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Ehlers-Danlos syndrome is a real diagnosis that is erroneously used to explain multiple fractures in suspected child abuse. This paper reviews the clinical and molecular diagnostic criteria for Ehlers-Danlos syndrome. This knowledge can help prevent misdiagnosis and support clinicians when evaluating infants and young children with multiple fractures.

Missed fractures are common in pediatric trauma patients. Pediatric bone differs from adult bone in its composition and response to injury, leading to fracture patterns that may be subtle, radiographically unfamiliar, and challenging to distinguish from normal variation. Familiarity with the unique fracture types of the pediatric skeleton and site-specific injury patterns is critical, because prompt diagnosis can significantly alter clinical management and outcome. This article examines the unique features of pediatric bone contributing to missed fractures, the incidence of missed fractures, common injury types of the pediatric skeleton, and frequently missed site-specific fracture patterns, highlighting problem-solving techniques for challenging cases.

Overnight in-house radiology has rapidly become an important part of contemporary practice models, and is increasingly the norm in pediatric radiology. MR imaging is an indispensable first-line and problem-solving tool in the pediatric population. This has led to increasingly complex MR imaging being performed "after hours" on pediatric patients. This article reviews the factors that have led to widespread overnight subspecialty radiology and the associated challenges for overnight radiologists, and provides an overview of up-to-date imaging techniques and imaging findings of the most common indications for emergent MR imaging in the pediatric population.

Recent developments regarding the treatment of pediatric liver tumors have significantly improved patient care. Stimulated by collaboration between international pediatric groups, advances have been made in surgical techniques, transplantation options, and chemotherapy schemas. In light of this progress, clear understanding of the state-of-the-art imaging evaluation of hepatobiliary tumors has become even more integral to the effective management of children with hepatic neoplasms. The unique imaging features of hepatic neoplasms in the pediatric population, when coupled with supportive demographic data and laboratory findings, can lead to accurate diagnosis and proper treatment of hepatobiliary tumors.

Pediatric urinary system neoplasms are a diverse group of tumors that frequently overlap in their clinical and radiologic features. By contrast, the histopathologic classification and treatment of these entities have become increasingly refined, resulting in improved outcomes, with the overall survival of Wilms tumors now exceeding 90%. Significantly, many contemporary protocols rely on radiologic diagnosis in the absence of tissue confirmation. This review article provides up-to-date clinical, epidemiologic, and imaging findings of pediatric urinary system neoplasms and their mimics frequently encountered in daily clinical practice.

BACKGROUND: The diagnosis of slipped capital femoral epiphysis (SCFE) often is delayed. Although lack of clinical suspicion is the main cause of delayed diagnosis, typical radiographic changes may not be present during the initial phases of SCFE. The peritubercle lucency sign for follow-up of the contralateral hip in patients with unilateral SCFE may be beneficial in assisting the early diagnosis. However, the accuracy and reliability of this sign in patients with SCFE is unknown. QUESTIONS/PURPOSES: (1) What is the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the peritubercle lucency sign on radiographs for the early diagnosis of SCFE compared with MRI as the gold standard? (2) What are the interobserver and intraobserver reliabilities of the peritubercle lucency sign on radiographs? METHODS: Between 2000 and 2017, 71 patients underwent MRI for an evaluation of pre-slip or a minimally displaced SCFE. Sixty percent of hips (43 of 71) had confirmed SCFE or pre-slip based on the presence of hip pain and MRI changes, and these patients underwent in situ pinning. Three independent experienced observers reviewed MR images of the 71 hips and agreed on the presence of a juxtaphyseal bright-fluid signal suggesting bone marrow edema in these 43 hips with SCFE, and absence MRI changes in the remaining 28 hips. The same three experienced observers and two inexperienced observers, including a general radiologist and an orthopaedic surgery resident, blindly assessed the radiographs for the presence or absence of the peritubercle lucency sign, without information about the diagnosis. Diagnostic accuracy measures including sensitivity, specificity, PPV, and NPV were evaluated. Intraobserver and interobserver agreements were calculated using kappa statistics. RESULTS: The overall accuracy of the peritubercle lucency sign on radiographs was 94% (95% CI 91 to 96), sensitivity was 97% (95% CI 95 to 99), specificity was 89% (95% CI 90 to 96), PPV was 93% (95% CI 90 to 96), and NPV was 95% (95% CI 92 to 99). All accuracy parameters were greater than 85% for the five observers, regardless of experience level. Intraobserver agreement was perfect (kappa 1.0), and interobserver agreement was excellent for the peritubercle lucency sign on radiographs across the five observers (kappa 0.81 [95% CI 0.73 to 0.88]). The reliability was excellent for experienced observers (kappa 0.88 [95% CI 0.74 to 1.00]) and substantial for inexperienced observers (kappa 0.70 [95% CI 0.46 to 0.93]), although no difference was found with the numbers available (p = 0.18). CONCLUSIONS: The peritubercle lucency sign on radiographs is accurate and reliable for the early diagnosis of SCFE compared with MRI as the gold standard. Improving the early diagnosis of SCFE may be possible with increased awareness, high clinical suspicion, and a scrutinized evaluation of radiographs including an assessment of the peritubercle lucency sign. LEVEL OF EVIDENCE: Level III, diagnostic study.

Overnight in-house radiology has rapidly become an important part of contemporary practice models, and is increasingly the norm in pediatric radiology. MR imaging is an indispensable first-line and problem-solving tool in the pediatric population. This has led to increasingly complex MR imaging being performed "after hours" on pediatric patients. This article reviews the factors that have led to widespread overnight subspecialty radiology and the associated challenges for overnight radiologists, and provides an overview of up-to-date imaging techniques and imaging findings of the most common indications for emergent MR imaging in the pediatric population.

A four-year-old girl presented to the emergency department vomiting after a foreign body ingestion. An anteroposterior plain radiograph demonstrated a disc-shaped foreign body. Ordinarily, a plain radiograph cannot conclusively identify an object as a coin rather than a button battery that requires emergent removal. However, this high-voltage radiograph, windowed to increase contrast, showed the visible face of George Washington to confirm the diagnosis of an ingested quarter.

The authors describe how schema-based instruction (SBI), a conceptual teaching approach that integrates the National Council for Teachers of Mathematics (2000) Standards, improved the mathematical problem-solving ability of 2 students with emotional and behavioral disorders (EBD). The authors illustrate the application of SBI to support students as they make sense of, and successfully solve, word problems. Last, the authors report on the factors that may have contributed to the effectiveness of SBI for students with EBD.

In a previous article, a conceptual scheme for describing and evaluating programs in behavioral disorders was presented. Using instrumentation based on that conceptual scheme, 145 special education administrators in 27 states were surveyed about current educational practices in public school programs for children with behavioral disorders. Results of the survey are presented under four broad headings: student identification practices, service delivery, student exit procedures, and program evaluation practices. Findings indicate that student identification procedures appear to be fairly well developed within programs, while student exit and evaluation practices are less formalized. Curriculum and behavior intervention practices vary widely within and across districts, although the emphasis is on changing students' behavior performance. A discussion of the “state of the art” in educational practices is presented.

This article describes a conceptual scheme for guiding comprehensive program description and evaluation in the field of behavioral disorders. Developed systematically over a three-year period with the assistance of numerous professionals from the field, the conceptual scheme presented herein identifies eight essential program components for well-designed district-wide service delivery: philosophy, student needs and identification, goals, instructional methods and curriculum, community involvement, program design and operation, exit procedures, and evaluation.

Program evaluation provides a powerful tool for meeting the formative and summative evaluation needs of school programs. Although a number of program evaluation approaches for special education programs have been cited in the literature, there is little evidence to show how far school districts have gone beyond compliance monitoring in their efforts to evaluate special education programs. This article presents the results of a national survey of 145 districts on the topic of program evaluation in special education to ascertain whether or not districts have taken a proactive, systematic approach to evaluating their special education programs. A number of features associated with program evaluation were explored, specifically, (a) preplanning, (b) who evaluates special education programs, (c) the focus of evaluation activities, (d) methods for obtaining evaluative information, (e) criteria for judging program effectiveness, and (f) the perceived benefits of the evaluation process.

The purpose of this paper is to share the results of an observational study con ducted on the frequency and severity of misbehaviors of 98 behaviorally dis ordered adolescent students as they rode school buses to and from a self contained, day-school program for an entire year. Events promulgated by the Board of Education during that year allowed data to be collected on the same students on two different transportation arrangements: mainstreamed and cate gorical. Misbehaviors were classified and recorded according to types. As a measure of impact upon school personnel, the type and frequency of interventions employed by them during the year are also reported. Results indicate a tremen dous increase in students ' misbehaviors and subsequent interventions during the period of categorical transportation. Transportation as a related service is mandated by the Education for All Handicapped Children Act of 1975. Its express purpose is to assist handicapped children to benefit from special education at all levels. Defined as a sequential series of events necessary to move passengers from origin to destination (Turner, 1980a), transportation service for the handi capped has traditionally been viewed administratively as opposed to programatically. That this is so is supported by the rather sparse body of literature on the subject which focuses upon the costs of transporting handicapped individuals (Bluth & Sweeney, 1981; Hennigan, 1978; Morgan, 1975), the safety of handicapped individuals during the bus ride (Turner, 1980a), modifications in the way of specialized equipment necessary for transporting the physically handicapped (Turner, 1980b), and the training of bus drivers and aides (Chiang, Iwata, & Dorsey, 1979; Land, 1984; Rogers, 1980). In this respect, transportation as it relates to the movement of students to and from school appears to be one of those educational "givens". Perceived and dealt with administratively, its effectiveness is typically judged against criteria reflecting administrative priorities. Thus, while transportation service is an integral — indeed a mandated —component of the overall educational process, it remains divorced from the rigors of programatic scrutiny and evaluation. Very little attention has been given to studying the different types of transportation arrangements available to school districts and the degree to which they might influence student behavior. Likewise, there have been no studies to examine the various impact one type of bus transportation arrangement versus another might have upon school personnel. In fact, it has yet to be acknowledged in the literature that the quality of events which occur during the bus rides may directly influence the quality of education students are capable of receiving in school. In the case of behaviorally disordered students, the type of bus transportation provided them may have serious programatic implications for both students and school personnel. Problems which occur among students on the buses may potentially produce results that linger far into the school day and interfere with the ongoing purposes of the school setting. The more frequent the incidents of bus misbehavior, the more time students, teachers, counselors, and administrators must invest sorting through a myriad of accusations and reports in their attempt to achieve resolution. The more severe the incidents of misbehavior, Behavioral Disorders May 1987 185 This content downloaded from 157.55.39.211 on Tue, 09 Aug 2016 06:02:30 UTC All use subject to http://about.jstor.org/terms the more profound the emotional repercussions for the students involved. While students enter their educational environment angry and unsettled, teachers must attempt to estab lish a readiness set for learning to occur. Currently, more than half (57%) of all behaviorally disordered students are served in separate classes, separate schools, and environments other than the regular classroom (U.S. Department of Education, 1985). Recently data has been gathered to show how these students are transported to and from their educational settings. Preliminary findings from a national survey on the plan and design of programs for behaviorally disordered/seriously emotionaly disturbed (Grosenick, George, & Geroge, 1985) indicate that districts use a variety of transportation options to transport behaviorally disordered students. While 83% of the 126 districts responding to the survey indicated grouping behaviorally disordered students with nonhandicapped students on buses, 71% of those districts also had provi sions for grouping behaviorally disordered students exclusively on separate buses. Trans porting behaviorally disordered students together on separate buses for their rides to and from school may be administratively efficient. In some districts, for example, grouping handicapped students together on buses greatly facilitates the computation of state reim bursement monies appropriated for transportation. The purpose of this paper is to share the results of a data collection effort regarding the frequency and severity of incidents of bus misbehavior of behaviorally disordered adoles cents as they rode their buses to and from school for an entire year. Circumstances occurred during the year which permitted data to be collected on the same group of students of two different transportation arrangements, categorical and mainstreamed. Instances of misbehavior were tallied and later classified according to type. Asa measure of the impact on school personnel, information was collected on the types and frequency of bus interventions employed by school staff during the year.

This article addresses the value of program descriptions for the field of serious emotional disturbance/behavioral disorders and presents data collected on the availability of written programs for this population of students. The development and field testing of instrumentation used to collect these and other data on the characteristics of district-wide programs for seriously emotionally disturbed children and youth are described. The availability of program descriptions was assessed in eight areas: philosophy, student needs and identification procedures, student and program goals, instructional methods and curriculum, community involvement, program design and operation, exit procedures, and evaluation. Findings indicated that relatively few comprehensive program descriptions are available to program planners and developers in the field of behavioral disorders, leading to a conclusion similar to one drawn by other writers with regard to the availability of program descriptions in the professional literature — while many high quality programs are likely to exist in the field they have not been adequately described on paper.