Since 1975 nearly 1 million persons have entered the United States from Southeast Asia, where infection with hepatitis B virus (HBV) is hyperendemic. To evaluate the prevalence and patterns of transmission of HBV infection among the children of refugees from Southeast Asia, we studied 196 refugee families with 257 children born in the United States. Of 31 children born in the United States to mothers with infectious disease, 17 (55 percent) had been infected with HBV. Of 226 children whose mothers did not have infectious disease, 15 had HBV infection--a prevalence of 6.6 percent (95 percent confidence interval, 4.1 to 10.7). The risk of infection was greatest (26 percent) among children living in households with children with infectious disease (relative risk, 5.5; confidence interval, 2.3 to 13.4). Exposure to fathers or other adults with infectious disease was not significantly associated with infection. Of children from households with no persons with infectious disease, 3.9 percent (confidence interval, 1.7 to 8.8) were infected. Nearly half (46 percent) the cases of HBV infection among the U.S.-born children of refugees were not attributable to perinatal transmission from a mother with infectious disease. We conclude that child-to-child transmission may be occurring within and between households. Current recommendations to immunize the newborns of mothers with infectious disease are not sufficient to protect all U.S.-born children of Southeast Asian refugees from HBV infection early in life, when the risk of chronic sequelae and premature death is highest. We recommend that the HBV vaccination policy be expanded to include all newborns of Southeast Asian immigrants.

Through case-writing pedagogy, an approach to case-method instruction, early intervention-early childhood leadership students examined interdisciplinary perspectives, reflected, and integrated new content. Students explored leadership theories and researched current issues and trends in early childhood mental health as they engaged in a collegial, reflective process. Furthermore, students identified issues or tensions from their work settings and developed problem-solving skills, including defining and reframing problems. The interdisciplinary leadership institute and the specific features of the case-writing pedagogy are described. Teaching outcomes are discussed, including course evaluation results and a descriptive case study. Changes in students' personal and professional beliefs; dispositions regarding reflective practice and mental health; and connections between theory, research, and practice are provided. Applications to other contexts are discussed.

Within recent years, federal legislation has required schools to develop and implement standardsbased accountability systems for the purposes of evaluating their performance. Although the implementation of accountability systems for K-12 programs is well underway, the design and implementation of such systems for Part C and Section 619 programs lag significantly behind. This article will provide a brief review of accountability-related laws and current efforts to design accountability systems for infants and young children with disabilities and will discuss the challenges inherent in the design of such systems for Part C and Section 619 programs. Finally, and most importantly, the article will address the implications of these accountability initiatives for personnel preparation programs within institutions of higher education.

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