Elk Grove Village Research Articles

Pediatrics (80)

Palliative care for children. (American Academy of Pediatrics, Elk Grove Village, IL) Pediatrics 2000;106:351–357.This article presented an integrated model for providing palliative care for children living with a life‐threatening or terminal condition. Advice on the development of a palliative care plan and on working with parents and children is also provided. Barriers to the provision of effective pediatric palliative care and potential solutions are identified. The American Academy of Pediatrics recommends the development and broad availability of pediatric palliative care services based on child‐specific guidelines and standards. Such services will require widely distributed and effective palliative care education of pediatric health care professionals. The Academy offers guidance on responding to requests for hastening death, but does not support the practice of physician‐assisted suicide or euthanasia of children.

The next stage-maintenance of certification.

1. Errol Alden, MD* 2. Robert Perelman, MD† 1. 2. *Deputy Executive Director 3. 4. †Director, Department of Education, American Academy of Pediatrics, Elk Grove Village, IL Since 1993, the American Board of Pediatrics (ABP) has provided its Program for Renewal of Certification (PRCP) as an at-home, computer-based examination, with an optional written version also available. While praised by some as an examination approach that also fostered learning, the at-home test drew criticism based on perceived and procedural shortcomings. In short, there was no guarantee that the person submitting the completed examination was the person who actually took the test, making some state licensure boards uncomfortable. This was clearly a vulnerability of the take-home examination system. Concerns about public perception …

Earning CME credit-completing the PIR quiz

The American Academy of Pediatrics (AAP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Pediatrics in Review(PIR) was planned and produced in accordance with the ACCME Essentials.The AAP designates this activity for up to 38 hours in Category 1 of the Physician’s Recognition Award of the American Medical Association (3 hours per completed print issue of PIR and 2 hours per completed compact disc issue of PIR). Each physician should claim only those hours of credit that he/she actually spent in the educational activity.PIR Quiz: A short quiz can be found at the end of each article in PIR. You may complete the quiz by recording your answers on the PIR Quiz Card (bound into the January issue) or by going online at www.pedsinreview.org. Each question has a single best answer. The answers to the questions appear on the inside front cover of each print issue and under the options in the online version.2000 Credit Deadline: December 31, 2000. If you want to receive CME credit in 2000, a completed PIR Quiz Card must be received in the PREP Office postmarked by December 31, 2000. Material received after December 31, 2000 will be applied to the following year. Your CME certificate will be mailed within 1 month after your credit reply material is received. If you test online, all quizzes must be completed by December 31, 2000.Expiration of Credit: December 31, 2002. Credit for completing the 2000 PIR will be awarded for up to 3 years. Credits will be posted to the year in which they are completed.Verification of Credit will be mailed by: April 30, 2001. If you are an AAP Member, you will receive a complimentary transcript by April 30, 2001, containing a summary of CME credits earned in 2000 through AAP programs. If you require a transcript at any other time of the year,there will be a $25 processing fee.Mail form to: American Academy of Pediatrics - PREP Office, 141 Northwest Point Boulevard, PO Box 927, Elk Grove Village, IL 60009-0927PREP Education Award: The AAP PREP Education Award recognizes Academy Fellows and Candidate Fellows who earn a minimum of 150 AAP-approved CME credits over 3 consecutive years. The Award will automatically be mailed in the summer of 2001 to all individuals who qualify. To qualify for the PREP Education Award, an Academy Fellow must: Other Organizations Granting Credit: PIR has been approved for credit as follows:

The First Video-Based Study in Pediatrics

Despite its many virtues (durability, portability, and readability, to list a few), a paper-based journal cannot show motion or convey sound. When we received Dr Rich's article1 on video intervention and prevention in asthma, published as the lead article in this month's issue of Pediatrics , it became apparent to us that we needed to cross yet another border on the electronic frontier, and integrate the presentation of videos into the journal. There is a paper-based presentation of the videos, which consists of still frames selected by the authors and editors. These frames are intended to represent a meaningful sequence within each video, to convey some of the content while … Address correspondence to Kent R. Anderson, American Academy of Pediatrics, 141 Northwest Point Blvd, PO Box 927, Elk Grove Village, IL 60007.

The Internet for Pediatricians

1. S. Andrew Spooner, MD* 2. Kent R. Anderson† 1. 2. *Assistant Professor of Pediatrics, University of Alabama at Birmingham, Children’s Hospital, Birmingham, AL. 3. 4. †Director, Division of Medical Journals & Professional Periodicals, American Academy of Pediatrics, Elk Grove Village, IL. Type the word “pediatrics” into one of the more robust search engines on the World-Wide Web, and you will retrieve more than 90,000 different sites that refer to the specialty in some manner. With more than 5 million different destinations on the Web (and 80,000 being added every week), the growth of this information source and communication tool is remarkable. However, the quality and reliability of information can be uneven, despite vast improvements in the offerings over the past 1 to 2 years, and sites still fall into disrepair when their champions lose interest or funding. To help readers sort through this daunting information repository, the editors of Pediatrics in Review invited us to highlight some of the primary touchstones on the Web for pediatricians and to point to other sites that we believe offer excellent content, useful features, timely information, and interesting perspectives. The following list is by no means exhaustive, and it is not intended to represent a “best of” list. It is simply a list of stable, useful, and intriguing sites that can serve as a fine collection of online resources and a springboard for further investigations for the pediatric health care specialist. We organized most of this list according to clinical categories used by the American Board of Pediatrics and by the AAP’s PREP program. We then focused on sites that have one or more of the following priorities apparent in their design:

Fat-soluble Vitamin Deficiencies

1. Uwe Blecker, MD* 2. Derendra I. Mehta* 3. Alfred I. duPont* 4. Rebecca Davis† 5. Melinda S. Sothern† 6. Robert M. Suskind† 1. 2. *Hospital for Children, Wilmington, DE 3. 4. †Department of Pediatrics, LSU Medical Center, New Orleans, LA 1. Machlin J, ed. Handbook of Vitamins . 1984 New York, NY and Basel, Switzerland.: Dekker 2. Lewinter-Suskind L, Suskind RM, eds. Textbook of Pediatric Nutrition . 1993 New York, NY.: Raven Press 3. Nutritional Vitamin D Deficiency Rickets in Sudanese Children. El Hag AI, Karrar ZA. Ann Trop Paediatr . 1995;15:69-76 [OpenUrl][1][PubMed][2][Web of Science][3] 4. Barness LA, ed. Pediatric Nutrition Handbook . 3rd 1993 Elk Grove Village, Ill.: American Academy of Pediatrics Vitamins A, D, E, and K are fat-soluble. As a class, fat-soluble vitamins are responsible for regulating protein synthesis. These vitamins require carrier proteins for transport. Vitamins A and D are carried by specific plasma proteins, and vitamins E and K are carried by plasma lipoproteins, mostly low-density lipoproteins. All of the fat-soluble vitamins are converted to active forms. Deficiencies in these vitamins during infancy and childhood often result in numerous complications. However, the medical manifestations of fat-soluble vitamin deficiency are preventable if recognized early and treated appropriately. Vitamin A is present in food. It is hydrolyzed in the small intestine by a pancreatic esterase and an intestinal hydrolase. Bile salts are required for activation of these enzymes. Human vitamin A requirements range from 10 to 30 mcg retinol per kilogram of body weight, although infants have higher requirements. Vitamin A deficiency in infants causes night blindness, Bitot spots (keratinization of the cornea), xerophthalmia (dry eyes), keratomalacia, corneal opacities, growth failure, hyperkeratosis, reduced resistance to infection, and death. Laboratory tests may show a mild leukopenia. Clouding of the cornea in a child who has vitamin A deficiency is considered a medical emergency and requires parenteral administration of high doses of the vitamin. Vitamin D is required to prevent rickets in children and osteoporosis and osteomalacia in adults. Rickets once was considered the most common disease of early childhood. With adequate light exposure, there is no need to supplement with vitamin D. Indeed, vitamin D is a facultative vitamin that … [1]: {openurl}?query=rft.jtitle%253DAnnals%2Bof%2Btropical%2Bpaediatrics%26rft.stitle%253DAnn%2BTrop%2BPaediatr%26rft.aulast%253Del%2BHag%26rft.auinit1%253DA.%2BI.%26rft.volume%253D15%26rft.issue%253D1%26rft.spage%253D69%26rft.epage%253D76%26rft.atitle%253DNutritional%2Bvitamin%2BD%2Bdeficiency%2Brickets%2Bin%2BSudanese%2Bchildren.%26rft_id%253Dinfo%253Apmid%252F7598440%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=7598440&link_type=MED&atom=%2Fpedsinreview%2F20%2F11%2F394.atom [3]: /lookup/external-ref?access_num=A1995QN99000010&link_type=ISI

A new capability: postpublication peer review for pediatrics

Beginning with this month's issue of Pediatrics , we will introduce a new and potentially transformational capability for the journal via its on-line version. We are calling this feature “Postpublication Peer Review,” or P3R. Traditional peer review is conducted by one or more (preferably two or more) respected peers during a prepublication screening process. For Pediatrics , this process eliminates nearly 80% of the manuscripts submitted to the journal in any given year. Once a study is published, however, a slow and rather cumbersome method of subsequent review, via Letters to the Editor, has been the only direct feedback mechanism available to authors, with subsequent studies being the other, even … Address correspondence to Kent R. Anderson, Director, Division of Medical Journals and Professional Periodicals, American Academy of Pediatrics, 141 Northwest Point Blvd, Elk Grove Village, IL 60007-1098.

Re: Obesity in adolescence

Dear Editor: I enjoyed the review of management of obesity in adolescence (Paediatr Child Health 1998;3:395–8). I have become involved more intensively with this clinical problem in the past decade because it is the most important risk factor for type 2 diabetes in aboriginal youth (1–3). I note in Table 1 of your article that abnormal glucose metabolism is listed as a health consequence of obesity. In Canada and the United States, we need to include type 2 diabetes as a significant consequence of obesity in youth at risk. In the Cree communities of northern Manitoba, the prevalence of type 2 diabetes in children age five to 19 years is 1.1%, and the age/sex-specific prevalence is 4% in adolescent females. The prevalence of obesity is 45% in females and 55% in males. I write this letter to help raise awareness of this growing problem, particularly among our paediatric colleagues. Because most of the youth with type 2 diabetes are asymptomatic, screening of fasting plasma glucose is essential. Clinical practice guidelines for the care of diabetes in Canada (4) recommend annual screening of fasting plasma glucose in persons at risk “at an earlier age” than 45 years. We have recommended screening over age six years based on our experience in Manitoba. Many organizations, such as the American Diabetic Association (Alexandria, Virginia), the Canadian Diabetic Association (Toronto, Ontario), Centers for Disease Control and Prevention (Atlanta, Georgia), National Institutes of Health (Bethesda, Maryland), Canadian Paediatric Society (Ottawa, Ontario), American Academy of Pediatrics (Elk Grove Village, Illinois) and American Pediatric Society (The Woodlands, Texas), are actively engaged in consultation regarding this problem in hispanic, black and native children. The next decade of research will provide better data from which we can make evidence-based recommendations.

Earning CME Credit-Completing the PIR Quiz

The American Academy of Pediatrics (AAP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME)to sponsor continuing medical education for physicians. Pediatrics in Review (PIR) was planned and produced in accordance with the ACCME Essentials.The AAP designates this activity for up to 38 hours in Category 1 of the Physician’s Recognition Award of the American Medical Association (3 hours per completed print issue of PIR and 2 hours per completed compact disc issue of PIR). Each physician should claim only those hours of credit that he/she actually spent in the educational activity.PIR Quiz: A short quiz can be found at the end of each article in PIR. You may complete the quiz by recording your answers on the PIR Quiz Card (bound into the January issue) or by going online at www.pedsinreview.org. Each question has a single best answer. The answers to the questions appear on the inside front cover of each print issue and under the options in the online version.1999 Credit Deadline: February 28, 2000. If you want to receive CME credit in 1999, a completed PIR Quiz Card must be received in the PREP Office by February 28,2000. Credit reply material received after February 28, 2000,will be applied to the following year. Your CME certificate will be mailed within 1 month after your credit reply material is received. If you test online, all quizzes must be completed by February 28, 2000.Expiration of Credit: December 31, 2001. Credit for completing the 1999 PIR will be awarded for up to 2 years. Credits will be posted to the year in which they are submitted.Verification of Credit will be mailed by: April 30, 2000. You will receive a complimentary transcript by April 30, 2000,containing a summary of CME credits earned in 1998 through AAP programs. If you require a transcript at any other time of the year, there will be a $25 processing fee.Mail form to: American Academy of Pediatrics - PREP Office,141 Northwest Point Boulevard,PO Box 927, Elk Grove Village, IL 60009-0927PREP Education Award: The AAP PREP Education Award recognizes Academy Fellows who earn a minimum of 150 AAP-approved CME credits over 3 consecutive years. The Award will automatically be mailed in the summer of 2000 to all individuals who qualify. To qualify for the PREP Education Award, an Academy Fellow must: Other Organizations Granting Credit: PIR has been approved for credit as follows:

Pediatric electronic pages: looking back and looking ahead.

* Abbreviations: URLs = : Uniform Resource Locators • AAP = : American Academy of Pediatrics To say that the rapidity of change on the World Wide Web has been extraordinary is an understatement. In less than 5 years, the Internet and the Web have gone from marginal technologies that were often derided to increasingly central information access points for millions of scientists, physicians, teachers, students, businesses, and others. Intellectual endeavors and economic life have likely only felt the first tremors of change. Uniform Resource Locators (URLs), those sometimes cryptic combinations of letters and dots (eg, http://www.whitehouse.gov for the White House), have become common elements in all forms of advertising and most publications. Large corporate interests are investing billions of dollars in this new medium. Dozens of innovative enterprises have been launched, employing thousands of highly skilled workers devoted to furthering Web technologies. Millions of dollars in stock transactions and consumer purchases are conducted over the Web each week, often more efficiently than by traditional means. Undoubtedly, the children of tomorrow will be profoundly affected by changes to pedagogy being wrought by new levels of information accessibility and interrelation. In February 1998, the National Academy of Sciences, National Academy of Engineering, and Institute of Medicine issued a recommendation for the “retooling of education at all levels, with the World Wide Web as the centerpiece.”1 It has gone beyond fad, and done so at a dizzying pace. In short, the Internet has turned out to be the best product the “computer nerds” have yet produced. Of all its possible uses, the Web has arguably done its most important work to date in the collection and dissemination of medical information. Vast databases of medical literature and genomic, chemical, physiological, and biological research are now available to practitioners and researchers around the world. Cryosections of human cadavers can be viewed and downloaded over the Web, as can magnetic … Address correspondence to: Mr Kent Anderson, American Academy of Pediatrics, 141 Northwest Point Blvd, Box 927, Elk Grove Village, IL 60009-0927.

Rocky Mountain spotted fever.

1. L. Akinbami, MD* 1. 2. *Pediatric Resident Children’s National Medical Center Washington, DC 1. Rocky Mountain Spotted Fever. Silber JL. Clin Dermatol . 1996;14:254-258 2. Lyme Disease, Rocky Mountain Spotted Fever, Ehrlichiosis: Emerging and Established Challenges for the Clinician. Jantausch BA. Ann Allergy . 1994;73:4-12 [OpenUrl][1][PubMed][2] 3. Treatment of Rocky Mountain Spotted Fever. Kamper C. J Pediatr Health Care . 1991;5:216-222 [OpenUrl][3][CrossRef][4][PubMed][5] 4. Therapeutic Delay and Mortality in Cases of Rocky Mountain Spotted Fever. Kirkland KB, Wilkinson WE, Sexton DJ. Clin Infect Dis . 1995;20:1118-1121 [OpenUrl][6][Abstract/FREE Full Text][7] 5. Rocky Mountain Spotted Fever. Weber DJ, Walker DH. Infect Dis Clin North Am . 1991;5:19-35 [OpenUrl][8][PubMed][9] Rocky Mountain spotted fever (RMSF) is a potentially fatal multisystem illness caused by Rickettsia rickettsii , a Gram-negative, obligate intracellular coccobacillus. A feeding tick inoculates the bacteria into the dermis from which they disseminate hematogenously and enter endothelial cells throughout the body. Intracellular replication leads to vasculitis and increased vascular permeability. The seasonal occurrence (April to October) of RMSF is associated with feeding activity of the vectors— the wood tick Dermacentor andersoni in Rocky Mountain states and the dog tick Dermacentor variabilis in the eastern two thirds of the United States. RMSF has been reported from every region of the continental United States, and the vector is found in both rural and urban areas. The incidence is highest in children ages 5 to 9 years. For all ages, risk factors include exposure to dogs, residence in wooded areas, and male gender. Clinical signs and symptoms of RMSF emerge after an average incubation of 1 week, which may range from 2 to 14 days, depending on the inoculum size. Patients present with fever, severe frontal headache, and myalgias, which make early RMSF difficult to distinguish from acute viral illnesses. Additional complaints … [1]: {openurl}?query=rft.jtitle%253DAnnals%2Bof%2Ballergy%26rft.stitle%253DAnn%2BAllergy%26rft.aulast%253DJantausch%26rft.auinit1%253DB.%2BA.%26rft.volume%253D73%26rft.issue%253D1%26rft.spage%253D4%26rft.epage%253D11%26rft.atitle%253DLyme%2Bdisease%252C%2BRocky%2BMountain%2Bspotted%2Bfever%252C%2Behrlichiosis%253A%2Bemerging%2Band%2Bestablished%2Bchallenges%2Bfor%2Bthe%2Bclinician.%26rft_id%253Dinfo%253Apmid%252F8030801%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=8030801&link_type=MED&atom=%2Fpedsinreview%2F19%2F5%2F171.atom [3]: {openurl}?query=rft.jtitle%253DJournal%2Bof%2Bpediatric%2Bhealth%2Bcare%2B%253A%2B%2Bofficial%2Bpublication%2Bof%2BNational%2BAssociation%2Bof%2BPediatric%2BNurse%2BAssociates%2B%2526%2BPractitioners%26rft.stitle%253DJ%2BPediatr%2BHealth%2BCare%26rft.aulast%253DKamper%26rft.auinit1%253DC.%26rft.volume%253D5%26rft.issue%253D4%26rft.spage%253D216%26rft.epage%253D222%26rft.atitle%253DTreatment%2Bof%2BRocky%2BMountain%2Bspotted%2Bfever.%26rft_id%253Dinfo%253Adoi%252F10.1016%252F0891-5245%252891%252990067-Z%26rft_id%253Dinfo%253Apmid%252F1865296%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [4]: /lookup/external-ref?access_num=10.1016/0891-5245(91)90067-Z&link_type=DOI [5]: /lookup/external-ref?access_num=1865296&link_type=MED&atom=%2Fpedsinreview%2F19%2F5%2F171.atom [6]: {openurl}?query=rft.jtitle%253DClin%2BInfect%2BDis.%26rft_id%253Dinfo%253Adoi%252F10.1093%252Fclinids%252F20.5.1118%26rft_id%253Dinfo%253Apmid%252F7619985%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [7]: /lookup/ijlink?linkType=ABST&journalCode=cid&resid=20/5/1118&atom=%2Fpedsinreview%2F19%2F5%2F171.atom [8]: {openurl}?query=rft.jtitle%253DInfectious%2Bdisease%2Bclinics%2Bof%2BNorth%2BAmerica%26rft.stitle%253DInfect%2BDis%2BClin%2BNorth%2BAm%26rft.aulast%253DWeber%26rft.auinit1%253DD.%2BJ.%26rft.volume%253D5%26rft.issue%253D1%26rft.spage%253D19%26rft.epage%253D35%26rft.atitle%253DRocky%2BMountain%2Bspotted%2Bfever.%26rft_id%253Dinfo%253Apmid%252F1904897%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [9]: /lookup/external-ref?access_num=1904897&link_type=MED&atom=%2Fpedsinreview%2F19%2F5%2F171.atom

Earning CME Credit Completing the PIR Quiz

The American Academy of Pediatrics (AAP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians. Pediatrics in Review (PIR) was planned and produced in accordance with the ACCME Essentials.The AAP designates this activity for up to 38 hours in Category 1 of the Physician’s Recognition Award of the American Medical Association (3 hours per completed print issue of PIR and 2 hours per completed compact disc issue of PIR). Each physician should claim only those hours of credit that he/she actually spent in the educational activity.PIR Quiz: A short quiz can be found at the end of each article in PIR. Use the PIR Quiz Card (bound into the January issue) to record your answers. Each question has a single best answer. The answers to the questions appear on the inside front cover of each issue.1998 Credit Deadline: February 28, 1999. If you want to receive CME credit in 1998, the PIR Quiz Card must be received in the PREP Office by February 28, 1999. Credit reply material received after February 28, 1999, will be applied to the following year.Expiration of Credit: December 31, 2000. Credit for completing the 1998 PIR will be awarded for up to 2 years. Credits will be posted to the year in which they are submitted.Verification of Credit will be mailed by: April 30, 1999. You will receive a complimentary transcript by April 30, 1999, containing a summary of CME credits earned in 1998 through AAP programs. If you require a transcript at any other time of the year, there will be a $25 processing fee.Mail form to: American Academy of Pediatrics - PREP Office, 141 Northwest Point Boulevard, PO Box 927, Elk Grove Village, IL 60009-0927PREP Education Award:The AAP PREP Education Award recognizes Academy Fellows and Candidate Fellows who earn a minimum of 150 AAP-approved CME credits over 3 consecutive years. The Award will be mailed July 1999 to all individuals who qualify. To qualify for the PREP Education Award, an Academy Fellow or Candidate Fellow must: Other Organizations Granting Credit: PIR has been approved for credit as follows:

Acellular pertussis vaccines.

1. Kathryn Edwards, MD* 1. 2. *Vanderbilt University Medical Center Nashville, TN Dr Edwards has funding for research from Connaught and Lederle-Praxis and is on their speaker’s bureaus. She also is a consultant for Smith-Kline Beecham Co. 1. Pertussis. Committee on Infectious Diseases. 1997 Red Book . 24th ed. 1994:394-407 American Academy of Pediatrics Elk Grove Village, Ill 2. Report of the Nationwide Multicenter Acellular Pertussis Trial . Decker MD, Edwards KM. Pediatrics . 1995;96(suppl):547-603 [OpenUrl][1][Abstract/FREE Full Text][2] 3. Bordetella Pertussis (Whooping Cough) . Cattaneo L, Edwards KM. Semin Pediatr Infect Dis . 1995;6:107-118 4. A Controlled Trial of Two Acellular Vaccines and One Whole-cell Vaccine Against Pertussis . Greco D, Salmaso S, Mastrantonis P, et al. N Engl J Med . 1996;334:341-348 [OpenUrl][3][CrossRef][4][PubMed][5][Web of Science][6] 5. A Controlled Trial of a Two-component Acellular, a Five-component Acellular, and a Whole-cell Pertussis Vaccine . Gustafsson L, Hallander HO, Olin P, Reizenstein E, Storsaeter J. N Engl J Med . 1996;334:349-355 [OpenUrl][7][CrossRef][8][PubMed][9][Web of Science][10] Bordetella pertussis , a fastidious, Gram-negative pleomorphic bacillus first isolated by Bordet and Gengou in 1906, has a marked tropism for ciliated respiratory tract epithelial cells and does not invade the bloodstream. The organism produces multiple antigens that have been the focus of extensive research in the past decade; their isolation and purification has made possible the development of new acellular pertussis vaccines that feature four major antigenic components: pertussis toxin, filamentous hemagglutinin, agglutinogens (fimbriae), and pertactin (Table 1⇓ ). View this table: Table 1. Components Considered for Incorporation into Acellular Vaccine1 Pertussis toxin (PT), also termed lymphocytosis-promoting factor, induces many of the biologic activities of the organism: histamine sensitization, lymphocytosis-promoting activity, pancreatic islet cell activation, and immune response enhancement. PT is composed of several subunits and has a structure similar to other bacterial toxins such as diphtheria. When administered to mice, PT induces antibodies that protect against lethal respiratory and intracerebral challenge with live B pertussis organisms. Many investigators believe PT has a central role in providing clinical protection for humans. For incorporation into a vaccine, active toxin must be inactivated (or toxoided) either chemically or genetically. Filamentous hemagglutinin (FHA), a component of the cell wall, is believed to be crucial for the attachment of organisms to the respiratory epithelium. Mice immunized with FHA are protected against lethal respiratory challenge with pertussis but not against intracerebral challenge. Agglutinogens are fimbrial-associated surface components that stimulate production of agglutinating antibodies. Although pertussis carries several different agglutinogens, three types (1, 2, and 3) occur in various combinations … [1]: {openurl}?query=rft.jtitle%253DPediatrics%26rft.stitle%253DPediatrics%26rft.issn%253D0031-4005%26rft.aulast%253DKlein%26rft.auinit1%253DD.%2BL.%26rft.volume%253D96%26rft.issue%253D3%26rft.spage%253D547%26rft.epage%253D548%26rft.atitle%253DMulticenter%2BAcellular%2BPertussis%2BVaccine%2BTrial%253A%2BA%2BNational%2BInstitutes%2Bof%2BHealth%2BPerspective%26rft_id%253Dinfo%253Apmid%252F7659474%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=pediatrics&resid=96/3/547&atom=%2Fpedsinreview%2F19%2F2%2F68.atom [3]: {openurl}?query=rft.jtitle%253DNew%2BEngland%2BJournal%2Bof%2BMedicine%26rft.stitle%253DNEJM%26rft.issn%253D0028-4793%26rft.aulast%253DGreco%26rft.auinit1%253DD.%26rft.volume%253D334%26rft.issue%253D6%26rft.spage%253D341%26rft.epage%253D349%26rft.atitle%253DA%2BControlled%2BTrial%2Bof%2BTwo%2BAcellular%2BVaccines%2Band%2BOne%2BWhole-Cell%2BVaccine%2Bagainst%2BPertussis%26rft_id%253Dinfo%253Adoi%252F10.1056%252FNEJM199602083340601%26rft_id%253Dinfo%253Apmid%252F8538704%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [4]: /lookup/external-ref?access_num=10.1056/NEJM199602083340601&link_type=DOI [5]: /lookup/external-ref?access_num=8538704&link_type=MED&atom=%2Fpedsinreview%2F19%2F2%2F68.atom [6]: /lookup/external-ref?access_num=A1996TT48700001&link_type=ISI [7]: {openurl}?query=rft.jtitle%253DNew%2BEngland%2BJournal%2Bof%2BMedicine%26rft.stitle%253DNEJM%26rft.issn%253D0028-4793%26rft.aulast%253DGustafsson%26rft.auinit1%253DL.%26rft.volume%253D334%26rft.issue%253D6%26rft.spage%253D349%26rft.epage%253D356%26rft.atitle%253DA%2BControlled%2BTrial%2Bof%2Ba%2BTwo-Component%2BAcellular%252C%2Ba%2BFive-Component%2BAcellular%252C%2Band%2Ba%2BWhole-Cell%2BPertussis%2BVaccine%26rft_id%253Dinfo%253Adoi%252F10.1056%252FNEJM199602083340602%26rft_id%253Dinfo%253Apmid%252F8538705%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [8]: /lookup/external-ref?access_num=10.1056/NEJM199602083340602&link_type=DOI [9]: /lookup/external-ref?access_num=8538705&link_type=MED&atom=%2Fpedsinreview%2F19%2F2%2F68.atom [10]: /lookup/external-ref?access_num=A1996TT48700002&link_type=ISI

Documenting the educational content of morning report.

To document the educational content of a pediatric morning report and to determine if it represents a curriculum. A midwestern, tertiary care, pediatric training program. A prospective, observational study was conducted of case presentations discussed during pediatric morning report from July 1995 through July 1996. Presented cases were analyzed for demographics, clinical venues where patients were encountered, case diagnoses, and ensuing discussion. Morning report by study criteria was considered a curriculum. A wide variety of patient ages (aged from birth to 41 years) and all clinical venues were represented. A broad spectrum of diagnoses covered 30 of 31 Pediatrics Review and Education Program (American Academy of Pediatrics, Elk Grove Village, Ill) Content Specification headings and most (72%) of the Educational Objectives listed (N = 977 [72%]). The most common topic areas were infectious diseases (n = 137 [18.2%]), disorders of the blood/neoplasms (n = 85 [11.2%]), neurological disorders (n = 57 [7.5%]), genetics or dysmorphology (n = 56 [7.4%]), and gastrointestinal tract disorders (n = 44 [5.8%]). Top discussion categories were patient clinical presentation (n = 399 [19.6%]), evaluation (n = 375 [18.4%]), and management (n = 377 [18.5%]). Morning report represents a curriculum in a pediatric residency training program. It can be used effectively to address nontraditional or rarely discussed topics that are important to the overall professional development of pediatric residents.

Analog and digital signal processing in a high-performance miniature sound-level meter

The design of a relatively low-cost Type 2 pocket-size sound-level meter with an embedded 8-bit microcontroller is described. The key design goal was to provide 110 dB of dynamic range without the need for user-controlled range switching. The miniature instrument meets all the current ANSI S1.4-1983 (R 1990) and IEC 651 (1979) sound-level meter standards. Relevant features in the future IEC 1672 sound level meter standard, such as level linearity, tone-burst response, over-range and under-range indication, measurement accuracy, and resolution are reviewed. Due to judicious separation of the functions performed by analog and digital hardware and software, the wide dynamic range is implemented with only 8 bits of A–D conversion. Extensive type testing confirmed that the instrument can satisfy the requirements of the standards over the required temperature range. [Work supported by Etymotic Research, Elk Grove Village, IL.]

The SIN report

Mead C. Killion, PhD is President of Elymotic Research, Inc. and Adjunct and Visiting Professor at Northwestern and Rush Universities, respectively. Write to Mead Killion at Elymotic Research, 61 Martin Lane, Elk Grove Village, IL 60007.

Insuring children: the next steps.

Research Article Health AffairsVol. 16, No. 4 Perspective: Insuring Children: The Next StepsSamuel S. Flint AffiliationsThe American Academy of Pediatrics, based in Elk Grove Village, Illinois. He has been with the academy since 1981.PUBLISHED:July/August 1997No Accesshttps://doi.org/10.1377/hlthaff.16.4.79AboutSectionsView articleView Full TextView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions View articleAbstractA strategy for establishing health care as a child's right.TOPICSChildren's healthMedicaidUninsuredAccess to careCrowd outInpatient careFederal health plansInsurance coverage and benefitsIncome levelsBeneficiaries Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 3 History Published online 1 July 1997 InformationCopyright © by Project HOPE: The People-to-People Health Foundation, Inc.ACKNOWLEDGMENTSThe author is indebted to the creative ideas of Beth Yudkowsky, Graham Newson, and the staff and members of the American Academy of Pediatrics (AAP) Committee on Child Health Financing. However, the content of this paper is the sole responsibility of the author and should not be interpreted as AAP policy.PDF downloadCited ByHow Bipartisanship and Incrementalism Stitched the Child Health Insurance Safety Net (1982-1997)22 May 2014 | Health & Social Work, Vol. 39, No. 2Crowd Out: Evidence From the Florida Healthy Kids Program1 September 1999 | Pediatrics, Vol. 104, No. 3Mental Health Carve-Outs: Effects and Implications15 December 2016 | Medical Care Research and Review, Vol. 56, No. 2_suppl

Improving radiologists' communication: drawing on radiographs with dry-erase markers.

J. T. Littleton1 T hroughout the field of radiology, we radiologists enter illustrative marks on radiographs, most often with the time-honored wax pencil (if one can be found). Inadvertent film marking by clinicians can leave indelible artifacts on rare case films, forever destroying the reproducibility of such films, to the disgust and anguish of the radiologist. Marking a stack of films for the photographer is often done too sparingly, so that accurate directions may not be clear. Wax pencil from one film may soil other films in a stack, requiring painstaking cleaning (when proper solutions are available). These and untold other problems result from wax pencils or indelible marking of films. I recently discovered a simple solution: the use of dry-erase whiteboard markers on radiographs. This type of marker was designed for white wall boards on which data can be easily entered by hand and as easily removed with a quick swipe of a dry eraser, soft cloth, or one’s own finger, leaving the board clean. Spear and Little [1] have described the effective use of the dry-erase board in resident teaching and procedure planning before plastic or reconstructive surgery. During film review with clinicians and residents at our institution, our staff have found the dry-erase marker to be a perfect way to enhance findings on radiographs. The flow of dye is uniform and is completely removable with a soft cloth or dry finger (Fig. I). Detailed instructions can be written on films sent to photographers for conversion to slides or prints for publication. Reasonable care must be taken when marked films are stacked. The compounds in the dry-erase markers are easily removed and will transfer to an adjacent film unless handled with care. When the copy process is complete, the markings are easily dry-wiped clean, leaving no residual soiling or iridescence on the radiograph. We have found that radiologists’ communication skills can be significantly enhanced by the use of these markers, especially when forwarding films to clinicians at remote sites. The salient pathologic findings can be clearly highlighted for the clinician. The markers are available in many colors to illustrate separate or superimposed findings. We know of five different types of dry-erase Fig. 2.-Five common dry-erase makers: 1 = Paper-Mate (Gillette, Boston, MA), four colors, bullet point; 2 = Expo (Sanford, Bellwood, IL); eight colors; bullet, chisel, and fine points;3= DryErase (Binney& Smith, Easton, PA),four colors, bullet point, 4 Dry Erase Marker (Pentel, Elk Grove Village, IL), four colors, chisel and fine points; 5 = Marks-A-Lot Dry Erase Marker (Avery, Framingham, MA), nine colors, chisel point

Quality improvement: an ACQIP exercise on telephone advice.

1. Robert H. Sebring, PhD* 2. Myra Gueco, MPH* 1. 2. *Staff of the Division of Quality Care As part of Pediatrics in Review’s ongoing focus on quality improvement, we present a self-assessment exercise taken from the American Academy of Pediatrics’ Ambulatory Quality Improvement Program (ACQIP). Readers are encouraged to participate in the ongoing ACQIP program. Additional information can be obtained by calling or writing to the Division of Quality Care, American Academy of Pediatrics, Box 927, Elk Grove Village, IL 60009-0927. When physicians and staff complete this exercise, review the accompanying material, and discuss their responses together, they will be able to create or improve office telephone protocols that will enhance patient care in the context of a mutual learning experience.

5553006 Method and apparatus for building environmental compliance : Benda Georg Elk Grove Village, IL, United States assigned to Chelsea Group Ltd

A series of phosphorus-containing copolyesters were synthesized by polycondensation of terephthalic acid (TPA), ethylene glycol (EG) and 9,10-dihydro-10-[2,3-di(hydroxycarbonyl)propyl]-9-oxa-10-phosphaphenanthrene-10-oxide (DDP). Chemical structures of these phosphorus-containing copolyesters were characterized by 1H-n.m.r.. Experimental results show that these methylene protons of the ethylene glycol unit resonate at lower field than those of the DDP aliphatic protons. The resonance intensity of DDP aliphatic protons increases with the increase of the phosphorus content. The 1H-n.m.r. spectrum of the DDP aliphatic protons contain three peaks since the proton in HCP has greater coupling constant than that of HCC. The chemical shifts of these methylene protons in the ethylene glycol unit vary with different sequences. The methylene protons in the ethylene glycol of the TET unit resonate at lower field than those of PET(TEP) and PEP units. The monomer molar fraction, sequential distribution and degree of randomness of the phosphorus-containing copolyester were determined through analyses of the resonances of methylene protons in the ethylene glycol unit. The molar fractions of the DDP comonomer determined by n.m.r. analyses are close to the charged values in synthetic step and the values determined by an UV method. Moreover, the copolyesters were found to be as random copolymers with a degree of randomness equal to about 1.