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IMPORTANCE Traditional approaches to practice guidelines frequently result in dissociation between strength of recommendation and quality of evidence. OBJECTIVE To construct a clinical guideline for pyogenic osteomyelitis management, with a new standard of evidence to resolve the gap between strength of recommendation and quality of evidence, through the use of a novel open access approach utilizing social media tools.

This study examined children's preferences and priorities for the design of assistive technologies to enhance communication for children with complex communication needs. Six children without disabilities were provided with drawing and craft materials and were asked to develop low-tech prototypes of inventions to support the communication of a young child who had significant speech and motor impairments. The design process and the inventions were analyzed using qualitative methods. Results showed that the children's inventions differed significantly from the designs of current AAC technologies. Their inventions were not simply speech prostheses; rather, they integrated multiple functions (e.g., communication, social interaction, companionship, play, artistic expression, telecommunications) and provided dynamic contexts to support social interactions with others, especially peers. The children characterized the systems as companions and utilized innovative names, bright colors, lights, transformable shapes, popular themes, humor, and amazing accomplishments to capture interest, enhance appeal, build self-esteem, and establish a positive social image. The systems were easily personalized to reflect the user's age, personality, attitude, interests, and preferences. Re-designing AAC technologies to incorporate these types of functions and features may increase their appeal and make them easier for young children to learn and use. Results are discussed with reference to implications for future research and development.

Most published recommendations for treatment of pediatric nerve agent poisoning are based on standard resuscitation doses for these agents. However, certain medical and operational concerns suggest that an alternative approach may be warranted for treatment of children by emergency medical personnel after mass chemical events. (1) There is evidence both that suprapharmacological doses may be warranted and that side effects from antidote overdosage can be tolerated. (2) There is concern that many emergency medical personnel will have difficulty determining both the age of the child and the severity of the symptoms. Therefore, the Regional Emergency Medical Advisory Committee of New York City and the Fire Department, City of New York, Bureau of Emergency Medical Services, in collaboration with the Center for Pediatric Emergency Medicine of the New York University School of Medicine and the Bellevue Hospital Center, have developed a pediatric nerve agent antidote dosing schedule that addresses these considerations. These doses are comparable to those being administered to adults with severe symptoms and within limits deemed tolerable after inadvertent nerve agent overdose in children. We conclude that the above approach is likely a safe and effective alternative to weight-based dosing of children, which will be nearly impossible to attain under field conditions.

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