Dieldrin accumulation, distribution in plant parts and phytoextraction potential for several plant species and Cucurbita pepo varieties.

Dieldrin, an organochlorine pesticide (OCP) widely used for crop protection in the second half of the 20th century till the 70's, is worldwide still present in arable soils. It can be transferred to crops, notably cucurbits, depending on plant species and cultivars. Finding strategies to decrease OCP bioavailability in soil is therefore a main concern. Phytomanagement strategies could provide (i) ready-to-use short term solution for maintaining the production of edible plant parts with dieldrin concentrations below the Maximum Residue Limits (MRL) and (ii) long-term solution for dieldrin phytoextraction reducing progressively its bioavailability in the soil. This field study aimed at determining dieldrin accumulation capacities and allocation pattern in 17 non-Cucurbitaceae species and 10 Cucurbita pepo varieties, and assessing the dieldrin phytoextraction potential of these plant species when grown to maturity in a historically dieldrin-contaminated soil. Out of the non-Cucurbitaceae species, vetiver was the only one able to accumulate significant amounts of dieldrin, which mainly remained in its roots. All C. pepo varieties were able to uptake and translocate high dieldrin amounts into the shoots, leading to the highest phytoextraction potential. Despite the intraspecific variability in dieldrin concentration in zucchini plant parts, mainly in the reproductive organs, the phytoextraction capacity for shoots and fruits was high for all tested varieties (147 to 275 µg dieldrin plant-1, corresponding to 5.6 % of the n-heptane extractable soil dieldrin), even for the one with low fruit dieldrin concentration. Both food safety and phytoextraction could be achieved by selecting productive zucchini varieties displaying low dieldrin concentration in fruits and high one in shoots.

Inter and intraspecific variability of dieldrin accumulation in Cucurbita fruits: New perspectives for food safety and phytomanagement of contaminated soils.

Due to past agricultural practices, it is common to identify arable soils contaminated with persistent and potentially toxic organochlorine pesticides (OCPs). Occurrence of OCPs, including dieldrin, in vegetables can lead to chronic exposure of the consumers. Some market vegetables, particularly the Cucurbitaceae, are known to accumulate high OCP concentrations. Dieldrin concentration in Cucurbita fruits can exceed the Maximal Residue Limit (MRL) resulting in cultivation and sale restrictions for market gardeners. To assess the intra- and interspecific variability of Cucurbitaceae species for low dieldrin concentration in fruits could be a solution. Here, 24 varieties from seven Cucurbitaceae species were cultivated outdoors in large pots, until fruiting, in soils historically contaminated with dieldrin. More than 330 fruits were harvested and analyzed for determining the inter and intraspecific variability of dieldrin accumulation. Significant interspecific differences occurred with mean fruit concentration ranging between 4.2 ± 7.0 and 85.0 ± 19.4 µg dieldrin kg-1 fresh weigh (FW) in watermelons (C. lanatus L.) and cucumbers (C. sativus L.), respectively. Intraspecific differences only occurred for Cucurbita pepo L. with mean concentration ranging between 4.9 ± 1.1 and 70.3 ± 3.6 µg dieldrin kg-1 FW for the varieties Noire maraîchère and Orélia, respectively. For this plant species, the influence of soil concentration, plant exposure time and biomass on fruit dieldrin concentration depended mainly on varieties.

The prenatal visit.

In their role as advocates for children and families, pediatricians are in an excellent position to support and guide parents during the prenatal period. Prenatal visits allow the pediatrician to gather basic information from parents, provide information and advice to them, and identify high-risk situations in which parents may need to be referred to appropriate resources for help. In addition, prenatal visits are the first step in establishing a relationship between the pediatrician and parents and help parents develop parenting skills. The prenatal visit may take several possible forms depending on the experience and preferences of the parents, competence and availability of the pediatrician, and provisions of the health care plan.

Communicating bad news: a pediatric department's evaluation of a simulated intervention.

OBJECTIVE: To determine if pediatric residents and emergency department (ED) fellows could improve their ability to counsel and inform standardized patients (SPs) about bad news. METHODOLOGY: A crossover, self-controlled design in which trainees were their own control individuals, and SPs provided feedback after the first interview. The setting was the consultation room in the ED of a large children's hospital. The outcome measures included examining the counseling and informing skills of study participants. RESULTS: Trainees improved their informing skills after being provided feedback in the broad areas of communication and follow-up and in the total number of content areas asked. Their counseling skills improved in two areas: 1) promoting more trust and 2) making parents feel less dependent. Those trainees who scored higher on counseling skills discussed more total and critical content issues with SPs in the study. Trainee feedback revealed a very high rating of the educational process, and the trainees also felt much more confident about their skills after the first and second sessions. CONCLUSIONS: Using SPs to teach residents and ED fellows to give bad news is an effective educational process that provides trainees with interactions that simulate real-life experience

Counseling parents of a child dead on arrival: a survey of emergency departments.

The purposes of this study were to (1) document whether or not responding emergency departments (EDs) have a process and/or team to interact with parents of children dead on arrival (DOA); (2) conduct a needs assessment to determine what information is essential to convey to a family of a child DOA; and (3) determine what EDs are doing to their residents/fellows in crisis counseling. A survey instrument was developed using input from key health care professionals at Children's Hospital who are involved in the acute care of children and their families. This survey was sent to directors of EDs in all children's hospitals and those general hospitals with more than 400 beds. Respondents identified themselves as ED directors at children's hospitals or general hospitals throughout the United States. The survey documented the lack of a process or team approach to counseling the family of a child who presents DOA. Often, the most inexperienced physicians are expected to provide this information and to counsel parents. Few EDs reported offering communication skills training in this area. Many respondents expressed dissatisfaction about the lack of a process or team regarding patients who present DOA and recognize the need for improvement.

Formulary issues at a pediatric hospital: experience at Children's National Medical Center.

At Children's National Medical Center in Washington, DC, patients treated range from premature babies to 21-year-olds. Therefore, a broad base of drug therapy is practiced. University affiliated, the facility serves as the pediatric department for George Washington University School of Medicine. This hospital is seen as an innovator in specialized areas, such as neonatology, pediatric trauma, oncology, and organ and bone marrow transplantation. P & T Committee participation and communication are excellent, allowing members to focus sharply on therapeutic issues. One of their successful strategies has been the institution of a rather extensive subcommittee structure, which has facilitated intense but timely formulary review and strengthened drug policy. In this exclusive Hospital Formulary interview, Dr. George Cohen and Mr. Stephen Allen, Chairman and Secretary of the P & T Committee, respectively, share their experiences, providing insight for other P & T Committee members in hospitals serving both children and adults nationwide.

Management of infections of the lower respiratory tract in children.

Different microorganisms can cause similar clinical patterns of lower respiratory tract disease, and a variety of clinical presentations can be caused by the same organism. Nevertheless by considering such factors as epidemiology, patient age, manifestations of nonrespiratory diseases, state of nutrition and course of illness, the physician can make reasonable assumptions as to the etiology of a child's respiratory infection. On this basis he or she can make a rational choice of initial therapy. The patient's response to treatment, as well as information gained from laboratory and radiographic studies, if available, can be used to change the management plan as necessary.

Children dead on arrival: predictors of short-term family follow-up.

Approximately three fourths of the parents whose children were pronounced dead in one emergency department maintained contact with a professional for at least a month following the death. Families whose children died of trauma did not maintain contact as well as those whose children died of anticipated death, sudden infant death syndrome, or infection. Strong family support system, employed parents, and appropriate response at the time of death all correlated with continued contact with a professional and adequate coping after death (P values all less than 0.04). Prior professional support was a less significant factor in follow-up, and disorganized, isolated parents with histories of poor social adjustment were far less likely to maintain contact.

Lead poisoning: 20 years later.

This report compares the clinical picture, diagnosis, treatment and outcome of children with lead poisoning in the 1950s and the 1970s. During this 20-year period, increasing attention has been given to lead poisoning both at the local and national level. This attention has produced legislation to fund screening programs and to reduce the allowable amount of lead in paint. Greater public awareness, more effective methods for screening both populations and environments, and a reduction in severe sequelae of lead poisoning have also been achieved.

Yersinia enterocolitica enteritis in children.

Five patients were admitted to Children's Hospital National Medical Center with manifestations of Yersinia enterocolitica infections. Four of five had primarily enteric illness, while the fifth had associated ocular and joint involvements. In three of five cases, the disease was self-limiting. Two of the patients (No. 1 and 2) may have had their disease improved by antibiotic therapy. Increased alertness to the potential of Y enterocolitica to cause a variety of syndromes is necessary to make an accurate bacteriologic diagnosis and to expedite medical treatment.