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The results of recent surveys in the United States have suggested a rising tide of fatalities due to child abuse or neglect (CAN). Because these surveys lack consistency in case definition and are incomplete in coverage, the use of death certificate data to estimate the number of CAN deaths was explored. To estimate these deaths among children 0 through 17 years old for 1979 through 1988, three models were formulated, each comprising six coding categories: (1) deaths coded explicitly as due to CAN, (2) homicides, (3) injury deaths of undetermined intentionality, (4) accidental injury deaths, (5) sudden infant death syndrome fatalities, and (6) natural-cause deaths. Research studies and crime data were relied on to estimate the proportions of deaths in categories 2 through 6 that were actually due to CAN, and other assumptions were varied to create a range of estimates. For the 10-year period, the estimated mean annual CAN fatalities ranged from 861 to 1814 for ages 0 through 4, and from 949 to 2022 for ages 0 through 17. Child abuse and neglect death rates did not increase over the period; in fact, they were relatively stable for ages 0 through 17 and showed a modest decline for 0 through 4. Ninety percent of fatal CAN occurs among children younger than 5 years old, and 41% occurs among infants. About 85% of CAN deaths are recorded as due to other causes. It is concluded that the magnitude of fatal CAN can be estimated from death certificates. It is recommended that the death coding system be modified to make CAN identification easier and that this study's methodology be refined to provide the basis for ongoing surveillance.

The partners CNES, Dasa, DLR, and SEP have decided to cooperate in the field of H2/O2 high pressure combustion research. The idea behind this collaboration is to concentrate European research activities of industry, research laboratories, and universities, with the aim to increase the basic knowledge about the dominating chemical and physical processes of high pressure hydrogen/oxygen combustion and heat transfer in rocket propulsion devices. For this purpose, a new research and technology test facility for high combustion chamber pressures, the P8, located at the DLR research and test center at Lampoldshause n, Germany, has been erected and is jointly operated by the partners [1] [2]. The paper gives a brief description of the major design features of this new high pressure research facility but concentrates on experimental results of the first hot fire test activities which characterized the operating capabilities of the P8. This first test campaign was made up by a total of 29 tests including 10 hot fire tests with combustion chamber pressures from 2 to 10 MPa. All tests have been successfully performed using a watercooled model combustor designed by DLR. After short presentations of the first technological test campaigns of the different partners and an overview on recently performed improvements of the test facility, the paper finally closes with an outlook on the coming activities on P8.

To determine the long-term neurologic, cognitive, and educational outcomes of Navajo children who survived Haemophilus influenzae type b meningitis.Retrospective cohort study, with 3.6- to 15.0-year follow-up.Navajo Indian reservation.Population-based cohort of 76 Navajo children with Haemophilus meningitis at less than 5 years of age between 1975 and 1986, with 41 (54%) consenting to undergo follow-up in 1990. Each case was matched to one nearest-age sibling and one unrelated age-matched control.Standard intelligence test scores, neurologic abnormalities, and school performance.The mean IQ for cases was lower than that for siblings (79 vs 87, P = .006) or age-matched controls (79 vs 95, P.001). Twenty-nine percent of cases had severe neurologic sequelae, including mental retardation (24%), severe hearing loss (5%), cerebral palsy (7%), and seizure disorder (12%). Eight percent of siblings (relative risk for cases vs siblings, 8.0; P = .05) and 2% of age-matched controls (relative risk vs cases, 10.0; P = .01) had mental retardation. No siblings or age-matched controls had any other severe neurologic sequela. Twenty-nine percent of cases, 23% of siblings (relative risk, 2.5; P = .45), and 0% of age-matched controls (P = .001) required special education services, while 42% of cases, 23% of siblings (relative risk, 3.3; P = .10), and 11% of age-matched controls (relative risk, 4.0; P = .005) had been retained in a grade in school.Navajo survivors of Haemophilus meningitis suffer more long-term neurologic, cognitive, and school-related disability than siblings or age-matched controls. They may also suffer higher morbidity than Haemophilus meningitis survivors in the general population.

To the Editor. —We want to correct the reference to our estimate of the magnitude of fatal child abuse and neglect made in the Special Communication entitled "Origins and Clinical Relevance of Child Death Review Teams." 1 A report on our complete work, a joint effort of the Centers for Disease Control and the University of Missouri School of Medicine, will soon be published in Pediatrics . Using cause-of-death data, Federal Bureau of Investigation data, the Missouri Child Fatality Study, and the results from other research, we estimated that, from 1979 to 1988, the annual number of child abuse and neglect fatalities averaged between 949 and 2022. The Special Communication attributes the following to us: "Over 1000 American children die each year of intentional [our emphasis] injuries at the hands of a caretaker." It was not our wish to suggest that these fatalities are either intentional or unintentional. We believe that