Smash finally gives us a look at the dark days of Marilyn Monroe, perfectly timed with Ivy's mounting paranoia and increasing bouts of self-doubt. Do real actors wear rehearsal outfits with that much cleavage? Are all 16-year-olds in New York City experienced with playing puff, puff, pass in the park? And would a political hopeful really make that overt of a pass at his dinner partner? (Don't answer that one.) Returning to our smashing discussion is Popdust Media Editor John Gara, who runs the world's only Jellice Cat rescue. Read on for our thoughts!

Emily: John! Oh how we've missed you.

John: Thanks. Even though I skipped a few episodes, it seems like nothing's changed. I did really like this week's musical number, though.

Emily: "Let's Be Bad" was great. Between the drug-addled Marilyn voice and the sparkly red dress during Ivy's full fantasy performance, I had my wallet out, ready to purchase a ticket to the show.

John: Is it weird that whenever I watch this, my brain automatically replaces "Marilyn" with "Lindsay Lohan?"

Emily: Well clearly everyone has their own word associations when it comes to Lindsay. For Matt Lauer, it's Whitney Houston, etc.

John: "Let's Be Bad" was taken straight off the set of I Know Who Killed Me.

Emily: Go on...

John: All you need to do is watch 20 minutes of that movie and you know Lohan was tanked throughout filming.

Emily: I liked this number because it connected to Ivy's impending breakdown, and the paranoia that everyone around her doubts her talent. Meta!

John: It was really good because they're finally showing what I like to call Fun Marilyn, also known as the boozy pill-popping one. It's very similar to Fun Britney Spears, when she wears a pink wig and drives all night to Mexico with Adnan Ghalib.

Emily: You know your stuff.

John: It also truly shows how boring the rest of the show is. Julia and Tom and all those non-performers are so painful to watch.

Emily: But they all can sing! Maybe they should just turn this into a complete musical series, for better or for worse. Tom's already proven he can make a near arrest the subject of a knee-slapping singalong. And really, the performers aren't always that much better. I cringed during Karen's "It's a Man's Man's Man's World."


Emily: Didn't they learn from Glee?

John: It was an EPIC fail when Quinn sang that.

Emily: Please make the flashbacks to dancing pregnant girls stop. I think they were wearing sunglasses?

John: Karen was sounding very Xtina last night, but McPhee couldn't pull it off.

Emily: And was so not sexy while doing a poor woman's version of Flashdance in the bedroom and then smugly saying she knows what she brings to the party. We do, too: A cups.

John: OUCH!

Emily: Sorry. Hold me back.

John: Karen brings non-alcoholic beer to the party. Ivy brings the promise of a nip slip and PILLS!

Emily: And slut-shaming. I hated Karen preaching about how "that's not how [she] was raised," which is the epitome of what someone who claims not to be judgmental condescendingly says about other people.

John: Lots of slut-shaming this episode.

Emily: Again with trying to keep the strong ladies down. Really, Theresa Rebeck?

John: I am OVER Derek! I don't buy the bullshit he feeds to Ivy at the end about him being inside his head trying to separate emotion.

Emily: And the look in her eyes when she found him up late poring over the songs. Poor baby.

John: He's trying to break her down and go all Svengali on her ass so she can be like Karen. TOTALLY impressionable.

Emily: Yes, I agree. I was happy Ivy went over to call him out (even if it was alcohol induced) but wanted to yell at her when she gave into his underhanded sleepover invite. Work through the martini haze and recognize what he uttered moments before: he doesn't like you enough, he doesn't want a relationship and is overall miserable all the damn time. Her caving in is an insult to Beyoncé and independent women everywhere.

John: Absolutely. He's just another man in the industry trying to cause drama between two divas.

Emily: Divas (pushed to) hate divas.

John: Will it take Ivy and Karen presenting at the Tony Awards in matching brown gowns to settle the rumors of rivalry? Rumors of animosity I should say. We know there is rivalry.

Emily: Try it on me! (Too soon?) Do you think there's ever any scenes like tonight's rehearsal meltdown during the actual filming of Smash? I could see Hilty hating McPhee.

John: I bet most of the on set crying is done in private by Angie Huston.

Emily: "How did I get here?"

John: I think this week's most improved is Julia's son Leo!

Emily: Ugh, but that name. I know this show is theater-related, but isn't that a moniker reserved solely for middle-aged characters played by Matthew Broderick?

John: Well he's on his way to being America's Next Top Angsty TV Teen. He needs something formidable.

Emily: Facebooking while listening to angry music. Just TRY and stop me, mom!

John: I would have preferred him being a suicidal gay teen (TOPICAL) but trying buy weed in the park isn't too bad.

Emily: And it also led to the best burn of Julia all season: "I'm 16 and I live in New York City. Next!" Beware of raising your children in one of the five boroughs, child-bearing adults.

John: All I'm saying is if he wants to compete with Breaking Bad's Walt Jr. or Homeland's Dana Brody, he better get a face tattoo or get hooked on crystal meth.

Emily: He was a little flip-floppy when he called his mother out on making everything in their lives about the adoption. Sorry, but you were crying when you heard you might not get a little baby brother or sister just a few weeks ago. Then again, maybe he was on the pot...

John: Enough with the adoption! Nobody cares. And while you're at it kill off the husband while he's on his retreat.

Emily: It's coming—a tragic car accident on PCH? Or where did Marilyn die? Tie it to that. Full circle!

John: In her home in a pile of vomit? We don't need that per se (save it for Ivy). I hope Mr. Julia just "finds himself" in Cali and never comes back.

Emily: Speaking of never coming back, where oh where is Eileen?

John: Eileen was so the stereotypical old lady who can't send an email over the Internets. What are they doing to her?

Emily: Help me young person!

John: I was expecting to see her whip out a jitterbug phone.

Emily: What? This banana doesn't make phone calls!

John: And ride off on her Jazzy chair.

Emily: Love a good Jazzy moment.

John: I will say Ellis on Eileen's computer just spells trouble. All of Eileen's personal sexy videos will be on YouLenz by next week. Just you wait and see.

Emily: For...Tom? The bodega owner on the corner? The bartender who dutifully gives her a free drink after she throws hers on someone's face?

John: Her gaydar is as good as her tech knowledge if she's going after Tom.

Emily: So now that we're clued in to Ivy's eventual demise (drugs!) I'm thoroughly convinced this production will be the next Spider-Man: Turn Off the Dark.

John: You don't need high wires when you can have two dancers make Ivy's arms move like she's a lady puppet, my favorite part of this week's episode.

Emily: Except instead of people dying after falling from the rafters, there will be real overdoses on stage. Julia said she wants to make this serious and dark.

John: Yes, live overdosing! Maybe there will be two Marilyns: the pill popper and the sober one with vibrato to spare.

Emily: I think producers would be all over that kind of show. Or why not get our mascot LiLo? Convince her to throw what hasn't gone to legal bills into Marilyn: The Musical, or whatever this funny little show is to be called.

John: That might be tough. I think Lohan has dropped her Marilyn obsession for Liz Taylor.

Emily: But then generous NBC would get to give her another job. Comeback take 37498204. Side note: Do you think there will be a Whitney Houston musical one day? They're already talking about a movie.

John: What would it be called?

Emily: "Crack is Wack."

John: In big lights.

Emily: Or maybe it's "And I..."

John: It would suffer from its lack of Google recognition.

Emily: Search Engine Optimization doesn't yet understand real art.

With its larger productions and more off-stage romance, is Smash beginning to heat up? Let us know what you think in the comments below.

Polysomnography and the pediatric patient: mastering a new set of skills for the pediatric population.

RT January 1, 2009 | Porquez, Emmanuel J.

As pediatricians become more aware of the importance of sleep for good health and parents become educated about the quality of their child's sleep behavior, traditional sleep laboratories will be challenged to do more. Although the quality of a child's sleep is evaluated in a manner similar to that for adults, there are differences the pediatric sleep technologist must consider. Age of the patient and medical condition of the child may challenge the sleep technologist's skills in obtaining a quality study. As a sleep technologist, how prepared are you to implement sleep studies in the pediatric age group?

Unless sleep technologists work in a medical facility specifically dedicated to children, they may have limited work experience with pediatric patients. Poly somnograms are frequently ordered in the pediatric patient population, ranging from birth to 18 years of age. Obstructive sleep apnea and various other medical conditions pertaining to respiratory pathology, including genetic and craniofacial anomalies, can affect the quality of the child's sleep. Fragmented and otherwise poor sleep can influence growth and development, including academic performance in the older child and behavior at any age. The polysomnographic technologist, with the proper knowledge and understanding, can derive valuable information for later analysis.

There are three broad age groups that display a variety of behavior patterns in sleep: birth to 2 years old (infants), 2 to 5 years old (toddler/preschool), and 5 to 18 years of age (school age/ adolescents). While performing pediatric polysomnograms, sleep professionals need to be especially cognizant of age-specific communication methods, electrode application techniques, and often-encountered medical conditions in the pediatric population. this web site arnold chiari malformation

Birth to 2 Years of Age Communication within this age group is mainly between the parent(s) and sleep technologist. The infant usually sleeps the majority of the night, with brief interruptions for feedings and diaper changes. Infants and toddlers are too young to understand and express their needs. They are totally dependent on the parent/ caregiver for assistance. Explaining the testing procedures will calm an anxious parent and allow a better understanding of the sleep study process.

Electrode application takes careful planning, and diligence and care should be emphasized. With this in mind, the sleep technologist must consider the child's fragility and small size. An asset to the sleep technologist is having the cooperation of the parent(s). A parent can be an indispensable assistant, aiding by holding the infant, keeping little hands away from secured electrodes, as well as distracting the baby. Electrode placement is usually performed in a crib, where the child should be held in a sitting position or lying down. Note that cribs must be readily available in the sleep laboratory where infant/toddler studies are performed. Not only can parents assist the sleep technologist during the placing of electrodes, they can provide additional information describing their child's sleep pattern and behavior at home. Accommodations must be available in the bedroom for the parent. A spare bed is provided for the caregiver since "co-sleeping" should be avoided. Circumstances where "co-sleep" might be allowed would be to achieve sleep onset, when co-sleeping is the routine at home, or to prevent inadvertent electrode removal by the child until they fall asleep.

Medical conditions seen within this age group may consist of upper airway, craniofacial, and chest wall anomalies, as well as neurodevelopmental abnormalities. Disorders such as down syndrome, treacher collins syndrome, pierre robin syndrome, cerebral palsy, and spina bifida/arnold chiari malformation may compromise normal sleep. An infant born premature (

Ages 2 to 5 Years Old Introduction and communication for this age group should be initiated by the sleep lab prior to the scheduled appointment. It is appropriate for the sleep facility day staff to assist in properly preparing the child, by giving tours of the sleep lab or supplying a video of what to expect. Encourage parents to use age-appropriate words while explaining the sleep study process to their child to relieve their anxiety.

A child is more likely to fall asleep naturally if they feel comfortable in their environment. Allowing adequate time for the child and parent to acclimate to their new surroundings is essential. The technologist's frequent visits in and out of the room help to increase familiarity, earning the parent's and child's trust while placing electrodes. The parent is encouraged to initiate the child's nightly routine by bringing books, snacks, pajamas, a favorite blanket, teddy bear, etc to help further simulate a homelike atmosphere. It is advisable for the patient to sleep in a bed with bedrails for safety. The sleep technologist should document "lights out" as close to the child's typical bedtime as possible.

How sleep technicians present themselves to patients can influence the behavior of the children in regard to the study. Scrubs or white coats may further frighten a child. more comforting wear such as casual street clothes or colorful scrubs should be considered. Mentioning "no shots" several times will relieve anxiety and apprehension. Having the setup cart containing supplies and electrodes already in the room, or allowing the child to feel some of the items, are more helpful techniques. These actions reaffirm to the child that there will be no surprises. If the child comes in holding a doll or stuffed animal, demonstration of one or two electrodes placed on the doll impresses upon the child that pain is not involved. If a doll is not available, placing an electrode on mom or dad can be entertaining and encourage family rapport. see here arnold chiari malformation

In difficult situations where the child is crying or restless and comfort measures are not successful, a fast yet effective hookup is suggested. One must be mindful to allow appropriate breaks for the crying child to catch their breath. Methods that expedite the hookup process include using disposable electrodes, utilizing a dimly lit room, and applying arm immobilizers. Sometimes it is necessary to have a second sleep technologist available to assist with a difficult patient. In rare situations, the placement of the thermistor or end-tidal [CO.sub.2] cannula may need to be delayed until sleep onset has been achieved. Once the electrodes are properly placed and the hookup is completed, allow the parent to embrace and console the upset child.

[ILLUSTRATIONS OMITTED] The sleep technologist may encounter medical cases as a follow-up to previous sleep studies or have to evaluate existing medical conditions. A history of seizures, enlarged tonsils/adenoids, and sleep disorders associated with behavioral problems are commonly seen within this age group.

5 to 18 Years of Age While adolescents may appear to be similar to adults, there are subtle but important differences. Certain techniques can be helpful in achieving a successful sleep study. Identifying the patient's presenting behavior can give insight to the sleep technician and help gain rapport. For example, by observing a teenager wearing headphones, looking down, or avoiding eye contact, you can assume they are either a little anxious about the study, just bored, or even angry with their parent for making them go through this embarrassing study. The technologist who recognizes this might say, "I know this might be difficult for you," or "I know you would rather be someplace else, but let me help you." By being observant, perceptive, and empathetic, the sleep technologist should be able to coax a cooperative spirit and obtain a good quality recording. Respect for the adolescent's privacy by knocking before entering the room and using the appropriate age-related terminology will also increase compliance.

Since this age group is more mature and cooperative, electrode placement is performed with relative ease. Sleep technologists must be willing to answer questions and treat adolescents with respect as they attempt to understand the sleep study process. Another helpful tip is to allow the adolescents to participate in the hookup process. Participation provides a sense of control in an attempt to lessen anxiety about the testing procedure.

Disorders the technologist may encounter in this age group are sleep terrors, sleepwalking, narcolepsy, sleep-related breathing disorders, delayed sleep phase syndrome, and sleep deprivation. Adolescents may also develop poor sleep hygiene habits that disrupt sleep at home. Poor sleep hygiene may be observed in the sleep lab as the adolescent may request to play video games, have the television turned on, or require music playing while trying to fall asleep.

Understanding normal development and behavior is helpful in providing individualized attention in an age-appropriate manner. In the pediatric sleep lab, flexibility is critical in obtaining a good quality study. In addition, using the appropriate size and type of equipment, along with a secure hookup, will help assure a quality study is collected.

Monitoring the pediatric age group also requires special considerations. The implementation of established pediatric protocols developed with the program's medical director is crucial in order to standardize procedures and ensure optimal data collection. For example, accidental electrode removal and re-referencing of electrodes may be tolerated more in a child than in an adult, in order to avoid disrupting sleep or further prolonging a difficult sleep onset. Vigilant and constant documentation of the child's (and parent's) behavior adds to the information obtained during the sleep study. Behavioral observations can help with the scoring and interpretation of the pediatric polysomnogram.

Despite the child's age, medical condition, or obstacles that may have occurred, the pediatric sleep technologist has the ability to provide reliable medical data for physician review and management of pediatric sleep disorders. The sleep technologist plays an integral role in the care of pediatric sleep patients. This can be a rewarding experience, as the sleep technologist has a significant impact on the well-being of the child and the entire family.

Emmanuel J. Porquez, BS, RPSGT, has been affiliated with the Atlanta School of Sleep Medicine and Technology since 2004, where he has taught and participated in physician's board reviews, technician's board reviews, and technician's A-STEP program, including lecturing in pediatric courses. He currently works for Children's Healthcare of Atlanta. The author wishes to thank Gary Montgomery, MD, sleep center director, Children's Healthcare of Atlanta; Scott Leibowitz, MD, medical director, The Sleep Disorders Center of the Piedmont Heart Institute; and Susan Keller Yenney, RPSGT, SKY Sleep Consulting, LLC. For more information, contact

Porquez, Emmanuel J.