Real American children: The challenge for after-school programs

Several million American children are currently unsupervised during the hours between school and parents' leaving for and/or return from the workplace. Many families would prefer other arrangements, but cost or availability factors present insurmountable barriers. Although growing, the public response continues to fall far short of the need; in the meantime, private entrepreneurs are moving to fill the gaps in available services. But if these programs for school-aged children are to serve functions other than the aggrandizement of their sponsors, they must be focused on the real needs that exist among real American children. Among the real children in need of care are those who are impoverished, unsupervised, unfit physically, unprepared for the demands of school and workplace, hurried into premature adulthood, and/or disconnected from the social worlds around them. Professional child and youth care workers with experience in day care and residential settings have the preparation needed to take leadership roles in creating developmentally appropriate, effective programs to meet the emerging demands for school-age child care and to weave them into a fabric of youth-centered community services.     

Development of traumatic retinal detachment

Post-traumatic retinal detachment occurs frequently as a late consequence of progressive vitreous changes, especially following penetrating injuries. Occasionally, it develops soon after the trauma, without preceding proliferative vitreoretinopathy, is based on posterior vitreous detachment and morphologically resembles an idiopathic retinal detachment. It is possible that the posterior vitreous detachment in these cases is encouraged by the presence of intravitreal hemorrhage.     

The combination of prazosin and verapamil in the treatment of essential hypertension

An exaggerated fall in blood pressure has been reported with the combination of an alpha 1-blocker and a calcium antagonist. This study investigated, in a placebo-controlled, randomized crossover trial, the clinical usefulness of the combination of prazosin (2 mg b.i.d.) and verapamil (160 mg b.i.d.). Therapeutic efficacy was monitored at regular outpatient visits: average supine and erect blood pressures were, respectively, 175/99 and 176/103 mm Hg with placebo, 160/91 and 164/96 mm Hg with single drug treatment, and 152/84 and 152/89 mm Hg with combination therapy. This significant and clinically useful reduction in blood pressure had an overall magnitude of approximately 28/18 mm Hg (supine) and 29/19 mm Hg (erect). Further measurements were made during a series of intensive study days, and the most important additional finding was a pharmacokinetic interaction that resulted in increased peak concentrations and bioavailability of prazosin. In conclusion, the combination of prazosin and verapamil proved effective in the treatment of 12 patients with essential hypertension who had been poorly responsive to conventional treatment with a beta-blocker and thiazide diuretic.