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ByLauranNeergaard TheAssociatedPress WASHINGTON Improvise isn't a word parents want to hear from their kid's doctor. Yet pediatric spe- cialists too often have to jury-rig care because many of the medical devices needed to treat sick chil- dren were built for adults. Part of the problem is size. Doctors fixed Alice de Pooter's faltering heart- beat by wedging an adult pacemaker into a baby's body. But the device's large battery bulged so badly under her rib cage that she struggled to sit upright un- til her first birthday. It's also an engineering problem. Children aren't just miniature adults; their bodies are growing and changing. When adult devices haven't been for- mally studied in children, using them in youngsters can raise safety questions. "It affects patient care. We need to find a resolu- tion," Dr. Matthew Oet- gen, chief of orthopedic surgery and sports medi- cine at Children's National Health System, said at a recent grants competition that the Washington hos- pital hosted to help spur development of innovative pediatric devices. There's little financial incentive to create and test pint-sized devices be- cause children overall are healthier than adults and make up a fraction of the treatment market. But families are starting to demand solutions. A birth defect left Mi- yah Williams with one leg missing at midthigh. The prosthetic leg she re- ceived as a toddler came with such a painful, sweat- and sore-inducing socket — a rigid cup connecting the leg to her thigh — that she refused to wear it. Her mother eventually found a small San Francisco com- pany willing to design a softer, adjustable socket able to grow some as Mi- yah does. Miyah, now 3, dances to show off a leg finally com- fortable enough to wear all day. "She told them ear- lier today that her bone no longer hurts," Tamara Williams of Fayetteville, North Carolina, said of manufacturer LIM Inno- vations. "They made her a socket that changed her life." The industry acknowl- edges medical devices de- signed specifically for chil- dren often lag five years to 10 years behind new tech- nology for adults, and Food and Drug Adminis- tration statistics illustrate the disparity. In 2013, eight of the 38 novel or higher-risk de- vices FDA approved were labeled for use by patients younger than 22. In 2014, six of 33 such device ap- provals were for pediatric use; so were two devices for rare disorders allowed to sell under a special fast- tracking program. Consider pacemak- ers. Children account for only about 1 percent of pacemaker implants, said Dr. Charles Berul, co-di- rector of Children's Na- tional Heart Institute. Adult pacemakers such as the biventricular ver- sion implanted into Alice de Pooter when she was 4 months old can save lives, but improvising has draw- backs, he said. Adults typically have a pacemaker's electri- cal leads, or wires, easily threaded into the heart through a vein, but babies require open-chest surgery attaching them to the out- side of the heart, explained Berul, Alice's longtime cardiologist. Faster child heartbeats wear out the batteries more rapidly, and the leads can stretch out of place as tots grow. Now 3 and living near Houston, Alice has a well- functioning heart and while the battery's out- line remains visible in her belly, "she's running and happy," said her mother, Charlotte Vanheusden. Manufacturers are de- veloping a tiny wireless pacemaker for adults. If it works, Berul hopes eventu- ally that could be adapted for children, too. Mean- while, he's developing a less invasive way to place today's wires in tots, with aid from a tiny camera normally used in the uri- nary tract. It's an example of part- nerships between doctors and bioengineers that are springing up at numer- ous children's hospitals and universities, sparked in part by 2007 legislation establishing an FDA pro- gram with a small budget to help fund early pediat- ric device development. This year, FDA awarded $3.5 million to eight such consortia around the coun- try. Some experts argue more far-reaching incen- tives are needed, such as tax credits and patent ex- clusivity that in recent years have spurred an in- crease in medications for rare diseases. Another incentive: Make a device that works first in kids, and "abso- lutely there will be ben- efit for the adult popula- tion. It's not as easy the other way around," said Dr. Vasum Peiris, FDA's new chief medical officer for pediatric devices. Doctors point to some successes. The Berlin Heart child- sized implantable pump was approved through a special FDA program in 2011 to help children sur- vive the wait for a heart transplant, an option long available for adults. Ortho- Pediatrics Corp. of War- saw, Indiana, recently cre- ated a device to repair a common knee injury, a torn ACL, without damag- ing young children's still- growing bones. Last month's competi- tion by Children's Nation- al's innovation institute highlighted early proto- types attempting to wind through the pipeline, from a device by Ireland's AventaMed to implant ear tubes in youngsters with- out requiring full anesthe- sia to a test by Prospiria Inc. in Galveston, Texas, showing if breathing tubes are inserted properly. The ideas don't have to come from pediatricians: "Just ask patients what they want," said Dr. An- drew Pedtke, an ortho- pedic surgeon who co- founded LIM Innovations after seeing adult ampu- tees struggle with painful sockets and had a small team beginning pediatric work when Miyah's mother made her request. PEDIATRICS Mo ve t o sp ur p in t- si ze d me di ca l devices to treat sick children MANUELBALCECENETA—THEASSOCIATEDPRESS Miyah Williams, 3, wearing her prosthetic leg, rests in Washington, Friday, Oct. 23, 2015, at a meeting on the need for new pediatric medical devices hosted by Children's National Health System. By LeeAnn Weintraub LA Daily News The debate over which kind of milk — skim, low- fat or whole — is the best choice is not a new one. But the 2015 Dietary Guidelines for Americans, due to be published by the end of the year, is sparking a new conversation about milk. The federal government is mandated to update these food and beverage recommendations every five years based on the sci- entific literature. Many re- main confused about what type of milk is healthi- est and if they should be drinking milk at all. The current debate about milk is focused on its fat content. While the long-standing advice per- taining to milk has been to choose non-fat and low- fat milk, there is emerg- ing evidence that full fat dairy products might not be so bad and may even be better. An analysis published in the European Journal of Nutrition that looked at 16 different studies found that consumption of whole milk dairy is associated with reduced body fat. Al- though the cause of this relationship is unknown, we do know that dietary fat increases satiety. It is possible that the fat in whole milk dairy products helps with fullness and can result in eating less. This advice might not hold up for people with high cholesterol. Accord- ing to the American Heart Association, about 25 to 35 percent of calories should come from fat, but less than 7 percent from satu- rated fats. Since the fat in whole milk is primarily satu- rated fat, a plan for low- ering cholesterol levels should include opting for low-fat and non-fat dairy. Also, portion control is important to consider. Most people only need two to three dairy serv- ings daily; the equivalent of 8 fluid ounces milk, 1 cup yogurt and 1/3 cup of shredded cheese. This ad- vice goes for children as well. Two cups of milk daily is sufficient to maintain both vitamin D and iron stores in adequate range for preschoolers. Milk has been touted as an excellent source of cal- cium, boasting 300 mg per cup, but it's certainly not the only thing that helps build strong bones. In fact, tofu, sardines and yogurt contain more calcium per serving than milk; other foods such as white beans, broccoli, al- monds, enriched non- dairy milks and seaweed — among other plant- based foods — are signifi- cant sources of this impor- tant mineral. Although dairy milk can help you reach the daily calcium goal of 1,000 mg, while providing pro- tein along the way, it is shortsighted to not count on other products for cal- cium. The selection of non- dairy milks has never been so plentiful. When scanning the dairy aisle in the super- market you have probably noticed everything from nut milks made from al- monds or cashews to soy and even hempseed milk. These products provide a convenient milk alterna- tive, particularly for veg- ans and those with lactose intolerance, a difficulty di- gesting milk sugar. Surprisingly, many of these products contain un- expected additives like gums, sugar and salt. When choosing a milk al- ternative, look for prod- ucts that are unsweetened and fortified with calcium, vitamin D and other es- sential nutrients. General nutrition guide- lines can lead to more con- fusion because they are created to advise popu- lations, while nutritional needs and food prefer- ences are unique to each person. As emerging science supports the use of whole milk and even organic dairy, I suspect the avail- ability and consumption of these products will con- tinue to rise. However, it's important to keep in mind that there probably is not and will not be one best or healthiest type of milk. Instead, your milk choice should be bal- anced with the other foods in your diet to optimize your nutrition and help you reach your health and wellness goals. LeeAnn Weintraub, a registered dietitian, provides nutrition counseling and consulting to individuals, families and businesses. Follow her on Twitter @halfacupRD. LeeAnn can be reached at RD@halfacup.com. DIET Although dairy milk can help you reach the daily calcium goal of 1,000mg, while providing protein along the way, it is shortsighted to not count on other products for calcium. Choosetherightmilk for your nutrition needs By Kevin Freking The Associated Press WASHINGTON Veterans' hospitals and clinics are beefing up staff and seeing more patients, but the num- ber of appointments not completed within 30 days continues to grow, Depart- ment of Veterans Affairs Robert McDonald said Fri- day. Speaking at the National Press Club in advance of Veterans Day, McDonald described a VA that is do- ing much to address prob- lems that investigators say caused chronic delays for veterans seeking care. Mc- Donald said the VA com- pleted 3.1 million more ap- pointments in the latest fiscal year than the previ- ous one. It also hired thou- sands of new doctors and nurses. Still, the organization is struggling to keep up. Mc- Donald said the number of appointments not com- pleted in 30 days has grown from 300,000 to nearly 500,000. McDonald said more vet- erans are coming to the VA despite often having access to Medicare, Medicaid or private insurance. He said the VA is more convenient, effective and cheaper. VETERANS HEALTH VA s ec re ta ry s ay s de ma nd outstripping extra resources HEALTH » redbluffdailynews.com Tuesday, November 10, 2015 MORE ATFACEBOOK.COM/RBDAILYNEWS AND TWITTER.COM/REDBLUFFNEWS A4