Urolithiasis and abdominal pain in children. According to a study published in the December 2009 issue of Pediatrics, urolithiasis is often overlooked as a cause of recurrent abdominal pain in children. The researchers suggest that a correct diagnosis in children is difficult for three main reasons: painful urination and blood in the urine can occur sporadically; the location of urolithiasis-associated pain is often diffuse rather than specific, particularly in younger children; and calculi aren't always present on imaging, especially when stones have already passed. Such difficulties with diagnosis may also result in unnecessary appendectomy (in the study group, 16% of children had had appendectomies, compared with 1.5% in the control population). A family history of stones and abdominal pain occurring infrequently (four or fewer days per month) may be a signal to clinicians of the presence of urolithiasis, even in the absence of dysuria and hematuria.

Figure. In December 2009, several major nursing unions united to form the National Nurses United (NNU)-a "superunion" that brought more than 150,000 nurses together by combining the California Nurses Association (CNA)/National Nurses Organizing Committee with the Massachusetts Nursing Association (MNA) and some members of the United American Nurses (UAN). As their first act, on December 8 delegates to the founding convention rallied outside the Phoenix offices of the Arizona Hospital and Healthcare Association to urge nurses to challenge hospital industry attacks on nurses' rights, patient care conditions, opposition to ratios, and other critical legislation. The NNU's newly appointed Council of Presidents comprises leaders from the three founding organizations, shown here from left to right: Jean Ross (from the UAN), Karen Higgins (from the MNA), and Deborah Burger (from the CNA). Photo by Jaclyn Kelley Higgs.