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Particulate matter (PM) contributes to an increased risk of respiratory and cardiovascular illnesses, cancer, and preterm birth complications. This project assessed PM exposure in Eastern Indonesia's largest city, where air quality has not been comprehensively monitored. We examined the efficacy of wearing masks as an individual intervention effort to reduce in-transit PM exposures. Handheld particulate counters were used to investigate ambient air quality for spatial analysis, as well as the differences in exposure to PM2.5 and PM10 (μg/m(3)) by different transportation methods [e.g. motorcycle (n=97), pete-pete (n=53), and car (n=55); note: n=1 means 1m(3) of air sample]. Mask efficacy to reduce PM exposure was evaluated [e.g. surgical masks (n=39), bandanas (n=52), and motorcycle masks (n=39)]. A Monte Carlo simulation was used to provide a range of uncertainty in exposure assessment. Overall PM10 levels (91±124 μg/m(3)) were elevated compared to the World Health Organization (WHO)'s 24-hour air quality guideline (50 μg/m(3)). While average PM2.5 levels (9±14 μg/m(3)) were below the WHO's guideline (25 μg/m(3)), measurements up to 139 μg/m(3) were observed. Compared to cars, average motorcycle and pete-pete PM exposures were four and three times higher for PM2.5, and 13 and 10 times higher for PM10, respectively. Only surgical masks were consistent in lowering PM2.5 and PM10 (p

People living in slums can be considered left behind with regard to national successes in achieving Millennium Development Goals (MDGs). The objective of this study was to evaluate the living and working conditions of waste pickers and their children in a landfill slum located in the largest city in eastern Indonesia. A total of 113 people from the landfill slum and 1184 people from the general population participated in face-to-face interviews. Municipal solid waste (MSW) was analyzed for metals, metalloids and fecal indicator bacteria. Ambient air quality including particulate matter was measured in the landfill. Households in the landfill slum were 5.73 (p=0.04) times more likely to be below the international poverty line (MDG 1: Poverty) and 15.6 times (p0.01) more likely to have no one in the household possessing a primary education (MDG 2: Universal Education), and 107 times (p0.01) more likely not to have improved sanitation facilities (MDG 7: Environmental Sustainability) when compared to the general population. Diarrhea is one of the leading causes of death in children under five in Indonesia. Young children living in the landfill slum were 2.87 times (p=0.02) more likely to develop diarrhea than their general population counterparts. Other survey results and environmental measurements suggest that landfill slum children have additional adverse health effects (e.g. infections and poisoning). Poverty underlies several MDG issues that directly or indirectly affect child health. Therefore, eradicating extreme poverty will continue to be the most critical challenge for the MDGs beyond 2015.

After 30+ years of clinical practice, it is this author's experience that adrenal fatigue is a common stress-related disorder in which the symptoms are strongly influenced by circulating cortisol levels. Although adrenal fatigue has appeared in the medical literature by various names for over 100 years, its prevalence is just now coming to the forefront. Healthcare professionals can make a dramatic difference by monitoring patients' health to check for signs and symptoms of adrenal fatigue. Despite the frequency with which this health condition occurs, even many skilled clinicians have not had the opportunity to learn about it or its importance to their practice. The intent of this article is to provide the practitioner with clinically relevant information about the diagnosis and successful treatment for adrenal fatigue.

Introduction A paucity of work force planning literature exists for hand therapy services. Purpose This descriptive study aimed to map the geographical distribution of US Certified Hand Therapists (CHTs) and describe characteristics of US populations living in respective CHT workplace Zip Code Tabulation Areas (ZCTAs). Methods A de-identified Zip Code list of all active CHTs through April 2016 from the Hand Therapy Certification Commission, included 5572 CHTs with US ZCTAs. The CHT ZCTAs were matched with population parameters “rurality”, “poverty” and “race and ethnicity” from the 2010 US Census and 2014 American Community Survey. Results The 5,572 CHTs practice ZCTAs mostly overlapped with high density US population areas, covering just 9% of the total number of 33,120 US ZCTAs. The population in CHT ZCTAs was 1) urban in nature, 2) with lower poverty rates than ZCTAs without CHTs, and 3) mostly reflecting US race and ethnicity population distribution. Only 3.7% of CHTs worked in large concentrations of 11 to 26 CHTs per ZCTA near or in urban centers. Most CHTs, 67%, worked in one to three CHTs per ZCTA concentrations, contributing to a larger geographic spread of CHT locations than expected. Discussion and Conclusion This study provides a foundational snap shot of the distribution, the potential availability, of the 2016 CHT workforce in the context of US population characteristics. It may serve as baseline for supply and demand studies and interventions to grow the CHT profession and optimize the distribution of CHTs to better meet population needs.

Summary We report a group of four infants and one child who showed a strikingly similar syndrome characterized by persistent dehydration, acidosis with hyperchloremia, and extensive diffuse deposits of calcium salts in and around the renal tubules.

Summary 1. One hundred and seventy-seven children were given a sulfonamide drug during two or more courses and had no reaction during the first course. Eighty-six were given sulfathiazole; three developed febrile reactions, none within the first forty-eight hours. Ninety-one were given sulfadiazine; four developed febrile reactions, only one within the first forty-eight hours. 2. In the total of seven cases (4 per cent) exhibiting reactions tothese two drugs, fever appeared first on the second, third, fourth, fifth, seventh, fourteenth, and fifteenth days, respectively. It is suggested these febrile responses were toxic reactions to the drug that might have occurred at any time and had no clear relation to previous drug therapy. 3. Two of the seven children with initial reactions were given botha second and a third course of the drug without reaction. 4. An “immediate” type of febrile reaction occurred during a secondcourse of sulfonamides in three of five children who had had reactions during a first course. 5. Our studies show that “sensitization” to sulfathiazole or sulfadiazineis not common or frequent in children, but that the occurrence of one reaction greatly increases the probability of future reactions. 6. Children who developed toxic symptoms during the first administration of the drug should be given the drug only with caution and close observation.

The action of intra-artenal priscoline ® supported by oral therapy has been studied intensively in seventeen cases of peripheral vascular disease. From the cases observed we may state that the drug is a valuable adjunct in two types of cases, namely, refractory leg ulcers prior to the onset of gangrene or established soft tissue necrosis and vasospasm whether due to trauma, the symptom complex of scleroderma or ulceration due to arteriosclerosis, diabetes or chronic thrombophlebitis.

Summary The respirator in poliomyelitis should be used as a means of giving physiologic rest in early and moderate paralysis of the respiratory muscles. The dramatized use of the respirator as an emergency lifesaving machine has occurred at the expense of interest in its more prosaic, but perhaps more valuable, function as a splint for weakened respiratory muscles. The early signs of respiratory weakness are often undetected, and the patient is given either no respiratory treatment at all, or none until a degree of fatigue occurs which would be considered a sign of intolerable neglect, were the muscles those of the arms. No clear distinction is made by many physicians between the various causes of respiratory failure in poliomyelitis. The respirator is seldom of use except where the intercostal muscles or diaphragm are paralyzed. Most cases of “bulbar” poliomyelitis are not helped. Two new types of machines for artificial respiration are described and their different advantages discussed. It is suggested that a national coordinated program for the handling of respiratory paralysis in poliomyelitis be planned as the only practical manner of meeting this problem.

T ~ E P R o GRAM of the American Pediatric Society begins with the Presidential Address which I am privileged to present. This honor is indeed to. me very great, and the briefness with which I acknowledge it, and with humility and pride express my thanks, in no way measures my personal gratification. The opportunity to give an address like this is a special privilege, since by tradition the President is allowed, if he so pleases, to point with pride, to view with alarm, to talk in generalities like an old man, and to express his prejudices without much challenge or at least overt criticism. The difficulty is that I have had thirteen months to prepare for this address, and the longer I have had, the less certainty I feel in deciding what I want to say. Also, the very length of this time robs me of any excuse, claiming that I have been in a rush, under pressure of work, and have had to plan this speech as an emergency. I have chosen a topic, however, and that is "Growth and Development of Pediatrics," an appropriate one for this group, I believe, and also one which gives me broad oppor

Summary Fourteen new cases of encephalitis following German measles arereported and the clinical features of thirty-four previously reported cases summarized.

Summary It is recommended that as a routine in examination of infants and smallchildren, the technique of prenasal and preoral auscultation be used before the patient is touched or before his clothing is removed for traditional routines of examination.