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The Journal implements CrossMark — Monica L. Helton, BA — William F. Balistreri, MD E nsuring the integrity of the medical literature is a high priority of the Editors of The Journal and its publisher, Elsevier Inc. When an error is brought to our attention, we maintain the accuracy of the literature by publishing an update as appropriate: (1) erratum (minor publishing error); (2) correction (minor author error); or (3) retraction (major error). According to the Committee on Publication Ethics, re- tractions are reserved for articles with clear evidence that the findings are unreliable (either as a result of misconduct or honest error); have been previously published else- where without proper cross-referencing, permission, or justification; contain plagia- rized material; and/or report unethical research (http://publicationethics.org/files/ retraction%20guidelines.pdf). Although the update itself links to the previously published article, how do readers know by looking at an article whether an update has been published? In the past, it was not always easy to find. To solve that problem, CrossRef, makers of CrossCheck and FundRef, have created CrossMark, a multipublisher initiative that allows jour- nals to create an interactive reading experience that notifies readers when updates have been made. Beginning with this issue, the CrossMark logo (as depicted on the left) in print articles indicates that The Journal is an active participant in the CrossMark program. However, the logo comes to life in the online version of The Journal’s articles. By clicking the CrossMark logo, readers will be directed to a page that states whether the article is current or an update has been published. If a correction, erratum, retraction, etc, has been published for an article, readers will be provided with a direct link and citation to the update. There is no charge to access CrossMark information; however, the CrossMark logo does not indicate whether the article itself is freely available. Additional information about CrossMark is available at http://www.crossref.org/crossmark. We hope that you find CrossMark to be a useful tool when reading The Journal, as well as other journals participating in this program. Mans best friend, except . — Sarah S. Long, MD J ust about everyone who owns and loves a pet, likely cannot imagine life without “man’s best friend.” There is no question of a pet’s value to the happi- ness and well-being of children. Pet-associated infectious risks for patients with cancer (and other immunocompromised children) also are clear. Guidance for pa- tients with cancer targets personal hygiene, as well as types and ages of animals suited/not suited as pets: dogs and cats under 6 months of age more likely carry Campylobacter and Bartonella species; reptiles, amphibians, and exotic animal spe- cies are nearly obligate Salmonella carriers; poultry and rodents have Salmonella and other communicable bacteria; and rodents can harbor lymphocytic choriome- ningitis virus. Veterinary, medical, public health, and population health departments teamed up to develop and administer a questionnaire to children cared for at the Children’s Hos- pital of Eastern Ontario to assess knowledge and attitudes toward pet ownership, perceived infectious risks, and ownership practices. They solicited enrollment of 217 August 2014 Volume 165 Number 2 Copyright ª 2014 Elsevier Inc.

The Journal implements CrossMark

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August 2014 � Volume 165 � Number 2 Copyright ª 2014 Elsevier Inc.

The JournalimplementsCrossMark

— Monica L. Helton, BA— William F. Balistreri, MD

Ensuring the integrity of the medical literature is a high priority of the Editors of TheJournal and its publisher, Elsevier Inc. When an error is brought to our attention,

we maintain the accuracy of the literature by publishing an update as appropriate:(1) erratum (minor publishing error); (2) correction (minor author error); or(3) retraction (major error). According to the Committee on Publication Ethics, re-tractions are reserved for articles with clear evidence that the findings are unreliable(either as a result of misconduct or honest error); have been previously published else-where without proper cross-referencing, permission, or justification; contain plagia-rized material; and/or report unethical research (http://publicationethics.org/files/retraction%20guidelines.pdf).

Although the update itself links to the previously published article, how do readersknow by looking at an article whether an update has been published? In the past, itwas not always easy to find. To solve that problem, CrossRef, makers of CrossCheckand FundRef, have created CrossMark, a multipublisher initiative that allows jour-nals to create an interactive reading experience that notifies readers when updateshave been made. Beginning with this issue, the CrossMark logo (as depicted onthe left) in print articles indicates that The Journal is an active participant in theCrossMark program. However, the logo comes to life in the online version of TheJournal’s articles. By clicking the CrossMark logo, readers will be directed to apage that states whether the article is current or an update has been published. Ifa correction, erratum, retraction, etc, has been published for an article, readerswill be provided with a direct link and citation to the update. There is no chargeto access CrossMark information; however, the CrossMark logo does not indicatewhether the article itself is freely available. Additional information about CrossMarkis available at http://www.crossref.org/crossmark. We hope that you find CrossMarkto be a useful tool when reading The Journal, as well as other journals participatingin this program.

Man’s best friend,except .

— Sarah S. Long, MD

Just about everyone who owns and loves a pet, likely cannot imagine lifewithout “man’s best friend.” There is no question of a pet’s value to the happi-

ness and well-being of children. Pet-associated infectious risks for patients withcancer (and other immunocompromised children) also are clear. Guidance for pa-tients with cancer targets personal hygiene, as well as types and ages of animalssuited/not suited as pets: dogs and cats under 6 months of age more likely carryCampylobacter and Bartonella species; reptiles, amphibians, and exotic animal spe-cies are nearly obligate Salmonella carriers; poultry and rodents have Salmonellaand other communicable bacteria; and rodents can harbor lymphocytic choriome-ningitis virus.

Veterinary, medical, public health, and population health departments teamed upto develop and administer a questionnaire to children cared for at the Children’s Hos-pital of Eastern Ontario to assess knowledge and attitudes toward pet ownership,perceived infectious risks, and ownership practices. They solicited enrollment of

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children diagnosed with cancer as the group of interest and children with diabetes (asalso having a chronic condition, with less risk of infection) as “controls” to assess ef-fects of knowledge and education on action. Sixty-five percent of parents/guardianscompleted the questionnaire (64 whose child had cancer and 150 whose child had dia-betes). At diagnosis, 45% of respondents had a household pet; few found them a newhome. Twenty percent of patients with cancer acquired a pet after diagnosis, 77% ofwhich were high-risk pets.

These findings and more, which can be found in the authors’ report, provideconvincing evidence of the need for improved education of households with immuno-compromised children, as well as that of pediatric and veterinary healthcare profes-sionals.

Article page 348

Bones, breaks,and BMI

— Thomas R. Welch, MD

I t seems that just about any childhood travail is somehow linked to obesity. Some ofthese associations are consistently reproducible, and others are less so. One of the

more interesting of these is the association between obesity and fracture risk. Studiesof this association have been mixed in their results, and are confounded by things likeactivity levels, sports participation, etc.

This issue of The Journal contains an article by Sabhaney et al that brings someclarity to the matter and has a surprising finding. These investigators studied over2000 children who came to one of two emergency departments with a non penetratingextremity injury. The children were classified according to body mass index, and theauthors examined the risk of having a fracture as a function of obesity status. Over-weight children had a small but significant decreased risk of fracture compared withthose of normal weight. Underweight children, however, had a significantly increasedrisk of fracture.

It is not immediately clear what we should do with this information. As the authorspoint out, weight status may have been a surrogate for bone mineral density, whichcould have been the major (unmeasured) risk factor. It also should be consideredthat these are generally low-severity upper extremity fractures, which may be theoften-unavoidable consequence of an active childhood!

Article page 313

An evaluationof pediatric clinical

trial design— Robert W. Wilmott, MD

S inha et al from the University of Sydney, Australia, asked whether recently pub-lished randomized controlled trials of pharmacologic agents in children demon-

strated any more risk of bias than similar trials performed in adults. This wasinvestigated by evaluating 100 trials involving only children and matching themby drug class and therapeutic area with similar trials completed in adults. The Co-chrane risk of bias tool was used to compare the pediatric and adult trials. The re-sults were reassuring in that the published randomized control trials involvingchildren had a largely similar risk of bias compared with the randomized controlledtrials in adults, suggesting that pediatric clinical investigators have a similar capa-bility to conduct and report randomized controlled trials to their adult colleagues.The study demonstrated several areas where bias potentially exists in pediatric trials,although, in most areas, the pediatric trials were slightly better than the adult ones.However, these areas will need close attention in the future. An important messagefrom this study is that we have the capability in pediatrics to perform robust, ran-domized, controlled trials in children, so there is no reason to neglect assessingdrugs in the pediatric population.

Article page 367

Vol. 165, No. 2

Au

A healthy mind in ahealthy body

— Thomas R. Welch, MD

gust 2014

The concept that overall physical fitness is positively associated with academic per-formance has been in circulation for a long time. In this issue of The Journal, Es-

teban-Cornejo et al advance this area of study considerably, with a study that isimpressive for the number of children involved and the detail with which the associ-ation was tested. In a group of over 2000 children, these authors performed standard-ized measures of three components of fitness: muscle strength, cardiorespiratorycapacity, and motor fitness. These were examined in relation to four measures of ac-ademic achievement.

Cardiorespiratory capacity and motor fitness were positively associated with allacademic measures, but muscular strength had no independent association. Obvi-ously, this work does not demonstrate cause and effect, but the results are striking.Their findings should stimulate carefully-designed interventional studies.

Article page 306

MgSO4 forneuroprotection

— Alan H. Jobe, MD, PhD

Survivors of very preterm birth often have neurodevelopmental abnormalities thatare certainly multifactoral in origin. Both antenatal and postnatal exposures can

contribute to these adverse outcomes. One of the few interventions that has beentested in randomized controlled trials is maternal treatment with MgSO4 prior tovery preterm delivery. This intervention, developed based on the frequent use ofMgSO4 as a tocolytic for preterm labor, decreased cerebral palsy diagnosed at 2 yearsof age. In this issue of The Journal, Chollat et al report the school-age outcomes for oneof the MgSO4 trials. Although not statistically significant, infants exposed to MgSO4

had less motor dysfunction, fewer behavioral disorders, fewer cognitive difficulties,less frequent repeating of school grade, and less use of special education servicesthan the control infants. An unsatisfying aspect of this therapy is that the mechanismof action of MgSO4 on the very preterm fetus/newborn is unknown. Nevertheless, allassessments were in the direction of benefit, at least demonstrating no harm, from theMgSO4 exposure at school age.

Article page 398

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