bluuebunny/crossref_metadata_2025_split huggingface dataset:
CONCEALED DIVERTICULUM OF THE MALE URETHRA AS A CAUSE OF URINARY OBSTRUCTION
Authors: GROSS ROBERT E. , BILL ALEXANDER H. 
Published: December 2021

In infancy and childhood there are many causes for obstruction to the flow of urine through the urethra. These include preputial adhesions,meatal narrowing, urethral stricture, posterior urethral valves, and contracted bladder neck. It has been known also that congenital diverticula of the urethra can give rise to urinary obstruction. These have been studied by Watts1 in 1906, by Lowsley and Gutierrez2 in 1928, by Kretschmer3 in 1936, and by Campbell4 in 1937. Such diverticula have been detected heretofore by the presence of a swelling on the ventral surface of the penis, in the peno-scrotal angle, or in the perineum. It is the purpose of this paper to present three cases of concealed diverticula of the urethra in each of which there was urinary obstruction; in none of these was there any swelling on the external surface of the penis. In two of these children the cause of obstruction was not recognized during life;death ensued as a result of urinary tract infection and the urethral abnormalities were found at autopsy. In the third child the cause of obstruction was found by roentgenologic visualization of the urethra, and surgical relief of the obstruction was prompdy instituted.
CASE REPORTS
Case 1
Children's Hospital #153,603. This 5-year-old boy was admitted to the Surgical Service on October 3, 1931, with a history of urinary dribbling,intermittent fever, and pyuria. The mother stated that until 1½ years of age, the child had had no urinary stream, the urine coming away only in a slow
THE AGE INCIDENCE OF POLIOMYELITIS IN CLEVELAND
Authors: DEHN HELMUT M. 
Published: December 2021

An apparent increase in the number of older children and adults attacked by poliomyelitis has been reported by a number of observers who have compared age distribution data of more recent epidemics (after 1930) with those of the years before 1920. Such reports have come from the northeastern,midwestern, and north central states,1,2,3 from California,4 from Sweden and Australia5 and from Germany.6 Relatively fewer infants and pre-school children have been affected, while the percentile participation of older children and adults has increased. Of course, adults have still remained a minority of patients everywhere.
Maxcy7 has questioned the reality of such an age shift for several reasons: (1) the shift may be merely an expression of the changing age distribution of the general population; (2) diagnosis may have become more accurate, especially for abortive forms; (3) selective under-reporting may obscure real conditions.
That the epidemiologic pattern of poliomyelitis can be badly distorted by under-reporting was shown by Nelson and Aycock8 in a thorough analysis of the data for Massachusetts. In brief, they found that of 2300 patients who were registered between 1928 and 1941 with the Harvard Commission for Infantile Paralysis for the treatment of paralysis due to poliomyelitis,23.1% or almost 1 out of 4 were not reported to the authorities at the time of their acute illness, although most of these unreported patients were attended by a physician. The greatest percentages of unreported cases occurred in non-epidemic years, off season months, small towns, and among infants and adults. One-third
CURARE (INTOCOSTRIN) IN THE ACUTE STAGE OF ANTERIOR POLIOMYELITIS
Authors: ROSENBERG DAVID , FISCHER ALFRED E. 
Published: December 2021

The efficacy of curare was tested in a hospital for communicable diseases during an epidemic of acute anterior poliomyelitis. Previous reports indicated that rapid results were to be expected. When the physical therapists who were treating our patients found little or no relaxation in the affected muscles, and the goniometric measurements showed no evidence of improvement, the dose of curare was cautiously increased in some patients. Larger doses than previously prescribed were tolerated with safety by some patients. Others, however, reacted alarmingly to small doses. This difference in therapeutic response may be explained by individual variations in response to a drug or by the fact that the concentration of the drug may rise rapidly, sometimes to unpredictable heights, before falling (Schlesinger).
The dangers of giving curare to patients with bulbar involvement, especially to those in which there is beginning bulbar or intercostal muscle weakness have been pointed out; also the probable cumulative effect when injections are given less than eight hours apart. The beneficial effects of small doses of curare, with which we obtained little or no muscle relaxation, cannot be confirmed or denied, when such doses are given for weeks in combination with physical therapy.
THE METABOLISM OF BILIRUBIN
Authors: NAJJAR VICTOR A. , PARK EDWARDS A. 
Published: December 2021

A little girl was asked by her teacher to write an essay on Benjamin Franklin and to make it short. She wrote: "Benjamin Franklin was born in Boston: he married a Philadelphia lady and discovered electricity." Dr. Najjar made an independent discovery of electricity in Missouri, a gentle, even and altogether pleasing current. I shall be short in my turn.
I regard my function on this occasion to be like that of a keeper whose business it is to exhibit to you a greyhound and, after demonstrating his points and recounting his exploits, to turn him loose.
Victor Najjar was born in Lebanon. He graduated from the American University of Beirut in 1932. After interning in pediatrics at the American University Hospital, Beirut, 1935 to 1937, he became instructor in Public Health and Hygiene at The Rural College for Teachers, Bagdad, Iraq, and the following year pediatrician-in-charge to the Children's Clinic, Bagdad. Najjar's residence in Bagdad leads me to believe that he could tell us much about grand viziers, caliphs and harems. In 1939 he came to this country joining the pediatric staff of Johns Hopkins University. In 1944 he became Associate and in 1945 was promoted to be an Assistant Professor of Pediatrics. In 1946 he was accorded a National Research Council Fellowship and elected to the laboratory of Carl F. Cori, Washington University School of Medicine, St. Louis, where he remained until The Department of Pediatrics, Johns Hopkins University Medical School, and the Harriet Lane Home, Johns Hopkins Hospital, Baltimore. 1948.
FURTHER STUDIES ON THE TREATMENT OF CONGENITAL ADRENAL HYPERPLASIA WITH CORTISONE
Authors: CRIGLER JOHN F. , SILVERMAN SAMUEL H. , WILKINS LAWSON 
Published: December 2021

Three cases of congenital adrenal hyperplasia with disturbed electrolyte metabolism, followed for 14 to 20 months, have been reported in detail.
The effects of cortisone (compound E) and corticosterone (compound B) on the suppression of the abnormal adrenals and on the electrolyte disturbance have been discussed. Cortisone produces more marked suppression of the adrenal overactivity/mg. (as measured by the urinary excretion of 17-KS), but less sodium retention than corticosterone. Both steroids, however, significantly improve the electrolyte abnormality.
The possible mechanism of action of cortisone on the electrolyte metabolism is discussed.
Suggestions concerning the therapeutic management of these patients are offered. The use of adequate NaCl without DCA in the initial treatment is emphasized, since suppression of the adrenal with cortisone seems to alter materially DCA requirement. The final combination of therapy, however, must be decided in each patient individually.
ELECTROPHORETIC ANALYSIS OF SERUM PROTEINS IN PREMATURE INFANTS
Authors: NORTON PATRICIA M. , KUNZ HANS , PRATT EDWARD L. 
Published: December 2021

Forty-four measurements of the concentrations of total serum protein determined by a Kjeldahl procedure and of albumin, alpha 1, alpha 2, beta and gamma globulins determined electrophoretically in the serum of 27 premature infants ranging in age from 7 hours to 65 days are reported.
Wide variations in all values are evident in individual cases. Certain trends are nevertheless apparent. During the first 5 to 6 weeks there is a gradual decline in the concentrations of total serum protein, albumin and gamma globulins. The alpha and beta globulins show no trend with age in this study.
Except for slightly higher values for alpha 1 globulins in the smaller infants, none of the concentrations could be correlated with the birth weights of the patients.
LEVEL OF HYALURONIDASE INHIBITOR IN THE SERUM OF PREMATURE INFANTS WITH RETROLENTAL FIBROPLASIA
Authors: MACKENZIE JULIA B. 
Published: December 2021

The serum of the premature infant contains material which inhibits bovine hyaluronidase. This inhibitor was found to be present to about the same degree in infants with and without retrolental fibroplasia and appeared to be unrelated to the severity of the disease.
The level of the physiologic inhibitor of hyaluronidase found in the blood of the premature and full term infant is approximately of the same order of magnitude.
BIRTH AND MORTALITY RATES AMONG SLAVE INFANTS ON SOUTHERN PLANTATIONS
Authors: POSTELL WILLIAM DOSITE 
Published: December 2021

THERE seems to be no end of writings about the Ante-bellum South but one of the most neglected fields has been the health of the slaves. Recently a monograph appeared dealing with this subject and since there are no better criteria in judging health standards than a study of infant birth and mortality rates, a further interpretation of the data presented in this monograph with some additional facts is herewith presented. There was nothing the planter was more interested in than the increase of his slaves through the birth and rearing of children, and within the bounds of medical knowledge of the period, he took the time and effort to promote conditions that were conducive to the rearing of large families.
The first care of the planter was the prenatal care of the mother. Rules were drawn up by the planter and overseers were instructed in the care of the expectant mother. Crude as this care was in comparison to our knowledge today it was still far superior to anything the Negro had known in Africa, and it compared favorably with the medical knowledge of the ante-bellum period. As soon as the mother reported her condition she was assigned lighter tasks. On confinement she was sent to the lying-in room of the plantation hospital or, if the plantation was large enough, to a separate hospital maintained for such cases. Throughout rural America confinement cases were usually handled by midwives or "grannies" as they were sometimes known. A Negro woman would serve as midwife for the plantation, serving both white and black.
MOBILITY OF THE UPPER CERVICAL SPINE IN HEALTH AND DISEASE
Authors: TOWNSEND EDWARD H. , ROWE M. LAURENS 
Published: December 2021

Four cases of cervical "subluxation" have been presented due to muscle spasm in the cervical region, which occurred during an upper respiratory infection. This syndrome differs from the atlanto-axial subluxation.
Roentgenograms in the diagnosis of this condition may lead to erroneous diagnosis and treatment.
The normal anatomic and functional ranges of the cervical spine were studied and are discussed. The degree of mobility of the cervical spine is greater than previously assumed.
PUBLIC HEALTH, NURSING AND MEDICAL SOCIAL WORK
Authors: HARDY ALBERT V. 
Published: December 2021

THERE are admitted limitations in our clinical examinations. The history may be biased. Significant departures from the normal may not be revealed by expert inspection, palpation and auscultation. Even x-ray is of help only when tissues of varying density are involved. Hence more and more we have turned to the laboratory for reliable data. It is to the great credit of the laboratories that in our teaching centers the results have had that degree of reliability which developed in our students a feeling of complete confidence in reported laboratory findings. It is not our intention to question whether this degree of confidence was warranted, but it is our purpose to make some observations on the reliability of laboratory examinations available to most of us in the practice of our profession. If laboratory findings are not as reliable as we expect them to be, can they be made so?
"Survey of the Accuracy of Chemical Analyses in Clinical Laboratories" by Belk and Sunderman has been quoted repeatedly. The Pennsylvania State Medical Society sponsored the study. The 59 laboratories which voluntarily participated were under the direction of pathologists and chiefly in hospitals. The quality of work of small laboratories operated by a technologist or performed by individual technicians in physicians' offices was not assessed. The findings, it is presumed, are the more favorable observations for laboratories of one state.
Samples for check-testing were submitted to the participating laboratories and results were reported and evaluated without identification of the laboratory concerned. To illustrate, a glucose solution with 60 mg. of glucose per 100 cc. was submitted, the result was considered satisfactory if readings were within the range of 50 to 70 mg. Of the 52 cxaminations reported, 33 were satisfactory.
SPECIAL REVIEWS
Authors: YANKAUER ALFRED 
Published: December 2021

Present knowledge of child growth and development hinges around three general principles: the pattern-formation or stage, the individual uniqueness, and the interrelationship of all aspects of the growth process.
If we are to apply these principles to school children we need to recruit and select better personnel to work with them; we need to bring the benefits of this knowledge to such personnel in their training; we need to break down the tendency to compartmentalization of such personnel in their daily work with children.
If we are to apply these principles to a school program we need to knit all aspects of that program together more closely than ever before. This is particularly true of the relationship of school health services to the school curriculum.
Technics of measuring physical growth have been devised which are superior to former technics. Although they have a useful, if limited, role to play in the total school health program, their role in the screening and assessment aspects of the program remains in an experimental stage.
SPECIAL REVIEWS
Authors: BARONDESS JEREMIAH A. 
Published: December 2021

The studies which have led to the availability of gamma globulin for clinical use have been briefly reviewed, including those having to do with isolation, immunologic assay, purity, stability, safety and technic of administration.
Its use in a variety of virus infections has been described and reviewed, and the preliminary nature of many of these studies has been emphasized. It has been established that gamma globulin is an effective prophylactic agent not only in measles but in infectious (epidemic) hepatitis. Gamma globulin prepared from convalescent mumps serum is useful in reducing the incidence of complicating orchitis in mumps. There is evidence that it may be a valuable prophylactic agent against rubella. It gives promise of value as a prophylactic against poliomyelitis, although the definitive field trials are yet to be conducted. Its proper application in serum hepatitis and varicella is yet to be defined.
It would seem, in view of the uniformity of antibody titers, where it has been possible to measure these, and in view of the uniformity of protection from gamma globulin in a variety of conditions in which it has been tested, that the donors from whose plasma the material has been prepared have in general been immunized against these diseases, either by clinical or subclinical infection, and this reasoning may be extended to the general population from which these donors are drawn. Thus, aside from the practical clinical and epidemiologic applications which are appearing for gamma globulin, it shows promise of becoming an important tool in research in the basic biology of host-parasite relationships, including certain aspects of immunity as well as virus ecology.
Child Development Services in Medicaid Managed Care Organizations: What Does It Take?
Authors: Berry Carolyn , Butler Pamela , Perloff Linda , Budetti Peter 
Published: December 2021

Objective.We sought to understand why certain Medicaid managed care organizations (MMCOs) implemented child development services or programs and how they had done so. We also sought to identify barriers and facilitators to successful initiation and implementation of child development programs.Methods.We conducted 9 key informant interviews and 4 site visits, and performed qualitative analyses to identify major themes across responses.Results.We identified a small number of MMCOs with child development services. High-level support was crucial for program initiation; physician buy-in, staff support, and strong working relationships with outside health professionals or agencies were principal factors in successful program implementation.Conclusions.MMCOs that were committed to implementing child development services were successful in doing so, without external funding or regulatory mandate. The results provide valuable strategies for MMCOs interested in developing programs and for researchers and advocates interested in promoting child development services for low-income children.
Measuring the Process of Preventive Service Delivery in Primary Care Practices for Children
Authors: Gest Kathleen L. , Margolis Peter , Bordley W. Clayton , Stuart Jayne 
Published: December 2021

Background.Children may fall behind on preventive services because they do not receive needed services at the time of an office visit (a missed opportunity). However, methods are needed to measure problems in the care delivery process that lead to missed opportunities. We developed a method to examine the key steps in the preventive service delivery process and identify problems; we assessed the feasibility and validity of the method in primary care practices for children.Methods.Using 3 data collection methods, we measured key steps in the process of preventive service delivery in primary care offices: a chart audit was used to measure each child's preventive service status before and after an office visit, a brief parent exit interview was used to assess preventive service delivery not documented in the chart, and a staff checklist was used to assess the role of nursing and other office staff. The feasibility of using this combination of measures to identify problems in the care delivery process was evaluated in 3 representative primary care practices (2 pediatric, 1 family practice) among children 5 years and younger.Results.The measurement method was implemented in all 3 practices. The validity of the method was supported by its ability to detect differences among practices in the proportion of children eligible for immunizations and screening tests and in the proportion of children undergoing key steps in the process of preventive service delivery. The practice with the lowest proportion of children whose charts were screened for preventive services needs had the lowest performance of preventive services.Conclusions.It is possible to assess specific elements in the process of preventive service delivery in primary care practices. Use of this approach may help practices design and monitor interventions to improve the quality of preventive care delivery.
The Association Between Hands-On Instruction and Proper Child Safety Seat Installation
Authors: Lane Wendy G. , Liu Gilbert C. , Newlin Elizabeth 
Published: December 2021

Objective.To determine if hands-on instruction in child safety seat (CSS) installation decreases the number of errors in installation.Design.Cross-sectional study.Setting.Primary care offices, emergency department, CSS checkpoint.Participants.Parents of children &lt;2 years old receiving medical care or attending a CSS check.Main Outcome Measure.Errors in CSS use.Results.Only 6.4% of parents had a correctly installed CSS. Hands-on instruction was associated with fewer errors in seat installation. Increased parent age, completion of college, and having private insurance were also associated with fewer errors in CSS placement. The majority of parents learned to install seats from reading the manual, from friends and relatives, and from figuring it out on their own.Conclusions.Errors in CSS installation are a significant problem. Hands-on instruction decreases the numbers of errors in CSS installation. However, few parents receive hands-on instruction from experts in CSS installation. Increases in correct CSS use could result from hands-on education by trained professionals.
Effect of a Reduced Postpartum Length of Stay Program on Primary Care Services Use by Mothers and Infants
Authors: Mandl Kenneth D. , Homer Charles J. , Harary Oren , Finkelstein Jonathan A. 
Published: December 2021

Objective.To determine the impact of reduced postpartum length of stay (LOS) on primary care services use.Methods.Design: Retrospective quasiexperimental study, comparing 3 periods before and 1 period after introducing an intervention and adjusting for time trends.Setting: A managed care plan.Intervention: A reduced obstetrical LOS program (ROLOS), offering enhanced education and services.Participants: mother-infant dyads, delivered during 4 time periods: February through May 1992, 1993, and 1994, before ROLOS, and 1995, while ROLOS was in effect.Independent Measures: Pre-ROLOS or the post-ROLOS year.Outcome Measures: Telephone calls, visits, and urgent care events during the first 3 weeks postpartum summed as total utilization events.Results.Before ROLOS, LOS decreased gradually (from 51.6 to 44.3 hours) and after, sharply to 36.5 hours. Although primary care use did not increase before ROLOS, utilization for dyads increased during ROLOS. Before ROLOS, there were between 2.37 and 2.72 utilization events per dyad; after, there were 4.60. Well-child visits increased slightly to .98 visits per dyad, but urgent visits did not.Conclusion.This program resulted in shortened stays and more primary care use. There was no increase in infant urgent primary care utilization. Early discharge programs that incorporate and reimburse for enhanced ambulatory services may be safe for infants; these findings should not be extrapolated to mandatory reduced LOS initiatives without enhancement of care.