bluuebunny/crossref_metadata_2025_split huggingface dataset:
CAT SCRATCH SYNDROME
Authors: WATERS WILLIAM J. , KALTER SEYMOUR S. , PRIOR JOHN T. 
Published: December 2021

The clinical, laboratory and pathologic findings of a series of cases of cat scratch syndrome have been reviewed. In spite of a variable clinical course, certain features associated with a selected group of laboratory tests appear to be constant enough to be of diagnostic value.
A history of contact with a cat and/or scratch which is usually associated with a peripheral skin lesion, lack of lymphangitis, presence of regional lymphadenopathy with tenderness to palpation are the most constant clinical findings. Fever, so frequently emphasized as a characteristic clinical sign, may be extremely variable in type and duration or entirely absent. A skin test with cat scratch antigen has been positive in all cases. Lacking this antigen, a negative Frei skin test in conjunction with a positive complement fixation test (Lygranum C. F.) is suggestive evidence for the diagnosis.
With positive evidence from the above data, biopsy of an affected gland with its relatively nonspecific pathologic picture is not considered essential for the establishment of the diagnosis of cat scratch syndrome.
THE PRESIDENT'S PAGE
Authors: QUILLIAN WARREN W. 
Published: December 2021

WITHIN the past few years American medicine has made tremendous strides in prestige and influence. The Academy has contributed its part to this advance. But, progress has not been gained by accident. Behind the scenes in organized medicine are many conscientious and tireless workers who, by their enthusiasm and consecrated effort, are accomplishing the tasks with which they are confronted. Committee members are often unsung heroes in the solution of problems pertaining to the furtherance of more adequate medical care for children. The individual Academy member occasionally forgets how much so many of us owe to so few in the practical application of our ideals.
For example, those of you who attended the Annual Meeting at Toronto last fall heard the panel discussion on Pediatric Education; and saw the exhibit, describing some of the aims and objectives of our Committee on Medical Education. Under the inspired leadership of the Chairman, Dr. Lee F. Hill, this group is making progress in attempting to answer some of the questions posed by the Academy Survey of 1946-48. During the current year, continuation of regional conferences throughout the United States and Canada, with emphasis upon the problems of undergraduate education, has resulted in an intelligent exchange of ideas and an opportunity for discussion unparalleled in the history of North American medical schools. The inevitable result of these discussions will be an improvement of standards for medical education. Interpretation and evaluation of new ideas, inclusion of practical and progressive concepts for the betterment of medical school curricula, requires a great deal of time and effort.
Developing Models for Pediatric Residency Training in Managed Care Settings
Authors: Devries Jeffrey M. , Berkelhamer Jay E. , Molteni Richard A. , Edwards Karen S. , Kachur Elizabeth K. 
Published: December 2021

The preparation of pediatric residents to function optimally in managed care environments challenges educators to create a new set of educational objectives and competencies and to incorporate these into curricula that are already full. Many of the skills needed to practice managed care are those that have been required for the practice of pediatrics in any setting. Nevertheless, the emergence of managed care requires the identification of new knowledge to be acquired and new skills and attitudes to be incorporated into daily practice. These competencies can be identified most thoroughly through collaboration among physicians, educators, and leaders of managed care organizations. This joint effort should also serve to establish a foundation on which collaborative, mutually beneficial learning environments can be created. The development of curricula that provide the opportunities needed to attain managed care proficiencies requires an individualized approach for each program that takes into account the degree of managed care penetration in each training environment. Programs in which a managed care approach to patient care predominates will be able to promote most easily their trainees' incorporation of these principles into routine practice. Those with less regular exposure will be forced either to promote managed care principles in an environment in which they may not be accepted or practiced, or to join in partnership with managed care organizations (MCOs) to train residents. Regardless of the setting, evaluation methodologies must be developed to ensure that each of the core competencies has been learned, can be applied to clinical situations, and is retained throughout the training period.These efforts require the development of faculty who understand and can model a managed care approach to patient management. The ongoing evolution of managed care systems encourages the development of new, creative strategies to train faculty, who may find themselves learning about this emerging environment at the same time as are their trainees.
The Impact of Graduate Medical Education Financing Policies on Pediatric Residency Training
Authors: Bazell Carol , Salsberg Edward 
Published: December 2021

Objective. To review special issues related to pediatric residency training in managed care organizations, the effects of the changing health care system on the demand for pediatricians and the potential impact on financial support for residency training, current methods of financing graduate medical education (GME), possible future approaches to financing GME, and policy directions to support training of pediatricians well prepared for future practice.
Methods. We reviewed current information on residency education in managed care settings, including the rationale for training in such settings and the realities of such educational experiences. We then assessed the evidence concerning the supply and demand for pediatricians in the present health care marketplace, with its evolution to managed systems of health care. We summarized current approaches to financing GME through Medicare, Medicaid, private insurers and purchasers, and direct federal and state support, with emphasis on the financing of ambulatory training which could occur in managed care settings. Lastly, we described factors influencing the upcoming revolution in GME financing and outlined possible new policy directions for the financing of relevant GME training experiences.
Results. Appropriate training experiences in managed care organizations may be a valuable strategy to address the current disconnect between the traditional hospital-based education of pediatricians and the expanded competencies necessary to practice in intensively managed, integrated and accountable health systems. Present pediatrician supply appears to be in relative balance with health maintenance organization staffing patterns and with needs-based requirements estimates. However, the pediatrician-to-child population ratio is predicted to increase rapidly over the next decade, leading to an oversupply of pediatricians under likely future health care delivery system scenarios. Medicare is the largest explicit payer of GME training costs, historically directing reimbursement primarily for hospital-based education. Numerous innovative financing strategies are being considered to facilitate funding of GME training in ambulatory settings and to open up funding to greater public scrutiny and accountability.
Conclusions. Although reforms in federal GME financing have been limited to date and other significant changes have been largely state-based, it is likely in the future that explicit funds will be targeted to specialties in demand that prepare physicians well for future practice. Pediatricians and medical educators must intensify their voices in the financing debate to ensure a productive future for quality pediatric residency training.
Evaluation of the Community Access to Child Health Program
Authors: Minkovitz Cynthia , Grason Holly , Aliza Barbara , Hutchins Vince , Rojas-Smith Lucia , MD Bernard Guyer 
Published: December 2021

Objective.
Increasing attention is being focused on the need for pediatricians to promote child health in their respective communities. The objective of this study was to evaluate, retrospectively, the American Academy of Pediatrics' Community Access to Child Health (CATCH) Program.

Study Design.
Case studies of 12 Community Pediatric projects in existence from 1989 to 1995 with varying degrees of involvement in the CATCH Program. In-person interviews were conducted with 17 pediatricians, 3 CATCH leaders who were not pediatricians, 27 project advisory committee members, 42 project staff, 47 community partners, 22 public health representatives, and personnel in 13 affiliated institutions.

Results.
These projects established or enhanced child health services. Although most pediatricians' interest in community child health preceded CATCH, mentoring, training, and peer support contributed to ongoing involvement. Community factors that facilitated project development included historical collaborative efforts and active public health agencies. However, across sites, significant barriers related to attitude and resource limitations were noted. Attitudinal barriers included both institutional concerns (eg, competition among providers or distrust among community agencies and organizations) and cultural concerns (eg, general negative perceptions of providers about Medicaid beneficiaries or of members of minority population toward medical or government establishments).

Conclusions.
In an era of devolution of responsibility to local communities, there are likely to be more opportunities for pediatricians to work with community members to promote child health. Specific strategies should be refined and expanded to support pediatricians' involvement in community-based activities, particularly because it is recognized that insurance alone will not guarantee children's health.
The Physiology of Pigmented Nevi
Authors: Kincannon Jay , Boutzale Christine 
Published: December 2021

Melanocytes are pigment-producing cells derived from the neural crest. These specialized exocrine cells produce melanin, which is packaged and dispersed to neighboring keratinocytes in organelles called melanosomes. Within the melanocyte, tyrosine is converted to dopa, and then dopaquinone via the bifunctional enzyme tyrosinase. Dopaquinone is oxidized further to form the pigment melanin. Each epidermal melanocyte secretes melanosomes to approximately 36 adjacent keratinocytes, forming an epidermal melanin unit. Genetically programmed constitutive skin color is determined by the amount of cutaneous melanin pigmentation.
The common mole or acquired melanocytic nevus (AMN) is a collection of nevomelanocytes grouped into nests located in the epidermis (junctional nevus), dermis (dermal nevus), or both (compound nevus). It is hypothesized that nevomelanocytes are derived from either epidermal melanoblasts or dermal Schwann cells. AMN first appear at ∼1 year of age, peaking in number during the second or third decades of life, and disappearing by the seventh to ninth decades. AMN may appear suddenly or become more prominent in response to sun exposure, cortisone and corticotropin, blistering diseases, chemotherapy, immunosuppression, and other factors that are not well-defined. Reports of AMN increasing in size and darkening in color during puberty and pregnancy have been reported but not quantitated systematically.melanocytes, keratinocytes, acquired melanocytic nevi.
PUBLIC HEALTH ASPECTS OF PROBLEMS OF CURRENT INTEREST IN NEONATAL PEDIATRICS
Authors: BAUMGARTNER LEONA 
Published: December 2021

The salient facts regarding fetal, neonatal and infant mortality in the United States are presented, using the most recent national figures available, or those from other large population groups. A plea is made for the use of perinatal mortality rates in order to obtain a better picture of the success of current programs designed to reduce infant loss.
Six areas for future attack are suggested: 1. Development of several research institutes to study the problems of human reproduction from a multidiscipline approach.
2. An organized program to raise standards of care in all lying-in hospitals with particular emphasis on activities which can be carried on by nurses and doctors at the local level.
3. Further experimentation with and development of ways to supply better service or pay for medical care for certain groups. More attention could be paid to regional plans whereby services of large medical centers are brought to smaller, less well cared for areas; to hospitalizing women with previous history of or current complications of pregnancy, including labor; to providing expert pediatric and obstetric consultation more freely, to supplementing the prenatal diet, et cetera.
4. Acceleration of activities which bring about closer cooperation between obstetric and pediatric services with full cooperation of general practitioners, nurses, nutritionists and all those involved in the care of mother and baby. More local studies of neonatal deaths with the studies used as the basis for community action and professional education.
5. Development of better prenatal service for all mothers in the local community.
6. Continued experimentation with methods of solving the many social problems created by the low economic and social status of those families which contribute so heavily to fetal and neonatal mortality rates today.
SYNDROME OF CONGENITAL HEMIHYPERTROPHY, SHORTNESS OF STATURE, AND ELEVATED URINARY GONADOTROPINS
Authors: SILVER HENRY K. , KIYASU WILLIAM , GEORGE JACK , DEAMER WILLIAM C. 
Published: December 2021

Two cases of a syndrome of hemihypertrophy, shortness of stature, and elevated levels of urinary gonadotropins are reported. One of the children was a male, the other a female.
The hemihypertrophy and shortness of stature had been present since birth and the elevated gonadotropins were found at 5½ and 6 years, respectively.
The possible relationship to other conditions in childhood including those which also have increased gonadotropins is discussed.
STUDIES OF THE IMMUNOLOGY OF THE NEWBORN INFANT
Authors: DANCIS JOSEPH , OSBORN JOHN J. , JULIA JUAN F. 
Published: December 2021

Two groups of 10 infants each were maintained on isocaloric milk formulas in which the protein content differed. One group received a milk formula containing 2.0% protein providing approximately protein 3 gm/kg. body weight; and the other group received a formula containing 3.6% protein providing approximately 5½ gm/kg. body weight. Both groups were immunized with diphtheria toxoid and the antitoxin response measured.
No difference in the antitoxin response between the two groups was seen.
This suggests that a high level of milk protein in the diet does not measurably improve the ability to produce antibodies.
PERSISTENCE AND DISTRIBUTION OF TOXOCARA LARVAE IN THE TISSUES OF CHILDREN AND MICE
Authors: SMITH MARGARET H. D. , BEAVER PAUL C. 
Published: December 2021

Two young mentally defective children were infected with a small number of embryonated eggs of the dog ascarid, Toxocara canis. They remained asymptomatic clinically but developed eosinophilia which persisted for more than 13 months.
Tissues from mice infected experimentally with the same dose of dog ascarid eggs were examined at intervals up to one year after infection. In the early stages of infection the larvae were found principally in the liver and lungs, but in the later stages they were most numerous in the brain.
It seems not improbable that some of the neurologic manifestations associated with ascariasis may be due to actual presence of Toxocara larvae in the tissues of the central nervous system, rather than to toxic or allergic effects of Ascaris lumbricoides.
This new evidence, added to previous observations on the effect of dog and cat ascarids in children, re-emphasizes the need for ridding household pets of their intestinal parasites at frequent intervals.
CONGENITAL MALFORMATIONS AND BIRTH INJURIES IN NEW YORK CITY
Authors: WALLACE HELEN M. , BAUMGARTNER LEONA , RICH HERBERT 
Published: December 2021

1. In 1951, a total of 1,501 children was reported to have been born alive with one or more congenital malformations, an over-all reported incidence of 9.2 per 1,000 live births.
a. Two-thirds of the babies were delivered by a private physician in a hospital, and one-third on a ward service in a hospital. The incidence in the two groups and in white and nonwhite babies was approximately the same. However, the incidence in babies weighing less than 2,500 gm. was twice that in those babies weighing more.
b. Club foot, dactylism, cleft palate and/or harelip, and hypospadias were the most frequent types of congenital malformations reported, accounting for 78% of the total.
c. There were 128 babies reported with cleft palate and/or harelip, an over-all incidence of 0.79 per 1,000 live births.
d. The effect on neonatal mortality is presented.
2. In 195 1 a total of 377 children was reported to have been born alive with one or more birth injuries, an over-all reported incidence of 2.3 per 1,000 live births. One half were reported with severe birth injury. The reported incidence was the same regardless of type of patient (private or ward service), color, or birth weight.
3. The 1951 data for New York City are compared with similar data for upstate New York for 1940-1942. The over-all incidence in reported congenital malformations in the two groups is similar, although some differences occurred in the frequency of individual malformations. The over-all incidence of reported birth injury in upstate New York was more than three times that in New York City; the incidence of each type of birth injury was higher in the upstate group.
4. The use of such data in planning services for these children in a community is discussed.
STUDIES OF IRON REQUIREMENTS IN INFANTS AND CHILDREN
Authors: STURGEON PHILLIP 
Published: December 2021

On an average the newborn infant serum compared to the normal adult male is hyperferremic (S.I. 193 µg./100 cc.), hypocupremic (S.C.51µg./100 cc.), and his free erythrocyte protoporphyrin is increased about two-fold (E.P. 55 µg./100 cc.). His total serum iron-binding capacity appears to be 50% or more saturated.
At 12 hours of age marked hypoferremia (S.I. 46 µg./100 cc.) is present and the total iron-binding capacity as measured in this study is 100% saturated. There is slight, if any, change in the serum copper or erythrocyte protoporphyrin during the first few hours or days of life.
From two weeks through one month of age an essentially normal pattern is present except for the slightly elevated (two-fold) protoporphyrin.
By 4 to 10 months of age, on an average, the normal infant has the pattern characteristic of infancy, namely, hypoferremia (S.I., 50 µ. g/100 cc.), hypercupremia (S.C., 146 µg./100 cc.), reduced saturation of the total serum iron-binding capacity (12%) and elevated free erythrocyte protoporphyrin (E.P., 70 µg./100 cc.).
Extreme ranges in values are found in different individuals at most ages.
The suggested explanation for these findings is that on an average, the normal infant relative to the adult is totally depleted of his iron reserve and that his state of "physiologic anemia" constitutes an additional, but lesser, iron deficit.
EFFECT OF ADDED CARBOHYDRATE ON GROWTH, NITROGEN RETENTION AND RENAL WATER EXCRETION IN PREMATURE INFANTS
Authors: CALCAGNO PHILIP L. , RUBIN MITCHELL I. 
Published: December 2021

With added carbohydrate in the formula during these short balance periods, there resulted a better weight gain, while on both a constant nitrogen intake and with a 19% reduction in dietary protein intake.
Nitrogen retention in these premature infants was greater both when the nitrogen intake was greater and when the total calories, as carbohydrates, were greater. Similar changes occurred in sodium and potassium retentions.
Infants fed "added carbohydrate" had a lower BUN level and a decreased urinary excretion of urea, sodium and potassium. Thus the kidney was presented with a lower total osmolar load for excretion.
The urine concentration on the various diets is a simple reflection of the load demanding excretion and the available expendable water. In the presence of a limited renal concentrating capacity, as is seen in the premature infant, and with suboptimal fluid intakes, a diet offering a smaller load for renal excretion would seem desirable.
BILIRUBIN ENCEPHALOPATHY
Authors: WATERS WILLIAM J. , RICHERT DAN A. , RAWSON HELEN H. 
Published: December 2021

Peripheral blood specimens from cases of varying degree of clinical severity of hemolytic disease of the newborn infant have been examined spectrophotometrically and a curve consistent with the presence of bilirubin was found in each case.
Extracts of the pigmented brain areas from five cases of hemolytic disease of the newborn infant, who died with clinical signs of brain damage, were examined spectrophotometrically and in each intance a curve consistent with bilirubin was obtained. An extract from comparable sections of brain not appearing grossly pigmented contained essentially no such pigment when examined spectrophotometrically.
Crystals were obtained from a chloroform extract of pigmented brain areas and when re-dissolved showed a typical type curve for bilirubin.
A positive van den Bergh was obtained on the extract solution.
RELATION BETWEEN SERUM TOCOPHEROL AND HEMOLYSIS IN HYDROGEN PEROXIDE OF ERYTHROCYTES IN PREMATURE INFANTS
Authors: MACKENZIE JULIA B. 
Published: December 2021

The low serum tocopherol which is characteristic of premature infants fed partially-skimmed milk mixtures is invariably associated with some degree of hemolysis of the red blood cells after exposure to H2O2 in vitro. Wide fluctuations occur in the degree of hemolysis (9 to 98%) despite the constant low values found for serum tocopherol (0.2 mg./100 cc.). The administration of small daily doses of vitamin E increases the amount of blood tocopherol (approximately 0.5 mg./100 cc.) to a level where no hemolysis of the red cell occurs.
Thus, it appears that in premature infants a critical level of serum tocopherol exists, above which complete protection against hemolysis is achieved, and below which there is invariably some susceptibility of the erythrocyte to the hemolytic action of hydrogen peroxide.