The United States is in the midst of a devastating opioid misuse epidemic leading to over 33,000 deaths per year from both prescription and illegal opioids. Roughly half of these deaths are attributable to prescription opioids. Federal and state governments have only recently begun to grasp the magnitude of this public health crisis. In 2016, the Centers for Disease Control and Prevention released their Guidelines for Prescribing Opioids for Chronic Pain. While not comprehensive in scope, these guidelines attempt to control and regulate opioid prescribing. Other federal agencies involved with the federal regulatory effort include the Food and Drug Administration (FDA), the Drug Enforcement Agency (DEA), and the Department of Justice. Each federal agency has a unique role in helping to stem the burgeoning opioid misuse epidemic. The DEA, working with the Department of Justice, has enforcement power to prosecute pill mills and physicians for illegal prescribing. The DEA could also implement use of prescription drug monitoring programs (PDMPs), currently administered at the state level, and use of electronic prescribing for schedule II and III medications. The FDA has authority to approve new and safer formulations of immediate- and long-acting opioid medications. More importantly, the FDA can also ask pharmaceutical companies to cease manufacturing a drug. Additionally, state agencies play a critical role in reducing overdose deaths, protecting the public safety, and promoting the medically appropriate treatment of pain. One of the states' primary roles is the regulation of practice of medicine and the insurance industry within their borders. Utilizing this authority, states can both educate physicians about the dangers of opioids and make physician licensure dependent on registering and using PDMPs when prescribing controlled substances. Almost every state has implemented a PDMP to some degree; however, in addition to mandating their use, increased interstate sharing of prescription information would greatly improve PDMPs' effectiveness. Further, states have the flexibility to promote innovative interventions to reduce harm such as legislation allowing naloxone access without a prescription. While relatively new, these types of laws have allowed first responders, patients, and families access to a lifesaving drug. Finally, states are at the forefront of litigation against pharmaceutical manufacturers. This approach is described as analogous to the initial steps in fighting tobacco companies. In addition to fighting for dollars to support drug treatment programs and education efforts, states are pursuing these lawsuits as a means of holding pharmaceutical companies accountable for misleading marketing of a dangerous product.

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Colic occurs in 11.4% of low birth weight infants. The usual onset is within two weeks of the expected birth date, regardless of gestational age at birth. Birth order does not play a role in the distribution of colic. White low birth weight infants are more likely to develop colic than Negro low birth weight infants. Although colic may persist for several months, the infants are generally healthy and develop normally.Colic, a disease of early in¬ fancy, is characterized by ex¬ cessive irritability and crying spells without a clinically discernible cause. This vague set of symptoms is proba¬ bly the most common complaint en¬ countered by the pediatrician. Lack of facts concerning the etiology of colic is reflected in the absence of a valid therapeutic approach to this disorder.We have surveyed low birth weight infants to determine whether developmental immaturity or intra¬ uterine growth retardation plays a role in the pathophysiology of colic, and to examine its possible effect on the short-term growth and devel¬ opment of this high-risk group of in¬ fants. Materials and MethodsColic was operationally defined as ex¬ treme intermittent irritability associated with episodes of excessive crying in an in-

SUMMARY Nine cries from a six‐day‐old trisomy 13–15 infant were analysed sonagraphically. They showed a generally low fundamental frequency pattern, with prominent quaver. The final position of the fundamental frequency at the end of the cries was much lower than that usually found in both normal and diseased infants without autosomal aberrations. Trisomy 13–15 cries seem to bear a much greater resemblance to those of Down's syndrome than to those of the ‘Cat‐cry’ syndrome. This is consistent with the similarity of the autosomal disorder involved in Down's and in trisomy 13–15 syndrome. Further studies of abnormal cry phenomena should include respiratory and airflow measurements to reveal more accurate correlations between the acoustic structure and the concomitant physiologic events of crying. RÉSUMÉ Analyse du cri au cows de la trisomie 13–15 Neuf périodes de cris chez un enfant de six jours presentant une trisomie 13–15 ont été analysées par sonographic II a pu etre observé une disposition de fréquence fondamentale généralement basse avec un tremblement prédominant. La position finale de la fréquence fondamentale à la fin du cri etait beaucoup plus basse que ce qui est observé chez l'enfant normal ou chez l'enfant malade sans aberration autosomique. Le cri de la trisomie 13–15 présente beaucoup plus de resemblances avec celui du mongolisme qu'avec celui de la maladie du cri du chat. Ceci correspond à la similitude de troubles autosomiques dans le mongolisme et dans la trisomie 13–15. D'áutres etudes de cris anormaux devraient inclure des appréciations respiratoires et de circulation aérienne pour préciser des corrélations plus étroites entre la structure acoustique et les caractéristiques physiologiques concomittantes du cri. ZUSAMMENFASSUNG Die Schreie eines trisomalen 13–15 Kindes Neun Schreie eines sechs Tage alten trisomalen 13–15 Kindes wurden sonographisch analysiert. Sie zeigten eine niedrige Grundfrequenz mit prominenten Zitterfrequenzen. Die Schlußposition der Grundfrequenz war am Ende der Schreie viel niedriger als bei normalen Kindern und kranken Kindern ohne autosomale Aberrationen. Die Schreie der trisomalen 13–15 Kinder scheinen denen der Mongolen viel ähnlicher zu sein als denen des Katzen‐Schrei‐Syndroms. Weitere Untersuchungen der abnormen Schreie sollten Messungen der Atmung und des Luftstromes einschließen, um genauere Korrelationen zwischen der akustischen Struktur und den begleitenden physiologischen Ereignissen beim Schreien zu ermitteln. RESUMEN El llanto en el lactante con Trisomia 13–15 Se realizó el estudio sonográfico de nueve llantos de un lactante de 6 dias con Trisomía 13–15. Todos mostraban una frecuencia básica fundamental, generalmente baja, con vibraciones prominentes. La posición final de la frecuencia fundamental al final de los llantos era mucho más baja que la que se encuentra usualmente en el niño normal o enfermo, pero sin aberraciones autosómicas. El llanto de la Trisomía 13–15 parece tener mayor semejanza con el síndrome de Down que con el sindrome del Maullido de G...

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