factors, Prevalence, and Treatment
Authors:   AMERICAN ACADEMY OF PEDIATRICS,   SECTION ON ALLERGY AND IMMUNOLOGY,   AD HOC COMMITTEE ON ANAPHYLAXIS IN SCHOOL, Wynn Susan Rudd , Frazier Claude A. , Munoz-Furlong Anne , Ostrom Nancy K. , Sampson Hugh A. , Yunginger John W. 
Published: December 2021

To the Editor.—
Anaphylaxis in children and adolescents is a medical emergency which requires immediate attention. Anaphylactic reactions caused by allergens such as foods, insect venoms, medications, and exercise may occur in susceptible children and adolescents while they are at school. Because children spend a significant percentage of their waking hours in a school setting, pediatricians should pay special attention to the unique features of the risks of anaphylaxis at school, as well as the possible obstacles to effective treatment.
Maternal and Neonatal Hyperparathyroidism as a Consequence of Maternal Renal Tubular Acidosis
Authors: SAVANI RASHMIN C. , MIMOUNI FRANCIS , TSANG REGINALD C. 
Published: December 2021

Neonatal hyperparathyroidism secondary to maternal hypocalcemia in pregnancy is a rare disorder.1 The effects of secondary hyperparathyroidism in patients with renal failure, including renal osteodystrophy, are well described.2 Neonatal hyperparathyroidism in the presence of maternal renal disease and secondary hyperparathyroidism has not previously been reported. We here present a unique situation in which a neonate developed congenital hyperparathyroidism secondary to maternal hypocalcemia as a consequence of renal tubular acidosis. This report emphasizes the significance of maternal serum calcium concentrations in pregnancy in determining the parathyroid state of the fetus and neonate.
METHODS
For this report, the following biochemical methods were employed and normal ranges, as measured in our laboratory, are indicated in the tables.
An Environmental Intervention to Reduce Dietary Fat in School Lunches
Authors: Whitaker Robert C. , Wright Jeffrey A. , Finch Anita J. , Psaty Bruce M. 
Published: December 2021

Objective. To determine whether making a low-fat entree available as one of two choices in an elementary school lunch program would reduce the fat content of meals selected by children.
Design. In this before-after trial, students had a daily choice between two entrees, one of which was sometimes low-fat. For 93% of school days during 14 consecutive school months, daily entree choices were recorded for 619976 student meals. The fat content of entrees was assessed with a computerized nutrient database supplemented by food manufacturer's data.
Setting. Sixteen elementary schools in the Bellevue (Washington) School District.
Participants. The number of students eating school lunch averaged 2440 per day, of whom 25% were less than 185% of poverty.
Intervention. After a baseline period of 6 months, the intervention increased the number of days per month when one of the two entrees had 30% or fewer calories from fat.
Main outcome measures. Data for the entire district were combined to estimate for each month the percent of students who selected low-fat entrees and the percent of calories from fat in the average meal selected by students.
Results. During the 6 months before the intervention, a low-fat entree was available on 23% of days; it was selected by 39% of students; and the average meal selected by students had 36% of calories from fat. By the end of the 8-month intervention, a low-fat option was available on 71% of days; it was selected by 29% of students; and the fat content of the average meal dropped from 36% to 30% of calories from fat (P = .02).
Conclusions. In this school district, many students, given the choice, selected low-fat entrees. Recommendations for dietary fat were met simply by the environmental intervention of increasing the availability of low-fat foods. Pediatrics 1993;91:1107-1111; child nutrition, food preferences, diet surveys, schools, dietary fat, child, nutrition.
Duration of Positive Throat Cultures for Group A Streptococci After Initiation of Antibiotic Therapy
Authors: Snellman Leonard W. , Stang Howard J. , Stang Jill M. , Johnson Dwight R. , Kaplan Edward L. 
Published: December 2021

Objective. To determine if it is appropriate to recommend that patients with group A β-hemolytic streptococcal pharyngitis, who are clinically well by the morning after starting antibiotic treatment, can return to school or day care, or if they should wait until they have completed 24 hours of antibiotics as recommended by the American Academy of Pediatrics Committee on Infectious Diseases.
Methods. We examined the duration of positivity of the throat culture after antibiotics were begun as a means of assessing the potential risk of transmission to close school contacts. Forty-seven children (4 to 17 years of age) with pharyngitis and a positive throat culture for group A streptococci in an outpatient, staff model health maintenance organization clinic were enrolled and were randomly selected to receive therapy with either oral penicillin V, intramuscular benzathine penicillin G, or oral erythromycin estolate. Additional throat cultures were obtained and clinical findings were recorded for each child during three home visits in the 24 hours after their initial clinic visit. Acute and convalescent sera were obtained for determination of anti-streptolysin O and anti-DNase B titers.
Results. Seventeen (36.2%) of the 47 patients had a positive culture the morning after initiating antibiotic therapy. However, thirty-nine (83%) of the patients became "culture negative" within the first 24 hours. Neither the time interval to the first negative culture nor the presence or absence of group A streptococcal organisms on any single convalescent culture could be predicted by clinical findings. Six of the eight children who failed to convert to a "negative" throat culture within 24 hours of initiating therapy were receiving erythromycin. We could detect no difference in either time to conversion to a negative culture or the presence of a positive culture 24 hours after starting antibiotics between those who demonstrated a significant antibody increase and those who did not.
Conclusion. The data from this study strongly suggest that children with group A β-hemolytic streptococcal pharyngitis should complete a full 24 hours of antibiotics before returning to school or daycare.
Measles Severity and Serum Retinol (Vitamin A) Concentration Among Children in the United States
Authors: Butler Jay C. , Havens Peter L. , Day Susan E. , Chusid Michael J. , Sowell Anne L. , Huff Dan L. , Peterson Dan E. , Bennin Robert A. , Circo Richard , Davis Jeffrey P. 
Published: December 2021

Background. Studies in developing countries have shown that children with measles have low serum retinol concentrations and that lower retinol levels are associated with measles-related mortality. Vitamin A therapy has been shown to reduce mortality among African children with acute measles.
Objectives. To determine whether serum retinol concentration is low among children with measles in the United States and to determine whether retinol concentration is associated with illness severity.
Setting. Pediatric referral hospital and clinic in Milwaukee, WI, during the measles outbreak of 1989-1990.
Patients. One hundred fourteen patients ≤5 years of age evaluated for serologically confirmed measles with serum obtained within 5 days following rash onset.
Methods. Serum retinol concentration was determined by high-performance liquid chromatography. Clinical data were collected by hospital record review. A modified Pediatric Risk of Mortality (PRISM) score was used to assess physiologic instability as a measure of illness severity.
Results. Retinol concentrations ranged from 0.25 to 1.18 µmol/L (median 0.58 µmol/L); 82 (72%) patients had low retinol concentration (≤0.70 µmol/L). Median retinol concentrations were lower among hospitalized patients (0.56 vs 0.70, P = .006) and patients with pneumonia (0.52 vs 0.64, P = .02) but higher among children with otitis media (0.63 vs 0.54, P = .01). Higher modified PRISM scores, reflecting greater physiologic instability, were associated with lower retinol concentration (β coefficient -.0147, P = .025). In multivariate analysis, higher modified PRISM scores were associated with lower retinol concentration (β coefficient -.0144, P = .025) even after controlling for hospitalization, presence of complications, race, age, receipt of Aid to Families With Dependent Children, gender, and interval from rash onset until serum was collected.
Conclusions. Among these children with measles in an urban United States community, retinol concentrations were depressed, and the degree of depression was associated with illness severity. Vitamin A therapy should be considered for children with measles in the United States who require hospitalization.