WorldWideScience

Sample records for preliminary pediatric experience

  1. Preliminary experience with the MicroMed DeBakey pediatric ventricular assist device.

    Science.gov (United States)

    Fraser, Charles D; Carberry, Kathleen E; Owens, W Richard; Arrington, Karol A; Morales, David L S; Heinle, Jeffery S; McKenzie, E Dean

    2006-01-01

    Mechanical circulatory support for both acute and chronic heart failure is a widely applied therapeutic option in the adult population with a variety of devices clinically available. Technology in this field has advanced sufficiently such that long-term support or "destination therapy" has become a generally accepted reality. Similar progress has not occurred in the field of device support for heart failure in children. While the number of potential patients is significantly lower in the pediatric population, the clinical relevance and poignancy of individual need are nonetheless real. Until recently, children with heart failure have been largely disadvantaged in comparison to their adult counterparts. The DeBakey VAD Child (MicroMed Technology, Inc, Houston, TX) represents a hopeful initial step in the direction of reducing the technological gap between adults and children. While the clinical experience with this device is limited at present, preliminary results are encouraging. This report will provide an overview of the DeBakey VAD Child, including device specifications, indications for clinical use, surgical and postoperative considerations, and updated clinical experience.

  2. Preliminary experience on the use of PET/CT in the management of pediatric post-transplant lymphoproliferative disorder.

    Science.gov (United States)

    Guerra-García, Pilar; Hirsch, Steffen; Levine, Daniel S; Taj, Mary M

    2017-06-14

    Post-transplant lymphoproliferative disorder (PTLD) is a well-known complication following prolonged immunosuppression. Contrary to other lymphomas, there is no standardized imaging approach to assess PTLD either at staging or for response to therapy. Positron emission tomography/computed tomography (PET/CT) is an imaging modality that has proven to be useful in lymphoma. However, there is still limited data concerning its use in pediatric PTLD. Our study evaluates the use of PET/CT in pediatric PTLD at our institution. To assess the role of PET/CT in pediatric PTLD, we reviewed the pediatric patients with PTLD who had undergone PET/CT at our institution between 2000 and 2016. Nine patients were identified. Six had PET/CT at diagnosis. All lesions seen on CT were identified with PET/CT. Fourteen PET/CTs were done during treatment. Eight PET/CTs were negative, including three where CT showed areas of uncertain significance. In these cases, PET/CT helped us to stop treatment and the patients remain in remission after a long follow-up (mean 74.3 months; range 12.4-180.9 months). PET/CT revealed additional disease in two cases, therefore treatment was intensified. Six biopsies and close follow-up was done to confirm PET/CT results. In one case, PET/CT did not identify central nervous system involvement demonstrated on magnetic resonance imaging. PET/CT may have an important role in the staging and follow-up of pediatric PTLD. In our cohort, PET/CT was helpful in staging and assessing treatment response and in clarifying equivocal findings on other imaging modalities. © 2017 Wiley Periodicals, Inc.

  3. Pediatric Liver Transplantation: Our Experiences

    Science.gov (United States)

    Basturk, Ahmet; Yılmaz, Aygen; Sayar, Ersin; Dinçhan, Ayhan; Aliosmanoğlu, İbrahim; Erbiş, Halil; Aydınlı, Bülent; Artan, Reha

    2016-01-01

    Objective: The aim of our study was to evaluate our liver transplant pediatric patients and to report our experience in the complications and the long-term follow-up results. Materials and Methods: Patients between the ages of 0 and 18 years, who had liver transplantation in the organ transplantation center of our university hospital between 1997 and 2016, were included in the study. The age, sex, indications for the liver transplantation, complications after the transplantation, and long-term follow-up findings were retrospectively evaluated. The obtained results were analyzed with statistical methods. Results: In our organ transplantation center, 62 pediatric liver transplantations were carried out since 1997. The mean age of our patients was 7.3 years (6.5 months–17 years). The 4 most common reasons for liver transplantation were: Wilson’s disease (n=10; 16.3%), biliary atresia (n=9; 14.5%), progressive familial intrahepatic cholestasis (n=8; 12.9%), and cryptogenic cirrhosis (n=7; 11.3%). The mortality rate after transplantation was 19.6% (12 of the total 62 patients). The observed acute and chronic rejection rates were 34% and 4.9%, respectively. Thrombosis (9.6%) was observed in the hepatic artery (4.8%) and portal vein (4.8%). Bile leakage and biliary stricture rates were 31% and 11%, respectively. 1-year and 5-year survival rates of our patients were 87% and 84%, respectively. Conclusion: The morbidity and mortality rates in our organ transplantation center, regarding pediatric liver transplantations, are consistent with the literature. PMID:28149148

  4. Pediatric Uveitis: Experience in Colombia.

    Science.gov (United States)

    Lonngi, Marcela; Aguilar, María Camila; Ríos, Hernán Andrés; Aristizábal-Duque, Cristhian H; Rodríguez, Francisco José; de-la-Torre, Alejandra

    2016-08-01

    To describe the clinical features of uveitis in children treated at two ophthalmologic centers in Bogotá, Colombia, in a 13 year-period. Retrospective observational clinical record review of pediatric children with diagnosis of uveitis. In total, 310 children were evaluated, 51.9% were female, mean age of 10.1 years. Posterior uveitis was the most common location (58.7%), of insidious onset (87.4%) and chronic course (78.1%). The most common etiology was infection (58.4%) caused by toxoplasmosis (76.8%). There was a statistically significant difference in visual acuity between anterior (20/68) and intermediate uveitis (20/70), compared with posterior uveitis (20/434) (puveitis in Colombia, where infectious etiologies are the leading cause. It will improve awareness and knowledge of pediatric uveitis in developing countries, and contribute to the development of public health policies of pediatric visual health. Received 12 September 2015; revised 23 February 2016; accepted 25 February 2016; published online 18 May 2016.

  5. Simultaneous whole body 18F-fluorodeoxyglucose positron emission tomography magnetic resonance imaging for evaluation of pediatric cancer: Preliminary experience and comparison with 18F-fluorodeoxyglucose positron emission tomography computed tomogra

    Institute of Scientific and Technical Information of China (English)

    Brian S Pugmire; Alexander R Guimaraes; Ruth Lim; Alison M Friedmann; Mary Huang; David Ebb; Howard Weinstein; Onofrio A Catalano; Umar Mahmood; Ciprian Catana; Michael S Gee

    2016-01-01

    AIM: To describe our preliminary experience with simultaneous whole body 18F-fluorodeoxyglucose(18F-FDG)positron emission tomography and magnetic resonance imaging(PET-MRI) in the evaluation of pediatric oncology patients.METHODS: This prospective, observational, singlecenter study was Health Insurance Portability and Accountability Act-compliant, and institutional review board approved. To be eligible, a patient was required to:(1) have a known or suspected cancer diagnosis;(2) be under the care of a pediatric hematologist/oncologist; and(3) be scheduled for clinically indicated 18F-FDG PETCT examination at our institution. Patients underwent PET-CT followed by PET-MRI on the same day. PET-CT examinations were performed using standard department protocols. PET-MRI studies were acquired with an integrated 3 Tesla PET-MRI scanner using whole body T1 Dixon, T2 HASTE, EPI diffusion-weighted imaging(DWI) and STIR sequences. No additional radiotracer was given for the PET-MRI examination. Both PET-CT and PETMRI examinations were reviewed by consensus by two study personnel. Test performance characteristics of PETMRI, for the detection of malignant lesions, including FDG maximum standardized uptake value(SUVmax) and minimum apparent diffusion coefficient(ADCmin), were calculated on a per lesion basis using PET-CT as a reference standard.RESULTS: A total of 10 whole body PET-MRI exams were performed in 7 pediatric oncology patients. The mean patient age was 16.1 years(range 12-19 years) including 6 males and 1 female. A total of 20 malignant and 21 benign lesions were identified on PET-CT. PET-MRI SUVmax had excellent correlation with PET-CT SUVmax for both benign and malignant lesions(R = 0.93). PETMRI SUVmax > 2.5 had 100% accuracy for discriminating benign from malignant lesions using PET-computed tomography(CT) reference. Whole body DWI was also evaluated: the mean ADCmin of malignant lesions(780.2 + 326.6) was significantly

  6. Pediatric lung transplantation: 10 years of experience

    Science.gov (United States)

    Camargo, Priscila C. L. B.; Pato, Eduardo Z. S.; Campos, Silvia V.; Afonso, José E.; Carraro, Rafael M.; Costa, André N.; Teixeira, Ricardo H. O. B.; Samano, Marcos N.; Pêgo-Fernandes, Paulo M.

    2014-01-01

    Lung transplantation is a well-established treatment for advanced lung diseases. In children, the diseases that most commonly lead to the need for a transplantation are cystic fibrosis, pulmonary hypertension, and bronchiolitis. However, the number of pediatric lung transplantations being performed is low compared with the number of transplants performed in the adult age group. The objective of this study was to demonstrate our experience with pediatric lung transplants over a 10-year period in a program initially designed for adults. PMID:24860860

  7. Pediatric lung transplantation: 10 years of experience

    Directory of Open Access Journals (Sweden)

    Priscila C. L. B. Camargo

    2014-01-01

    Full Text Available Lung transplantation is a well-established treatment for advanced lung diseases. In children, the diseases that most commonly lead to the need for a transplantation are cystic fibrosis, pulmonary hypertension, and bronchiolitis. However, the number of pediatric lung transplantations being performed is low compared with the number of transplants performed in the adult age group. The objective of this study was to demonstrate our experience with pediatric lung transplants over a 10-year period in a program initially designed for adults.

  8. Pediatric renal transplantation: Jordan′s experience

    Directory of Open Access Journals (Sweden)

    Issa Hazza

    2013-01-01

    Full Text Available To evaluate our experience with pediatric renal transplantation at King Hussein Medical Center, the medical records of 71 pediatric patients who underwent a renal transplantation procedure between the years 2004 and 2010 or started follow-up at our center within one week of transplantation done elsewhere were reviewed. Over the seven-year period, 71 children under the age of 14 years who received their first renal transplant were studied. About 56% (40 were males. The mean age was 9.44 ± 2.86 years. Dysplastic kidney was the most common cause of end-stage renal failure in our group, followed by glomerulonephritis. Mothers were the donors in 39.4% of the cases, followed by fathers. Twenty-three patients (32.4% were transplanted preemptively. The overall one-year graft survival was 96%, three-year survival was 95%, and the five-year survival was 88%. Prednisone, tacrolimus, and mycophenolate mofetil formed the main-stay of immunosuppressive agents. We have developed a successful live donor program for renal transplantation in children at King Hussein Medical Center in Amman. Although our experience is still short, the graft survival is similar to that achieved in the developed world, especially with preemptive transplant.

  9. Fathering and the Pediatric Cancer Experience.

    Science.gov (United States)

    1979-12-01

    Company, 1974. Bowlby , John . Attachment and Loss: Volume I. New York: Basic Books, Inc., 1969. Brazelton, T. Berry. Infants and Mothers: Differences in...conmittee, acted as my preceptor during my year in the Pediatric Oncology Clinic. To Dr. John Hutter, Pediatric Oncologist, and Sonnie Larman, Pediatric...37 Informants ..... .................. . . . . . . 39 John ................... . . . . .. 40 Steve........................ .. ... 41 AnlSisv of

  10. Minimally invasive pediatric surgery: Our experience

    Directory of Open Access Journals (Sweden)

    Saravanan K

    2008-01-01

    Full Text Available Aim: Departmental survey of the pediatric laparoscopic and thoracoscopic procedures. Materials and Methods: It is a retrospective study from January 1999 to December 2007. The various types of surgeries, number of patients, complications and conversions of laparoscopic and thoracoscopic procedures were analyzed. Results: The number of minimally invasive procedures that had been performed over the past 9 years is 734, out of which thoracoscopic procedures alone were 48. The majority of the surgeries were appendicectomy (31%, orchiopexy (19% and diagnostic laparoscopy (16%. The other advanced procedures include laparoscopic-assisted anorectoplasty, surgery for Hirschprung′s disease, thoracosocpic decortication, congenital diaphragmatic hernia repair, nephrectomy, fundoplication, etc. Our complications are postoperative fever, bleeding, bile leak following choledochal cyst excision and pneumothorax following bronchogenic cyst excision. A case of empyema thorax following thoracoscopic decortication succumbed due to disseminated tuberculosis. Our conversion rate was around 5% in the years 1999 to 2001, which has come down to 3% over the past few years. Conversions were for sliding hiatus hernia, nephrectomy, perforated adherent appendicitis, Meckel′s diverticulum, thoracoscopic decortication and ileal perforation. Conclusion: The minimally invasive pediatric surgical technique is increasingly accepted world wide and the need for laparoscopic training has become essential in every teaching hospital. It has a lot of advantages, such as less pain, early return to school and scarlessness. Our conversion rate has come down from 5% to 3% with experience and now we do more advanced procedures with a lower complication rate.

  11. [One stop surgery in pediatric surgery. Preliminary report].

    Science.gov (United States)

    Sanges, G; Astuto, M; Sentina, P; Morinello, E; Di Benedetto, A

    2002-01-01

    The One-Stop Surgery (OSS) is a new method of Day Surgery, which combines preoperative evaluation and subsequent operation into one visit. This report describes the initial experience of the authors. Referring physicians were informed by fax about method and selected surgical procedures. Included form helped them to gain anamnestic data and to inform parents about preoperative fast. Form was then sent back by fax to the pediatric surgeon and anesthesiologist who determined the patient suitability and scheduled the day of the surgery. At hospital admission, if the diagnosis was confirmed and no anesthesiologic contraindications were discovered, the patient underwent the prescheduled surgical procedure and was discharged as a day case. Another form containing informations about home postoperative care and telephone numbers for emergency call was gave to the parents. From November 2000 through February 2001 43 patients, aged from 2 to 7 years, underwent one-stop surgical procedure: central venous catheter removal (n = 16), umbilical (n = 2) and inguinal (n = 10) hernia repair, prepuce dorsal slit (n = 15). Recovery of all patient was uneventful. None of them called during the period considered necessary for postoperative follow-up. Decreased costs and increased satisfaction of the patients and parents are the most important advantages of the OSS. Potential disadvantages are a not appropriate indication for the planned procedure and/or an anesthesiologic contraindication at hospital admission. It could involve a waste of human and financial resources and an useless psychologic stress for the family. Authors conclude it is not advisable the OSS use on a large scale without a sound experience in pediatric Day Surgery.

  12. THIRTY YEARS OF EXPERIENCE OF RIBOSOMAL VACCINE APPLICATION IN PEDIATRICS

    OpenAIRE

    O. V. Shamsheva; S. A. Sokolov; I. V. Polesko

    2014-01-01

    The experience of Ribomunyl application in domestic pediatrics has shown its high preventive efficacy at respiratory infections, especially in sickly children with various somatic pathologies even in postvaccinal period. Peroral administration of Ribomunyl, its low toxicity, capability for creating cross-immunity to various serotypes of the pathogen, makes it indispensable in pediatric practice.

  13. Pediatric renal transplantation: a single center experience

    Directory of Open Access Journals (Sweden)

    João Nascimento

    2015-12-01

    Full Text Available Introduction: End-stage renal disease in children is associated with numerous comorbidities and with age-specific mortality rates approximately 30 times higher than in healthy children. The first kidney transplantation in children was performed successfully in 1954. Surgical advances and new immunosuppressive medications have greatly improved patient’s and graft’s survival in the last years. Aim: Report Centro Hospitalar do Porto experience in pediatric renal transplantation in the last 30 years. Methods: Epidemiological and clinical data of all patients younger than 18 years, transplanted between January 1984 and August 2013, were collected from our database. In order to analyze the transplantation outcome in our center we compare graft survival between decades (1984-89 / 1990-99 / 2000-09 / 2010-13. We also compare graft survival between two age groups of patients (0-10 years ; 11-17 years at the time of surgery. Results: One hundred thirty-nine patients (58.3% male underwent 147 renal transplants (6.8% live donors. Congenital anomalies of the kidney and urinary tract (56.5% and glomerulonephritis (18.4% were the major causes of renal disease. Uncensored graft survivals rates at 5, 10, 15 and 20 years were 84.7%, 71.1%, 60.0% and 51.0%, while patient survivals were 97.9%, 95.9%, 94.7% and 94.7% respectively. Graft survival improved over time and the difference between the decades was statistically significant (p=0.004. Despite the better survival in the group of patients older than 11 years, graft’s survival difference between the two age groups was not statistically significant (p=0.697. Conclusion: The results of our hospital are comparable to other international centers. Significant improvement in survival was observed over the time. It seems that an accurate follow-up of our patients helps to minimize the negative impact of adolescence on graft survival rates.

  14. A Pediatric Near-Death Experience: Tunnel Variants.

    Science.gov (United States)

    Serdahely, William J.

    1990-01-01

    Presents case study of boy who had near-death experience (NDE) due to nearly drowning when he was seven years old. Discusses case's variation of tunnel experience not before reported in either adult or pediatric NDE literature: while in the tunnel, the boy was comforted by two of his family's pets who had died prior to his accident. (Author/NB)

  15. Helical tomotherapy in the treatment of pediatric malignancies: a preliminary report of feasibility and acute toxicity

    Directory of Open Access Journals (Sweden)

    Beltrán César

    2011-08-01

    Full Text Available Abstract Background Radiation therapy plays a central role in the management of many childhood malignancies and Helical Tomotherapy (HT provides potential to decrease toxicity by limiting the radiation dose to normal structures. The aim of this article was to report preliminary results of our clinical experience with HT in pediatric malignancies. Methods In this study 66 consecutive patients younger than 14 years old, treated with HT at our center between January 2006 and April 2010, have been included. We performed statistical analyses to assess the relationship between acute toxicity, graded according to the RTOG criteria, and several clinical and treatment characteristics such as a dose and irradiation volume. Results The median age of patients was 5 years. The most common tumor sites were: central nervous system (57%, abdomen (17% and thorax (6%. The most prevalent histological types were: medulloblastoma (16 patients, neuroblastoma (9 patients and rhabdomyosarcoma (7 patients. A total of 52 patients were treated for primary disease and 14 patients were treated for recurrent tumors. The majority of the patients (72% were previously treated with chemotherapy. The median prescribed dose was 51 Gy (range 10-70 Gy. In 81% of cases grade 1 or 2 acute toxicity was observed. There were 11 cases (16,6% of grade 3 hematological toxicity, two cases of grade 3 skin toxicity and one case of grade 3 emesis. Nine patients (13,6% had grade 4 hematological toxicity. There were no cases of grade 4 non-hematological toxicities. On the univariate analysis, total dose and craniospinal irradiation (24 cases were significantly associated with severe toxicity (grade 3 or more, whereas age and chemotherapy were not. On the multivariate analysis, craniospinal irradiation was the only significant independent risk factor for grade 3-4 toxicity. Conclusion HT in pediatric population is feasible and safe treatment modality. It is characterized by an acceptable level of

  16. Assessment of the contralesional corticospinal tract in early-onset pediatric hemiplegia: Preliminary findings.

    Science.gov (United States)

    Hawe, Rachel L; Dewald, Jules P A

    2014-01-01

    While pediatric hemiplegia results from a unilateral lesion, the immature state of the brain at the time of injury increases the likelihood of observing changes in the non-lesioned hemisphere as well. The purpose of this preliminary study was to use diffusion tensor imaging to evaluate the contralesional corticospinal tracts in individuals with early-onset pediatric hemiplegia. Twelve individuals with pediatric hemiplegia and ten age-matched controls underwent diffusion tensor imaging (DTI). Corticospinal projections were reconstructed using probabilistic tractography for both the lesioned and contralesional side in pediatric hemiplegia as well as the dominant and non-dominant sides in control subjects. The contralesional tract was found to have decreased white matter integrity relative to control subjects. Compared to controls, the contralesional tract also showed increased tract volume. The increase in volume suggests the presence of ipsilateral corticospinal projections from the contralesional hemisphere that are maintained during development to control the paretic extremities. Decreases in integrity may be explained by diffuse damage or incomplete maturation. The findings of this study support the notion of bilateral motor involvement in pediatric hemiplegia, and the need to address bilateral neural changes as well as motor deficits in this population.

  17. International aircraft ECMO transportation: first French pediatric experience.

    Science.gov (United States)

    Rambaud, Jerome; Léger, Pierre L; Porlier, Ludovic; Larroquet, Michelle; Raffin, Herve; Pierron, Charlotte; Walti, Herve; Carbajal, Ricardo

    2017-04-01

    Refractory severe hemodynamic or respiratory failure may require extracorporeal membrane oxygenation (ECMO). Since some patients are too sick to be transported safely to a referral ECMO center on conventional transportation, mobile ECMO transport teams have been developed. The experiences of some ECMO transport teams have already been reported, including air and international transport. We report the first French pediatric international ECMO transport by aircraft. This case shows that a long distance intervention of the pediatric ECMO transport team is feasible, even in an international setting. Long distance ECMO transportations are widely carried out for adults, but remain rare in neonates and children.

  18. Mycophenolate mofetil in pediatric renal transplantation: A single center experience.

    LENUS (Irish Health Repository)

    Raheem, Omer A

    2011-05-01

    Raheem OA, Kamel MH, Daly PJ, Mohan P, Little DM, Awan A, Hickey DP. Mycophenolate mofetil in pediatric renal transplantation: A single center experience. Pediatr Transplantation 2011: 15:240-244. © 2009 John Wiley & Sons A\\/S. Abstract:  We assessed our long-term experience with regards to the safety and efficacy of MMF in our pediatric renal transplant population and compared it retrospectively to our previous non-MMF immunosuppressive regimen. Forty-seven pediatric renal transplants received MMF as part of their immunosuppressive protocol in the period from January 1997 till October 2006 (MMF group). A previously reported non-MMF group of 59 pediatric renal transplants was included for comparative analysis (non-MMF group). The MMF group comprised 29 boys and 18 girls, whereas the non-MMF group comprised 34 boys and 25 girls. Mean age was 11.7 and 12 yr in the MMF and non-MMF groups, respectively. The incidence of acute rejection episodes was 11 (23.4%) and 14 (24%) in the MMF and non-MMF group, respectively. Two (3.3%) grafts were lost in the non-MMF group compared with one (2.1%) in the MMF group. Twenty-one (44.68%) patients in the MMF group developed post-transplant infections compared with 12 (20.33%) in the non-MMF group (p < 0.0001). In conclusion, the use of MMF in pediatric renal transplantation was not associated with a lower rejection rate or immunological graft loss. It did, however, result in a significantly higher rate of viral infections.

  19. Neuroimaging experience in pediatric Horner syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Kadom, Nadja [Boston University School of Medicine, Department of Radiology, Boston University Medical Center, Boston, MA (United States); Rosman, N.P. [Boston Medical Center, Division of Pediatric Neurology, Departments of Pediatrics and Neurology, Boston University School of Medicine, Boston, MA (United States); Jubouri, Shams; Trofimova, Anna; Egloff, Alexia M. [Children' s National Medical Center, Department of Radiology and Diagnostic Imaging, Washington, DC (United States); Zein, Wadih M. [National Eye Institute (NEI), Bethesda, MD (United States)

    2015-09-15

    Horner syndrome in children is rare. The frequency and spectrum of malignancy as the cause of Horner syndrome in children remains unclear. Also unclear is whether the imaging work-up should include the entire oculo-sympathetic pathway or should be more targeted. In addition, the value of cross-sectional angiographic imaging in Horner syndrome is uncertain. To review imaging pathology in a cohort of children with Horner syndrome at a major academic pediatric medical center. We reviewed a 22-year period of CT and MR imaging studies in children with a clinical diagnosis of Horner syndrome referred for imaging. We found 38 patients who fulfilled study criteria of Horner syndrome and 6/38 had relevant imaging findings: 2/6 etiologies were neoplastic (congenital neuroblastoma and central astrocytoma), 1/6 had a vascular abnormality (hypoplastic carotid artery), 1/6 had maldevelopment (Chiari I malformation), and 2/6 had inflammatory/traumatic etiology (viral cervical lymphadenopathy, post jugular vein cannulation). There was a similar number of congenital and acquired pathologies. The malignancies were found at any level of the oculosympathetic pathway. There are treatable causes, including malignancies, in children presenting with Horner syndrome, which justify imaging work-up of the entire oculosympathetic pathway, unless the lesion level can be determined clinically. (orig.)

  20. Pediatric osteosarcoma: a single institution's experience.

    Science.gov (United States)

    Vijayakumar, Vani; Lowery, Rachel; Zhang, Xu; Hicks, Chindo; Rezeanu, Luminita; Barr, Jennifer; Giles, Henry; Vijayakumar, Srinivasan; Megason, Gail

    2014-11-01

    The aim of the study was to evaluate outcomes with an examination of individual predictors influencing survival at a single institution. This was a retrospective review of the 28 pediatric osteosarcoma patients diagnosed and studied from 2000 through 2012. Twenty-eight patient charts and imaging studies were reviewed for age, race, sex, location, extent of disease at presentation, imaging results, histology, treatment options, and overall survival. Of the 28 patients who were identified, the median age at diagnosis was 14 years. The majority of the patients were male African Americans with the tumor located in the lower long bones and most had conventional osteosarcoma histology. Four patients had metastasis at diagnosis. Of the 28 patients, 16 patients underwent limb salvage surgery, 6 underwent amputation, 4 had biopsy only, 1 had hip disarticulation, and 1 moved out of state and had no information available. All 28 patients received chemotherapy. Four patients received additional radiation therapy. On follow-up, 15 patients were still alive at last clinical contact and 13 died. Of the deceased, the median survival time was 2.3 years. The patient who lived the longest survived 8.3 years. Metastasis at diagnosis was associated with poorer outcome (P = 0.002). The 5-year overall survival rate was 40% (95% confidence interval 18-62) for our entire population of patients. Survival in our patient cohort tended to be at the lower end of the spectrum reported by other contemporary treatment centers of excellence or Surveillance, Epidemiology, and End Results databases probably because of the large number of African American patients with associated poor socioeconomic status. Future studies should be conducted to explore biological and nonbiological factors that may affect the prognosis in this disease.

  1. Mycophenolate mofetil in pediatric renal transplantation: a single center experience.

    LENUS (Irish Health Repository)

    Raheem, Omer A

    2012-02-01

    We assessed our long-term experience with regards to the safety and efficacy of MMF in our pediatric renal transplant population and compared it retrospectively to our previous non-MMF immunosuppressive regimen. Forty-seven pediatric renal transplants received MMF as part of their immunosuppressive protocol in the period from January 1997 till October 2006 (MMF group). A previously reported non-MMF group of 59 pediatric renal transplants was included for comparative analysis (non-MMF group). The MMF group comprised 29 boys and 18 girls, whereas the non-MMF group comprised 34 boys and 25 girls. Mean age was 11.7 and 12 yr in the MMF and non-MMF groups, respectively. The incidence of acute rejection episodes was 11 (23.4%) and 14 (24%) in the MMF and non-MMF group, respectively. Two (3.3%) grafts were lost in the non-MMF group compared with one (2.1%) in the MMF group. Twenty-one (44.68%) patients in the MMF group developed post-transplant infections compared with 12 (20.33%) in the non-MMF group (p < 0.0001). In conclusion, the use of MMF in pediatric renal transplantation was not associated with a lower rejection rate or immunological graft loss. It did, however, result in a significantly higher rate of viral infections.

  2. Pediatric nurses' grief experience, burnout and job satisfaction.

    Science.gov (United States)

    Adwan, Jehad Z

    2014-01-01

    Correlations among grief, burnout, and job satisfaction among highly satisfied pediatric nurses were examined using the Revised Grief Experience Inventory (RGEI), Maslach Burnout Inventory (MBI), and Index of Work Satisfaction (IWS). Results showed that grief had significant correlations; positive with burnout, negative with job satisfaction. RN's reported significantly higher emotional exhaustion if their primary patients died and higher guilt if patients died younger. Conclusions suggest a dynamic statistical interaction among nurses' grief, burnout, and job satisfaction representing a pathway to intention to leave their unit, organization, or nursing. Recommendations include implementation and evaluation of grief intervention and education programs.

  3. Magnetic resonance imaging features of the spinal cord in pediatric multiple sclerosis: a preliminary study

    Energy Technology Data Exchange (ETDEWEB)

    Verhey, Leonard H. [Hospital for Sick Children, Neuroscience and Mental Health, Toronto, ON (Canada); University of Toronto, Institute of Medical Science, Faculty of Medicine, Toronto, ON (Canada); Branson, Helen M.; Shroff, Manohar [Hospital for Sick Children, Department of Diagnostic Imaging (Neuroradiology), Toronto, ON (Canada); University of Toronto, Department of Medical Imaging, Toronto, ON (Canada); Makhija, Monica [Hospital for Sick Children, Neuroscience and Mental Health, Toronto, ON (Canada); Banwell, Brenda [Hospital for Sick Children, Neuroscience and Mental Health, Toronto, ON (Canada); University of Toronto, Institute of Medical Science, Faculty of Medicine, Toronto, ON (Canada); University of Toronto, Department of Pediatrics (Neurology), Toronto, ON (Canada)

    2010-12-15

    Spinal cord lesions in adults with multiple sclerosis (MS) are thought to contribute to disability. The magnetic resonance imaging (MRI) appearance and clinical correlates of spinal cord lesions in children with MS have not been reported. T1-weighted pre- and post-gadolinium and T2-weighted TSE/FSE spine MR images of 36 children (age, 14.3 {+-} 3.3) with relapsing-remitting MS (annualized relapse rate, 0.7; disease duration, 7.5 {+-} 3.3 years) were analyzed for total lesion count, lesion location and length, intramedullary extent, and gadolinium enhancement. Clinical, demographic, laboratory, and MRI data were correlated. Lesions preferentially involved the cervical region, were predominantly focal, and involved only a portion of the transverse cord diameter. However, ten of 36 patients demonstrated longitudinally extensive lesions. Children with the highest clinical relapse rate also tended to have more spinal cord lesions and were more likely to accrue new lesions on serial spinal scans. These preliminary data suggest that MS lesions of the spinal cord in children are radiographically similar to that of adult-onset MS - supporting a common biology of pediatric- and adult-onset disease. However, children with relapsing-remitting MS can also develop longitudinally extensive lesions, suggesting that such lesions may be less specific for diseases such as neuromyelitis optica in pediatric patients. All patients recovered well from spinal cord attacks, and the presence of spinal cord lesions in the first few years of disease did not correlate with physical disability. Measures of spinal cord atrophy and longer periods of observation are required to determine the impact of spinal cord involvement in pediatric-onset MS. (orig.)

  4. [Minimally Invasive Surgery in Pediatric Oncology. Tertiary center experience].

    Science.gov (United States)

    Gómez-Chacón Villalba, J; Rodríguez Caraballo, L; Marco Macián, A; Segarra Llido, V; Vila Carbó, J J

    2015-07-20

    To describe our experience using Minimally Invasive Surgery (MIS) techniques in tertiary center with specific oncological pediatric surgery unit. Retrospective review of patients undergoing MIS techniques in pediatric oncology surgery unit between January 2011 and December 2014. MIS procedures were considered made by both techniques such as laparoscopy and thoracoscopy with both diagnostic and therapeutic intent. 4 procedures were diagnostic and the rest were therapeutic: During the study, 56 procedures were performed by MIS. By type of technique, 13 were thoracoscopic (7 metastasectomies, 6 thoracic masses) and 43 laparoscopic (3 hepatic masses, 3 pancreatic masses 7 abdominal masses, 2 ovarian masses, 2 typhlitis 1 splenic mass and 25 oophorectomy for ovarian cryopreservation). In 5 cases (2 thoracic masses 1 pancreatic mass abdominal masses) conversion to open surgery to complete the procedure (2 for caution in the absence of vascular control bleeding 1 and 2 for lack of space) was necessary. In all cases safety principles of oncological surgery were respected. Providing an adecuate selection of patiens, MIS techniques are safe, reproducible and fulfill the objectives of quality of cancer surgery.

  5. Early Career Experience of Pediatric Orthopaedic Fellows: What to Expect and Need for Their Services.

    Science.gov (United States)

    Glotzbecker, Michael P; Shore, Benjamin J; Fletcher, Nicholas D; Larson, A Noelle; Hydorn, Christopher R; Sawyer, Jeffery R

    2016-06-01

    A dramatic increase in the number of pediatric orthopaedic fellows being trained has led to concerns that there may be an oversupply of pediatric orthopaedists. The purpose of this study was to determine whether this perception is accurate and whether the practice expectations of recent pediatric fellowship graduates are being met by surveying recent pediatric fellowship graduates about their early practice experiences. A 36-question survey approved by the Pediatric Orthopaedic Society of North America (POSNA) leadership was electronically distributed to 120 recent graduates of pediatric orthopaedic fellowships; 81 responses were ultimately obtained (67.5% response rate). Almost all (91%) of the respondents were very or extremely satisfied with their fellowship experience. Half of the respondents had at least 1 job offer before they entered their fellowships. After completion of fellowships, 35% received 1 job offer and 62.5% received ≥2 job offers; only 2.5% did not receive a job offer. Most reported a practice consisting almost entirely of pediatric orthopaedics, and 93.5% thought this was in line with their expectations; 87% indicated satisfaction with their current volume of pediatric orthopaedics, and 85% with the complexity of their pediatric orthopaedic cases. Despite the high employment percentages and satisfaction with practice profiles, nearly a third (28%) of respondents replied that too many pediatric orthopaedists are being trained. Positive messages from this survey include the satisfaction of graduates with their fellowship training, the high percentage of graduates who readily found employment, and the satisfaction of graduates with their current practice environments; this indicates that the pediatric orthopaedic job environment is not completely saturated and there are continued opportunities for graduating pediatric fellows despite the increased number of fellows being trained. Although not determined by this study, it may be that the stable

  6. Preliminary experiments on quantification of skin condition

    Science.gov (United States)

    Kitajima, Kenzo; Iyatomi, Hitoshi

    2014-03-01

    In this study, we investigated a preliminary assessment method for skin conditions such as a moisturizing property and its fineness of the skin with an image analysis only. We captured a facial images from volunteer subjects aged between 30s and 60s by Pocket Micro (R) device (Scalar Co., Japan). This device has two image capturing modes; the normal mode and the non-reflection mode with the aid of the equipped polarization filter. We captured skin images from a total of 68 spots from subjects' face using both modes (i.e. total of 136 skin images). The moisture-retaining property of the skin and subjective evaluation score of the skin fineness in 5-point scale for each case were also obtained in advance as a gold standard (their mean and SD were 35.15 +/- 3.22 (μS) and 3.45 +/- 1.17, respectively). We extracted a total of 107 image features from each image and built linear regression models for estimating abovementioned criteria with a stepwise feature selection. The developed model for estimating the skin moisture achieved the MSE of 1.92 (μS) with 6 selected parameters, while the model for skin fineness achieved that of 0.51 scales with 7 parameters under the leave-one-out cross validation. We confirmed the developed models predicted the moisture-retaining property and fineness of the skin appropriately with only captured image.

  7. Preliminary Observations from the 2014 Sand Dunes Experiment

    Science.gov (United States)

    2014-10-01

    2014 Sand Dunes Experiment by Christopher W. Miller, Ching-Sang Chiu, D. Benjamin Reeder, Ying-Jang Yang, Linus Chiu, and Chi-Fang Chen...COVERED (From-To) June 2014 4. TITLE AND SUBTITLE Preliminary Observations from the 2014 Sand Dunes Experiment 5a. CONTRACT NUMBER 5b. GRANT NUMBER...position of the Department of Defense or the U.S. Government 14. ABSTRACT The Sand Dunes 2014 experiment was international US – Taiwan

  8. [Physical therapy in pediatric primary care: a review of experiences].

    Science.gov (United States)

    de Sá, Miriam Ribeiro Calheiros; Thomazinho, Paula de Almeida; Santos, Fabiano Luiz; Cavalcanti, Nicolette Celani; Ribeiro, Carla Trevisan Martins; Negreiros, Maria Fernanda Vieira; Vinhaes, Marcia Regina

    2014-11-01

    To review pediatric physical therapy experiences described in the literature and to analyze the production of knowledge on physical therapy in the context of pediatric primary health care (PPHC). A systematic review was conducted according to the PRISMA criteria. The following databases were searched: MEDLINE, LILACS, SciELO, PubMed, Scopus and Cochrane; Brazilian Ministry of Health's CAPES doctoral dissertations database; and System for Information on Grey Literature in Europe (SIGLE). The following search terms were used: ["primary health care" and ("physical therapy" or "physiotherapy") and ("child" or "infant")] and equivalent terms in Portuguese and Spanish, with no restriction on publication year. Thirteen articles from six countries were analyzed and grouped into three main themes: professional dilemmas (three articles), specific competencies and skills required in a PPHC setting (seven articles), and practice reports (four articles). Professional dilemmas involved expanding the role of physical therapists to encompass community environments and sharing the decision-making process with the family, as well as collaborative work with other health services to identify the needs of children. The competencies and skills mentioned in the literature related to the identification of clinical and sociocultural symptoms that go beyond musculoskeletal conditions, the establishment of early physical therapy diagnoses, prevention of overmedication, and the ability to work as team players. Practice reports addressed stimulation in children with neurological diseases, respiratory treatment, and establishing groups with mothers of children with these conditions. The small number of studies identified in this review suggests that there is little knowledge regarding the roles of physical therapists in PPHC and possibly regarding the professional abilities required in this setting. Therefore, further studies are required to provide data on the field, along with a continuing

  9. Preliminary results of noise radar experiments

    Science.gov (United States)

    Malanowski, Mateusz; Contartese, Clara; Maslikowski, Lukasz; Baczyk, Marcin; Kulpa, Krzysztof

    2009-06-01

    The paper describes the first results of noise radar experiments carried out at Warsaw University of Technology. The radar system was built with Commercial Off-The-Shelf (COTS) components: log-periodic antennas, an arbitrary waveform generator and a two-channel spectrum analyzer. The radar operated in the continuous-wave mode, and the aim was to detect moving targets in the received signal. The paper shows the system setup as well as the numerical results obtained from the recorded signals.

  10. Pediatrics

    Science.gov (United States)

    Spackman, T. J.

    1978-01-01

    The utilization of the Lixiscope in pediatrics was investigated. The types of images that can presently be obtained are discussed along with the problems encountered. Speculative applications for the Lixiscope are also presented.

  11. Metabolic Control with Insulin Pump Therapy: Preliminary Experience

    Directory of Open Access Journals (Sweden)

    Shang-Ren Hsu

    2008-07-01

    Conclusion: Our preliminary experience demonstrated the effectiveness of insulin pump therapy for both type 1 and type 2 diabetic patients. The reduction in their HbA1C values was both statistically and clinically significant. This treatment should be considered for patients poorly controlled by subcutaneous insulin injection therapy.

  12. Pediatric peripheral vascular injuries: a review of our experience.

    Science.gov (United States)

    Shah, Sohail R; Wearden, Peter D; Gaines, Barbara A

    2009-05-01

    This study evaluated peripheral vascular injuries in a pediatric trauma population to identify injury patterns, to identify diagnostic and therapeutic modalities used, and to understand the role of pediatric surgical subspecialists. A retrospective review of children treated for trauma between 2000 and 2006 at a Level I Pediatric Trauma Center was performed. Patients with vascular injury were identified through an institutional trauma registry. There were 42 vascular injuries identified during the study period. The average age was 9.8 years, with 64% occurring in males. The mechanism of injury was almost equally distributed between penetrating (55%) and blunt (45%) trauma. Forty-eight percent of patients had an associated fracture. Seventeen diagnostic angiograms were performed. Ninety-eight percent of patients were taken to the operating room for definitive management of one or more of their trauma injuries. Sixty-seven percent underwent operative management specifically for their vascular injury. Twenty-six percent of patients were diagnosed with vasospasm, and all were conservatively managed. Of the 42 patients, 23% were managed by pediatric surgeons, 43% by extremity specialists (orthopedic or plastic surgeons), and 29% by adult vascular surgeons. Pediatric traumatic vascular injuries are associated with a higher rate of penetrating trauma than other pediatric trauma and have a relatively high rate of operative intervention. Diagnosis and treatment of pediatric vascular injuries can be made difficult by a high rate of vasospasm. Additionally, traumatic vascular injuries in the pediatric population present a unique challenge in the overlap of their management by many different surgical subspecialists.

  13. Relationships Between Program Size, Training Experience, and Career Intentions: Pediatrics Resident Reports From 2010 to 2014.

    Science.gov (United States)

    Schumacher, Daniel J; Frintner, Mary Pat; Cull, William

    2016-01-01

    To determine the relationship between pediatric residency program size and resident demographic characteristics, career intentions, and training experiences. Annual national random samples of 1000 graduating pediatrics residents were surveyed between 2010 and 2014. Response years were pooled for analysis, and trends in resident demographic characteristics, career intentions and job search, and training experiences were compared across program class size: small (training as program size decreases. These findings suggest that the training experiences of some residents do not optimally align with their future practice. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  14. Preliminary results of the echo-seeding experiment at SLAC

    Energy Technology Data Exchange (ETDEWEB)

    Xiang, D.; Colby, E.; Ding, Y.; Dunning, M.; Frederico, J.; Gilevich, S.; Hast, C.; Jobe, K.; McCormick, D.; Nelson, J.; Raubenheimer, T.O.; Soong, K.; Stupakov, G.; Szalata, Z.; Walz, D.; Weathersby, S.; Woodley, M.; Corlett, J.; Qiang, J.; Penn, G.; Prestemon, S.; Schlueter, R.; Venturini, M.; Wan, W.; Pernet, P-L.

    2010-05-23

    ECHO-7 is a proof-of-principle echo-enabled harmonic generation FEL experiment in the Next Linear Collider Test Accelerator (NLCTA) at SLAC. The experiment aims to generate coherent radiation at 318 nm and 227 nm, which are the 5th and 7th harmonic of the infrared seed laser. In this paper we present the preliminary results from the commissioning run of the completed experimental setup which started in April 2010.

  15. Percutaneous aspiration thromboembolectomy: a preliminary experience.

    Science.gov (United States)

    Murray, J G; Brown, A L; Wilkins, R A

    1994-08-01

    Percutaneous aspiration thromboembolectomy (PAT) is a radiological alternative to surgical embolectomy or thrombolysis in the treatment of acute arterial thromboembolic disease. We report our experience in eight patients aged 63-83 years (mean 71 years). Indications were graft thrombosis (1) or emboli from atrial fibrillation (3), abdominal aneurysm (2) or proximal angioplasty (2). PAT was performed at 10 arterial sites; common iliac (1), profunda femoris (1), superficial femoral (2), femoro-popliteal graft (1), popliteal (2) and arteries of the trifurcation (3). PAT was used as an adjunct to thrombolysis or angioplasty in five patients and as the sole procedure in three patients. It was successful in six patients (seven sites) with mean ABI rising from 0.4 pre- to 0.8 post-procedure. Two of the failures required amputations. One of these was a completely thrombosed dacron femoro-popliteal graft with poor run-off, and the second case had a failed surgical embolectomy prior to amputation. There were no major complications, and no mortality on follow-up at 1 month. PAT is a useful adjunct to thrombolysis and balloon angioplasty in the radiological treatment of acute thromboembolic disease. In patients in whom thrombolysis is contraindicated, it offers an alternative to surgical embolectomy.

  16. Valve replacement in pediatric patients:a single center experience

    Institute of Scientific and Technical Information of China (English)

    YU Jian-hua; GUO Hong-wei; ZHANG Gong; WU Shu-ming; SONG Guang-min; SUN Wen-yu

    2011-01-01

    Background Reconstructive surgery is the primary goal in pediatric patients with valve disease.However,in cases with irreparable valve lesions,valve replacement is the only option.This study aimed to retrospectively analyze the clinical experience of heart valve prosthesis replacement in children.Methods Between January 1990 and July 2009,35 pediatric patients (16 boys,19 girls) underwent mechanical valve replacement in Shandong University Qilu Hospital.The ages ranged from 2.5 to 14 years (mean,(8.8±3.8) years) and body weight varied from 11 to 37 kg (mean,(22.1±5.2) kg).Mechanical valve replacement was performed because of congenital heart disease in 23 patients,rheumatic disease in ten patients and infective endocarditis in two patients.St.Jude bileaflet mechanical valves were implanted in all the 35 patients including mitral valve replacement (MVR) in 18,aortic valve replacement (AVR) in 12,tricuspid valve replacement (TVR) in two,AVR and MVR in two and MVR and TVR in one.The size of the prostheses ranged between 19 and 27 mm.All patients received long-term anticoagulation treatment with sodium warfarin,aiming to maintain an international normalized ratio between 1.5 to 2.0.Follow-up was performed in all the patients with a total follow-up of 119.4 patient-years.Results The operative mortality was 8.57% (3/35).One patient,who underwent cardiac debridement and AVR,died 2 hours after being admitted to the intensive care unit because of severe low cardiac output syndrome and ventricular fibrillation.Two patients died of cardiogenic shock and renal failure during initial hospitalization after the operation.One patient who received replacement of a tricuspid valve developed complete heart block requiring temporary pacing and recovered sinus rhythm 4 days later.Thirty-two patients survived and their cardiac function was in New York Heart Association (NYHA) class Ⅰ to class Ⅱ when discharged.Late events included hemorrhage and endocarditis.Two patients required

  17. Safety and feasibility of transcranial direct current stimulation in pediatric hemiparesis: randomized controlled preliminary study.

    Science.gov (United States)

    Gillick, Bernadette T; Feyma, Tim; Menk, Jeremiah; Usset, Michelle; Vaith, Amy; Wood, Teddi Jean; Worthington, Rebecca; Krach, Linda E

    2015-03-01

    Transcranial direct current stimulation (tDCS) is a form of noninvasive brain stimulation that has shown improved adult stroke outcomes. Applying tDCS in children with congenital hemiparesis has not yet been explored. The primary objective of this study was to explore the safety and feasibility of single-session tDCS through an adverse events profile and symptom assessment within a double-blind, randomized placebo-controlled preliminary study in children with congenital hemiparesis. A secondary objective was to assess the stability of hand and cognitive function. A double-blind, randomized placebo-controlled pretest/posttest/follow-up study was conducted. The study was conducted in a university pediatric research laboratory. Thirteen children, ages 7 to 18 years, with congenital hemiparesis participated. Adverse events/safety assessment and hand function were measured. Participants were randomly assigned to either an intervention group or a control group, with safety and functional assessments at pretest, at posttest on the same day, and at a 1-week follow-up session. An intervention of 10 minutes of 0.7 mA tDCS was applied to bilateral primary motor cortices. The tDCS intervention was considered safe if there was no individual decline of 25% or group decline of 2 standard deviations for motor evoked potentials (MEPs) and behavioral data and no report of adverse events. No major adverse events were found, including no seizures. Two participants did not complete the study due to lack of MEP and discomfort. For the 11 participants who completed the study, group differences in MEPs and behavioral data did not exceed 2 standard deviations in those who received the tDCS (n=5) and those in the control group (n=6). The study was completed without the need for stopping per medical monitor and biostatisticial analysis. A limitation of the study was the small sample size, with data available for 11 participants. Based on the results of this study, tDCS appears to be safe

  18. High-fidelity simulation enhances pediatric residents' retention, knowledge, procedural proficiency, group resuscitation performance, and experience in pediatric resuscitation.

    Science.gov (United States)

    Mills, David M; Wu, Chang L; Williams, Daniel C; King, Lydia; Dobson, Joseph V

    2013-07-01

    The goal of this study was to assess the effect of high-fidelity simulation (HFS) pediatric resuscitation training on resident performance and self-reported experience compared with historical controls. In this case-control study, pediatric residents at a tertiary academic children's hospital participated in a 16-hour HFS resuscitation curriculum. Primary outcome measures included cognitive knowledge, procedural proficiency, retention, and self-reported comfort and procedural experience. The intervention group was compared with matched-pair historical controls. Forty-one residents participated in HFS training with 32 matched controls. The HFS group displayed significant initial and overall improvement in knowledge (P historical controls but also reported increased real-life resuscitation experiences and related procedures.

  19. Are Pediatric Emergency Physicians More Knowledgeable and Confident to Respond to a Pediatric Disaster after an Experiential Learning Experience?

    Science.gov (United States)

    Bank, Ilana; Khalil, Elene

    2016-10-01

    Pediatric hospital disaster responders must be well-trained and prepared to manage children in a mass-casualty incident. Simulations of various types have been the traditional way of testing hospital disaster plans and training hospital staff in skills that are used in rare circumstances. The objective of this longitudinal, survey-based, observational study was to assess the effect of disaster response and management-based experiential learning on the knowledge and confidence of advanced learners. A simulation-based workshop was created for practicing Pediatric Emergency Medicine (PEM) physicians, senior PEM physicians, and critical care and pediatric surgery residents to learn how to manage a disaster response. Given that this particular group of learners had never been exposed to such a disaster simulation, its educational value was assessed with the goal of improving the quality of the hospital pediatric medical response to a disaster by increasing the responders' knowledge and confidence. Objective and subjective measures were analyzed using both a retrospective, pre-post survey, as well as case-based evaluation grids. The simulation workshop improved the learners' perceived ability to manage patients in a disaster context and identified strengths and areas needing improvement for patient care within the disaster context. Advanced learners exposed to an experiential learning activity believed that it improved their ability to manage patients in a disaster situation and felt that it was valuable to their learning. Their confidence was preserved six months later. Bank I , Khalil E . Are pediatric emergency physicians more knowledgeable and confident to respond to a pediatric disaster after an experiential learning experience? Prehosp Disaster Med. 2016;31(5):551-556.

  20. Preliminary results from the MINERvA experiment

    Energy Technology Data Exchange (ETDEWEB)

    Harris, Deborah A.; /Fermilab

    2011-11-01

    The MINERvA experiment, operating since 2009 in the NuMI neutrino beam line at Fermilab, has collected neutrino and antineutrino scattering data on a variety of nuclear targets. The detector is designed to identify events originating in plastic scintillator, lead, carbon, iron, water, and liquid helium. The goal of the experiment is to measure inclusive and exclusive cross sections for neutrino and antineutrino with much greater precision than previous experiments. We present preliminary kinematic distributions for charged current quasi-elastic scattering and other processes.

  1. Reward learning in pediatric depression and anxiety: preliminary findings in a high-risk sample.

    Science.gov (United States)

    Morris, Bethany H; Bylsma, Lauren M; Yaroslavsky, Ilya; Kovacs, Maria; Rottenberg, Jonathan

    2015-05-01

    Reward learning has been postulated as a critical component of hedonic functioning that predicts depression risk. Reward learning deficits have been established in adults with current depressive disorders, but no prior studies have examined the relationship of reward learning and depression in children. The present study investigated reward learning as a function of familial depression risk and current diagnostic status in a pediatric sample. The sample included 204 children of parents with a history of depression (n = 86 high-risk offspring) or parents with no history of major mental disorder (n = 118 low-risk offspring). Semistructured clinical interviews were used to establish current mental diagnoses in the children. A modified signal detection task was used for assessing reward learning. We tested whether reward learning was impaired in high-risk offspring relative to low-risk offspring. We also tested whether reward learning was impaired in children with current disorders known to blunt hedonic function (depression, social phobia, PTSD, GAD, n = 13) compared to children with no disorders and to a psychiatric comparison group with ADHD. High- and low-risk youth did not differ in reward learning. However, youth with current anhedonic disorders (depression, social phobia, PTSD, GAD) exhibited blunted reward learning relative to nondisordered youth and those with ADHD. Our results are a first demonstration that reward learning deficits are present among youth with disorders known to blunt anhedonic function and that these deficits have some degree of diagnostic specificity. We advocate for future studies to replicate and extend these preliminary findings. © 2015 Wiley Periodicals, Inc.

  2. The effect of dual training in internal medicine and pediatrics on the career path and job search experience of pediatric graduates.

    Science.gov (United States)

    Chamberlain, John K; Cull, William L; Melgar, Tom; Kaelber, David C; Kan, Brian D

    2007-10-01

    To compare the job search experience and career plans of medicine-pediatrics (med-peds) and pediatric residents. Annual surveys of graduating med-peds and pediatric residents were compared from 2003 and 2004. The survey response rates were 58% for med-peds residents (n = 427) and 61% for pediatric residents (n = 611). Pediatric residents were more likely to be female or an International Medical Graduate. The groups were equally satisfied with their career choice and had equivalent debt. Med-peds residents were more likely to seek and accept generalist and hospitalist positions. Pediatric residents were more likely to seek subspecialty careers and research opportunities. More than 94% of med-peds residents expected to care for pediatric patients. Among residents seeking generalist positions, med-peds residents sent half as many applications to get the same number of interviews and offers as pediatric residents, were more likely to be offered their most desired position, and were more likely to accept a position in a rural area/small town. Med-peds residents had substantially greater starting salaries as hospitalists or generalists compared with pediatric residents. Med-peds and pediatric trainees differ in their career plans, although primary care is their most popular choice. Med-peds- trained physicians have an easier job search experience and greater market valuation.

  3. Accommodation in pediatric oncology: parental experiences, preferences and unmet needs.

    Science.gov (United States)

    Daniel, Gunar; Wakefield, Claire E; Ryan, Barbara; Fleming, Catharine Ak; Levett, Nicole; Cohn, Richard J

    2013-01-01

    For families of children diagnosed with cancer, proximity to the treatment center and staying close to immediate family members are essential for proper patient management. Accommodation services are therefore a key consideration in pediatric oncology. This descriptive study explored the accommodation used, and preferred, by parents of pediatric cancer patients at Sydney Children's Hospital, Randwick (SCH), Australia, and investigated their accommodation and practical needs. Forty-two parents from 25 families participated in individual semi-structured telephone interviews. Interviews were recorded, transcribed verbatim and coded line-by-line. Coding was facilitated by data analysis software QSR NVivo v8 (www.qsrinternational.com). Emergent themes were numerically assessed to minimize the potential for researcher bias. Nine families (36%) lived near SCH and were able to stay at their own residence during treatment (mean distance of 15.4 km from SCH). The remaining families were categorized 'local, but requiring accommodation' (n=3 families represented by five parent interviews; mean distance of 82.22 km from SCH),'inner regional' (IR) (n=8 families, 15 parent interviews; mean distance of 396.75 km from SCH) or 'outer regional' (OR) (n=3 families, 5 interviews; mean distance of 547.4 km from SCH) according to the Australian Standard Geographical Classification (ASGC) remoteness ratings. Accommodation provided for families from both IR and OR areas was mixed, with several families using multiple accommodation options during treatment, including Ronald Macdonald House (RMH), private accommodation or a rental property close to the hospital for the duration of the treatment. Six IR and one OR family utilized hotel or motel accommodation as an alternative to RMH due to unavailability of rooms. The majority of parents (37/42) preferred to stay on the hospital campus, near their child. Seven out of 11 IR and OR mothers preferred self-contained accommodation, while three out

  4. Safe intravenous administration in pediatrics: A 5-year Pediatric Intensive Care Unit experience with smart pumps.

    Science.gov (United States)

    Manrique-Rodríguez, S; Sánchez-Galindo, A C; Fernández-Llamazares, C M; Calvo-Calvo, M M; Carrillo-Álvarez, Á; Sanjurjo-Sáez, M

    2016-10-01

    To estimate the impact of smart pump implementation in a pediatric intensive care unit in terms of number and type of administration errors intercepted. Observational, prospective study carried out from January 2010 to March 2015 with syringe and great volumen infusion pumps available in the hospital. A tertiary level hospital pediatric intensive care unit. Infusions delivered with infusion pumps in all pediatric intensive care unit patients. Design of a drug library with safety limits for all intravenous drugs prescribed. Users' compliance with drug library as well as number and type of errors prevented were analyzed. Two hundred and eighty-three errors were intercepted during 62 months of study. A high risk drug was involved in 58% of prevented errors, such as adrenergic agonists and antagonists, sedatives, analgesics, neuromuscular blockers, opioids, potassium and insulin. Users' average compliance with the safety software was 84%. Smart pumps implementation has proven effective in intercepting high risk drugs programming errors. These results might be exportable to other critical care units, involving pediatric or adult patients. Interdisciplinary colaboration is key to succeed in this process. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  5. Pediatric Vascular Surgery Review with a 30-Year-Experience in a Tertiary Referral Center

    Science.gov (United States)

    Min, Seung-Kee; Cho, Sungsin; Kim, Hyun-Young; Kim, Sang Joon

    2017-01-01

    Pediatric vascular disease is rare, and remains a big challenge to vascular surgeons. In contrast to adults, surgery for pediatric vascular disease is complicated by issues related to small size, future growth, and availability of suitable vascular conduit. During the last 30 years, 131 major vascular operations were performed in a tertiary referral center, Seoul National University Hospital, including aortoiliac aneurysm, acute or chronic arterial occlusion, renovascular hypertension, portal venous hypertension, trauma, tumor invasion to major abdominal vessels, and others. Herein we review on the important pediatric vascular diseases and share our clinical experiences on these rare diseases. PMID:28690995

  6. Avoiding steroids in pediatric renal transplantation: long-term experience from a single centre

    DEFF Research Database (Denmark)

    Pedersen, Erik Bo; El-Faramawi, Mohamad; Foged, Nils

    2007-01-01

    We report our experience in pediatric renal transplantation avoiding steroids whenever possible. Immunosuppression consisted of an initial induction with antithymocyte globulin followed by maintenance therapy with a calcineurin inhibitor and MMF. Steroids were only given to selected patients......). Unfortunately PTLD occurred in three patients, but all survived with functioning grafts. Accordingly, our findings indicate that steroid avoidance in pediatric renal transplantation is possible with good results with respect to acute graft rejection as well as long-term graft survival....

  7. The Development of a Pediatric Inpatient Experience of Care Measure: Child HCAHPS®

    OpenAIRE

    Toomey, Sara L.; Zaslavsky, Alan M.; Elliott, Marc N; Gallagher, Patricia M.; Fowler, Floyd J.; Klein, David J; Shulman, Shanna; Ratner, Jessica; McGovern, Caitriona; LeBlanc, Jessica L.; Schuster, Mark A.

    2015-01-01

    CMS uses Adult HCAHPS® scores for public reporting and pay-for-performance for most U.S. hospitals, but no publicly available standardized survey of inpatient experience of care exists for pediatrics. To fill the gap, CMS/AHRQ commissioned the development of the Consumer Assessment of Healthcare Providers and Systems Hospital Survey – Child Version (Child HCAHPS), a survey of parents/guardians of pediatric patients (

  8. Global general pediatric surgery partnership: The UCLA-Mozambique experience.

    Science.gov (United States)

    Amado, Vanda; Martins, Deborah B; Karan, Abraar; Johnson, Brittni; Shekherdimian, Shant; Miller, Lee T; Taela, Atanasio; DeUgarte, Daniel A

    2017-09-01

    There has been increasing recognition of the disparities in surgical care throughout the world. Increasingly, efforts are being made to improve local infrastructure and training of surgeons in low-income settings. The purpose of this study was to review the first 5-years of a global academic pediatric general surgery partnership between UCLA and the Eduardo Mondlane University in Maputo, Mozambique. A mixed-methods approach was utilized to perform an ongoing needs assessment. A retrospective review of admission and operative logbooks was performed. Partnership activities were summarized. The needs assessment identified several challenges including limited operative time, personnel, equipment, and resources. Review of logbooks identified a high frequency of burn admissions and colorectal procedures. Partnership activities focused on providing educational resources, on-site proctoring, training opportunities, and research collaboration. This study highlights the spectrum of disease and operative case volume of a referral center for general pediatric surgery in sub-Saharan Africa, and it provides a context for academic partnership activities to facilitate training and improve the quality of pediatric general surgical care in limited-resource settings. Level IV. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Survey of pediatric MDCT radiation dose from university hospitals in Thailand. A preliminary for national dose survey

    Energy Technology Data Exchange (ETDEWEB)

    Kritsaneepaiboon, Supika [Dept. of Radiology, Faculty of Medicine, Prince of Songkla Univ., Hat Yai (Thailand)], e-mail: supikak@yahoo.com; Trinavarat, Panruethai [Dept. of Radiology, Faculty of Medicine, Chulalongkorn Univ., Bangkok (Thailand); Visrutaratna, Pannee [Dept. of Radiology, Faculty of Medicine, Chiang Mai Univ., Chiang Mai (Thailand)

    2012-09-15

    Background: Increasing pediatric CT usage worldwide needs the optimization of CT protocol examination. Although there are previous published dose reference level (DRL) values, the local DRLs should be established to guide for clinical practice and monitor the CT radiation. Purpose: To determine the multidetector CT (MDCT) radiation dose in children in three university hospitals in Thailand in four age groups using the CT dose index (CTDI) and dose length product (DLP). Material and Methods: A retrospective review of CT dosimetry in pediatric patients (<15 years of age) who had undergone head, chest, and abdominal MDCT in three major university hospitals in Thailand was performed. Volume CTDI (CTDIvol) and DLP were recorded, categorized into four age groups: <1 year, 1- < 5 years, 5- <10 years, and 10- <15 years in each scanner. Range, mean, and third quartile values were compared with the national reference dose levels for CT in pediatric patients from the UK and Switzerland according to International Commission on Radiological Protection (ICRP) recommendation. Results: Per age group, the third quartile values for brain, chest, and abdominal CTs were, respectively, in terms of CTDIvol: 25, 30, 40, and 45 mGy; 4.5, 5.7, 10, and 15.6 mGy; 8.5, 9, 14, and 17 mGy; and in terms of DLP: 400, 570, 610, and 800 mGy cm; 80, 140, 305, and 470 mGy cm; and 190, 275, 560,765 mGy cm. Conclusion: This preliminary national dose survey for pediatric CT in Thailand found that the majority of CTDIvol and DLP values in brain, chest, and abdominal CTs were still below the diagnostic reference levels (DRLs) from the UK and Switzerland regarding to ICRP recommendation.

  10. A phenomenologic investigation of pediatric residents' experiences being parented and giving parenting advice.

    Science.gov (United States)

    Bax, A C; Shawler, P M; Blackmon, D L; DeGrace, E W; Wolraich, M L

    2016-09-01

    Factors surrounding pediatricians' parenting advice and training on parenting during residency have not been well studied. The primary purpose of this study was to examine pediatric residents' self-reported experiences giving parenting advice and explore the relationship between parenting advice given and types of parenting residents received as children. Thirteen OUHSC pediatric residents were individually interviewed to examine experiences being parented and giving parenting advice. Phenomenological methods were used to explicate themes and secondary analyses explored relationships of findings based upon Baumrind's parenting styles (authoritative, authoritarian, permissive). While childhood experiences were not specifically correlated to the parenting advice style of pediatric residents interviewed, virtually all reported relying upon childhood experiences to generate their advice. Those describing authoritative parents reported giving more authoritative advice while others reported more variable advice. Core interview themes related to residents' parenting advice included anxiety about not being a parent, varying advice based on families' needs, and emphasis of positive interactions and consistency. Themes related to how residents were parented included discipline being a learning process for their parents and recalling that their parents always had expectations, yet always loved them. Pediatric residents interviewed reported giving family centered parenting advice with elements of positive interactions and consistency, but interviews highlighted many areas of apprehension residents have around giving parenting advice. Our study suggests that pediatric residents may benefit from more general educational opportunities to develop the content of their parenting advice, including reflecting on any impact from their own upbringing.

  11. The first experience of mobile pediatric palliative team in Ukraine

    Directory of Open Access Journals (Sweden)

    O. О. Riga

    2016-12-01

    Full Text Available The aim of the study was to identify needs among young children with life-limiting diseases under 4 years old and their parents living in rural area of Kharkiv region Ukraine during home visiting. Materials and methods. After the creation of the first mobile pediatric palliative team, we reviewed the visits of 31 families at home to define their clinical, and psychological, and social needs. The first mobile pediatric palliative care team has been created for 2015. 31 families who have young children with life –threating diseases were visited to determine their clinical, and psychological, and social needs. Results. All children (31 had severe pathology of the central nervous system: congenital birth defects (29 %; cerebral palsy (35.4 %; genetic disorders (12.9 %. Parental and children’s needs were divided into three categories. Medical needs: orthopedic (93.5 %, vaccination (93.5 %, food (80.6 %, posture (61.3 %, salivation (32.2 %, anticonvulsant therapy (16 %. Psychological problems: communication with siblings (100 %; socialization of children (90.3 %; sensory activity (83.8 %, parental relationships (74.2 %. Social issues: the need for support/social worker or volunteers (58.1 %, poverty (58.1 %, communication with local rehabilitation centers (54.8 %, the need for medical equipment (41.9 %. Along with high medical, social and psychological needs of children with incurable diseases, both they and their families feel the lack of pediatric palliative care, and at present they have no access to it. The authors suggest that pediatric palliative care in Ukraine requires its development, application and inclusion in the general health care at all levels of the health system. The establishment of a national concept of modern educational programs, protocols and standards, dissemination of public information communities is also very necessary due to author’s point of view. Conclusions. Mobile team that performs home visits may be one of the

  12. Pediatric intracranial aneurysms--our experience and review of literature.

    Science.gov (United States)

    Garg, Kanwaljeet; Singh, Pankaj Kumar; Sharma, Bhawani Shankar; Chandra, Poodipedi Sarat; Suri, Ashish; Singh, Manmohanjit; Kumar, Rajinder; Kale, Shashank Sarad; Mishra, Nalin Kumar; Gaikwad, Shailesh K; Mahapatra, Ashok Kumar

    2014-05-01

    Intracranial aneurysms in children are not as common as in adults and there are many differences in the etiology, demographic variables, aneurysm location, aneurysm morphological characteristics, clinical presentation, and outcome in pediatric and adult intracranial aneurysms. All children (≤18 years) suffering from intracranial aneurysm managed at our center from July 2001 through June 2013 were included in the study, and the details of these patients were retrieved from the computerized database of our hospital. A total of 62 pediatric patients were treated for 74 aneurysms during the study period and constituted 2.3% of all intracranial aneurysms treated during the same period. The mean age at presentation was 13.5 years. Headache (82%) was the commonest presenting feature; other symptoms included seizures (21%), ictal loss of consciousness (27%), and motor/cranial nerve deficits (22.6%). Computed tomogram revealed subarachnoid hemorrhage in 58% of patients. Eighty-two percent of aneurysms were in anterior circulation. Sixty-seven percent of aneurysms were complex aneurysms. Fifty-eight percent of patients underwent surgical intervention while 30% underwent endovascular procedures. Twenty-one percent of the patients developed vasospasm. There was no postoperative mortality. Favorable outcome was seen in 72% of the patients. Pediatric intracranial aneurysms are uncommon as compared to in adult patients. Seizures and cranial nerve involvement are seen more often as the presenting features in children. Posterior circulation aneurysms are more common in children, as are the internal carotid artery bifurcation aneurysms. There is high incidence of giant, posttraumatic, and mycotic aneurysms in children.

  13. Initial experience with tadalafil in pediatric pulmonary arterial hypertension.

    Science.gov (United States)

    Takatsuki, Shinichi; Calderbank, Michelle; Ivy, David Dunbar

    2012-06-01

    This study aimed to investigate the safety, tolerability, and effects of tadalafil on children with pulmonary arterial hypertension (PAH) after transition from sildenafil or after tadalafil received as initial therapy. A total of 33 pediatric patients with PAH were retrospectively evaluated. Of the 33 patients, 29 were switched from sildenafil to tadalafil. The main reason for the change from sildenafil was once-daily dosing. The average dose of sildenafil was 3.4 ± 1.1 mg/kg/day, and that of tadalafil was 1.0 ± 0.4 mg/kg/day. For 14 of the 29 patients undergoing repeat catheterization, statistically significant improvements were observed after transition from sildenafil to tadalafil in terms of mean pulmonary arterial pressure (53.2 ± 18.3 vs. 47.4 ± 13.7 mmHg; p sildenafil to tadalafil including headache, nausea, myalgia, nasal congestion, flushing, and allergic reaction. Two patients discontinued tadalafil due to migraine or allergic reaction. One patient receiving sildenafil had no breakthrough syncope after transition to tadalafil. Tadalafil can be safely used for pediatric patients with PAH and may prevent disease progression.

  14. The Relationship Between Nursing Experience and Education and the Occurrence of Reported Pediatric Medication Administration Errors.

    Science.gov (United States)

    Sears, Kim; O'Brien-Pallas, Linda; Stevens, Bonnie; Murphy, Gail Tomblin

    2016-01-01

    Medication errors are one of the most common incidents in the hospitals. They can be harmful, and they are even more detrimental for pediatric patients. This study explored the relationship between nursing experience, education, the frequency and severity of reported pediatric medication administration errors (PMAEs). The data for this study were collected from a larger pan Canadian study. A survey tool was developed to collect self-reported data from nurses. In addition to descriptive statistics, a Poisson regression or a multiple linear regression was completed to address the research questions, and a Boneferrai correction was conducted to adjust for the small sample size. Results demonstrated that on units with more nurses with a higher level of current experience, more PMAEs were reported (p=.001), however; the PMAEs reported by these nurses were not as severe (p=.003). Implications to advance both safe medication delivery in the pediatric setting and safe culture of reporting for both actual and potential errors are identified.

  15. Retrospective Analysis of Decreasing the Use of Anesthesia in Pediatric Audiology: A Preliminary Study.

    Science.gov (United States)

    Padish-Clarin, Gail; Hawkins, Andrea J

    2015-12-01

    The purpose of this article is to analyze outcomes of processes aimed at reducing the need for use of anesthesia in evaluating pediatric hearing loss. A retrospective chart review was completed to assess how often a pediatric hearing evaluation was successful/not successful and auditory brainstem response (ABR) testing with anesthesia was avoided/required following review of orders for ABR testing with anesthesia. A total of 30% of the patients referred for ABR with anesthesia successfully completed a pediatric hearing evaluation, therefore avoiding anesthesia. Male subjects and subjects with developmental delay were less likely to avoid testing with anesthesia. None of the subjects with a comorbidity of developmental delay completed a pediatric hearing evaluation successfully. Other comorbidities with low success rates were autism spectrum disorder and speech delay. No significant outcome differences were measured as a function of referral source. Processes implemented in this study resulted in elimination of the need to use anesthesia to evaluate hearing in a large portion of patients referred. Success rates for avoiding anesthesia may vary depending on available resources, physician education, and population tested. Additional benefits of the described process include reduced stress on the health care system and families receiving services.

  16. Mitchell′s technique for epispadias repair: Our preliminary experience

    Directory of Open Access Journals (Sweden)

    Sarin Yogesh

    2006-01-01

    Full Text Available Aim: We present here experience of a single surgeon with Mitchell′s procedure for correction of epispadias. Materials and Methods: Nine boys (mean age 5½ years, range 9 months to 16 years underwent Mitchell′s repair in Department of Pediatric Surgery over a period of 5½ (September 1999 to March 2005 for correction of epispadias. Six of these patients had come for the second stage of exstrophy-epispadias repair after primary bladder closure; the other three had incontinent penopubic epispadias. Results: The penis was cosmetically acceptable as regards to size, glans shape and peno-pubic angle in all the patients. However, there was a high incidence of penopubic fistula (44%. These patients with penopubic fistula also required postoperative urethral dilatations, at times repeated. One of the common factors to these subset patients was their younger age when Mitchell′s urethroplasty was performed. Limitations: The series is descriptive in nature, short in numbers and does not provide statistical comparison of Mitchell′s procedure with the previously done procedures. Conclusions: Mitchell′s complete penile disassembly technique for epispadias repair is more acceptable anatomical procedure that results in near-pendulous penis. However, when performed at young age, it is fraught with the complication of penopubic fistula similar to that as seen with Cantwell-Ransley′s procedure. Mitchell′s procedure creates a hypospadiac meatus initially and the meatal advancement is required as for any other distal penile/coronal hypospadias.

  17. [Experience of an Ethics Committee of a pediatric reference hospital].

    Science.gov (United States)

    Ledesma, Fernanda; García, Hernán; Barraza, Norma; Ciruzzi, Susana; Ferrería, Juan Carlos; de los Ángeles Iervolino, Ma; Marín, Daniela; Mazzuccheli, Teresa; Menéndez, Célica; Novali, Luis; Ortega, Laura; Ponce, Corina; Quintana, Susana; Scrigni, Adriana; Selandari, Jorge; Shejter, Virginia; Rodríguez, Estela

    2015-01-01

    Since 1960, there has been a growing interest in the complexity of the ethical problems posed by medical practice. Ever since then, many ethical theories have attempted to support bioethics, setting the necessary grounds for decision making process. The aim of this article is to briefly present the history and working of a pediatric hospital's Assistance Ethics Committee, as well as its evolution from the very beginning. Throughout the Committee's career, progressive changes were made in the way of working. During its first years, the fulfillment of certain formalities was demanded when presenting patients, but this was modified overtime towards a less rigid and more reflexive and pluralistic presentation. Regarding our Ethics Committee, deliberation is the main and most valuable tool in the search for the best option when dealing with harsh and problematic cases that are presented.

  18. High-Frequency Oscillatory Ventilation in Pediatric Acute Lung Injury : A Multicenter International Experience

    NARCIS (Netherlands)

    Rettig, Jordan S; Smallwood, Craig D; Walsh, Brian K; Rimensberger, Peter C; Bachman, Thomas E; Bollen, Casper W.; Duval, Els L; Gebistorf, Fabienne; Markhorst, Dick G; Tinnevelt, Marcel; Todd, Mark; Zurakowski, David; Arnold, John H

    2015-01-01

    OBJECTIVE: We aim to describe current clinical practice, the past decade of experience and factors related to improved outcomes for pediatric patients receiving high-frequency oscillatory ventilation. We have also modeled predictive factors that could help stratify mortality risk and guide future hi

  19. High-Frequency Oscillatory Ventilation in Pediatric Acute Lung Injury : A Multicenter International Experience

    NARCIS (Netherlands)

    Rettig, Jordan S; Smallwood, Craig D; Walsh, Brian K; Rimensberger, Peter C; Bachman, Thomas E; Bollen, Casper W.|info:eu-repo/dai/nl/304813362; Duval, Els L; Gebistorf, Fabienne; Markhorst, Dick G; Tinnevelt, Marcel; Todd, Mark; Zurakowski, David; Arnold, John H

    2015-01-01

    OBJECTIVE: We aim to describe current clinical practice, the past decade of experience and factors related to improved outcomes for pediatric patients receiving high-frequency oscillatory ventilation. We have also modeled predictive factors that could help stratify mortality risk and guide future hi

  20. High-Frequency Oscillatory Ventilation in Pediatric Acute Lung Injury : A Multicenter International Experience

    NARCIS (Netherlands)

    Rettig, Jordan S; Smallwood, Craig D; Walsh, Brian K; Rimensberger, Peter C; Bachman, Thomas E; Bollen, Casper W.; Duval, Els L; Gebistorf, Fabienne; Markhorst, Dick G; Tinnevelt, Marcel; Todd, Mark; Zurakowski, David; Arnold, John H

    2015-01-01

    OBJECTIVE: We aim to describe current clinical practice, the past decade of experience and factors related to improved outcomes for pediatric patients receiving high-frequency oscillatory ventilation. We have also modeled predictive factors that could help stratify mortality risk and guide future

  1. Innovative Training in Pediatrics, General Psychiatry, and Child Psychiatry: Background, Outcomes, and Experiences

    Science.gov (United States)

    Gleason, Mary Margaret; Fritz, Gregory K.

    2009-01-01

    Objectives: The authors describe the history, rationale, and outcomes of combined training programs in pediatrics, psychiatry, and child psychiatry ("triple board"), including narrative feedback from graduates and reflections upon the important components of the program. Methods: This article reviews the background and experiences of triple board…

  2. The "SCORPION" experiment onboard the International Space Station. Preliminary results.

    Science.gov (United States)

    Borisov, V; Deshevaya, E; Grachov, E; Grigoryan, O; Tchurilo, I; Tsetlin, V

    2003-01-01

    The "SCORPION" program onboard the Russian Segment (RS) of the International Space Station (ISS) is designed to carry out complex research of the effects of the nar-Earth space parameters on the conditions under which various experiments and operations are being conducted. Special attention in this program was paid to the biological objects onboard the orbital station, e.g. it was found that variation in the number of colony forming units (micromicets and bacteria) correlates with the solar activity and the absorbed dose. The "SCORPION" experiment onboard the RS ISS started in January 2002. It was designed to measure the following parameters inside the space absorbed doses in different places inside the RS ISS, the fluxes of energetic charged particles, neutrons and gamma-quanta; the vectors of the magnetic field and low-frequency electromagnetic waves. At the same time the growth of micromicets on the samples of various materials was studied. The description of the "SCORPION" experiment and the preliminary results obtained onboard the RS ISS in 2002 are presented.

  3. Calibration Study and Preliminary Results of PRad Experiment

    Science.gov (United States)

    Levillain, Maxime; PRad Collaboration

    2016-09-01

    The latest measurements of the proton radius through muonic hydrogen Lamb shift show a discrepancy of 7 σ from a global analysis of standard hydrogen Lamb shift and elastic ep -scattering. In order to understand this proton radius puzzle, the PRad experiment successfully took in last June some elastic ep -scattering data at very low Q2 (2 .10-4 to 10-1 GeV2) with very accurate angle and energy measurements to minimize the systematic uncertainties. Before measuring the cross-sections that will be used to extract the electromagnetic form factor GE(Q2) and the proton radius, a very careful calibration of the electromagnetic calorimeter (HyCal) must be performed to get a good energy resolution and separate ep -events from M øller events especially at low angle. We will present an extended study of the electromagnetic calorimeter calibration of this experiment as well as some preliminary results on ep - and ee -scattering processes extracted from the data. The PRad experiment is supported in part by NSF MRI Award PHY-1229153.

  4. The Development of a Pediatric Inpatient Experience of Care Measure: Child HCAHPS.

    Science.gov (United States)

    Toomey, Sara L; Zaslavsky, Alan M; Elliott, Marc N; Gallagher, Patricia M; Fowler, Floyd J; Klein, David J; Shulman, Shanna; Ratner, Jessica; McGovern, Caitriona; LeBlanc, Jessica L; Schuster, Mark A

    2015-08-01

    The Centers for Medicare and Medicaid Services (CMS) uses Adult Hospital Consumer Assessment of Healthcare Providers and Systems (Adult HCAHPS) scores for public reporting and pay-for-performance for most US hospitals, but no publicly available standardized survey of inpatient experience of care exists for pediatrics. To fill the gap, CMS and the Agency for Healthcare Research and Quality commissioned the development of a pediatric version (Child HCAHPS), a survey of parents/guardians of pediatric patients (development of Child HCAHPS, which included an extensive review of the literature and quality measures, expert interviews, focus groups, cognitive testing, pilot testing of the draft survey, a national field test with 69 hospitals in 34 states, psychometric analysis, and end-user testing of the final survey. We conducted extensive validity and reliability testing to determine which items would be included in the final survey instrument and develop composite measures. We analyzed national field test data of 17,727 surveys collected in November 2012 to January 2014 from parents of recently hospitalized children. The final Child HCAHPS instrument has 62 items, including 39 patient experience items, 10 screeners, 12 demographic/descriptive items, and 1 open-ended item. The 39 experience items are categorized based on testing into 18 composite and single-item measures. Our composite and single-item measures demonstrated good to excellent hospital-level reliability at 300 responses per hospital. Child HCAHPS was developed to be a publicly available standardized survey of pediatric inpatient experience of care. It can be used to benchmark pediatric inpatient experience across hospitals and assist in efforts to improve the quality of inpatient care.

  5. Preliminary experience with laparoscopic repair of associated inguinal and umbilical hernias in children.

    Science.gov (United States)

    Bertozzi, M; Magrini, E; Appignani, A

    2015-08-01

    The authors report their preliminary experience in laparoscopic repair of associated inguinal and umbilical hernias in children. Twenty-six patients affected by the association of inguinal and umbilical hernia with an umbilical defect larger than 5 mm underwent a laparoscopic procedure. A 5-mm trocar was placed through the umbilical defect for the optic. To fix the trocar to avoid loss of carboperitoneum, we fashioned and tightened a purse-string non-absorbable suture with a sliding knot around the defect. In this manner, we ensured the trocar, fixing it and avoiding any loss of CO2, proceeding safely to the laparoscopic IH repair, by means of two additional 3 mm operative trocars. At the end of the inguinal herniorrhaphy, the previously fashioned purse-string suture was tightened to repair the umbilical defect. The mean operative time for the repair of associated inguinal and umbilical hernias was 30.1 ± 7.4 min in cases of unilateral inguinal hernia and 39.5 ± 10.6 for bilateral inguinal hernia. Follow-up ranged from 8 to 32 months. Neither intra- nor post-operative complications nor recurrences were seen. This small sample suggests that this simple method is safe, effective and might be useful for pediatric surgeons performing laparoscopic repair for inguinal hernia in presence of an associated UH with a statistically significant decrease of operative time.

  6. Pre-clinical medical student experience in a pediatric pulmonary clinic

    Directory of Open Access Journals (Sweden)

    Thomas G. Saba

    2015-11-01

    Full Text Available Objective: Our objective was to evaluate the educational value of introducing pre-clinical medical students to pediatric patients and their families in a subspecialty clinic setting. Methods: First- and second-year medical students at the University of Michigan seeking clinical experience outside of the classroom attended an outpatient pediatric pulmonary clinic. Evaluation of the experience consisted of pre- and post-clinic student surveys and post-clinic parent surveys with statements employing a four-point Likert scale as well as open-ended questions. Results: Twenty-eight first-year students, 6 second-year students, and 33 parents participated in the study. Post-clinic statement scores significantly increased for statements addressing empathic attitudes, confidence communicating with children and families, comfort in the clinical environment, and social awareness. Scores did not change for statements addressing motivation, a sense of team membership, or confidence with career goals. Students achieved their goals of gaining experience interacting with patients, learning about pulmonary diseases, and observing clinic workflow. Parents felt that they contributed to student education and were not inconvenienced. Conclusions: Students identified several educational benefits of exposure to a single pediatric pulmonary clinic. Patients and families were not inconvenienced by the participation of a student. Additional studies are warranted to further investigate the value of this model of pre-clinical medical student exposure to subspecialty pediatrics.

  7. Design, integration and preliminary results of the IXV Catalysis experiment

    Science.gov (United States)

    Viladegut, Alan; Panerai, F.; Chazot, O.; Pichon, T.; Bertrand, P.; Verdy, C.; Coddet, C.

    2016-08-01

    The CATalytic Experiment (CATE) is an in-flight demonstration of catalysis effects at the surface of thermal protection materials. A high-catalytic coating was applied over the baseline ceramic material on the windward side of the intermediate experimental vehicle (IXV). The temperature jump due to different catalytic activities was detected during re-entry through measurements made with near-surface thermocouples on the windward side of the vehicle. The experiment aimed at contributing to the development and validation of gas/surface interaction models for re-entry applications. The present paper summarizes the design of CATE and its integration on the windward side of the IXV. Results of a qualification campaign at the Plasmatron facility of the von Karman Institute for Fluid Dynamics are presented. They provided an experimental evidence of the temperature jump at the low-to-high catalytic interface of the heat shield under aerothermal conditions relevant to the actual IXV flight. These tests also gave confidence so that the high-catalytic patch would not endanger the integrity of the vehicle and the safety of the mission. A preliminary assessment of flight data from the thermocouple measurements shows consistency with results of the qualification tests.

  8. Headache in the pediatric emergency service: a medical center experience.

    Science.gov (United States)

    Hsiao, Hsiang-Ju; Huang, Jing-Long; Hsia, Shao-Hsuan; Lin, Jainn-Jim; Huang, I-Anne; Wu, Chang-Teng

    2014-06-01

    Headache is a common complaint in children and is one of the most common reasons for presentation at a pediatric emergency department (PED). This study described the etiologies of patients with headache seen in the PED and determined predictors of intracranial pathology (ICP) requiring urgent intervention. A secondary objective was to develop rapid, practical tools for screening headache in the PED. We conducted a retrospective chart review of children who presented with a chief complaint of headache at the PED during 2008. First, we identified possible red flags in the patients' history or physical examination and neurological examination findings. Then, we recorded the brain computed tomography results. During the study period, 43,913 visits were made to the PED; in 409 (0.9%) patients, the chief complaint was headache. Acute viral, respiratory, and febrile illnesses comprised the most frequent cause of headache (59.9%). Six children (1.5%) had life-threatening ICP findings. In comparison with the group without ICP, the group with ICP had a significantly higher percentage of blurred vision (p = 0.008) and ataxia (p = 0.002). Blurred vision and ataxia are the best clinical parameters to predict ICP findings. Copyright © 2013. Published by Elsevier B.V.

  9. Evaluation of undergraduate clinical learning experiences in the subject of pediatric dentistry using critical incident technique

    Directory of Open Access Journals (Sweden)

    S Vyawahare

    2013-01-01

    Full Text Available Introduction: In pediatric dentistry, the experiences of dental students may help dental educators better prepare graduates to treat the children. Research suggests that student′s perceptions should be considered in any discussion of their education, but there has been no systematic examination of India′s undergraduate dental students learning experiences. Aim: This qualitative investigation aimed to gather and analyze information about experiences in pediatric dentistry from the students′ viewpoint using critical incident technique (CIT. Study Design: The sample group for this investigation came from all 240 3 rd and 4 th year dental students from all the four dental colleges in Indore. Using CIT, participants were asked to describe at least one positive and one negative experience in detail. Results: They described 308 positive and 359 negative experiences related to the pediatric dentistry clinic. Analysis of the data resulted in the identification of four key factors related to their experiences: 1 The instructor; 2 the patient; 3 the learning process; and 4 the learning environment. Conclusion: The CIT is a useful data collection and analysis technique that provides rich, useful data and has many potential uses in dental education.

  10. Promoting positive pediatric experiences for nursing students at the Children's Hospital of Pittsburgh of UPMC.

    Science.gov (United States)

    Bagay, Joann Marie

    2014-01-01

    Challenges in professional nursing education today can be astonishing. Cognizant of the commitment to provide the most valuable learning experiences for our future nurses, academia and service organizations strive to meet this challenge. The escalation in nursing school enrollment, along with the increase in patient acuity and ongoing health care changes, requires hospitals and schools to continually review their practices to ensure positive outcomes. Providing pediatric nursing experiences to over 1,300 students annually, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center (UPMC) implemented a process to meet this need. A Faculty Advisory Council was established to provide a venue for representative nursing instructors to meet with the Nursing Education Department at the hospital. The commonality of focus by nursing faculty and Children's Hospital continues to strengthen both academia and service. This well-defined process supports positive pediatric experiences for nursing students at Children's Hospital of Pittsburgh of UPCM.

  11. Knowledge and attitudes regarding neonatal pain among nursing staff of pediatric department: an Indian experience.

    Science.gov (United States)

    Nimbalkar, Archana S; Dongara, Ashish R; Phatak, Ajay G; Nimbalkar, Somashekhar M

    2014-03-01

    Neonates receiving care in intensive care units are highly likely to experience pain due to investigations and/or treatments carried out by the health care providers. Neonates are a vulnerable population because they are unable to vocalize their pain. Unaddressed and mismanaged pain can not only affect the child's comfort, but also may alter the development and cognitive abilities of the child in a later part of his/her life. Therefore it is entirely the caregiver's responsibility to accurately assess and manage neonatal pain. We assessed and compared the knowledge and attitudes regarding neonatal pain among the nurses posted in the various units of a pediatric department [pediatric ward, pediatric intensive care unit (PICU) and neonatal intensive care unit (NICU)]. An appropriately modified Knowledge and Attitudes Survey Regarding Pain questionnaire was consensually validated, pretested, and then administered to the nursing staff of the pediatric department at a department at a hospital in Gujarat. Data were entered in Epi-Info and analyzed with the use of SPSS 14.0. The questionnaire was administered to 41 nurses working in the Department of Pediatrics, and the response rate was 97.5%. Mean age of the nurses in the study sample was 25.75 years (SD 5.513). The mean total score of the participants was 8.75 out of 17 (SD 2.549), which was unsatisfactory. The mean correct answer rate was 49.67% among the staff of NICU and 48.67% among the pediatric ward and PICU staff. The attitudes among the nurses were assessed. It was concluded that the nurses lack knowledge and that their attitudes also were hindering pain management. One of the barriers identified by the nurses was that physicians do not prescribe analgesics for managing neonatal pain. So not only the nursing staff, but all of the caregivers involved in neonatal care may be lacking in knowledge and hold perceptions and attitudes that hamper neonatal pain management.

  12. Results From a Patient Experience Study in Pediatric Gastrointestinal Endoscopy

    Directory of Open Access Journals (Sweden)

    Divya Ann Jacob MBBS

    2015-11-01

    Full Text Available Objective: Gastrointestinal endoscopy in children has become a standard diagnostic and therapeutic modality. The aim of our study was to characterize the most memorable elements of the patient experience from the parent’s and patient’s perspective and determine ways to improve the overall quality of their experience. Methods: Using a structured questionnaire, we conducted 47 phone interviews with families who had recently undergone gastrointestinal endoscopic procedures. Results: Our study showed clear communication and mutual agreement on care decisions contributed to positive experiences. Inadequate communication of information regarding alternatives to the procedure and risk of complications during the informed consent discussion contributed to negative patient experiences. Standardization of postprocedure follow-up and timely communication of pathology findings also had potential for improvement. Conclusion: Our study revealed 2 areas for quality improvement interventions: The need to ensure that alternatives and complications are thoroughly discussed and the need for standardization of postprocedure follow-up.

  13. Transperineal ultrasonography for evaluation of the perianal fistula and abscess in pediatric Crohn disease: preliminary study

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Jae Yeon [Dept. of Radiology, Pusan National University Yangsan Hospital, Yangsan (Korea, Republic of); Yoon, Hye Kyung; Kim, Wee Kyung; Cho, Young Ah; Lee, Jin Seong; Yoon, Chong Hyun [Dept. of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Lee, Yeoun Joo [Dept. of Pediatrics, Pusan National University Children' s Hospital, Yangsan (Korea, Republic of); Kim, Kyung Mo [Dept. of Pediatrics, Asan Medical Center Children' s Hospital, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2014-10-15

    To assess the feasibility and effectiveness of transperineal ultrasonography (TPUS) for the evaluation of perianal Crohn disease (PCD) in pediatric patients. Between September 2010 and August 2013, 64 TPUS examinations were performed in 43 patients (34 males and 9 females; mean age±standard deviation, 13.3±2.4 years; age range, 6 to 17 years) to evaluate PCD. The pain severity, location, and activity of perianal fistula, the presence of an abscess, and anal canal hyperemia were retrospectively evaluated. Spearman rank correlation analysis was performed to assess the relationship between the severity of the pain and the fistula activity, the presence of an abscess, and anal canal hyperemia. All examinations were successfully performed. Thirty-nine examinations (60.9%) were performed without any pain experienced by the patient, 19 examinations (29.7%) with mild pain, five examinations (7.8%) with moderate pain, and one examination (1.6%) with severe pain. The pain severity was correlated with the fistula activity (P<0.01). An anterior fistula location was more common than a posterior location. Active fistulas and abscesses were identified during 30 examinations (46.9%) and 12 examinations (18.8%), respectively. Anal canal hyperemia was identified in 31 examinations (48.4%). TPUS with a color Doppler study is useful for visualizing a perianal fistula or abscess and for assessing its inflammatory activity in pediatric Crohn patients.

  14. Preliminary results of the XR2-1 experiment

    Energy Technology Data Exchange (ETDEWEB)

    Gauntt, R.O.; Helmick, P.H. [Sandia National Labs., Albuquerque, NM (United States); Humphries, L. [SAIC, Albuquerque, NM (United States)

    1996-03-01

    The XR2-1 (Ex-Reactor) experiment, investigating metallic core-melt relocation in boiling water reactor geometry, was performed on October 12, 1995, following two previous simpler XR1-series tests in August and November of 1993. The XR2-1 test made use of a highly detailed replication of the lower region of the BWR core, including the control blade and channel box structures, fuel rods, fuel canister nosepieces, control blade velocity limiter, and fuel support pieces, in order to investigate a key core melt progression uncertainty for BWR Station Blackout type accidents. The purpose of this experiment program is to examine the behavior of downward-draining molten metallic core materials in a severe reactor accident in a dry BWR core, and to determine conditions under which the molten materials drain out of the core region, or freeze to form blockages in the lower portion of the core. In the event that the draining metallic materials do not form stable blockages in the lower core region, and instead erode the lower core structures such as the lower core plate, then the subsequent core melt progression processes may proceed quite differently than was observed in the TMI-2 accident, with correspondingly different impact on vessel loading and vessel release behavior. The results of the Ex-Reactor tests are preliminary. All of the tests conducted have shown a significant degree of channel box destruction induced by the draining control blade materials. The XR2-1 test further showed that the draining zircaloy melt causes significant disruption of the fuel rod geometry. All of the tests have shown tendencies to form interim blockages as the melts temporarily freeze, but that these blockages re-melt, assisted by eutectic interactions, resulting in the sudden draining of accumulated metallic melt pools.

  15. Myocardial stress perfusion magnetic resonance: initial experience in a pediatric and young adult population using regadenoson

    Energy Technology Data Exchange (ETDEWEB)

    Noel, Cory V. [Baylor College of Medicine, Department of Pediatric Cardiology, Houston, TX (United States); Texas Children' s Hospital, Department of Pediatric Cardiology, Houston, TX (United States); Krishnamurthy, Ramkumar; Krishnamurthy, Rajesh [Texas Children' s Hospital, Department of Radiology, Houston, TX (United States); Moffett, Brady [Texas Children' s Hospital, Department of Pharmacology, Houston, TX (United States)

    2017-03-15

    Dipyridamole and adenosine are traditional pharmacological stressors for myocardial perfusion. Regadenoson, a selective adenosine A2A agonist, has a lower side effect profile with lower incidence of bronchospasm and bradycardia. There is a growing need for myocardial perfusion assessment within pediatrics. There is no report on the utility of regadenoson as a stress agent in children. To observe the safety and feasibility of regadenoson as a pharmacologic stressor for perfusion cardiac MR in a pilot cohort of pediatric patients weighing more than 40 kg who have congenital heart disease and pediatric acquired heart disease. We reviewed our initial experience with regadenoson stress cardiac MR in 31 pediatric patients 15.8 ± 1.7 years (range 12-22 years) with congenital heart disease and acquired heart disease. Mean patient weight was 60 ± 15 kg (range of 40-93 kg). All patients underwent cardiac MR because of concern for ischemia. The cohort included a heterogeneous group of patients at a pediatric institution with potential risk for ischemia. Subjects' heart rate and blood pressure were monitored and pharmacologic stress was induced by injection of 400 mcg of regadenoson. We evaluated their hemodynamic response and adverse effects using changes in vital signs and onset of symptoms. A pediatric cardiologist and radiologist qualitatively assessed myocardial perfusion and viability images. One child was unable to complete the stress perfusion portion of the examination, but did complete the remaining portion of the CMR. Resting heart rate was 72 ± 14 beats per minute (bpm) and rose to peak of 124 ± 17 bpm (95 ± 50% increase, P < 0.005) with regadenoson. Image quality was considered good or diagnostic in all cases. Three patients had irreversible perfusion defects. Four patients had reversible perfusion defects. Nine of the patients underwent cardiac catheterization with angiography and the findings showed excellent agreement. Regadenoson might be a safe and

  16. Trends in operative experience of pediatric surgical residents in the United States and Canada.

    Science.gov (United States)

    Fingeret, Abbey L; Stolar, Charles J H; Cowles, Robert A

    2013-01-01

    Expansion of the number of training programs in pediatric surgery occurred from 2003 through 2010. We sought to determine the effect of program expansion on case volume and distribution of operative experience. Public domain data on pediatric surgery resident summary statistics available from the Accreditation Council for Graduate Medical Education (ACGME) from July 2003 through June 2010 were analyzed. Total case volume as primary surgeon or teaching assistant, mean case volume per resident, standard deviation, mode, minimum, and maximum number of cases per resident were evaluated. Mean total cases per resident, minimally invasive laparoscopic and thoracoscopic cases, and requisite cases as defined by the ACGME categories of: tumor, important pediatric surgical, and neonatal cases were analyzed by a Cuzick Wilcoxon-type nonparametric trend statistic using a significance level of 0.05. Skew was assessed by Pearson coefficient with levels of -0.5 to 0.5 defining a parametric distribution. The number of pediatric surgical training residents increased by 42% during the years reported, from 24 to 34. No statistically significant difference was found in the mean number of total cases or requisite cases per resident. The mean volume of minimally invasive procedures increased significantly. Case volume per resident was non-parametrically distributed with increasing positive skew over time. The increase in number of pediatric surgical resident training positions has not adversely affected overall operative experience or exposure to highly specialized requisite cases, on average. The increasing positive skew of total and index cases, however, suggests that variability between programs in case exposure is increasing over time. Copyright © 2013 Elsevier Inc. All rights reserved.

  17. Minimally Invasive Thoracic Surgery in Pediatric Patients: The Taiwan Experience

    Directory of Open Access Journals (Sweden)

    Yu-Kai Huang

    2013-01-01

    Full Text Available Minimally invasive technology or laparoscopic surgery underwent a major breakthrough over the past two decades. The first experience of thoracoscopy in children was reported around 1980 for diagnosis of intrathoracic pathology and neoplasia. Up until the middle of the 1990s, the surgical community in Taiwan was still not well prepared to accept the coming era of minimally invasive surgery. In the beginning, laparoscopy was performed in only a few specialties and only relatively short or simple surgeries were considered. But now, the Taiwan’s experiences over the several different clinical scenarios were dramatically increased. Therefore, we elaborated on the experience about pectus excavatum: Nuss procedure, primary spontaneous hemopneumothorax, thoracoscopic thymectomy, and empyema in Taiwan.

  18. [Clinical characteristics of pediatric victims in the Lushan and Wenchuan earthquakes and experience of medical rescue].

    Science.gov (United States)

    Jiang, Xin; Xiang, Bo; Liu, Li-Jun; Liu, Min; Tang, Xue-Yang; Huang, Lu-Gang; Li, Yuan; Peng, Ming-Xing; Xin, Wen-Qiong

    2013-06-01

    To get a more comprehensive understanding of the clinical characteristics of pediatric victims in earthquake and to summarize the experience of medical rescue. The clinical information was collected from the pediatric victims who were admitted to West China Hospital, Sichuan University following the Lushan earthquake in 2013 and Wenchuan earthquake in 2008. The clinical data were compared between the pediatric victims in the two earthquakes. Thirty-four children under 14 years of age, who were injured in the Lushan earthquake, were admitted to the West China Hospital before April 30, 2013. Compared with the data in the Wenchuan earthquake, the mean age of the pediatric victims in the Lushan earthquake was significantly lower (Pearthquake to hospitalization was significantly shorter (Pearthquake, 67.6% of the injured children had variable limb fractures; traumatic brain injury was found in 29.4% of hospitalized children, versus 9.5% in the Wenchuan earthquake (Pearthquake than in the Wenchuan earthquake. But these cases recovered well, which was possibly due to timely on-site rescue and transfer and multi-sector, multi-institution, and multidisciplinary cooperation.

  19. Role of laser myringotomy in a pediatric otolaryngology practice: initial experience

    Science.gov (United States)

    Shah, Udayan K.

    2001-05-01

    A new technology (OtoLAM) to fenestrate the tympanic membrane with the carbon dioxide laser (CO2), in the office or the operating room, has been introduced over the last three years. While not new conceptually, this product offers the ability to easily create a precise window into the middle ear using a portable system. Controversy regarding the indications and benefits of this technique, amplified by the costs of the system and the marketing of the technology prior to extensive clinical testing, has plagued the clinical application of this technology. We report our experience over the past year with this system in a busy pediatric otolaryngology practice. Laser fenestration of the tympanic membrane has been useful for the insertion of tympanostomy tubes, and for the minimally invasive evaluation of the middle ear. Our small experience to date reveals that there is a limited role for laser tympanic membrane fenestration in a busy pediatric otolaryngology practice.

  20. Experiences of Early Transdisciplinary Teams in Pediatric Community Rehabilitation

    Science.gov (United States)

    Aubin, Tamie; Mortenson, Patricia

    2015-01-01

    Although a transdisciplinary approach (TA) is considered best practice for children aged 0-3 years, there is limited information for professionals on how to successfully implement TA services. Using qualitative inquiry, in-depth interviews were conducted to explore the experiences of 6 service providers and managers who took part in early…

  1. Pediatric and congenital heart transplant: twenty-year experience in a tertiary Brazilian Hospital

    OpenAIRE

    Leonardo Augusto Miana; Estela Azeka; Luiz Fernando Canêo; Aída Luisa Turquetto; Carla Tanamati; Juliano Gomes Penha; Alexandre Cauduro; Marcelo Biscegli Jatene

    2014-01-01

    Introduction: Cardiac transplantation remains the gold standard for end-stage cardiomyopathies and congenital heart defects in pediatric patients. Objective: This study aims to report on 20 years of experience since the first case and evaluate our results. Methods: We conducted a retrospective analysis of the database and outpatient follow-up. Between October 1992 and April 2012, 109 patients underwent 114 transplants. 51.8% of them being female. The age of patients ranged from 12 days to...

  2. Are Prior Experience and Subspecialty Training Time Predictive of Pediatric Anesthesia Exit Exam Scores for Rotating CA-2 Residents?

    Science.gov (United States)

    Nelson, Jonathon H; Deutsch, Nina; Cohen, Ira T; Reddy, Srijaya K

    2017-01-01

    Anesthesiology residency programs commonly have rotations at free-standing children's hospitals to provide and/or supplement their residents' training in pediatric anesthesia. Length and timing of these rotations differ from program to program as can their residents' existing medical knowledge and clinical skills. We predicted that residents with prior pediatric anesthesia experience, who rotate at our pediatric institution for two consecutive months, will score higher on an exit exam compared to residents without prior pediatric experience or those that only rotate for one month. A 50-question multiple choice test was created using pediatric questions released from The American Board of Anesthesiology (ABA) written examinations. The test was administered and proctored at the end of each rotation. Study participants came from three different programs: Program A offers prior pediatric anesthesia experience and a one month rotation; Program B - offers prior pediatric anesthesia experience and a two month rotation; and Program C - does not offer prior pediatric anesthesia experience but includes a two month rotation. The 2014-2015 cohort consisted of 26 rotating second-year clinical anesthesia (CA-2) residents. One resident's exam scores were excluded from this study due to protocol violation. Mean exam scores for Program A, B, and C were 70.5% ± 5.7, 64.2% ± 7.0, and 67.3% ± 4.3, respectively. There was no statistically significant difference in the exit exam scores among the three groups. Prior pediatric anesthesia experience or length of time for subspecialty rotation was not associated with any significant difference in exit exam scores for CA-2 residents.

  3. Development and Preliminary Face and Content Validation of the "Which Health Approaches and Treatments Are You Using?" (WHAT) Questionnaires Assessing Complementary and Alternative Medicine Use in Pediatric Rheumatology.

    Science.gov (United States)

    Toupin April, Karine; Stinson, Jennifer; Boon, Heather; Duffy, Ciarán M; Huber, Adam M; Gibbon, Michele; Descarreaux, Martin; Spiegel, Lynn; Vohra, Sunita; Tugwell, Peter

    2016-01-01

    Complementary and alternative medicine (CAM) is commonly used by children with juvenile idiopathic arthritis (JIA), yet no validated questionnaires assess that use. The objective of this study was to develop child self- and parent proxy-report questionnaires assessing CAM use and to determine the face and content validity of the "Which Health Approaches and Treatments are you using?" (WHAT) questionnaires in pediatric rheumatology. A sequential phased mixed methods approach was used to develop the questionnaires. A Delphi Survey of 126 experts followed by an interdisciplinary consensus conference of 14 stakeholders in CAM, general pediatrics and pediatric rheumatology was held to develop consensus on the content of the questionnaires using a nominal group technique. To determine face and content validity of the questionnaires, two groups, including (a) a purposive sample of 22 children with JIA 8 to 18 years and their parents from the Children's Hospital of Eastern Ontario and the Hospital for Sick Children, and (b) 21 Canadian pediatric rheumatology experts, participated in interviews. Participants were independently asked about the goal, understandability and comprehensiveness of the WHAT questionnaires, as well as the relevance of items. Consensus was reached on 17 items of the WHAT questionnaires. The domains found to be relevant were child's CAM use, factors associated with CAM use, perceived impact of CAM use, and communication about CAM. A total of 15 items in the parent proxy-report questionnaire and 13 items in the child report questionnaire showed adequate content validity. Consensus was reached by experts on the content of a pediatric CAM questionnaire. Face and content validity testing and modifications made to the WHAT questionnaires have helped ensure adequate preliminary validity for use in pediatric rheumatology. This constitutes the basis for further testing of these questionnaires in pediatric rheumatology and for adaptation to other chronic

  4. Validation of predictive equations for resting energy expenditure in Japanese pediatric Crohn's disease patients: preliminary study.

    Science.gov (United States)

    Arai, Katsuhiro; Funayama, Rie; Takahashi, Mieko; Sakai, Rie; Shimizu, Hirotaka; Obayashi, Naho; Matsui, Akira

    2015-04-01

    Predictive equations are often used to estimate resting energy expenditure (REE). Determining the appropriate equation for different patient types, however, remains inconclusive, as in the case of Japanese children with Crohn's disease (CD). The aim of this study was to identify an appropriate predictive equation for measuring REE in Japanese children with CD. Twelve Japanese children with CD managed at the National Center for Child Health and Development in Tokyo, Japan, were studied. REE (kcal/day) was measured using indirect calorimetry. The predictive equations used were the Japanese Dietary Reference Intakes (2010), the Schofield equation, the Food and Agriculture Organization/World Health Organization/United Nations University (FAO/WHO/UNU) equation and the Cunningham equation. Difference between predicted and measured REE was analyzed on Bland-Altman plot. Japanese Dietary Reference Intakes (2010) had the smallest difference between predicted and measured REE. Weight was the primary predictor of REE on multiple regression analysis. As well, Japanese Dietary Reference Intakes (2010) had the highest ratio of weight to predicted REE (98.5%). Of the four equations, Japanese Dietary Reference Intakes (2010) appeared to be the most practical and accurate predictive equation for REE in Japanese children with CD. © 2014 Japan Pediatric Society.

  5. "Spaghetti Maneuver": A useful tool in pediatric laparoscopy - Our experience

    Directory of Open Access Journals (Sweden)

    Antonio Marte

    2011-01-01

    Full Text Available Aims: The laparoscopic "Spaghetti Maneuver" consists in holding an organ by its extremity with a grasper and rolling it up around the tool to keep the organ stable and facilitate its traction within a small space. We describe our experience with the "Spaghetti Maneuver" in some minimally invasive procedures. Materials and Methods: We successfully adopted this technique in 13 patients (5F : 8M aged between 6 and 14 years (average age, 10 on whom we performed 7 appendectomies, 2 ureteral reimplantation and 4 cholecystectomies. In all cases, after the first steps, the appendix, the gallbladder and the ureter were rolled around the grasper and easily isolated; hemostasis was thus induced and the organ was mobilized until removal during cholecystectomy and appendectomy, and before the reimplantation in case of ureteral reimplantation. Results: We found that this technique facilitated significantly the acts of holding, isolating and removing, when necessary, the structures involved, which remained constantly within the visual field of the operator. This allowed a very ergonomic work setting, overcoming the problem of the "blind" zone, which represents a dangerous and invisible area out of the operator′s control during laparoscopy. Moreover the isolation maneuvers resulted easier and reduced operating time. Conclusion: We think that this technique is easy to perform and very useful, because it facilitates the dissection of these organs, by harmonizing and stabilizing the force of traction exercised.

  6. Preliminary experience with laparoscopic cholecystectomy in a nigerian teaching hospital.

    Science.gov (United States)

    Afuwape, O O; Akute, O O; Adebanjo, A T

    2012-01-01

    Presently many centers have facilities for laparoscopic surgery in Nigeria, but the practice is just evolving in most of these centers. This article presents the preliminary experience of the endoscopic surgery unit (general surgery) at the University College Hospital Ibadan Nigeria. The University College Hospital is the premier Nigerian teaching hospital and is located in the south-western part of the country. All the patients who had laparoscopic cholecystectomy at the University College Hospital between June 2009 and January 2011 were included in this study. The patients' demographic data, diagnosis, results of investigations and intra-operative findings were obtained from the records. Additional information extracted from the records was the duration of surgery, complications, outcome and discharge periods. There were thirteen patients over the twenty month period consisting of twelve females and one male. The age range was twenty six to sixty seven years with a mean of 44.6 years. The duration of surgery ranged from 90 to 189 minutes with a mean of 124 minutes. There were two complications. These were adhesive bowel obstruction and common bile duct injury. The duration of admission ranged from four to thirty two days with a mean of 7.53SD ± 8.5 days. There was one conversion to open surgery due to intra-operative gallbladder perforation with consequent dispersal of multiple gall stones within the peritoneal cavity. The common bile duct injury was diagnosed four days following surgery for which a choledochojejunostomy was done after initial conservative treatment. There was no mortality. Laparoscopic surgery is feasible in Nigeria and is likely to show increasing popularity among patients and surgeons. A careful patient selection protocol is necessary for an acceptable success rate with minimal complications. Our protocol of patient selection eliminated the need for intra-operative common bile duct exploration which requires expensive instruments. However, to

  7. Inverse Correlation between Helicobacter pylori Colonization and Pediatric Overweight: A Preliminary Study.

    Science.gov (United States)

    Moran-Lev, Hadar; Lubetzky, Ronit; Mandel, Dror; Yerushalmy-Feler, Anat; Cohen, Shlomi

    2017-08-01

    Helicobacter pylori, one of the most common bacterial pathogens in humans, is generally acquired during childhood. The inverse correlation between H. pylori colonization and obesity that was found in adults has not been investigated in depth in children. Our aim was to assess the correlation between overweight and obesity and H. pylori colonization in a pediatric population. H. pylori colonization in 70 symptomatic children was determined after antral biopsies during esophagogastroduodenoscopy. Data on anthropometric measurements, sociodemographic characteristics, and medical history were recorded. The participants' mean age was 12.41 ± 3.16 years, 58% were females, and 24% were obese or overweight (BMI >85th percentile). The H. pylori colonization rate was 31%. There were no significant differences between the H. pylori-infected and H. pylori-noninfected groups in terms of age, gender, or clinical and sociodemographic characteristics. Nevertheless, the prevalence of overweight and obesity was significantly lower in children with H. pylori colonization compared to children with normal histology (31% in the noninfected group compared to 11% in the infected group, p = 0.04). The mean fat percentage was 24.3 ± 8.8 and 19.4 ± 6.9, respectively (p = 0.02). The findings of this prospective study are in agreement with previous studies and demonstrate an inverse relationship between H. pylori colonization and overweight or obesity among symptomatic children. A larger prospective, multiethnic investigation is warranted to more definitively determine the extent of this association.

  8. Preliminary Design of a Pendulum Experiment for Searching for a Lorentz-Violation Signal

    CERN Document Server

    Shao, Cheng-Gang; Tan, Yu-Jie

    2016-01-01

    This work mainly presents a preliminary design for a pendulum experiment with both the source mass and the test mass in a striped pattern to amplify the Lorentz-violation signal, since the signal is sensitive to edge effects.

  9. Patient experience in the pediatric emergency department: do parents and children feel the same?

    Science.gov (United States)

    Parra, Cristina; Vidiella, Nereida; Marin, Irene; Trenchs, Victoria; Luaces, Carles

    2017-07-01

    The objectives are to describe the experience of children and parents in a pediatric emergency service (PED) and to determine whether there are differences of opinion between the two groups. This was a descriptive study. A questionnaire was designed based on the Picker questionnaire on the patient experience. From July through December 2015, a survey was made of the children aged 8-18 treated in the PED, as well as of their parents. The proportion of dissatisfaction was determined. A total of 514 questionnaires (257 children, 257 parents) were completed. The most poorly rated aspects according to the children and parents were the entertainment activities (43.2%), the waiting time (23.7%), and the treatment for pain (10.5%). Differences were detected in the experiences of the children and the parents regarding the overlong waiting time (28.0% children vs 19.5% parents; p = 0.023), inadequate explanations (7.0 vs 1.6%, p = 0.002), inadequate treatment for pain (14.4 vs 6.6%; p = 0.004), and insufficient privacy (11.7 vs 2.7%; p experience as patients more negatively, which needs to be borne in mind in order to improve the attention provided. What is Known: • Studying the experience of patients is a key point in patient-centered medicine. • The experience of the pediatric patient has been little studied to date. The experience of the children is often inferred from that of their parents. Nevertheless, the experience of the children as patients might be different. What is New: • Overall, the experience of children and parents in the pediatric emergency department in the study is positive. Some aspects of the experience in emergency are poorly rated by the children, such as the waiting time, the information provided, treatment for pain, and privacy during the visit. • The experience of the children (and not merely that of their parents) needs to be studied in order to improve those areas that are rated poorly do as to enrich the experience in the

  10. Expression of Innate Immunity Genes in Epithelial Cells of Hypertrophic Adenoids with and without Pediatric Chronic Rhinosinusitis: A Preliminary Report

    Institute of Scientific and Technical Information of China (English)

    Xiao-Peng Qu; Zhen-Xiao Huang; Yan Sun; Ting Ye; Shun-Jiu Cui; Qian Huang; Li-Jing Ma

    2015-01-01

    Background:Adenoid hypertrophy (AH) is associated with pediatric chronic rhinosinusitis (pCRS),but its role in the inflammatory process of pCRS is unclear.It is thought that innate immunity gene expression is disrupted in the epithelium of patients with chronic rhinosinusitis (CRS),including antimicrobial peptides and pattern recognition receptors (PRRs).The aim of this preliminary study was to detect the expression of innate immunity genes in epithelial cells of hypertrophic adenoids with and without pCRS to better understand their role in pCRS.Methods:Nine pCRS patients and nine simple AH patients undergoing adenoidectomy were recruited for the study.Adenoidal epithelium was isolated,and real-time quantitative polymerase chain reaction (RT-qPCR) was employed to measure relative expression levels of the following messenger RNAs in hypertrophic adenoid epithelial cells of pediatric patients with and without CRS:Human β-defensin (HBD) 2 and 3,surfactant protein (SP)-A and D,toll-like receptors 1-10,nucleotide-binding oligomerization domain (NOD)-like receptors NOD 1,NOD 2,and NACHT,LRR and PYD domains-containing protein 3,retinoic acid-induced gene 1,melanoma differentiation-associated gene 5,and nuclear factor-KB (NF-κB).RT-qPCR data from two groups were analyzed by independent sample t-tests and Mann-Whitney U-tests.Results:The relative expression of SP-D in adenoidal epithelium of pCRS group was significantly lower than that in AH group (pCRS 0.73 ± 0.10 vs.AH 1.21 ± 0.15;P =0.0173,t =2.654).The relative expression levels of all tested PRRs and NF-κB,as well as HBD-2,HBD-3,and SP-A,showed no statistically significant differences in isolated adenoidal epithelium between pCRS group and AH group.Conclusions:Down-regulated SP-D levels in adenoidal epithelium may contribute to the development of pCRS.PRRs,however,are unlikely to play a significant role in the inflammatory process of pCRS.

  11. Expression of Innate Immunity Genes in Epithelial Cells of Hypertrophic Adenoids with and without Pediatric Chronic Rhinosinusitis: A Preliminary Report

    Directory of Open Access Journals (Sweden)

    Xiao-Peng Qu

    2015-01-01

    Full Text Available Background: Adenoid hypertrophy (AH is associated with pediatric chronic rhinosinusitis (pCRS, but its role in the inflammatory process of pCRS is unclear. It is thought that innate immunity gene expression is disrupted in the epithelium of patients with chronic rhinosinusitis (CRS, including antimicrobial peptides and pattern recognition receptors (PRRs. The aim of this preliminary study was to detect the expression of innate immunity genes in epithelial cells of hypertrophic adenoids with and without pCRS to better understand their role in pCRS. Methods: Nine pCRS patients and nine simple AH patients undergoing adenoidectomy were recruited for the study. Adenoidal epithelium was isolated, and real-time quantitative polymerase chain reaction (RT-qPCR was employed to measure relative expression levels of the following messenger RNAs in hypertrophic adenoid epithelial cells of pediatric patients with and without CRS: Human β-defensin (HBD 2 and 3, surfactant protein (SP-A and D, toll-like receptors 1-10, nucleotide-binding oligomerization domain (NOD-like receptors NOD 1, NOD 2, and NACHT, LRR and PYD domains-containing protein 3, retinoic acid-induced gene 1, melanoma differentiation-associated gene 5, and nuclear factor-κB (NF-κB. RT-qPCR data from two groups were analyzed by independent sample t-tests and Mann-Whitney U-tests. Results: The relative expression of SP-D in adenoidal epithelium of pCRS group was significantly lower than that in AH group (pCRS 0.73 ± 0.10 vs. AH 1.21 ± 0.15; P = 0.0173, t = 2.654. The relative expression levels of all tested PRRs and NF-κB, as well as HBD-2, HBD-3, and SP-A, showed no statistically significant differences in isolated adenoidal epithelium between pCRS group and AH group. Conclusions: Down-regulated SP-D levels in adenoidal epithelium may contribute to the development of pCRS. PRRs, however, are unlikely to play a significant role in the inflammatory process of pCRS.

  12. Initial Experience of Transurethral Resection with Pediatric Resectoscope for Incomplete Anterior Urethral Stricture

    Directory of Open Access Journals (Sweden)

    Won Seok Jang

    2013-04-01

    Full Text Available Purpose Endoscopic urethrotomy is an alternative method in treatment of urethral stricture. However, it have high recurrence rate because of the remained fibrotic tissue. Removal of the fibrotic tissue can maintain the patency of the urethral lumen after the procedure. We report the therapeutic efficacy of our initial experience using pediatric resectoscope for treating anterior urethral stricture in 16 cases. Materials and Methods From January 2009 to April 2011, transurethral resection with pediatric resectoscope was primarily performed on 16 patients with anterior urethral stricture. Retrograde urethrography, uroflowmetry, postvoid residual volume, IPSS score and QoL score were performed preoperatively. We used 11.5Fr pediatric resectoscope (Wolf and monopolar electrosurgical generator. The stricture was incised under vision at the 12 o'clock location or the site of maximum scar tissue or narrowing in asymmetric strictures for working space. After incision, transurethral resection with pediatric resectoscope was performed to all scar tissues. Monopolar cutting current was set on 45 watt and coagulation current was set on 30 watt, fulgurate mode. Postoperatively, drainage of the bladder was performed for 7 days using an 18F latex catheter. Patients were followed up by IPSS score, QoL score, uroflowmetry and postvoid residual volume. Results Successful results without recurrence were achieved in 11 of 16patients. Postoperative urethral dilation had been performed average 2.4 times (0∼6 times. When we classified the results by etiology, the number of successful results in strictures with a trauma, iatrogenic, or unknown cause was 5 (7/11, 3 (3/4 and 1 (1/1, respectively. In 5 patients who failed treatment, we repeated transurethral resection with pediatric resectoscope in 1 patient, and periodic urethral dilation in 4 patients. No operative complications occurred in any patients. Conclusions Transurethral resection with pediatric resectoscope

  13. Accountability and pediatric physician-researchers: are theoretical models compatible with Canadian lived experience?

    Directory of Open Access Journals (Sweden)

    Czoli Christine

    2011-10-01

    Full Text Available Abstract Physician-researchers are bound by professional obligations stemming from both the role of the physician and the role of the researcher. Currently, the dominant models for understanding the relationship between physician-researchers' clinical duties and research duties fit into three categories: the similarity position, the difference position and the middle ground. The law may be said to offer a fourth "model" that is independent from these three categories. These models frame the expectations placed upon physician-researchers by colleagues, regulators, patients and research participants. This paper examines the extent to which the data from semi-structured interviews with 30 physician-researchers at three major pediatric hospitals in Canada reflect these traditional models. It seeks to determine the extent to which existing models align with the described lived experience of the pediatric physician-researchers interviewed. Ultimately, we find that although some physician-researchers make references to something like the weak version of the similarity position, the pediatric-researchers interviewed in this study did not describe their dual roles in a way that tightly mirrors any of the existing theoretical frameworks. We thus conclude that either physician-researchers are in need of better training regarding the nature of the accountability relationships that flow from their dual roles or that models setting out these roles and relationships must be altered to better reflect what we can reasonably expect of physician-researchers in a real-world environment.

  14. Parents' Experience with Pediatric Microarray: Transferrable Lessons in the Era of Genomic Counseling.

    Science.gov (United States)

    Hayeems, R Z; Babul-Hirji, R; Hoang, N; Weksberg, R; Shuman, C

    2016-04-01

    Advances in genome-based microarray and sequencing technologies hold tremendous promise for understanding, better-managing and/or preventing disease and disease-related risk. Chromosome microarray technology (array based comparative genomic hybridization [aCGH]) is widely utilized in pediatric care to inform diagnostic etiology and medical management. Less clear is how parents experience and perceive the value of this technology. This study explored parents' experiences with aCGH in the pediatric setting, focusing on how they make meaning of various types of test results. We conducted in-person or telephone-based semi-structured interviews with parents of 21 children who underwent aCGH testing in 2010. Transcripts were coded and analyzed thematically according to the principles of interpretive description. We learned that parents expect genomic tests to be of personal use; their experiences with aCGH results characterize this use as intrinsic in the test's ability to provide a much sought-after answer for their child's condition, and instrumental in its ability to guide care, access to services, and family planning. In addition, parents experience uncertainty regardless of whether aCGH results are of pathogenic, uncertain, or benign significance; this triggers frustration, fear, and hope. Findings reported herein better characterize the notion of personal utility and highlight the pervasive nature of uncertainty in the context of genomic testing. Empiric research that links pre-test counseling content and psychosocial outcomes is warranted to optimize patient care.

  15. Effect of oxygen manipulations on benthic foraminifera: A preliminary experiment

    Digital Repository Service at National Institute of Oceanography (India)

    Panchang, R.; Nigam, R.; Linshy, V.; Rana, S.S.; Ingole, B.S.

    marine protists, which have a great potential to detect ecological stress at a very early stage. Due to their high fossilization potential, an understanding of the ecology of foraminifera allows interpretations of the past benthic environmental...’. Many soft-shelled forms also exist, but have not been considered in the present study as they have no fossilization potential and thereby of no geological significance. This is a preliminary report and only presents the effect of oxygen...

  16. Preliminary Experiments with XKaapi on Intel Xeon Phi Coprocessor

    OpenAIRE

    Ferreira Lima, Joao Vicente; Broquedis, Francois; Gautier, Thierry; Raffin, Bruno

    2013-01-01

    International audience; This paper presents preliminary performance comparisons of parallel applications developed natively for the Intel Xeon Phi accelerator using three different parallel programming environments and their associated runtime systems. We compare Intel OpenMP, Intel CilkPlus and XKaapi together on the same benchmark suite and we provide comparisons between an Intel Xeon Phi coprocessor and a Sandy Bridge Xeon-based machine. Our benchmark suite is composed of three computing k...

  17. Pediatric Discharge Content: A Multisite Assessment of Physician Preferences and Experiences

    Science.gov (United States)

    Coghlin, Daniel T.; Leyenaar, JoAnna K.; Shen, Mark; Bergert, Lora; Engel, Richard; Hershey, Daniel; Mallory, Leah; Rassbach, Caroline; Woehrlen, Tess; Cooperberg, David

    2014-01-01

    BACKGROUND AND OBJECTIVES Professional medical societies endorse prompt, consistent discharge communication to primary care providers (PCPs) on discharge. However, evidence is limited about what clinical elements to communicate. Our main goal was to identify and compare the clinical elements considered by PCPs and pediatric hospitalists to be essential to communicate to PCPs within 2 days of pediatric hospital discharge. A secondary goal was to describe experiences of the PCPs and pediatric hospitalists regarding sending and receiving discharge information. METHODS A survey of physician preferences and experiences regarding discharge communication was sent to 320 PCPs who refer patients to 16 hospitals, with an analogous survey sent to 147 hospitalists. Descriptive statistics were calculated, and χ2 analyses were performed. RESULTS A total of 201 PCPs (63%) and 71 hospitalists (48%) responded to the survey. Seven clinical elements were reported as essential by >75% of both PCPs and hospitalists: dates of admission and discharge; discharge diagnoses; brief hospital course; discharge medications; immunizations given during hospitalization; pending laboratory or test results; and follow-up appointments. PCPs reported reliably receiving discharge communication significantly less often than hospitalists reported sending it (71.8% vs 85.1%; P < .01), and PCPs considered this communication to be complete significantly less often than hospitalists did (64.9% vs 79.1%; P < .01). CONCLUSIONS We identified 7 core clinical elements that PCPs and hospitalists consider essential in discharge communication. Consistently and promptly communicating at least these core elements after discharge may enhance PCP satisfaction and patient-level outcomes. Reported rates of transmission and receipt of this information were suboptimal and should be targeted for improvement. PMID:24435595

  18. Whose Experience Is Measured?: A Pilot Study of Patient Satisfaction Demographics in Pediatric Otolaryngology

    Science.gov (United States)

    Nieman, Carrie L.; Benke, James R.; Ishman, Stacey L.; Smith, David F.; Boss, Emily F.

    2015-01-01

    Objectives/Hypothesis Despite a national emphasis on patient-centered care and cultural competency, minority and low-income children continue to experience disparities in health care quality. Patient satisfaction scores are a core quality indicator. The objective of this study was to evaluate race and insurance-related disparities in parent participation with pediatric otolaryngology satisfaction surveys. Study Design Observational analysis of patient satisfaction survey respondents from a tertiary pediatric otolaryngology division. Methods Demographics of survey respondents (Press Ganey Medical Practice Survey©) between January and July 2012 were compared to a clinic comparison group using t test and chi-square analyses. Multivariate logistic regression analyses were performed to assess likelihood to complete a survey based on race or insurance status. Results A total of 130 survey respondents were compared to 1,251 patients in the comparison group. The mean patient age for which the parent survey was completed was 5.7 years (6.1 years for the comparison group, P =0.18); 59.2% of children were ≤5 years old. Relative to the comparison group, survey respondents were more often white (77.7% vs. 58.1%; P <0.001) and privately insured (84.6% vs. 60.8%; P <0.001). Similarly, after controlling for confounding variables, parents of children who were white (OR 1.8, 95% CI 1.13–2.78, P =0.013) or privately insured (OR 2.9, 95% CI 1.74–4.85, P <0.001) were most likely to complete a survey. Conclusion Methods to evaluate satisfaction did not capture the racial or socioeconomic patient distribution within this pediatric division. These findings challenge the validity of applying patient satisfaction scores, as currently measured, to indicate health care quality. Future efforts to measure and improve patient experience should be inclusive of a culturally diverse population. Level of Evidence 2c. PMID:23853050

  19. AGC-1 Experiment and Final Preliminary Design Report

    Energy Technology Data Exchange (ETDEWEB)

    Robert L. Bratton; Tim Burchell

    2006-08-01

    This report details the experimental plan and design as of the preliminary design review for the Advanced Test Reactor Graphite Creep-1 graphite compressive creep capsule. The capsule will contain five graphite grades that will be irradiated in the Advanced Test Reactor at the Idaho National Laboratory to determine the irradiation induced creep constants. Seven other grades of graphite will be irradiated to determine irradiated physical properties. The capsule will have an irradiation temperature of 900 C and a peak irradiation dose of 5.8 x 10{sup 21} n/cm{sup 2} [E > 0.1 MeV], or 4.2 displacements per atom.

  20. The influence of family accommodation on pediatric hospital experience in Canada.

    Science.gov (United States)

    Franck, Linda S; Ferguson, Deron; Fryda, Sarah; Rubin, Nicole

    2017-08-15

    The goals of our study were to describe the types of family accommodation for parents of hospitalized children and to examine their influence on the pediatric hospital experience. This multi-site cohort survey included 10 hospitals in Ontario Province, Canada. Participants were parents of inpatient children (n = 1240). Main outcome measures included ratings of three parent-reported measures of hospital experience: overall hospital experience; willingness to recommend the hospital to family or friends; and how much the accommodation type helped parent stay involved in their child's hospital care. Parents most often stayed in the child's room (74.7%), their own home (12.3%), hotel (4.0%) or a Ronald McDonald House (3.0%). Accommodation varied based on hospital, parent and child factors. Length of stay and the child's health status were significant predictors for overall hospital experience and recommending the hospital to family or friends, but accommodation type was not. Families who stayed at a Ronald McDonald House reported greater involvement in their child's care compared with other accommodation types (odds ratio: 1.54-20.73 for contrasted accommodation types). Use of different overnight accommodations for families of hospitalized pediatric patients in Canada is similar to a previous report of U.S. family hospital accommodations. In contrast to the previous U.S. findings, Canadian hospital experience scores were lower and accommodation type was not a significant predictor of overall hospital experience or willingness to recommend the hospital. In Canada, as in the U.S., families who stayed at a Ronald McDonald House reported that this accommodation type significantly improved their ability to be involved in their child's care.

  1. A qualitative study exploring the experiences of parents of children admitted to seven Dutch pediatric intensive care units

    NARCIS (Netherlands)

    Latour, Jos M.; van Goudoever, Johannes B.; Schuurman, Beatrix Elink; Albers, Marcel J. I. J.; van Dam, Nicolette A. M.; Dullaart, Eugenie; van Heerde, Marc; Verlaat, Carin W. M.; van Vught, Elise M.; Hazelzet, Jan A.

    2011-01-01

    To explore parents' experiences during the admission of their children to a pediatric intensive care unit (PICU). Qualitative method using in-depth interviews. Thematic analysis was applied to capture parents' experiences. Thirty-nine mothers and 25 fathers of 41 children admitted to seven of the ei

  2. A qualitative study exploring the experiences of parents of children admitted to seven Dutch pediatric intensive care units

    NARCIS (Netherlands)

    J.M. Latour (Jos); J.B. van Goudoever (Hans); B.E. Schuurman (Beatrix); M.J.I.J. Albers (Marcel); N.A.M. van Dam (Nicolette); E. Dullaart (Eugenie); M. van Heerde (Marc); C.W.M. Verlaat (Carin); E.M. van Vught (Elise); J.A. Hazelzet (Jan)

    2011-01-01

    textabstractPurpose: To explore parents' experiences during the admission of their children to a pediatric intensive care unit (PICU). Method: Qualitative method using in-depth interviews. Thematic analysis was applied to capture parents' experiences. Thirty-nine mothers and 25 fathers of 41 childre

  3. The role of psychology in a pediatric outpatient cardiology setting: preliminary results from a new clinical program.

    Science.gov (United States)

    Brosig, Cheryl; Yang, Kai; Hoffmann, Raymond G; Dasgupta, Mahua; Mussatto, Kathleen

    2014-12-01

    The aim of this study was to provide a descriptive analysis of a new clinical program integrating psychology services within a pediatric outpatient cardiology clinic. Patients with congenital heart disease (CHD) (n = 79) were referred for psychological services by their pediatric cardiologist. Parents completed the child behavior checklist, and the pediatric quality of life inventory generic core scales (PedsQL parent report). Teachers completed the teacher report form. Reasons for referral included: emotional problems (29%); attention problems (25%); learning problems (22%); behavior problems (16%); and developmental delay (8%). Parents and teachers reported higher rates of behavior problems and lower quality of life scores than the general population. Psychological evaluation suggested that incorporating a psychologist within a pediatric cardiology clinic may be beneficial for children with CHD in order to optimize their psychosocial functioning. Practice implications for implementing psychology services within a pediatric outpatient cardiology program are discussed.

  4. Pediatric palliative sedation therapy with propofol: recommendations based on experience in children with terminal cancer.

    Science.gov (United States)

    Anghelescu, Doralina L; Hamilton, Hunter; Faughnan, Lane G; Johnson, Liza-Marie; Baker, Justin N

    2012-10-01

    The use of propofol for palliative sedation of children is not well documented. Here we describe our experience with the use of propofol palliative sedation therapy (PST) to alleviate intractable end-of-life suffering in three pediatric oncology patients, and propose an algorithm for the selection of such candidates for PST. We identified inpatients who had received propofol PST within 20 days of death at our institution between 2003 and 2010. Their medical records were reviewed for indicators of pain, suffering, and sedation from 48 hours before PST to the time of death. We also tabulated consumption of opioids and other symptom management medications, pain scores, and adverse events of propofol, and reviewed clinical notes for descriptors of suffering and/or palliation. Three of 192 (1.6%) inpatients (aged 6-15 years) received propofol PST at the end of life. Consumption of opioids and other supportive medications decreased during PST in two cases. In the third case, pain scores remained high and sedation was the only effective comfort measure. Clinical notes suggested improved comfort and rest in all patients. Propofol infusions were continued until the time of death. Our experience demonstrates that propofol PST is a useful palliative option for pediatric patients experiencing intractable suffering at the end of life. We describe an algorithm that can be used to identify such children who are candidates for PST.

  5. Preliminary results of the scientific experiments on the Kosmos-936 biosatellite

    Science.gov (United States)

    1977-01-01

    The scientific equipment and experiments on the Kosmos-936 biosatellite are described, including various ground controls and the lab unit for studies at the descent vehicle landing site. Preliminary results are presented of the physiological experiment with rats, biological experiments with drosophila and higher and lower plants, and radiation physics and radiobiology studies for the planning of biological protection on future space flights. The most significant conclusion from the preliminary data is that rats tolerate space flight better with an artificial force of gravity.

  6. Zero-gravity cloud physics laboratory: Experiment program definition and preliminary laboratory concept studies

    Science.gov (United States)

    Eaton, L. R.; Greco, E. V.

    1973-01-01

    The experiment program definition and preliminary laboratory concept studies on the zero G cloud physics laboratory are reported. This program involves the definition and development of an atmospheric cloud physics laboratory and the selection and delineations of a set of candidate experiments that must utilize the unique environment of zero gravity or near zero gravity.

  7. Interactions between piscivores, zooplanktivores and zooplankton in submerged macrophytes : Preliminary observations from enclosure and pond experiments

    DEFF Research Database (Denmark)

    Jacobsen, Lene; Perrow, M.R.; Landkildehus, F.

    1997-01-01

    behavioural changes of zooplanktivores has received little attention, even though this may be an important mechanism in enhancing the stability of submerged macrophytes in shallow lakes. Preliminary observations from an unreplicated large-scale field enclosure experiment and a replicated pond experiment...

  8. [Acute alcohol intoxication among children and adolescents admitted to the Department of Pediatrics, Pediatric Endocrinology and Diabetes, Medical University of Silesia, Katowice during 2000-2010--preliminary study].

    Science.gov (United States)

    Kamińska, Halla; Agnieszka, Zachurzok-Buczyńska; Gawlik, Aneta; Małecka-Tendera, Ewa

    2012-01-01

    The alcohol drinking at the young age is a risk factor of alcohol addiction later in life, and is connected with school problems, binge drinking, tobacco addiction, illegal drug use, violence, crime commitment, and risky sexual behaviors. Alcohol drinking in the last 12 months is declared by 78% Polish children. The aim of the study was to evaluate the frequency of admissions due to alcohol intoxication to the Department of Pediatrics, Pediatric Endocrinology and Diabetes, Pediatric Center of Silesia and the identification of the risk factors of the acute alcohol intoxication among Polish children and adolescents. Ten-year retrospective study includes investigation of patients medical records from the Department of Pediatrics. Among 8048 patients hospitalized in the Department of Pediatrics between the years 2000-2010, 220 (2.7%) cases of acute alcohol poisoning occurred The detailed data analysis from 139 patients [66 (47.5%) girls, 73 (52,5%) boys] was done. In the years 2006-2010 the number of girls admitted to the department increased in comparison to boys. The largest group of patients was at age between 14 and 16 years [61 (44%) children]. The blood alcohol concentration at the moment of admission to the hospital was 0.1 to 4.0 per thousand. In most cases (92.8%) the alcohol intoxication was intentional. Five percent of them were suicide attempts. In the youngest group of children alcohol abuse was unintentional. 23 (16.5%) of patients initially needed admission to the intensive care unit. In 30 (21.6%) patient the family was incomplete and five times more often father was absent. The alcohol addiction occurs in 18 (13.0%) fathers and 10 (7.2%) mothers of our patients. It is concluded that over the last decade the number of girls admitted due to alcohol abuse increased. Children at school grade between 7-9 are intoxicated most often. One six of intoxicated patents needed hospitalization at intensive care unit.

  9. Preliminary Studies for Three Experiments at Treiman-Yang Criterion

    Science.gov (United States)

    Kres, I. V.; Kondratyev, V. N.; Cherubini, S.; Spitaleri, C.

    2016-05-01

    Nuclear reactions with three bodies in their final state may proceed through different reaction mechanisms. The Feynman graph technique has been widely used to describe such reactions. However, it is very difficult in general to select the graphs that dominate in given process. The Treiman-Yang criterion is one of the most powerful experimental tests for verifying the pole approximation prediction when describing a quasi-free reaction mechanism. We propose the theoretical study of the H2(B10, α Be7)ns, H1(B11, α1α2)αs, He3(Be9, α1α2)αs reactions at different energies. The preliminary study helps to check the existence of a QF channel by using the TY creterion.

  10. Nursing and dental students' and pediatric dentistry residents' responses to experiences with interprofessional education.

    Science.gov (United States)

    Czarnecki, Gail A; Kloostra, Stephanie J; Boynton, James R; Inglehart, Marita R

    2014-09-01

    Interprofessional education (IPE) has received increasingly more attention over recent years. The objectives of this study were to assess 1) how nursing students' considerations concerning their own oral health and oral health-related knowledge changed from before to after experiencing IPE; 2) how nursing students', dental students', and pediatric dentistry residents' IPE-related attitudes and Readiness for Interprofessional Learning Scale (RIPLS) scores changed after experiencing an IPE rotation; and 3) how these groups' attitudes and RIPLS scores were related. Data were collected from three groups who participated in an IPE rotation: thirty-eight of forty third-year dental students (95 percent response rate), all thirty-three nursing students (100 percent), and all six pediatric dentistry residents (100 percent) prior to the rotation, and 100 percent of each group after the rotation. As a control group, data were also collected at the beginning of the winter term from first-year dental students (104 out of 105; 99 percent response rate) and second-year dental students (102 out of 116; 88 percent); the same groups were surveyed at the end of term, with response rates of 98 percent for first-year students and 89 percent for second-year students. After the rotation, the nursing students' tooth brushing frequency increased, and their comfort level with dental visits and oral health-related knowledge improved. The dental students rated the importance of nurses' having oral health-related knowledge and skills lower than did the nursing students and pediatric dentistry residents. The groups' RIPLS scores correlated with these importance ratings. Overall, while the nursing students showed positive responses to IPE, the dental students' attitudes and RIPLS scores did not change as a result of the IPE experience. Future research should explore the conditions under which dental students are impacted by IPE.

  11. Surgical analysis of pediatric and adolescent sporadic pheochromocytoma: single center experience.

    Science.gov (United States)

    Osman, Yasser; Hussein, Naser; Sarhan, Osama; Shorrab, Ahmed A; Dawaba, Mohamed; Ghoneim, Mohamed A

    2011-12-01

    The aim of this study is to review our experience with sporadic pheochromocytoma in pediatrics and adolescents focusing upon surgical approach, incidence of malignancy, and recurrence rate. Between 1990 and 2007, 8 pediatric patients were diagnosed with sporadic pheochromocytoma. Demographic data, clinical and radiological findings, laboratory profile, preoperative preparation, surgical approach, operative findings, postoperative course as well as pathologic diagnosis of the removed specimen were reviewed. Mean age of presentation was 13.1 ± 4.7 years. Five patients had right-sided masses, 1 harbored left-sided mass, and bilaterality was observed in 2 with mean size of 5.7 ± 1.3 cm. Computed tomography showed no evidence of local infiltration, regional lymphadenopathy or distant metastasis in all patients but two. Six masses were excised through thoraco-abdominal approach, 3 were removed laparoscopically, while percutaneous alcohol ablation was adopted for the last. We had one postoperative death (12.5%:1/8), and the remaining 7 patients were followed for a mean of 8.6 ± 3 years. Five patients never had recurrence. Bilateral recurrence developed in 2 patients, where they were safely excised in one patient and was a part of disseminated disease in the other. Malignant nature of the disease was proved in 2 patients and showed poor survival. Under adequate anesthetic control, pediatric pheochromocytoma could be safely managed through both the open and laparoscopic approaches. Advanced radiological stage would suggest the malignant nature of the disease with dismal outcome. Long-term follow-up is warranted for possibility of delayed curable recurrence.

  12. Private Cord Blood Banking: Experiences And Views Of Pediatric Hematopoietic Cell Transplantation Physicians

    Science.gov (United States)

    Thornley, Ian; Eapen, Mary; Sung, Lillian; Lee, Stephanie J.; Davies, Stella M.; Joffe, Steven

    2011-01-01

    Objective Private cord blood banks are for-profit companies that facilitate storage of umbilical cord blood for personal or family use. Pediatric hematopoietic cell transplantation (HCT) physicians are currently best situated to use cord blood therapeutically. We sought to describe the experiences and views of these physicians regarding private cord blood banking. Participants and Methods Emailed cross-sectional survey of pediatric HCT physicians in the United States and Canada. 93/152 potentially eligible physicians (93/130 confirmed survey recipients) from 57 centers responded. Questions addressed the number of transplants performed using privately banked cord blood, willingness to use banked autologous cord blood in specific clinical settings, and recommendations to parents regarding private cord blood banking. Results Respondents reported having performed 9 autologous and 41 allogeneic transplants using privately banked cord blood. In 36/40 allogeneic cases for which data were available, the cord blood had been collected because of a known indication in the recipient. Few respondents would choose autologous cord blood over alternative stem cell sources for treatment of acute lymphoblastic leukemia in second remission. In contrast, 55% would choose autologous cord blood to treat high-risk neuroblastoma, or to treat severe aplastic anemia in the absence of an available sibling donor. No respondent would recommend private cord blood banking for a newborn with one healthy sibling when both parents were of Northern European descent; 11% would recommend banking when parents were of different minority ethnicities. Conclusions Few transplants have been performed using cord blood stored in the absence of a known indication in the recipient. Willingness to use banked autologous cord blood varies depending on disease and availability of alternative stem cell sources. Few pediatric HCT physicians endorse private cord blood banking in the absence of an identified recipient

  13. Long term outcome of acquired food allergy in pediatric liver recipients: a single center experience

    Directory of Open Access Journals (Sweden)

    Antigoni Mavroudi

    2012-01-01

    Full Text Available Food induced sensitization has been reported in pediatric liver recipients. However long term follow up has not been established so far. We report here our experience regarding 3 pediatric patients who developed acquired food allergy after liver transplantation. The first patient suffered from persistent diarrhea and eczema. The second one presented with abdominal pain with no signs of rejection, abdominal discomfort, vomiting when ingesting milk proteins and responded well to the elimination diet. The third patient presented with facial angioedema and hoarseness of voice. She had multiple food allergies and reacted to milk, egg and sesame. All the patients had elevated total Immunoglobulin E (IgE and elevated specific IgE antibodies to the implicated food allergens. The first patient presented clinical manifestations of allergy when she was 19 months old. The second patient became allergic at the age of 16 and the third patient at the age of 3. The symptoms of food allergy persisted for 8 years in the first case and for 2 years in the other two cases. Low levels of specific IgE antibodies to the implicated food allergens and an enhanced T-helper 1 cell immune response toward interferon-gamma production were markers of tolerance acquisition. The long term prognosis in our cases was excellent. Food allergy resolved in all the patients. The long term prognosis of acquired food allergy after liver transplantation is currently obscure. More studies would be needed including greater number of patients to determine whether acquired food allergy is transient in pediatric liver recipients.

  14. A new extra-abdominal channel alternative to the mitrofanoff principle: experimental and preliminary clinical experience

    Directory of Open Access Journals (Sweden)

    Antonio Macedo Jr.

    2009-04-01

    Full Text Available INTRODUCTION: The appendix is the gold-standard channel for the Mitrofanoff principle in pediatric urology, but the search for alternatives is justified considering it may not be available or preferably used for colonic stomas (Malone antegrade continence enema. The aim of this study is to report on technical feasibility of a new approach for creating catheterizable channels in a rabbit model and to present our preliminary clinical experience. MATERIAL AND METHODS: We configured a tube from two rectangular skin flaps 1x4 cm opposite each other in the middle line of the lower inferior abdomen. The channel was anastomosed to the bladder dome with embedding sutures to create a valvular mechanism. The experimental study consisted of 12 rabbits, divided in 4 groups according to the sacrifice schedule at 2, 4, 8 and 12 weeks. At 30th postoperative day, an urodynamic evaluation was performed to record continence of the stoma. A histological analysis of the specimens stained with hematoxylin-eosin, Masson trichrome and Picrosirius red was also done in group 2 (sacrifice at 4 weeks postoperatively. We used this method in 3 patients with congenital non-neurogenic bladder disease presenting with massive residual volumes without compliance deficits. RESULT: The technique proved feasible in all animals, 9 of 12 could be easily catheterized and underwent urodynamic study. No stoma leakage was observed in 7 animals at high bladder pressures (> 50 cm H20 and only 2 animals had some leakage at 40 cm H20. Urodynamics performed through the stoma showed urethral leakage at 20 cm H20, therefore demonstrating the efficacy of the valvular mechanism. Histological analysis confirmed good integration between the tube and the bladder. Mean follow-up of the clinical series (3 patients was 7.2 months. Two patients remained continent up to 4 hours, whereas 1 patient had some leakage after 2 hours. CONCLUSION: We were able to confirm feasibility of a new extra

  15. Preliminary results from the {sup 51}Cr neutrino source experiment in GALLEX

    Energy Technology Data Exchange (ETDEWEB)

    Hampel, W.; Heusser, G.; Kiko, J. [Max-Planck-Institut fuer Kernphysik, Heidelberg (Germany)] [and others

    1996-09-01

    The GALLEX collaboration performed a second {sup 51}Cr neutrino source experiment during fall 1995. The full results from this second source experiment will not be available before the end of 1996. Meanwhile, we present a short description and preliminary results in this informal note. The (preliminary) value of the activity obtained form direct measurements has been found equal to (68.7 {+-}0.7) PBq (with 1-sigma error). This value, which is about 10% higher than the activity of the first source, was achieved by optimizing the irradiation conditions in the Silo{acute e} reactor and doing a longer irradiation of the enriched chromium. Preliminary results show that the ratio, R, of the radiochemically determined activity from {sup 71}Ge counting (57.1 {+-} PBq) to the directly measured activity is (0.83 {+-} 0.10). The combined value of R for the two source experiments is (0.92 {+-} 0.08).

  16. A critical appraisal of the first-year experience of 5 pediatric orthopaedic surgeons.

    Science.gov (United States)

    Fletcher, Nicholas D; Larson, Annalise N; Glotzbecker, Michael P; Shore, Benjamin J; Hydorn, Christopher R

    2014-09-01

    The transition into practice following a fellowship in pediatric orthopaedics is challenging. This study seeks to describe the first-year experiences of 5 pediatric orthopaedists. An Institutional Review Board-approved retrospective review was conducted of 5 pediatric orthopaedic surgeons' first year in practice. All were fellowship trained and practiced at private or academic subspecialty groups. Clinical volume, payor mix, surgical cases, as well as complications were evaluated. A total of 1172 surgical procedures were available for review. Surgeons performed an average of 234 cases with a mean case load of 19.5 procedures per month. Fracture care and surgical management of infection represented the largest number of procedures. 42.3% of patients were covered by government insurance or were uninsured. Surgeons saw an average of 30.5 new patients per week in clinic. Of these, 10.7% of patients were scheduled for an elective surgical case. A sample of clinical practice revealed that 41.3% of patients were covered by government or no insurance. 17.8% of surgical patients sustained a complication with the majority being minor or expected. 18.8% of complications were major and required repeat operation. Complications peaked in the fourth month of practice. Although clinical and surgical volumes can vary during the first year of practice, fracture care and surgical management of infection represent the majority of operative cases. A large portion of surgical volume results from emergent care, whereas elective cases are more elusive with only 1 in 10 elective patients resulting in surgical treatment. Despite a significant number of untoward events related to surgery, major surgical complications are uncommon in the first year of practice. The majority of surgical cases in the first year of practice are due to trauma and infection. A high volume of patients must be seen to establish a practice, particularly given the high rate of Medicaid patients. These figures provide

  17. High-Frequency Oscillatory Ventilation in Pediatric Acute Lung Injury: A Multicenter International Experience.

    Science.gov (United States)

    Rettig, Jordan S; Smallwood, Craig D; Walsh, Brian K; Rimensberger, Peter C; Bachman, Thomas E; Bollen, Casper W; Duval, Els L; Gebistorf, Fabienne; Markhorst, Dick G; Tinnevelt, Marcel; Todd, Mark; Zurakowski, David; Arnold, John H

    2015-12-01

    We aim to describe current clinical practice, the past decade of experience and factors related to improved outcomes for pediatric patients receiving high-frequency oscillatory ventilation. We have also modeled predictive factors that could help stratify mortality risk and guide future high-frequency oscillatory ventilation practice. Multicenter retrospective, observational questionnaire study. Seven PICUs. Demographic, disease factor, and ventilatory and outcome data were collected, and 328 patients from 2009 to 2010 were included in this analysis. None. Patients were classified into six cohorts based on underlying diagnosis. We used univariate analysis to identify factors associated with mortality risk and multivariate logistic regression to identify independent predictors of mortality risk. An oxygenation index greater than 35 and immunocompromise exhibited the greatest predictive power (p highly dependent on primary underlying condition. A trend toward an increase in oscillator amplitude and frequency was observed when compared with historical data. Given the number of centers and subjects included in the database, these findings provide a robust description of current practice regarding the use of high-frequency oscillatory ventilation for pediatric hypoxic respiratory failure. Patients with severe hypoxic respiratory failure and immunocompromise had the highest mortality risk, and those with respiratory syncytial virus had the lowest. A means of identifying the risk of 30-day mortality for subjects can be obtained by identifying the underlying disease and oxygenation index on conventional ventilation preceding the initiation of high-frequency oscillatory ventilation.

  18. FDDI information management system for centralizing interactive, computerized multimedia clinical experiences in pediatric rheumatology/Immunology.

    Science.gov (United States)

    Rouhani, R; Cronenberger, H; Stein, L; Hannum, W; Reed, A M; Wilhelm, C; Hsiao, H

    1995-01-01

    This paper describes the design, authoring, and development of interactive, computerized, multimedia clinical simulations in pediatric rheumatology/immunology and related musculoskeletal diseases, the development and implementation of a high speed information management system for their centralized storage and distribution, and analytical methods for evaluating the total system's educational impact on medical students and pediatric residents. An FDDI fiber optic network with client/server/host architecture is the core. The server houses digitized audio, still-image video clips and text files. A host station houses the DB2/2 database containing case-associated labels and information. Cases can be accessed from any workstation via a customized interface in AVA/2 written specifically for this application. OS/2 Presentation Manager controls, written in C, are incorporated into the interface. This interface allows SQL searches and retrievals of cases and case materials. In addition to providing user-directed clinical experiences, this centralized information management system provides designated faculty with the ability to add audio notes and visual pointers to image files. Users may browse through case materials, mark selected ones and download them for utilization in lectures or for editing and converting into 35mm slides.

  19. An initial experience with a digital drainage system during the postoperative period of pediatric thoracic surgery

    Science.gov (United States)

    Costa, Altair da Silva; Bachichi, Thiago; Holanda, Caio; Rizzo, Luiz Augusto Lucas Martins De

    2016-01-01

    ABSTRACT Objective: To report an initial experience with a digital drainage system during the postoperative period of pediatric thoracic surgery. Methods: This was a prospective observational study involving consecutive patients, ≤ 14 years of age, treated at a pediatric thoracic surgery outpatient clinic, for whom pulmonary resection (lobectomy or segmentectomy via muscle-sparing thoracotomy) was indicated. The parameters evaluated were air leak (as quantified with the digital system), biosafety, duration of drainage, length of hospital stay, and complications. The digital system was used in 11 children (mean age, 5.9 ± 3.3 years). The mean length of hospital stay was 4.9 ± 2.6 days, the mean duration of drainage was 2.5 ± 0.7 days, and the mean drainage volume was 270.4 ± 166.7 mL. The mean maximum air leak flow was 92.78 ± 95.83 mL/min (range, 18-338 mL/min). Two patients developed postoperative complications (atelectasis and pneumonia, respectively). The use of this digital system facilitated the decision-making process during the postoperative period, reducing the risk of errors in the interpretation and management of air leaks. PMID:28117476

  20. Kinetics experiments and bench-scale system: Background, design, and preliminary experiments

    Energy Technology Data Exchange (ETDEWEB)

    Rofer, C.K.

    1987-10-01

    The project, Supercritical Water Oxidation of Hazardous Chemical Waste, is a Hazardous Waste Remedial Actions Program (HAZWRAP) Research and Development task being carried out by the Los Alamos National Laboratory. Its objective is to obtain information for use in understanding the basic technology and for scaling up and applying oxidation in supercritical water as a viable process for treating a variety of DOE-DP waste streams. This report gives the background and rationale for kinetics experiments on oxidation in supercritical water being carried out as a part of this HAZWRAP Research and Development task. It discusses supercritical fluid properties and their relevance to applying this process to the destruction of hazardous wastes. An overview is given of the small emerging industry based on applications of supercritical water oxidation. Factors that could lead to additional applications are listed. Modeling studies are described as a basis for the experimental design. The report describes plug flow reactor and batch reactor systems, and presents preliminary results. 28 refs., 4 figs., 5 tabs.

  1. Preliminary Experiments on the Propagation of Plastic Deformation

    Science.gov (United States)

    2013-04-25

    Burnh:l.m Kelly Assist:J.nt to the Chief 2 Defense and Offense • • .. , . R E _S __ 1 RIC TED ., Preface ’ . The work described ~n this...variance with t he t heoreticall ;J- obta i ned curves and , hence, needs f~ther explanation. The object of the experiment s des cribed in t hi s...quite well with the experiments . The shape of t he pl3.stic wave is at some variance with the theor et i cally obta i ned curves. A.s shown by

  2. The MathScheme Library: Some Preliminary Experiments

    CERN Document Server

    Carette, Jacques; Jeremic, Filip; Maccio, Vincent; O'Connor, Russell; Tran, Quang M

    2011-01-01

    We present some of the experiments we have performed to best test our design for a library for MathScheme, the mechanized mathematics software system we are building. We wish for our library design to use and reflect, as much as possible, the mathematical structure present in the objects which populate the library.

  3. Long term sequelae of pediatric craniopharyngioma - literature review and 20 years of experience.

    Science.gov (United States)

    Cohen, Michal; Guger, Sharon; Hamilton, Jill

    2011-01-01

    Craniopharyngioma are rare histologically benign brain tumors that develop in the pituitary-hypothalamic area. They may invade nearby anatomical structures causing significant rates of neurological, neurocognitive, and endocrinological complications including remarkable hypothalamic damage. Information regarding long term implications of the tumors and treatment in the pediatric population is accumulating, and treatment goals appear to be changing accordingly. In this review we aim to present data regarding long term complications of craniopharyngioma in children and adolescents and our experience from a large tertiary center. Hypothalamic dysfunction was noted to be the most significant complication, adversely affecting quality of life in survivors. Obesity, fatigue, and sleep disorders are the most notable manifestations of this dysfunction, and treatment is extremely difficult. Changes in management in recent years show a potential for improved long term outcomes; we found a trend toward less aggressive surgical management and increasing use of adjuvant treatment, accompanied by a decrease in complication rates.

  4. Long term sequelae of pediatric craniopharyngioma - literature review and 20 years of experience

    Directory of Open Access Journals (Sweden)

    Michal eCohen

    2011-11-01

    Full Text Available Craniopharyngioma are rare histologically benign brain tumors that develop in the pituitary- hypothalamic area. They may invade nearby anatomical structures causing significant rates of neurological, neurocognitive and endocrinological complications including remarkable hypothalamic damage. Information regarding long term implications of the tumors and treatment in the pediatric population is accumulating, and treatment goals appear to be changing accordingly. In this review we aim to present data regarding long term complications of craniopharyngioma in children and adolescents and our experience from a large tertiary center. Hypothalamic dysfunction was noted to be the most significant complication, adversely affecting quality of life in survivors. Obesity, fatigue and sleep disorders are the most notable manifestations of this dysfunction, and treatment is extremely difficult. Changes in management in recent years show a potential for improved long term outcomes; we found a trend towards less aggressive surgical management and increasing use of adjuvant treatment, accompanied by a decrease in complication rates.

  5. Senior dental students' experience with Cariogram in a pediatric dentistry clinic.

    Science.gov (United States)

    Gonzalez, Cesar D; Okunseri, Christopher

    2010-02-01

    The study objective was to assess predoctoral dental students' experience with a caries risk assessment computer program in the pediatric dentistry clinic at Marquette University School of Dentistry. In 2005, spring semester sophomore dental students (class of 2008) were introduced to the caries risk assessment computer program "Cariogram." The students received a fifty-minute lecture on caries risk assessment and a demonstration on how to use Cariogram in the clinic. After two years of clinical exposure to Cariogram, sixty-six out of eighty senior dental students completed an anonymous eleven-item questionnaire on their experience with the tool. Each item on the questionnaire was scored on a five-point Likert scale with the exception of two questions. Full- and part-time faculty members in the pediatric dentistry clinic were involved in teaching and supervising students in the use of Cariogram for caries risk assessment after their training and calibration. Forty-five percent of the students who participated in the study agreed that Cariogram was easy to understand, and 18 percent disagreed. Thirty-six percent felt that it was easy to apply, and 25 percent reported that it was useful in determining caries preventive procedures. The students reported that 60 percent of full-time and 33 percent of part-time faculty were knowledgeable about Cariogram use. A majority of the students felt that Cariogram was not easy to understand, and eighty-two percent of them reported that they would not be using Cariogram in their private offices. Future studies should explore reasons why students do not feel inclined to use Cariogram as a caries risk assessment tool in their private practices even after being exposed to the tool in dental school.

  6. Discrete choice experiment to evaluate factors that influence preferences for antibiotic prophylaxis in pediatric oncology.

    Directory of Open Access Journals (Sweden)

    Dean A Regier

    Full Text Available BACKGROUND: Bacterial and fungal infections in pediatric oncology patients cause morbidity and mortality. The clinical utility of antimicrobial prophylaxis in children is uncertain and the personal utility of these agents is disputed. Objectives were to use a discrete choice experiment to: (1 describe the importance of attributes to parents and healthcare providers when deciding between use and non-use of antibacterial and antifungal prophylaxis; and (2 estimate willingness-to-pay for prophylactic strategies. METHODS: Attributes were chances of infection, death and side effects, route of administration and cost of pharmacotherapy. Respondents were randomized to a discrete choice experiment outlining hypothetical treatment options to prevent antibacterial or antifungal infections. Each respondent was presented 16 choice tasks and was asked to choose between two unlabeled treatment options and an opt-out alternative (no prophylaxis. RESULTS: 102 parents and 60 healthcare providers participated. For the antibacterial discrete choice experiment, frequency of administration was significantly associated with utility for parents but not for healthcare providers. Increasing chances of infection, death, side effects and cost were all significantly associated with decreased utility for parents and healthcare providers in both the antibacterial and antifungal discrete choice experiment. Parental willingness-to-pay was higher than healthcare providers for both strategies. CONCLUSION: Chances of infection, death, side effects and costs were all significantly associated with utility. Parents have higher willingness-to-pay for these strategies compared with healthcare providers. This knowledge can help to develop prophylaxis programs.

  7. Preliminary results of solar constant observations with the SOLCON experiment on ATLAS-1

    Science.gov (United States)

    Crommelynck, D.; Domingo, V.; Barkstrom, B.; Lee, R. B., II; Donaldson, J.; Telljohann, U; Warren, L.; Fichot, A.

    1994-01-01

    A brief description is given of the Solar Constant (SOLCAN) experiment on Atmospheric Laboratory for Applications and Science (ATLAS) 1, its scientific and technical objectives, as well as its measurement principle and its on board chronology of operations. A preliminary value of the solar constant during the third solar operation of the mission is also provided.

  8. THE MORPHOLOGICAL BASIS FOR OLFACTORY PERCEPTION OF STEROIDS DUING AGONISTIC BEHAVIOR IN LOBSTER: PRELIMINARY EXPERIMENTS

    Science.gov (United States)

    The morphological basis for olfactory perception of steroids during agonistic behavior in lobsters: preliminary experiments. Borsay Horowitz, DJ1, Kass-Simon, G2, Coglianese, D2, Martin, L2, Boseman, M2, Cromarty, S3, Randall, K3, Fini, A.3 1US EPA, NHEERL, ORD, Atlantic Ecology...

  9. Apheresis therapy in children: an overview of key technical aspects and a review of experience in pediatric renal disease.

    Science.gov (United States)

    Hunt, Elizabeth A K; Jain, Namrata G; Somers, Michael J G

    2013-02-01

    Although there is less experience with its use in children than adults, apheresis can be a life-saving treatment modality in certain pediatric diseases. With attention to specific technical aspects of the treatment, especially circuit volume, apheresis can be safely performed in children of any age or size. Even in pediatric diseases where it is recognized as an important part of therapy, apheresis is unfortunately still underutilized in North America and there needs to be increased awareness of its role and its availability within the pediatric community. Apheresis has been used particularly in children with certain renal diseases, notably ANCA-associated nephritis, anti-GBM disease, and atypical HUS. In addition, it can improve outcomes in transplantation of children with FSGS and can be part of a pre-transplant strategy for children who are highly sensitized and at high risk for graft failure.

  10. Preliminary experience with laparoscopic surgery in Ile-Ife, Nigeria.

    Science.gov (United States)

    Adisa, A O; Arowolo, O A; Salako, A A; Lawal, O O

    2009-12-01

    This study presents a pioneer experience with laparoscopic operations in a General Surgical unit of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. Consecutive patients who had laparoscopic operations from April through December 2008 were prospectively studied. Following clinical diagnosis, initial diagnostic laparoscopy was undertaken in all patients, followed by therapeutic open or laparoscopic procedures. All procedures were done under general anaesthesia. Duration of operation and outcome including complications were recorded. In all, there were 12 patients (8 males, 4 females), aged 15 to 50 years. Eight patients had clinical diagnoses of acute appendicitis, one each had undetermined right lower abdominal pain suspected ectopic gestation, adhesive intestinal obstruction and metastatic liver disease. The first 4 patients with inflammed appendix confirmed at laparoscopy had open appendicectomy. Of the next cohort of 5 patients, laparoscopic appendicectomy was completed in four but converted to open procedure in one. Normal findings were noted in the lady with suspected ectopic gestation. Laparoscopic adhesiolysis was done for adhesive intestinal obstruction while a laparoscopic liver biopsy was done for the patient with metastatic liver disease. Operative time ranged from 55-105 minutes with marked reduction in operation time as confidence and experience grew. No intraoperative complication was observed but one patient had superficial port site infection postoperatively. We conclude that with good patient selection and some improvisation, laparoscopic general surgical operations are feasible with acceptable outcome even in a poor resource setting.

  11. Personal experience in pediatric emergency medicine training in Canada and China

    Institute of Scientific and Technical Information of China (English)

    LIN Gang-xi; LUO Yi-ming; Adam CHENG; YANG Shu-yu; WANG Jian-she; Ran-D Goldman

    2012-01-01

    Currently,pediatric emergency medicine (PEM) as practiced in many developed countries is different from ours in China.Chinese pediatric emergency medicine is just children's internal medicine and does not include general surgery,ear-nose-throat,etc.If children have an emergency condition that require specialized treatments they need to go to different departments.However in Canada,the pediatric emergency physicians will first treat the patients whatever the condition,then,if it is a complicated sub specialty problem,they will consult the specialist or let the patient see the specialist later.In addition,resuscitation is done in the pediatric intensive care unit (PICU) in China,but it is done in the emergency room in Canada.This article compares the differences in the pediatric emergency systems in Canada and China and also introduces the international standard system of pediatric triage.

  12. Preliminary skyshine calculations for the Poloidal Diverter Tokamak Experiment

    Science.gov (United States)

    Nigg, D. W.; Wheeler, F. J.

    1981-01-01

    A calculational model is presented to estimate the radiation dose, due to the skyshine effect, in the control room and at the site boundary of the Poloidal Diverter Experiment (PDX) facility at Princeton University which requires substantial radiation shielding. The required composition and thickness of a water-filled roof shield that would reduce this effect to an acceptable level is computed, using an efficient one-dimensional model with an Sn calculation in slab geometry. The actual neutron skyshine dose is computed using a Monte Carlo model with the neutron source at the roof surface obtained from the slab Sn calculation, and the capture gamma dose is computed using a simple point-kernel single-scatter method. It is maintained that the slab model provides the exact probability of leakage out the top surface of the roof and that it is nearly as accurate as and much less costly than multi-dimensional techniques.

  13. A PRELIMINARY EXPERIMENT ON DENITRIFICATION OF WASTE LANDFILL LEACHATE

    Science.gov (United States)

    Wada, Nariaki; Nakamichi, Tamihiro; Yagi, Masahiro; Matsumoto, Toshihide; Kugimiya, Akikazu; Michioku, Kohji

    A laboratory experiment on denitrification was carried out in order to reduce nitrogen load from municipal landfill leachate. Nitrogen was efficiently removed by feeding sludge of the leachate pond into the tanks, which could activate denitrification bacteria. Although inorganic reducing agent such as iron powder was not able to make the whole water mass anoxic, denitrification took place by supplying organic matters such as methanol, hydrogen feeding agent, etc.. It is considered that small amount of anoxic water film produced on surfaces of container and carriers might contribute to denitrification, although the bulk water is kept aerobic. It is found that organic matters contained in the leachate is so insufficient that nitrification liquid circulation does not work well for denitrification.

  14. Preliminary Results of the Echo-Seeding Experiment ECHO-7 at SLAC

    Energy Technology Data Exchange (ETDEWEB)

    Xiang, D.; Colby, E.; Ding, Y.; Dunning, M.; Frederico, J.; Gilevich, S.; Hast, C.; Jobe, K.; McCormick, D.; Nelson, J.; Raubenheimer, T.O.; Soong, K.; Stupakov, G.; Szalata, Z.; Walz, D.; Weathersby, S.; Woodley, M.; /SLAC; Corlett, J.; Qiang, J.; Penn, G.; Prestemon, S.; /LBL, Berkeley /LPHE, Lausanne

    2010-06-15

    ECHO-7 is a proof-of-principle echo-enabled harmonic generation FEL experiment in the Next Linear Collider Test Accelerator (NLCTA) at SLAC. The experiment aims to generate coherent radiation at 318 nm and 227 nm, which are the 5th and 7th harmonic of the infrared seed laser. In this paper we present the preliminary results from the commissioning run of the completed experimental setup which started in April 2010.

  15. Pediatric and congenital heart transplant: twenty-year experience in a tertiary Brazilian Hospital

    Directory of Open Access Journals (Sweden)

    Leonardo Augusto Miana

    2014-09-01

    Full Text Available Introduction: Cardiac transplantation remains the gold standard for end-stage cardiomyopathies and congenital heart defects in pediatric patients. Objective: This study aims to report on 20 years of experience since the first case and evaluate our results. Methods: We conducted a retrospective analysis of the database and outpatient follow-up. Between October 1992 and April 2012, 109 patients underwent 114 transplants. 51.8% of them being female. The age of patients ranged from 12 days to 21 years with a mean of 8.8±5.7 years and a median of 5.2 years. The underlying diagnosis was dilated cardiomyopathy in 61.5%, congenital heart disease in 26.6% and restrictive cardiomyopathy in 11.9%. All patients above 17 years old had congenital heart disease. Results: Survival rate at 30 days, 1, 5, 10, 15, and 20 years were 90.4%, 81.3%, 70.9%, 60.5%, 44.4% and 26.7%, respectively. Mean cold ischemic time was 187.9 minutes and it did not correlate with mortality (P>0.05. Infectious complications and rejection episodes were the most common complications (P<0.0001, occurring, respectively, in 66% and 57.4% of the survivors after 10 years. There was no incidence of graft vascular disease and lymphoproliferative disease at year one, but they affected, respectively, 7.4% and 11% of patients within 10 years. Conclusion: Twenty-year pediatric heart transplant results at our institution were quite satisfactory and complication rates were acceptable.

  16. Adolescents growing with HIV/AIDS: experiences of the transition from pediatrics to adult care

    Directory of Open Access Journals (Sweden)

    Daisy Maria Machado

    Full Text Available Abstract The main objective of this work is to describe the formation of the Transition Adolescent Clinic (TAC and understand the process of transitioning adolescents with HIV/AIDS from pediatric to adult care, from the vantage point of individuals subjected to this process. A qualitative method and an intentional sample selected by criteria were adopted for this investigation, which was conducted in São Paulo, Brazil. An in-depth semi-structured interview was conducted with sixteen HIV-infected adolescents who had been part of a transitioning protocol. Adolescents expressed the need for more time to become adapted in the transition process. Having grown up under the care of a team of health care providers made many participants have reluctance toward transitioning. Concerns in moving away from their pediatricians and feelings of disruption, abandonment, or rejection were mentioned. Participants also expressed confidence in the pediatric team. At the same time they showed interest in the new team and expected to have close relationships with them. They also ask to have previous contacts with the adult health care team before the transition. Their talks suggest that they require slightly more time, not the time measured in days or months, but the time measured by constitutive experiences capable of building an expectation of future. This study examines the way in which the adolescents feel, and help to transform the health care transition model used at a public university. Listening to the adolescents’ voices is crucial to a better understanding of their needs. They are those who can help the professionals reaching alternatives for a smooth and successful health care transition.

  17. Adolescents growing with HIV/AIDS: experiences of the transition from pediatrics to adult care.

    Science.gov (United States)

    Machado, Daisy Maria; Galano, Eliana; de Menezes Succi, Regina Célia; Vieira, Carla Maria; Turato, Egberto Ribeiro

    2016-01-01

    The main objective of this work is to describe the formation of the Transition Adolescent Clinic (TAC) and understand the process of transitioning adolescents with HIV/AIDS from pediatric to adult care, from the vantage point of individuals subjected to this process. A qualitative method and an intentional sample selected by criteria were adopted for this investigation, which was conducted in São Paulo, Brazil. An in-depth semi-structured interview was conducted with sixteen HIV-infected adolescents who had been part of a transitioning protocol. Adolescents expressed the need for more time to become adapted in the transition process. Having grown up under the care of a team of health care providers made many participants have reluctance toward transitioning. Concerns in moving away from their pediatricians and feelings of disruption, abandonment, or rejection were mentioned. Participants also expressed confidence in the pediatric team. At the same time they showed interest in the new team and expected to have close relationships with them. They also ask to have previous contacts with the adult health care team before the transition. Their talks suggest that they require slightly more time, not the time measured in days or months, but the time measured by constitutive experiences capable of building an expectation of future. This study examines the way in which the adolescents feel, and help to transform the health care transition model used at a public university. Listening to the adolescents' voices is crucial to a better understanding of their needs. They are those who can help the professionals reaching alternatives for a smooth and successful health care transition.

  18. Preliminary experiments: High-energy alpha PIXE in archaeometry

    Energy Technology Data Exchange (ETDEWEB)

    Dupuis, Thomas, E-mail: T.Dupuis@ulg.ac.b [Centre Europeen d' Archeometrie, Atomique et Spectroscopie, Universite de Liege, Sart Tilman B15, B-4000 Liege (Belgium); Institut de Physique Nucleaire, Atomique et Spectroscopie, Universite de Liege, Sart Tilman B15, B-4000 Liege (Belgium); Chene, G.; Mathis, F. [Centre Europeen d' Archeometrie, Atomique et Spectroscopie, Universite de Liege, Sart Tilman B15, B-4000 Liege (Belgium); Institut de Physique Nucleaire, Atomique et Spectroscopie, Universite de Liege, Sart Tilman B15, B-4000 Liege (Belgium); Marchal, A.; Philippe, M.; Garnir, H.-P. [Institut de Physique Nucleaire, Atomique et Spectroscopie, Universite de Liege, Sart Tilman B15, B-4000 Liege (Belgium); Strivay, D. [Centre Europeen d' Archeometrie, Atomique et Spectroscopie, Universite de Liege, Sart Tilman B15, B-4000 Liege (Belgium); Institut de Physique Nucleaire, Atomique et Spectroscopie, Universite de Liege, Sart Tilman B15, B-4000 Liege (Belgium)

    2010-06-15

    This paper describes the work realized at the 'Centre Europeen d'Archeometrie' to highlight the utility of high-energy alpha PIXE in the particular field of archaeometry and to introduce the developments done and to be done to complete the knowledge of high-energy alpha PIXE. It starts with the comparison of the yield and the noise background between several alpha particle beams and the comparison between alpha particle and proton beams on different thick and thin references. After, this paper depicts the developments done at the 'Institut de Physique Nucleaire, Atomique et Spectroscopie' to perform such high-energy experiments, first on standards and later on cultural heritage objects. Moreover, it introduces the problematics of such beams for the quantification in PIXE by the intermediary of the knowledge of the ionization and X-ray production cross-sections and also the developments done to answer to this serious lack in the databases.

  19. Smart Ultrasound Remote Guidance Experiment (SURGE) Preliminary Findings

    Science.gov (United States)

    Hurst, Victor; Dulchavsky, Scott; Garcia, Kathleen; Sargsyan, Ashot; Ebert, Doug

    2009-01-01

    To date, diagnostic quality ultrasound images were obtained aboard the International Space Station (ISS) using the ultrasound of the Human Research Facility (HRF) rack in the Laboratory module. Through the Advanced Diagnostic Ultrasound in Microgravity (ADUM) and the Braslet-M Occlusion Cuffs (BRASLET SDTO) studies, non-expert ultrasound operators aboard the ISS have performed cardiac, thoracic, abdominal, vascular, ocular, and musculoskeletal ultrasound assessments using remote guidance from ground-based ultrasound experts. With exploration class missions to the lunar and Martian surfaces on the horizon, crew medical officers will necessarily need to operate with greater autonomy given communication delays (round trip times of up to 5 seconds for the Moon and 90 minutes for Mars) and longer periods of communication blackouts (due to orbital constraints of communication assets). The SURGE project explored the feasibility and training requirements of having non-expert ultrasound operators perform autonomous ultrasound assessments in a simulated exploration mission outpost. The project aimed to identify experience, training, and human factors requirements for crew medical officers to perform autonomous ultrasonography. All of these aims pertained to the following risks from the NASA Bioastronautics Road Map: 1) Risk 18: Major Illness and Trauna; 2) Risk 20) Ambulatory Care; 3) Risk 22: Medical Informatics, Technologies, and Support Systems; and 4) Risk 23: Medical Skill Training and Maintenance.

  20. Preliminary experience with biodegradable implants for fracture fixation

    Directory of Open Access Journals (Sweden)

    Dhillon Mandeep

    2008-01-01

    Full Text Available Background: Biodegradable implants were designed to overcome the disadvantages of metal-based internal fixation devices. Although they have been in use for four decades internationally, many surgeons in India continue to be skeptical about the mechanical strength of biodegradable implants, hence this study. Materials and Methods: A prospective study was done to assess the feasibility and surgeon confidence level with biodegradable implants over a 12-month period in an Indian hospital. Fifteen fractures (intra-articular, metaphyseal or small bone fractures were fixed with biodegradable implants. The surgeries were randomly scheduled so that different surgeons with different levels of experience could use the implants for fixation. Results: Three fractures (one humeral condyle, two capitulum, were supplemented by additional K-wires fixation. Trans-articular fixator was applied in two distal radius and two pilon fractures where bio-pins alone were used. All fractures united, but in two cases the fracture displaced partially during the healing phase; one fibula due to early walking, and one radius was deemed unstable even after bio-pin and external fixator. Conclusions: Biodegradable -implants are excellent for carefully selected cases of intra-articular fractures and some small bone fractures. However, limitations for use in long bone fractures persist and no great advantage is gained if a "hybrid" composite is employed. The mechanical properties of biopins and screws in isolation are perceived to be inferior to those of conventional metal implants, leading to low confidence levels regarding the stability of reduced fractures; these implants should be used predominantly in fracture patterns in which internal fixation is subjected to minimal stress.

  1. Physician and medical student perceptions and expectations of the pediatric clerkship: a Qatar experience

    Directory of Open Access Journals (Sweden)

    Hendaus MA

    2016-05-01

    Full Text Available Mohamed A Hendaus,1,2 Shabina Khan,1 Samar Osman,1 Yasser Alsamman,2 Tushar Khanna,2 Ahmed H Alhammadi1,2 1Department of Pediatrics, General Academic Pediatrics Division, Hamad Medical Corporation, Doha, 2Weill Cornell Medical College-Qatar, Al Rayyan, Qatar Background: The average number of clerkship weeks required for the pediatric core rotation by the US medical schools is significantly lower than those required for internal medicine or general surgery. Objective: The objective behind conducting this survey study was to explore the perceptions and expectations of medical students and pediatric physicians about the third-year pediatric clerkship. Methods: An anonymous survey questionnaire was distributed to all general pediatric physicians at Hamad Medical Corporation and to students from Weill Cornell Medical College-Qatar. Results: Feedback was obtained from seven attending pediatricians (100% response rate, eight academic pediatric fellow physicians (100% response rate, 36 pediatric resident physicians (60% response rate, and 36 medical students (60% response rate. Qualitative and quantitative data values were expressed as frequencies along with percentages and mean ± standard deviation and median and range. A P-value <0.05 from a 2-tailed t-test was considered to be statistically significant. Participants from both sides agreed that medical students receive <4 hours per week of teaching, clinical rounds is the best environment for teaching, adequate bedside is provided, and that there is no adequate time for both groups to get acquainted to each other. On the other hand, respondents disagreed on the following topics: almost two-thirds of medical students perceive postgraduate year 1 and 2 pediatric residents as the best teachers, compared to 29.4% of physicians; 3 weeks of inpatient pediatric clerkship is enough for learning; the inpatient pediatric environment is safe and friendly; adequate feedback is provided by physicians to

  2. Preliminary Experience with a New Total Distal Radioulnar Joint Replacement

    Science.gov (United States)

    Ewald, Timothy J.; Skeete, Kshamata; Moran, Steven L.

    2012-01-01

    resurfacing design may provide a means of decreasing pain and restoring DRUJ stability and motion following severe trauma, failed hemiarthroplasty, or failed Sauvé–Kapandji procedure. More experience is needed with this implant to confirm these initial encouraging results. The level of evidence for this study is IV (therapeutic, case series). PMID:23904976

  3. Biological therapies for the treatment of juvenile idiopathic arthritis: Lessons from the adult and pediatric experiences

    Directory of Open Access Journals (Sweden)

    Matthew L Stoll

    2008-06-01

    Full Text Available Matthew L Stoll, Alisa C GotteDepartment of Pediatrics, Division of Rheumatology, UT Southwestern Medical Center, Dallas, TX, USAAbstract: Biologics have advanced the therapy of adult and pediatric arthritis. They have been linked to rare serious adverse outcomes, but the actual risk of these events is controversial in adults, and largely unknown in pediatrics. Because of the paucity of safety and efficacy data in children, pediatric rheumatologists often rely on the adult literature. Herein, we reviewed the adult and pediatric literature on five classes of medicines: Tumor necrosis factor (TNF inhibitors, anakinra, rituximab, abatacept, and tocilizumab. For efficacy, we reviewed randomized controlled studies in adults, but did include lesser qualities of evidence for pediatrics. For safety, we utilized prospective and retrospective studies, rarely including reports from other inflammatory conditions. The review included studies on rheumatoid arthritis and spondyloarthritis, as well as juvenile idiopathic arthritis. Overall, we found that the TNF inhibitors have generally been found safe and effective in adult and pediatric use, although risks of infections and other adverse events are discussed. Anakinra, rituximab, abatacept, and tocilizumab have also shown positive results in adult trials, but there is minimal pediatric data published with the exception of small studies involving the subgroup of children with systemic onset juvenile idiopathic arthritis, in whom anakinra and tocilizumab may be effective therapies.Keywords: juvenile idiopathic arthritis, biologics, rheumatoid arthritis

  4. Long-term experience of steroid-free pediatric renal transplantation

    DEFF Research Database (Denmark)

    Wittenhagen, Per; Thiesson, Helle C; Baudier, François;

    2014-01-01

    Increased focus on the potential negative side effects of steroid usage in pediatric transplantation has led to steroid minimization or steroid-free transplantation. In this study, we report results after complete steroid avoidance in renal transplantation in the period 1994-2009. We evaluate...... in the youngest (pediatric renal transplantation is safe and protects against steroid-induced obesity and short stature....

  5. Preliminary tests in skull pediatric phantom for dosimetry in computerized tomography; Testes preliminares em um simulador pediatrico de cranio para dosimetria em tomografia computadorizada

    Energy Technology Data Exchange (ETDEWEB)

    Martins, Elaine Wirney; Potiens, Maria da Penha de A., E-mail: elainewirney@uso.br, E-mail: mppalbu@ipen.br [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil)

    2014-07-01

    Computed tomography (CT) is one of the techniques in the field of radiology with striking technological advance in recent years. One reason for this was the increased number of channels associated with the increased power of the X-ray tube. These conditions allowed the equipment high speed in the acquisition of the cuts, reducing the patient exposure time essential characteristic for the increase of its use in pediatric patients. In this context, were developed a new pediatric skull simulator to analyze the results of measurements performed in laboratory and clinic beams with the objective of creation and use of diagnostic reference levels observing risks stochastic effects and assessing the reduction of absorbed doses in patients undergoing growing. Preliminary tests performed in clinical beams showed C{sub w} values: 2.525 ± 0.212 mGy for the developed simulator quoted and 3.362 ± 0.282 mGy for a simulator developed by IPEN called standard, both being between uncertainty values of 8.4% and 14.4% suggested by TRS number 457.

  6. Biological therapies for the treatment of juvenile idiopathic arthritis: Lessons from the adult and pediatric experiences.

    Science.gov (United States)

    Stoll, Matthew L; Gotte, Alisa C

    2008-06-01

    Biologics have advanced the therapy of adult and pediatric arthritis. They have been linked to rare serious adverse outcomes, but the actual risk of these events is controversial in adults, and largely unknown in pediatrics. Because of the paucity of safety and efficacy data in children, pediatric rheumatologists often rely on the adult literature. Herein, we reviewed the adult and pediatric literature on five classes of medicines: Tumor necrosis factor (TNF) inhibitors, anakinra, rituximab, abatacept, and tocilizumab. For efficacy, we reviewed randomized controlled studies in adults, but did include lesser qualities of evidence for pediatrics. For safety, we utilized prospective and retrospective studies, rarely including reports from other inflammatory conditions. The review included studies on rheumatoid arthritis and spondyloarthritis, as well as juvenile idiopathic arthritis. Overall, we found that the TNF inhibitors have generally been found safe and effective in adult and pediatric use, although risks of infections and other adverse events are discussed. Anakinra, rituximab, abatacept, and tocilizumab have also shown positive results in adult trials, but there is minimal pediatric data published with the exception of small studies involving the subgroup of children with systemic onset juvenile idiopathic arthritis, in whom anakinra and tocilizumab may be effective therapies.

  7. Axial length in eyes with bilateral pediatric cataract at tertiary eye care center in Nepal: a preliminary report.

    Science.gov (United States)

    Shrestha, U D; Shrestha, M K

    2011-03-01

    The aim of the study was to determine the average axial length reading of the bilateral pediatric cataract undergoing cataract surgery. Pre-operative axial length measurement was done in 80 children below 15 years who had bilateral pediatric cataract. Axial length measurement was done in 56 fellow eyes. The axial length was measured under general anesthesia with the Accutome A-scan. The mean age was 69.7 months (SD=52.6), range from one month to 168 months. The mean axial length reading was 21.3 mm in operated eyes and 21.1 mm in fellow eyes. The range of axial length reading was 16.2 -31.5 mm in operated eyes and it was 16.5 -31.5 mm in fellow eyes. This short observation found that in bilateral pediatric cataract, the axial length value is similar in both operated and fellow eyes. Based on the axial length value of the operated eye, the patients with bilateral congenital cataract can undergo surgery in those eye hospitals where facilities of measurement of axial length is not available.

  8. CBD-enriched medical cannabis for intractable pediatric epilepsy: The current Israeli experience.

    Science.gov (United States)

    Tzadok, Michal; Uliel-Siboni, Shimrit; Linder, Ilan; Kramer, Uri; Epstein, Orna; Menascu, Shay; Nissenkorn, Andrea; Yosef, Omer Bar; Hyman, Eli; Granot, Dorit; Dor, Michael; Lerman-Sagie, Tali; Ben-Zeev, Bruria

    2016-02-01

    To describe the experience of five Israeli pediatric epilepsy clinics treating children and adolescents diagnosed as having intractable epilepsy with a regimen of medical cannabis oil. A retrospective study describing the effect of cannabidiol (CBD)-enriched medical cannabis on children with epilepsy. The cohort included 74 patients (age range 1-18 years) with intractable epilepsy resistant to >7 antiepileptic drugs. Forty-nine (66%) also failed a ketogenic diet, vagal nerve stimulator implantation, or both. They all started medical cannabis oil treatment between 2-11/2014 and were treated for at least 3 months (average 6 months). The selected formula contained CBD and tetrahydrocannabinol at a ratio of 20:1 dissolved in olive oil. The CBD dose ranged from 1 to 20mg/kg/d. Seizure frequency was assessed by parental report during clinical visits. CBD treatment yielded a significant positive effect on seizure load. Most of the children (66/74, 89%) reported reduction in seizure frequency: 13 (18%) reported 75-100% reduction, 25 (34%) reported 50-75% reduction, 9 (12%) reported 25-50% reduction, and 19 (26%) reported epilepsy in a population of children and adolescents are highly promising. Further prospective, well-designed clinical trials using enriched CBD medical cannabis are warranted. Copyright © 2016 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  9. Blood culture contamination in hospitalized pediatric patients: a single institution experience

    Science.gov (United States)

    Min, Hyewon; Park, Cheong Soo; Kim, Dong Soo

    2014-01-01

    Purpose Blood culture is the most important tool for detecting bacteremia in children with fever. However, blood culture contamination rates range from 0.6% to 6.0% in adults; rates for young children have been considered higher than these, although data are limited, especially in Korea. This study determined the contamination rate and risk factors in pediatric patients visiting the emergency room (ER) or being admitted to the ward. Methods We conducted a retrospective chart review of blood cultures obtained from children who visited Yonsei Severance Hospital, Korea between 2006 and 2010. Positive blood cultures were labeled as true bacteremia or contamination according to Centers for Disease Control and Prevention/National Healthcare Safety Network definitions for laboratory-confirmed bloodstream infection, after exclusion of cultures drawn from preexisting central lines only. Results Among 40,542 blood cultures, 610 were positive, of which 479 were contaminations and 131 were true bacteremia (overall contamination rate, 1.18%). The contamination rate in the ER was significantly higher than in the ward (1.32% vs. 0.66%, P6 years, respectively). Conclusion Overall, contamination rates were higher in younger children than in older children, given the difficulty of performing blood sampling in younger children. The contamination rates from the ER were higher than those from the ward, not accounted for only by overcrowding and lack of experience among personnel collecting samples. Further study to investigate other factors affecting contamination should be required. PMID:24868215

  10. PEDIATRIC HEAD INJURIES, MECHANISM TO MANAGEMENT: EXPERIENCE OF A SINGLE CENTER

    Directory of Open Access Journals (Sweden)

    Pankaj

    2016-01-01

    Full Text Available INTRODUCTION Head injury is very common in modern life. Patients of any age group may have head injury however mechanism of head injury, pathophysiology and outcome of head injury is quite different in adults as compared to children. Road traffic accident is a common mode of head injury in adults while fall from height and household abuse is common mode in children. In Western countries, there is a separate registry system for pediatric head injury but there is no such system exist in india. Our present study is focused on pediatric head injury and evaluation of factors that affect the final outcome in pediatric patients.

  11. Muon-catalyzed fusion experiment target and detector system. Preliminary design report

    Energy Technology Data Exchange (ETDEWEB)

    Jones, S.E.; Watts, K.D.; Caffrey, A.J.; Walter, J.B.

    1982-03-01

    We present detailed plans for the target and particle detector systems for the muon-catalyzed fusion experiment. Requirements imposed on the target vessel by experimental conditions and safety considerations are delineated. Preliminary designs for the target vessel capsule and secondary containment vessel have been developed which meet these requirements. In addition, the particle detection system is outlined, including associated fast electronics and on-line data acquisition. Computer programs developed to study the target and detector system designs are described.

  12. Charge generation associated with liquid spraying in tank cleaning and comparable processes - preliminary experiments

    Science.gov (United States)

    Blum, Carsten; Losert, Oswald F. J.

    2015-10-01

    The BG RCI has initiated investigations in order to improve the data basis for assessing the ignition hazard by electrostatic charging processes associated with the spraying of liquids. On the base of preliminary experiments, we established procedures for measurements of electric field strength and charging current in the presence of aerosol particles. Results obtained with three different nozzle types, variation of pressure and with built-in deflecting plate are presented.

  13. The RPC-based IFR system at BaBar experiment preliminary results

    CERN Document Server

    Piccolo, D; Bagnasco, S; Baldini, R; Band, H R; Bionta, R; Buzzo, A; Calcaterra, A; Cavallo, N; Contri, R; Crosetti, G; De Nardo, Gallieno; De Sangro, R; Fabozzi, F; Falciai, D; Finocchiaro, G; Gatto, C; Johnson, J; Lista, L; Lo Vetere, M; Macri, M; Monge, R; Palano, A; Paolucci, P; Passaggio, S; Patrignani, C; Patteri, P; Peruzzi, I; Piccolo, M; Robutti, E; Santroni, A; Sciacca, C; Wright, D; Yu, Z; Zallo, A

    2002-01-01

    The IFR system is a RPC-based detector used to identify muons and neutral hadrons in the BaBar experiment at PEP II machine in SLAC. The RPC system can be used to reconstruct the trajectory of muons, pions and neutral hadrons interacting in the iron of the IFR. The different range and hit pattern allow to discriminate different particles crossing the IFR. An overview of the system design and the preliminary results on the IFR performances are reported.

  14. Clinical Boot Camp: An Innovative Simulation Experience to Prepare Nursing Students for Obstetric and Pediatric Clinicals.

    Science.gov (United States)

    Hogewood, Connie; Smith, Tedra; Etheridge, Sherita; Britt, Sylvia

    2015-01-01

    Obstetric and pediatric patients require unique specialized care not included in traditional adult health education. To prepare nursing students for clinical rotations beginning the second week of class, faculty developed an innovative one-day simulation seminar, the OB/PEDS Boot Camp, in which groups of students rotated through six stations of obstetric and pediatric simulation exercises. This article provides insight on the development and implementation of the OB/PEDS Boot Camp.

  15. Fiscal year 1981 US corn and soybeans pilot preliminary experiment plan, phase 1

    Science.gov (United States)

    Livingston, G. P.; Nedelman, K. S.; Norwood, D. F.; Smith, J. H. (Principal Investigator)

    1981-01-01

    A draft of the preliminary experiment plan for the foreign commodity production forecasting project fiscal year 1981 is presented. This draft plan includes: definition of the phase 1 and 2 U.S. pilot objectives; the proposed experiment design to evaluate crop calendar, area estimation, and area aggregation components for corn and soybean technologies using 1978/1979 crop-year data; a description of individual sensitivity evaluations of the baseline corn and soybean segment classification procedure; and technology and data assessment in support of the corn and soybean estimation technology for use in the U.S. central corn belt.

  16. Learning Experience of Student Nurses through Reflection on Clinical Practice: A Case Study in Pediatric Nursing, Southern Thailand

    Directory of Open Access Journals (Sweden)

    Charuai SUWANBAMRUNG

    2015-07-01

    Full Text Available This article aims to describe student nurse experiences of clinical practice through their reflections. Forty reflections on clinical practice in a pediatric department were conducted at a tertiary hospital. Student nurses wrote reflections which were then thematically analyzed. Analysis was founded on the following: First, situations of nursing care in medical and surgical pediatrics; Second, clinical practice with nursing care as procedurals; Third, results after student’s activities; and Fourth, reflections of students presented as “what?”, “now what?”, and “new actions?” Particularly, reflections of student nurses were classed into 7 themes; 1 “Significant knowledge for nursing practice”, 2“Better self-confidence for nursing practices”, 3“Patient and family centers”, 4 “Concentration/attention must come first”, 5 “Practice carefully”, 6 “Make students have accountability, honesty, and ethics” and 7 “Mirror for improving intervention in the future as professional nurses”. Overall, student nurses had an improved learning experience in pediatric nursing care through reflection on clinical practice.

  17. An initial experience with a digital drainage system during the postoperative period of pediatric thoracic surgery.

    Science.gov (United States)

    Costa, Altair da Silva; Bachichi, Thiago; Holanda, Caio; Rizzo, Luiz Augusto Lucas Martins De

    2016-01-01

    To report an initial experience with a digital drainage system during the postoperative period of pediatric thoracic surgery. This was a prospective observational study involving consecutive patients, ≤ 14 years of age, treated at a pediatric thoracic surgery outpatient clinic, for whom pulmonary resection (lobectomy or segmentectomy via muscle-sparing thoracotomy) was indicated. The parameters evaluated were air leak (as quantified with the digital system), biosafety, duration of drainage, length of hospital stay, and complications. The digital system was used in 11 children (mean age, 5.9 ± 3.3 years). The mean length of hospital stay was 4.9 ± 2.6 days, the mean duration of drainage was 2.5 ± 0.7 days, and the mean drainage volume was 270.4 ± 166.7 mL. The mean maximum air leak flow was 92.78 ± 95.83 mL/min (range, 18-338 mL/min). Two patients developed postoperative complications (atelectasis and pneumonia, respectively). The use of this digital system facilitated the decision-making process during the postoperative period, reducing the risk of errors in the interpretation and management of air leaks. Relatar a experiência inicial com um sistema de drenagem digital no pós-operatório de cirurgia torácica pediátrica. Estudo observacional e prospectivo envolvendo pacientes consecutivos do ambulatório de cirurgia torácica pediátrica da instituição, com idade até 14 anos, e com indicação de ressecção pulmonar (lobectomia e/ou segmentectomia através de toracotomia poupadora muscular). Os parâmetros avaliados foram perda aérea (quantificada com o sistema digital), biossegurança, tempo de drenagem, tempo de internação e complicações. O sistema digital foi utilizado em 11 crianças, com média de idade de 5,9 ± 3,3 anos. A média do tempo de internação foi de 4,9 ± 2,6 dias, a de tempo de drenagem foi de 2,5 ± 0,7 dias, e a de volume de drenagem foi de 270,4 ± 166,7 ml. A média da perda aérea máxima foi de 92,78 ± 95,83 ml

  18. The NASA Juncture Flow Experiment: Goals, Progress, and Preliminary Testing (Invited)

    Science.gov (United States)

    Rumsey, Christopher L.; Neuhart, Danny H.; Kegerise, Michael A.

    2016-01-01

    NASA has been working toward designing and conducting a juncture flow experiment on a wing-body aircraft configuration. The experiment is planned to provide validation-quality data for CFD that focuses on the onset and progression of a separation bubble near the wing-body juncture trailing edge region. This paper describes the goals and purpose of the experiment. Although currently considered unreliable, preliminary CFD analyses of several different configurations are shown. These configurations have been subsequently tested in a series of "risk-reduction" wind tunnel tests, in order to help down-select to a final configuration that will attain the desired flow behavior. The risk-reduction testing at the higher Reynolds number has not yet been completed (at the time of this writing), but some results from one of the low-Reynolds-number experiments are shown.

  19. Fully liquid DTaP-IPV-Hib pediatric combination vaccine (Pediacel): a review of 18 years of clinical experience.

    Science.gov (United States)

    Reynolds, Donna L; Vidor, Emmanuel

    2014-08-01

    Safe and effective combination pediatric vaccines are necessary to simplify complex immunization schedules and to improve coverage and protection for children worldwide. We provide an overview of the 18 years of clinical and worldwide experience with DTaP-IPV-Hib (Pediacel(®)), a unique fully liquid pentavalent vaccine (diphtheria [D], tetanus [T], acellular pertussis, inactivated poliovirus [IPV], Haemophilus influenzae type b [Hib]). Pediacel has demonstrated good and lasting immunogenicity in many populations, with differing primary series and booster schedules, and with a variety of coadministered vaccines. The acellular pertussis antigens have proven efficacy and real-world effectiveness. Clinical and post-marketing studies confirm the safety of Pediacel. Pediacel can be used for primary series and toddler booster doses, as well as in mixed pediatric vaccine schedules.

  20. Single-Port Robotic Cholecystectomy in Pediatric Patients: Single Institution Experience.

    Science.gov (United States)

    Rosales-Velderrain, Armando; Alkhoury, Fuad

    2017-04-01

    Modifications to conventional laparoscopic cholecystectomy are aimed to decrease abdominal pain and improve cosmetic results. Single-port robotic cholecystectomy is a safe and feasible approach that has been reported in adults, though reports are limited in children. This study aims to report our experience with single-port robotic cholecystectomy in children, and to evaluate the safety, feasibility, and outcomes of this approach. After single-port robotic approach was available at our institution, we prospectively followed our patients who underwent a single-port robotic cholecystectomy from March 2013 to May 2015 in our children's hospital. There were 14 patients [female 11 (79%) versus male 3 (21%)], the average age was 12.20 ± 4.97 years, with a mean body mass index of 28.01 ± 8.57 m/kg(2). Of the 14 patients, 4 (29%) had cholelithiasis with choledocolithiasis and had undergone an endoscopic retrograde cholangiopancreatography before the operation, 6 (43%) had symptomatic cholelithiasis, and 4 (28%) had acute cholecystitis. The median operative room time was 125 minutes (range 60-202), the median time of operation was 77.5 minutes (range 64-169), the median estimated blood loss was 2 mL (range 2-25), and a median length of stay was 1 day (range 0-2). There were no conversions to another approach. The median follow-up was 7 months (range 3-22). One patient (7%) developed an umbilical port site seroma, which was managed conservatively, no other complications occurred. Single-port robotic cholecystectomy is a feasible and safe approach for cholecystectomy in the pediatric population. More studies are required to compare it to different approaches.

  1. Competency Testing for Pediatric Cardiology Fellows Learning Transthoracic Echocardiography: Implementation, Fellow Experience, and Lessons Learned.

    Science.gov (United States)

    Levine, Jami C; Geva, Tal; Brown, David W

    2015-12-01

    There is currently great interest in measuring trainee competency at all levels of medical education. In 2007, we implemented a system for assessing cardiology fellows' progress in attaining imaging skills. This paradigm could be adapted for use by other cardiology programs. Evaluation consisted of a two-part exercise performed after years 1 and 2 of pediatric cardiology training. Part 1: a directly observed evaluation of technical skills as fellows imaged a normal subject (year 1) and a patient with complex heart disease (year 2). Part 2: fellows interpreted and wrote reports for two echocardiograms illustrating congenital heart disease. These were graded for accuracy and facility with communicating pertinent data. After 5 years of testing, fellows were surveyed about their experience. In 5 years, 40 fellows were tested at least once. Testing identified four fellows who underperformed on the technical portion and four on the interpretive portion. Surveys were completed by 33 fellows (83 %). Most (67 %) felt that intermittent observation by faculty was inadequate for assessing skills and that procedural volume was a poor surrogate for competency (58 %). Posttest feedback was constructive and valuable for 90, and 70 % felt the process helped them set goals for skill improvement. Overall, fellows felt this testing was fair and should continue. Fellow performance and responses identified programmatic issues that were creating barriers to learning. We describe a practical test to assess competency for cardiology fellows learning echocardiography. This paradigm is feasible, has excellent acceptance among trainees, and identifies trainees who need support. Materials developed could be easily adapted to help track upcoming ACGME-mandated metrics.

  2. [Initial experiences with propofol (Disoprivan) for anesthesia induction in pediatric anesthesia].

    Science.gov (United States)

    Motsch, J; Must, W; Hutschenreuter, K

    1988-09-01

    Propofol is a new intravenous anesthetic agent that provides smooth and rapid induction of anesthesia. A short elimination half-life guarantees rapid recovery. Since it has been reformulated as an emulsion in soya bean oil, anaphylactoid reactions are unlikely to occur. As compared to adults, there is very little experience with propofol in pediatric anesthesia. The aim of this study was to evaluate propofol as an induction agent in children with respect to cardiovascular and respiratory effects and to investigate the incidence of other side-effects. METHOD. In 25 ASA I children aged 3-12 years (6.4 +/- 2.7 SD) anesthesia was induced with a single dose of propofol, after standard premedication with atropine 0.01 mg/kg and Thalamonal 0.04 ml/kg. Anesthesia was maintained with halothane, nitrous oxide, and oxygen. Blood pressure (BP), heart rate (HR), and arterial oxygen saturation (SaO2) were measured before and each minute for 6 min after propofol administration. The incidence of side-effects during induction of anesthesia as well as during recovery and the postoperative period were recorded. RESULTS. Propofol 2.5 mg/kg produced rapid and smooth induction of anesthesia. Mean arterial pressure decreased after 1 min by 14.3% with a maximum of 16.8% after 3 min. HR was influenced differently by propofol; children with initially high HR had a decrease in HR, whereas in children with a low initial rate, HR increased transiently. After 1 min, no further changes occurred. Although no apnea was observed, respiration was shallow and depressed, as indicated by a decrease in SaO2. Two children complained of pain and 4 of discomfort at the site of the injection; 1 of these developed transient phlebitis.(ABSTRACT TRUNCATED AT 250 WORDS)

  3. Knowledge of and Attitudes Regarding Postoperative Pain among the Pediatric Cardiac Nursing Staff: An Indian Experience.

    Science.gov (United States)

    Dongara, Ashish R; Shah, Shail N; Nimbalkar, Somashekhar M; Phatak, Ajay G; Nimbalkar, Archana S

    2015-06-01

    Pain following cardiac intervention in children is a common, but complex phenomenon. Identifying and reporting pain is the responsibility of the nursing staff, who are the primary caregivers and spend the most time with the patients. Inadequately managed pain in children may lead to multiple short- and long-term adverse effects. The aim of this cross-sectional study was to assess the knowledge and attitudes regarding postoperative pain in children among the nursing staff at B.M. Patel Cardiac Center, Karamsad, Anand, Gujarat, India. The study included 42 of the 45 nurses employed in the cardiac center. The nurses participating in the study were responsible for the care of the pediatric patients. A modified Knowledge and Attitudes Survey Regarding Pain and a sociodemographic questionnaire were administered after obtaining written informed consent. The study was approved by the institutional Human Research Ethics Committee. Mean (SD) experience in years of the nursing staff was 2.32 (1.69) years (range 1 month to 5 years). Of the nurses, 67% were posted in the cardiac surgical intensive care unit (ICU). The mean (SD) score for true/false questions was 11.48 (2.95; range 7,19). The average correct response rate of the true/false questions was 45.9%. Knowledge about pain was only affected by the ward in which the nurse was posted. In first (asymptomatic) and second (symptomatic) case scenarios, 78.6% and 59.5% underestimated pain, respectively. Knowledge and attitudes regarding pain and its management is poor among nurses. Targeted training sessions and repeated reinforcement sessions are essential for holistic patient care.

  4. [THE WORLD EXPERIENCE OF THE PEDIATRIC INTESTINAL FAILURE PROGRAM: SUCCESSFUL OUTCOMES FROM INTESTINAL REHABILITATION].

    Science.gov (United States)

    Abbou, Benyamine; Sukhotnik, Igor; Rofe, Amnon

    2015-12-01

    Management of children with short bowel syndrome is optimized by interdisciplinary coordination of parenteral and enteral nutrition support, medical management of associated complications, surgical lengthening procedures, and intestinal transplantation. Pediatric Intestinal Failure Centers were established in 14 pediatric hospitals throughout the United States and Canada and the Pediatric Intestinal Failure Consortium has been developed and is implementing prospective, multi-institutional studies to better define the specific aspects of intestinal failure management that optimize long-term outcomes. The published data from these studies suggest that intestinal failure in pediatric patients is quite treatable and provides further evidence that all infants at risk for intestinal failure should be treated aggressively and referred early to a dedicated intestinal rehabilitation center. Improved communication and integration with the transplant service have resulted in earlier assessment, decreased rates of transplantation, and decreased mortality from liver failure. The data presented demonstrates that a newly established intestinal failure program can achieve excellent survival in a cohort of chronically ill and complex pediatric cases that have historically been associated with substantial mortality.

  5. Hospitalized pediatric antituberculosis drug induced hepatotoxicity: Experience of an Indonesian referral hospital

    Directory of Open Access Journals (Sweden)

    Heda Melinda Nataprawira

    2017-05-01

    Full Text Available Objective: To determine the characteristics and risk factors of pediatric antituberculosis drug induced hepatotoxicity (ADIH in Dr. Hasan Sadikin Hospital, a referral hospital in West Java, Indonesia. Methods: Medical records of hospitalized pediatric ADIH from October 2010 to October 2015 were reviewed retrospectively through computer-based search. Descriptive data were presented as percentage. Analytical case-control study on characteristics of ADIH was conducted using Chi-square and Mann Whitney test. Results: Fifty (3.5% out of 1 424 pediatric TB patients developed ADIH; 20 (40% were boys and 30 (60% girls. More than half were under 5 years old and 33 (66% were malnourished. ADIH occured in 29 (58% cases treated for pulmonary TB, 15 (30% for extrapulmonary TB and 6 (12% for both; 34 cases (68% occured during the intensive phase. We identified hepatic comorbidities including CMV infection [1 (2%] and typhoid [1 (2%], and other diseases treated by hepatotoxic drugs such as chemotherapeutic drugs, antiepileptics, and antiretroviral drugs [9 (18%]. Case-control analysis of 50 ADIH cases and 100 TB controls without ADIH showed that the correlation between gender, age, type of TB, nutritional status and comorbidities to occurence of ADIH was statistically insignificant (P = 0.26, 0.765, 0.495, 0.534 9 and 0.336, respectively. Pediatric ADIH was treated using modified British Thoracic Society guidelines. Conclusions: Pediatric ADIH in our hospital is quite frequent, thus identifying risk factors and development of pediatric guideline is mandatory. Further study is needed to identify other risk factors such as genetic acetylator status.

  6. An evaluation of the Positive Emotional Experiences Scale: A preliminary analysis

    Directory of Open Access Journals (Sweden)

    Rene van Wyk

    2016-04-01

    Full Text Available Orientation: The positive organisational behaviour movement emphasises the advantages of psychological strengths in business. The psychological virtues of positive emotional experiences can potentially promote human strengths to the advantages of business functioning and the management of work conditions. This is supported by Fredrickson’s broaden-and-build theory that emphasises the broadening of reactive thought patterns through experiences of positive emotions.Research purpose: A preliminary psychometric evaluation of a positive measurement of dimensions of emotional experiences in the workplace, by rephrasing the Kiefer and Barclay Toxic Emotional Experiences Scale.Motivation for the study: This quantitative Exploratory Factor Analysis investigates the factorial structure and reliability of the Positive Emotional Experiences Scale, a positive rephrased version of the Toxic Emotional Experiences Scale.Research approach, design and method: This Exploratory Factor Analysis indicates an acceptable three-factor model for the Positive Emotional Experiences Scale. These three factors are: (1 psychological recurrent positive state, (2 social connectedness and (3 physical refreshed energy, with strong Cronbach’s alphas of 0.91, 0.91 and 0.94, respectively.Main findings: The three-factor model of the Positive Emotional Experiences Scale provides a valid measure in support of Fredrickson’s theory of social, physical and psychological endured personal resources that build positive emotions.Practical/Managerial implications: Knowledge gained on positive versus negative emotional experiences could be applied by management to promote endured personal resources that strengthen positive emotional experiences.Contribution/value-add: The contribution of this rephrased Positive Emotional Experiences Scale provides a reliable measure of assessment of the social, physical and endured psychological and personal resources identified in Fredrickson’s broaden

  7. Pediatric MR elastography of hepatic fibrosis: principles, technique and early clinical experience

    Energy Technology Data Exchange (ETDEWEB)

    Binkovitz, Larry A.; Glaser, Kevin J.; Yin, Meng; Ehman, Richard L. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); El-Youssef, Mounif [Mayo Clinic, Pediatric Gastroenterology, Rochester, MN (United States); Binkovitz, Anna K. [Macalaster College, St. Paul, MN (United States)

    2012-04-15

    Numerous pediatric conditions result in hepatic fibrosis. As treatments develop for the underlying disorders, a non-invasive assessment of liver fibrosis would be beneficial as an adjunct or possible replacement for the traditional gold standard, liver biopsy. Magnetic resonance elastography is a noninvasive imaging technique that has been used successfully in adults for identification and assessment of liver fibrosis. This review describes the basic principles of MR elastography as well as the technical aspects specific to children. Clinical pediatric applications, limitations and areas for future research are described. (orig.)

  8. BIOMEX (Biology and Mars Experiment): Preliminary results on Antarctic black cryptoendolithic fungi in ground based experiments

    OpenAIRE

    C. Pacelli; Selbmann, L.; S. Onofri; de Vera, J.P.P.

    2014-01-01

    The main goal for astrobiologists is to find traces of present or past life in extraterrestrial environment or in meteorites. Biomolecules, such as lipids, pigments or polysaccharides, may be useful to establish the presence of extant or extinct life (Simoneit, B et al., 1998). BIOMEX (Biology and Mars Experiment) aims to measure to what extent biomolecules, such as pigments and cellular components, preserve their stability under space and Mars-like conditions. The experiment has just been la...

  9. Spinel dissolution via addition of glass forming chemicals. Results of preliminary experiments

    Energy Technology Data Exchange (ETDEWEB)

    Fox, K. M. [Savannah River Site (SRS), Aiken, SC (United States); Johnson, F. C. [Savannah River Site (SRS), Aiken, SC (United States)

    2015-11-01

    Increased loading of high level waste in glass can lead to crystallization within the glass. Some crystalline species, such as spinel, have no practical impact on the chemical durability of the glass, and therefore may be acceptable from both a processing and a product performance standpoint. In order to operate a melter with a controlled amount of crystallization, options must be developed for remediating an unacceptable accumulation of crystals. This report describes preliminary experiments designed to evaluate the ability to dissolve spinel crystals in simulated waste glass melts via the addition of glass forming chemicals (GFCs).

  10. Preliminary experience with Piccolo Composite™, a radiolucent distal fibula plate, in ankle fractures.

    Science.gov (United States)

    Caforio, Marco; Perugia, Dario; Colombo, Massimiliano; Calori, Giorgio Maria; Maniscalco, Pietro

    2014-12-01

    The radiolucent plate has many advantageous properties in the treatment of complex ankle fractures, particularly trimalleolar fractures. Surgeons may sometimes have difficulty observing the posterior malleolus after synthesis of lateral malleolus with a traditional plate because common materials of conventional plates are not radiolucent. In this study, the authors highlight the importance of the radiolucent property in the treatment of ankle fractures and describe their preliminary experience with a carbon fibre-reinforced polyetheretherketone distal fibula plate, with good results at 4 months' follow-up and no signs of tissue inflammatory reaction.

  11. Percutaneous pulmonary valve implantation in a single artery branch: A preliminary experience

    Institute of Scientific and Technical Information of China (English)

    Massimo; Chessa; Gianfranco; Butera; Luca; Giugno; Angelo; Micheletti; Diana; G; Negura; Mario; Carminati

    2015-01-01

    To describe preliminary experience of percutaneous pulmonary valve implantation, in a single pulmonary branch position. Two procedures in 2 patients from a single center are described, where implantation of percutaneous valves within a single pulmonary artery branch was technically successful. The procedural indication was pulmonary valve regurgitation and/or residual stenosis. The 2 patients were symptomatic. An Edwards Sapien? valve(Patient 1), and a Medtronic Melody? valve(Patient 2) were implanted. Both pts were discharged with an excellent valve function. In this report it is underlined that this modality is technically feasible and may be considered an option in patients with congenital heart defect under special circumstances.

  12. Low-dose fetal CT for evaluation of severe congenital skeletal anomalies: preliminary experience

    Energy Technology Data Exchange (ETDEWEB)

    Victoria, Teresa; Epelman, Monica; Johnson, Ann M.; Kramer, Sandra; Jaramillo, Diego [Children' s Hospital of Philadelphia, Diagnostic Imaging, Philadelphia, PA (United States); Bebbington, Michael [Children' s Hospital of Philadelphia, Center for Fetal Diagnosis and Treatment, Philadelphia, PA (United States); Wilson, R.D. [University of Calgary, Obstetrics and Gynecology, Calgary (Canada)

    2012-01-15

    Congenital skeletal abnormalities compose a heterogeneous and complex group of conditions that affect bone growth and development and result in various anomalies in shape and size of the skeleton. Prenatal sonographic diagnosis of these anomalies is challenging because of the relative rarity of each skeletal dysplasia, the multitude of differential diagnoses encountered when the bony abnormalities are identified, lack of precise molecular diagnosis and the fact that many of these disorders have overlapping features and marked phenotypic variability. The following review is a preliminary summary of our experience at the Children's Hospital of Philadelphia (CHOP) using low-dose fetal CT in the evaluation of severe fetal osseous abnormalities. (orig.)

  13. The use of handheld spectral domain optical coherence tomography in pediatric ophthalmology practice: Our experience of 975 infants and children

    Directory of Open Access Journals (Sweden)

    Ashwin Mallipatna

    2015-01-01

    Full Text Available Purpose: Optical coherence tomography (OCT is an important imaging tool assessing retinal architecture. In this article, we report a single centers experience of using handheld spectral domain (SD-OCT in a pediatric population using the Envisu 2300 (Bioptigen Inc., Research Triangle Park, NC, USA. Methods: We studied SD-OCT images from 975 patients imaged from January 2011 to December 2014. The variety of cases that underwent an SD-OCT was analyzed. Cases examples from different case scenarios were selected to showcase unique examples of many diseases. Results: Three hundred and sixty-eight infants (37.7% were imaged for retinopathy of prematurity, 362 children (37.1% underwent the test for evaluation of suboptimal vision or an unexplained vision loss, 126 children (12.9% for evaluation of nystagmus or night blindness, 54 children (5.5% for an intraocular tumor or a mass lesion such as retinoblastoma, and 65 children (6.7% for other diseases of the pediatric retina. The unique findings in the retinal morphology seen with some of these diseases are discussed. Conclusion: The handheld SD-OCT is useful in the evaluation of the pediatric retinal diseases. The test is useful in the assessment of vision development in premature children, evaluation of unexplained vision loss and amblyopia, nystagmus and night blindness, and intraocular tumors (including retinoblastoma.

  14. Development and Preliminary Face and Content Validation of the “Which Health Approaches and Treatments Are You Using?” (WHAT) Questionnaires Assessing Complementary and Alternative Medicine Use in Pediatric Rheumatology

    Science.gov (United States)

    Toupin April, Karine; Stinson, Jennifer; Boon, Heather; Duffy, Ciarán M.; Huber, Adam M.; Gibbon, Michele; Descarreaux, Martin; Spiegel, Lynn; Vohra, Sunita; Tugwell, Peter

    2016-01-01

    Objective Complementary and alternative medicine (CAM) is commonly used by children with juvenile idiopathic arthritis (JIA), yet no validated questionnaires assess that use. The objective of this study was to develop child self- and parent proxy-report questionnaires assessing CAM use and to determine the face and content validity of the “Which Health Approaches and Treatments are you using?” (WHAT) questionnaires in pediatric rheumatology. Methods A sequential phased mixed methods approach was used to develop the questionnaires. A Delphi Survey of 126 experts followed by an interdisciplinary consensus conference of 14 stakeholders in CAM, general pediatrics and pediatric rheumatology was held to develop consensus on the content of the questionnaires using a nominal group technique. To determine face and content validity of the questionnaires, two groups, including (a) a purposive sample of 22 children with JIA 8 to 18 years and their parents from the Children’s Hospital of Eastern Ontario and the Hospital for Sick Children, and (b) 21 Canadian pediatric rheumatology experts, participated in interviews. Participants were independently asked about the goal, understandability and comprehensiveness of the WHAT questionnaires, as well as the relevance of items. Results Consensus was reached on 17 items of the WHAT questionnaires. The domains found to be relevant were child’s CAM use, factors associated with CAM use, perceived impact of CAM use, and communication about CAM. A total of 15 items in the parent proxy-report questionnaire and 13 items in the child report questionnaire showed adequate content validity. Conclusions Consensus was reached by experts on the content of a pediatric CAM questionnaire. Face and content validity testing and modifications made to the WHAT questionnaires have helped ensure adequate preliminary validity for use in pediatric rheumatology. This constitutes the basis for further testing of these questionnaires in pediatric

  15. An interactive E-Learning portal in pediatric endocrinology: practical experience

    NARCIS (Netherlands)

    Kranenburg-van Koppen, L.J.C.; Grijpink-van den Biggelaar, K.; Drop, S.L.S.

    2013-01-01

    Based on educational considerations, the European Society for Paediatric Endocrinology (ESPE) e-learning portal has been developed, providing an interactive learning environment for up-to-date information in pediatric endocrinology. From March 2011 to January 2012, five small-scale pilot studies wer

  16. Long term sequelae of pediatric craniopharyngioma - literature review and 20 years of experience

    OpenAIRE

    Michal eCohen; Guger, Sharon L.; Jill eHamilton

    2011-01-01

    Craniopharyngioma are rare histologically benign brain tumors that develop in the pituitary- hypothalamic area. They may invade nearby anatomical structures causing significant rates of neurological, neurocognitive and endocrinological complications including remarkable hypothalamic damage. Information regarding long term implications of the tumors and treatment in the pediatric population is accumulating, and treatment goals appear to be changing accordingly. In this review we aim to present...

  17. Relationship between antibiotic resistance and sickle cell anemia: preliminary evidence from a pediatric carriage study in Ghana

    Directory of Open Access Journals (Sweden)

    Donkor ES

    2013-07-01

    Full Text Available Eric S Donkor,1 Ebenezer Foster-Nyarko,2 Christabel C Enweronu-Laryea3 1Department of Microbiology, University of Ghana Medical School, Accra, Ghana; 2Department of Medical Laboratory Science, School of Allied Health Sciences, University of Ghana, Accra, Ghana; 3Department of Child Health, University of Ghana Medical School, Accra, GhanaBackground: Antibiotics are frequently used among people with sickle cell anemia (homozygous SS or HbSS disease, especially for prophylaxis. However, the relationship between antibiotic resistance and people with HbSS disease has not been adequately studied, especially in the developing world. The objectives of the study were (1 to compare antibiotic resistance patterns of nasal Staphylococcus aureus between children with HbSS disease and children without HbSS disease (healthy children and (2 to evaluate nasopharyngeal carriage of antibiotic-resistant Streptococcus pneumoniae among children with HbSS disease.Methods: This was a prospective cross-sectional study, and the subjects were children under 12 years old. Nasal swabs were collected from 50 children with HbSS disease and 50 children without HbSS disease. Nasopharyngeal swabs were collected from another group of 92 children with HbSS disease. The nasal and nasopharyngeal swabs were cultured for S. aureus and S. pneumoniae, respectively. Susceptibility testing was carried out on the S. aureus and S. pneumoniae isolates for various antibiotics, including penicillin, ampicillin, cefuroxime, erythromycin, cloxacillin, and cotrimoxazole.Results: The carriage rates of S. aureus among pediatric subjects with HbSS disease and those without HbSS disease were 48% and 50%, respectively (P > 0.05. S. pneumoniae carriage among the pediatric subjects with HbSS disease was 10%. Antibiotic resistance patterns of S. aureus carried by children with HbSS disease and children without HbSS disease were similar, and the S. aureus resistance rates were >40% for the various

  18. Promoting major pediatric surgical care in a low-income country: a 4-year experience in Eritrea.

    Science.gov (United States)

    Calisti, Alessandro; Belay, Kibreab; Mazzoni, Guglielmo; Fiocca, Guido; Retrosi, Giuseppe; Olivieri, Claudio

    2011-04-01

    -through of functional stoma was the treatment of choice for patients with Hirschsprung's disease because frozen sections were not possible. Eight late-referred bladder extrophy cases were all managed by internal diversion (Mainz II pouch). Solid abdominal tumors always came to observation weeks or months after the first symptoms appeared. No CT scan was available and indications of surgery were based on clinical symptoms only. Only 11 of 18 cases were resectable, and only 5 of them with favorable histology survived, 2 after adjuvant therapy abroad. A large number of hypospadias were observed at the mean age of 4.5 years. Failures of previous attempts at correction were frequently found. The postoperative complications rate progressively decreased with the use of dripping stents to avoid the risk of accidental catheter removal or kinking. On the basis of our experience, major pediatric surgery in many under-resourced areas of sub-Saharan Africa can be developed, taking care to adapt surgical options to local conditions. Late referral of many congenital abnormalities, the impact of local culture, difficulties to establish regular follow-up, and shortage of facilities and medical devices must always be kept in mind before transferring modern protocols of management. Strong efforts have been devoted to train local medical and nursing staff to establish pediatric surgical manpower to cope with a still largely unanswered demand of care in this area of Africa.

  19. The development, testing, and preliminary feasibility of an adaptable pediatric oncology nutrition algorithm for low-middle income countries

    Directory of Open Access Journals (Sweden)

    CAK Fleming

    2015-01-01

    Full Text Available Background: Survivors of childhood cancer are at increased risk for several cardiometabolic complications. Obesity/overweight and metabolic syndrome have been widely reported in Western literature, but data from India are lacking. Aims: To perform an objective assessment of nutritional status in a cohort of childhood cancer survivors (CCSs and to find risk factors for extremes in nutritional status. Settings And Design: The study was a retrospective chart review of CCSs who attended the late effects clinic of a referral pediatric oncology center over the period of 1 year. Materials And Methods: An objective assessment of nutritional status was done, and results were analyzed in two groups: Adult survivors (present age 20 years or current age >30 years in adult survivors. Conclusions: The prevalence of obesity/overweight is lower in our cohort when compared to Western literature. It remains to be clarified whether this reflects the underlying undernutrition in our country, or whether our cohort of survivors is indeed distinct from their Western counterparts. Comparison with age/sex-matched normal controls and baseline parameters would yield more meaningful results.

  20. The development, testing, and preliminary feasibility of an adaptable pediatric oncology nutrition algorithm for low-middle income countries.

    Science.gov (United States)

    Fleming, C A K; Viani, K; Murphy, A J; Mosby, T T; Arora, B; Schoeman, J; Ladas, E J

    2015-01-01

    Survivors of childhood cancer are at increased risk for several cardiometabolic complications. Obesity/overweight and metabolic syndrome have been widely reported in Western literature, but data from India are lacking. To perform an objective assessment of nutritional status in a cohort of childhood cancer survivors (CCSs) and to find risk factors for extremes in nutritional status. The study was a retrospective chart review of CCSs who attended the late effects clinic of a referral pediatric oncology center over the period of 1 year. An objective assessment of nutritional status was done, and results were analyzed in two groups: Adult survivors (present age obesity, overweight, normal, and undernutrition was 2.6%, 10.8%, 62.7%, and 28.8% (CASs) and 0%, 8.5%, 62.7%, and 28.8% (adult survivors), respectively. Factors predictive of overweight/obesity were an initial diagnosis of acute lymphoblastic leukemia, or brain tumor and follow-up duration of >20 years or current age >30 years in adult survivors. The prevalence of obesity/overweight is lower in our cohort when compared to Western literature. It remains to be clarified whether this reflects the underlying undernutrition in our country, or whether our cohort of survivors is indeed distinct from their Western counterparts. Comparison with age/sex-matched normal controls and baseline parameters would yield more meaningful results.

  1. Adolescents' Observations of Parent Pain Behaviors: Preliminary Measure Validation and Test of Social Learning Theory in Pediatric Chronic Pain.

    Science.gov (United States)

    Stone, Amanda L; Walker, Lynn S

    2017-01-01

    Evaluate psychometric properties of a measure of adolescents’ observations of parental pain behaviors and use this measure to test hypotheses regarding pain-specific social learning. We created a proxy-report of the Patient Reported Outcomes Measurement Information System (PROMIS) Pain Behavior–Short Form (PPB) for adolescents to report on parental pain behaviors, which we labeled the PPB-Proxy. Adolescents (n = 138, mean age = 14.20) with functional abdominal pain completed the PPB-Proxy and a parent completed the PPB. Adolescents and their parents completed measures of pain and disability during the adolescent’s clinic visit for abdominal pain. Adolescents subsequently completed a 7-day pain diary period. The PPB-Proxy moderately correlated with the PPB, evidencing that adolescents observe and can report on parental pain behaviors. Both the PPB-Proxy and PPB significantly correlated with adolescents’ pain-related disability. Parental modeling of pain behaviors could represent an important target for assessment and treatment in pediatric chronic pain patients.

  2. China ADS sub-critical experimental assembly-Venus-1 and preliminary experiment

    Institute of Scientific and Technical Information of China (English)

    SHI Yongqian; ZHANG Wei; CAO Jian; QUAN Yanhui; LUO Huangda; WU Xiaofei; XIA Pu; LUO Zhanglin; ZHAO Zhixiang; DING Dazhao; LI Yiguo; ZHU Qinfu; XIA Haihong; LI Jien

    2007-01-01

    China's accelerator-driven sub-critical system (ADS) sub-critical experimental assembly--Venus-1 and the preliminary experiment is presented. The core of Venus-1 is a coupled one of a fast neutron zone and a thermal neutron zone. The fast neutron zone is at the centre of the core and formed by natural uranium fuel. A fast neutron spectrum field can be produced in the fast neutron zone and used for the transmutation of minor actinides (Mas). The thermal neutron zone surrounds the fast neutron zone and is formed by low-enriched uranium fuel. It is a fission zone. An epithermal neutron zone between the fast neutron zone and the thermal neutron zone can be established for the transmutation of longlived fission products (LLFP). On July 18, 2005, the first fuel element was loaded into the Venus-Ⅰ sub-critical assembly and some preliminary experiments about the subcritical neutronics were performed. The Venus-1 can be driven by an Am-Be source or other steady neutron source (Cf-252, D-D reaction and D-T reaction) to study the effect of the external neutron source with different energies or a D-T pulsed neutron source on the dynamic characteristics.

  3. Rayleigh-Taylor Instability within Sediment Layers Due to Gas Retention: Preliminary Theory and Experiments

    Energy Technology Data Exchange (ETDEWEB)

    Gauglitz, Phillip A.; Wells, Beric E.; Buchmiller, William C.; Rassat, Scot D.

    2013-03-21

    In Hanford underground waste storage tanks, a typical waste configuration is settled beds of waste particles beneath liquid layers. The settled beds are typically composed of layers, and these layers can have different physical and chemical properties. One postulated configuration within the settled bed is a less-dense layer beneath a more-dense layer. The different densities can be a result of different gas retention in the layers or different degrees of settling and compaction in the layers. This configuration can experience a Rayleigh-Taylor (RT) instability where the less dense lower layer rises into the upper layer. Previous studies of gas retention and release have not considered potential buoyant motion within a settle bed of solids. The purpose of this report is to provide a review of RT instabilities, discuss predictions of RT behavior for sediment layers, and summarize preliminary experimental observations of RT instabilities in simulant experiments.

  4. Investigation of fracture-matrix interaction: Preliminary experiments in a simple system

    Energy Technology Data Exchange (ETDEWEB)

    Foltz, S.D. [New Mexico Univ., Albuquerque, NM (United States). Dept. of Physics and Astronomy; Tidwell, V.C.; Glass, R.J.; Sobolik, S.R. [Sandia National Labs., Albuquerque, NM (United States)

    1992-12-31

    Paramount to the modeling of unsaturated flow and transport through fractured porous media is a clear understanding of the processes controlling fracture-matrix interaction. As a first step toward such an understanding, two preliminary experiments have been performed to investigate the influence of matrix imbibition on water percolation through unsaturated fractures in the plane normal to the fracture. Test systems consisted of thin slabs of either tuff or an analog material cut by a single vertical fracture into which a constant fluid flux was introduced. Transient moisture content and solute concentration fields were imaged by means of x-ray absorption. Flow fields associated with the two different media were significantly different owing to differences in material properties relative to the imposed flux. Richards` equation was found to be a valid means of modeling the imbibition of water into the tuff matrix from a saturated fracture for the current experiment.

  5. [The use of nitric oxide during transport of newborns with critical respiratory insufficiency: own experience, preliminary report].

    Science.gov (United States)

    Ziebiński, Marek; Walas, Wojciech

    2002-01-01

    This preliminary report presents author's experience with inhaled nitric oxide during transport of newborns with critical respiratory insufficiency. The theoretical basis, indications and contraindications as well as principles of administration during transport are described. The required equipment and some technical aspects are discussed. A short preview of performed transportations is given. Preliminary data show, that use of NO during transport is very helpful in children with critical respiratory insufficiency.

  6. Trends in Pediatric Surgery Operative Volume among Residents and Fellows: Improving the Experience for All.

    Science.gov (United States)

    Talutis, Stephanie; McAneny, David; Chen, Catherine; Doherty, Gerard; Sachs, Teviah

    2016-06-01

    The ACGME requires general surgery residents (GSR) to perform 20 pediatric surgery cases as part of the total 750 cases before graduation. We queried the ACGME General Surgery (1999 to 2014) and Pediatric Surgery (2003 to 2014) Case Logs for all pediatric operations performed during training. Means (±SD) and medians (10(th):90(th) percentiles) were compared, and R(2) was calculated for all trends. The number of pediatric surgery fellows (PSF) increased 63% (23 to 39; R(2) = 0.82), while GSR numbers increased 12% (989 to 1,105; R(2) = 0.77). Total and average pediatric surgery case volume for GSR decreased from 39,309 to 32,156 (R(2) = 0.90) and 39.7 ± 13 to 29.1 ± 10 (R(2) = 0.91), respectively. Meanwhile, average PSF case volume increased from 980 ± 208 to 1,137 ± 202 (R(2) = 0.83). These trends persisted for inguinal/umbilical hernia (GSR 22.1 ± 13 to 15.6 ± 10; R(2) = 0.93; PSF 90.5 ± 17.6 to 104.4 ± 20.7; R(2) = 0.34), pyloric stenosis (GSR 3.9 ± 3 to 2.8 ± 3; R(2) = 0.60; PSF 29.6 ± 15 to 39.7 ± 16.8; R(2) = 0.69), and intestinal atresia (GSR 1.3 ± 2 to 1.1 ± 2; R(2) = 0.34; PSF 4.3 ± 4 to 11.8 ± 8; R(2) = 0.21). The mean number of GSR pediatric operations diminished for both junior (37.1 ± 20 to 27.3 ± 16; R(2) = 0.88) and chief (2.6 ± 5 to 1.7 ± 5; R(2) = 0.75) years. Teaching cases in pediatric surgery decreased at all levels. Although the percentage of GSR teaching cases performed during chief years fell modestly (6.6% to 4.7%; R(2) = 0.53), median teaching cases dropped from 2 (0:11 [10(th):90(th) percentiles]) to zero (0:0 [10(th):90(th) percentiles]). Mean PSF teaching cases declined (100.7 ± 396 to 44.5 ± 42; R(2) = 0.72), while the percentage of operations that were teaching cases decreased more sharply (10.3% to 3.5%; R(2) = 0.82). Total pediatric surgery cases and PSF operative volume have increased, while GSR operative volume has decreased. Opportunities may exist to increase resident participation while

  7. Outcomes following Pediatric Auditory Brainstem Implant Surgery: Early Experiences in a North American Center.

    Science.gov (United States)

    Puram, Sidharth V; Barber, Samuel R; Kozin, Elliott D; Shah, Parth; Remenschneider, Aaron; Herrmann, Barbara S; Duhaime, Ann-Christine; Barker, Fred G; Lee, Daniel J

    2016-07-01

    There are no approved Food and Drug Administration indications for pediatric auditory brainstem implant (ABI) surgery in the United States. Our prospective case series aims to determine the safety and feasibility of ABI surgery in pediatric patients age, 2.52 ± 0.39 years). Four patients underwent ABI surgery (age, 19.2 ± 3.43 months), including 4 primary procedures and 1 revision for device failure. Spontaneous device failure occurred in another subject postoperatively. No major/minor complications occurred, including cerebrospinal fluid leak, facial nerve injury, hematoma, and nonauditory stimulation. All subjects detected sound with environmental awareness, and several demonstrated babbling and mimicry. Poor durability of older implants underscores need for updated technology. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

  8. Experience of clinical pharmaceutical care carried out in pediatric respiratory department

    Institute of Scientific and Technical Information of China (English)

    DU Xiao-ming; JIAN Ling-yan; ZHAO Li-mei

    2008-01-01

    Objective To discuss the role of clinical pharmacists in providing pharmaceutical care in pediatric respiratory department. Methods Supply pharmaceutical information, participate in clinical rounds, provide the rationalization proposal, help doctors to formulate correctly dose regimen, enhance medication efficiency; establish medicine record for the patient, record the drugs which were used, provide pharmaceutical care for the patient such as disease propaganda, medicine-use education, medicine consultation and so on. Results Promote rational administration, enhance the security of medical practice, the clinical pharmacists' work obtains the doctors' approval; improve the medication compliance, reduce patients' economy and spiritual burden, and obtain the patients' trust. Conclusions The pharmaeeutical care carried out in pediatric respiratory department can help reduce the incidence of medication errors, cut down the medication cost, shorten the time of patients to be hospitalized, raise the medication efficieney, and promote the doctor-patient relationship harmoniously. In a word the clinical pharmacists are indispensable.

  9. The ACGME case log: general surgery resident experience in pediatric surgery.

    Science.gov (United States)

    Gow, Kenneth W; Drake, F Thurston; Aarabi, Shahram; Waldhausen, John H

    2013-08-01

    General surgery (GS) residents in ACGME programs log cases performed during their residency. We reviewed designated pediatric surgery (PS) cases to assess for changes in performed cases over time. The ACGME case logs for graduating GS residents were reviewed from academic year (AY) 1989-1990 to 2010-2011 for designated pediatric cases. Overall and designated PS cases were analyzed. Data were combined into five blocks: Period I (AY1989-90 to AY1993-94), Period II (AY1994-95 to AY1998-99), Period III (AY1999-00 to AY2002-03), Period IV (AY2003-04 to AY2006-07), and Period V (AY2007-08 to AY2010-11). Periods IV and V were delineated by implementation of duty hour restrictions. Student t-tests compared averages among the time periods with significance at P pediatric cases declined for each period from an average of 47.7 in Period I to 33.8 in Period V. These changes are due to a decline in hernia repairs, which account for half of cases. All other cases contributed only minimally to the pediatric cases. The only laparoscopic cases in the database were anti-reflux procedures, which increased over time. GS residents perform a diminishing number of designated PS cases. This decline occurred before the onset of work-hour restrictions. These changes have implications on the capabilities of the current graduating workforce. However, the case log does not reflect all cases trainees may be exposed to, so revision of this list is recommended. Copyright © 2013 Elsevier Inc. All rights reserved.

  10. The ACGME case log: General surgery resident experience in pediatric surgery

    Science.gov (United States)

    Gow, Kenneth W.; Drake, F. Thurston; Aarabi, Shahram; Waldhausen, John H.

    2014-01-01

    Background General surgery (GS) residents in ACGME programs log cases performed during their residency. We reviewed designated pediatric surgery (PS) cases to assess for changes in performed cases over time. Methods The ACGME case logs for graduating GS residents were reviewed from academic year (AY) 1989–1990 to 2010–2011 for designated pediatric cases. Overall and designated PS cases were analyzed. Data were combined into five blocks: Period I (AY1989–90 to AY1993–94), Period II (AY1994–95 to AY1998–99), Period III (AY1999–00 to AY2002–03), Period IV (AY2003–04 to AY2006–07), and Period V (AY2007–08 to AY2010–11). Periods IV and V were delineated by implementation of duty hour restrictions. Student t-tests compared averages among the time periods with significance at P < .05. Results Overall GS case load remained relatively stable. Of total cases, PS cases accounted for 5.4% in Period I and 3.7% in Period V. Designated pediatric cases declined for each period from an average of 47.7 in Period I to 33.8 in Period V. These changes are due to a decline in hernia repairs, which account for half of cases. All other cases contributed only minimally to the pediatric cases. The only laparoscopic cases in the database were anti-reflux procedures, which increased over time. Conclusions GS residents perform a diminishing number of designated PS cases. This decline occurred before the onset of work-hour restrictions. These changes have implications on the capabilities of the current graduating workforce. However, the case log does not reflect all cases trainees may be exposed to, so revision of this list is recommended. PMID:23932601

  11. Long Term Sequelae of Pediatric Craniopharyngioma – Literature Review and 20 Years of Experience

    OpenAIRE

    Cohen, Michal; Guger, Sharon; Hamilton, Jill

    2011-01-01

    Craniopharyngioma are rare histologically benign brain tumors that develop in the pituitary–hypothalamic area. They may invade nearby anatomical structures causing significant rates of neurological, neurocognitive, and endocrinological complications including remarkable hypothalamic damage. Information regarding long term implications of the tumors and treatment in the pediatric population is accumulating, and treatment goals appear to be changing accordingly. In this review we aim to present...

  12. Pediatric Specialists

    Science.gov (United States)

    ... Healthy Children > Family Life > Medical Home > Pediatric Specialists Pediatric Specialists Article Body ​Your pediatrician may refer your child to a pediatric specialist for further evaluation and treatment. Pediatric specialists ...

  13. Risk and relevance of open lung biopsy in pediatric ECMO patients: the Dutch experience.

    Science.gov (United States)

    Houmes, Robert Jan; Ten Kate, Chantal A; Wildschut, Enno D; Verdijk, Rob M; Wijnen, René M H; de Blaauw, Ivo; Tibboel, Dick; van Heijst, Arno F

    2017-03-01

    Open lung biopsy can help differentiate between reversible and irreversible lung disease and may guide therapy. To assess the risk-benefit ratio of this procedure in pediatric extracorporeal membrane oxygenation (ECMO) patients, we reviewed data of all patients who underwent an open lung biopsy during ECMO in one of the two pediatric ECMO centers in a nationwide study in the Netherlands. In nineteen neonatal and six pediatric patients (0-15.5years), twenty-five open lung biopsies were performed during the study period. In 13 patients (52%), a classifying diagnosis of underlying lung disease could be made. In another nine patients (36%), specific pathological abnormalities were described. In three patients (12%), only nonspecific abnormalities were described. The histological results led to withdrawal of ECMO treatment in 6 neonates with alveolar capillary dysplasia/misalignment of pulmonary veins (24%) and in another 6 patients, corticosteroids were started (24%). All patients survived the biopsy procedure. Hemorrhagic complications were rare. An open lung biopsy during an ECMO run in neonates and children is a safe procedure with a minimum risk for blood loss and biopsy-related death. It can be very useful in diagnosing the underlying pathology and can guide cessation of ECMO treatment and thereby avoid continuation of futile treatment, especially in neonatal patients. III. Diagnostic study. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Seizure outcomes of lesionectomy in pediatric lesional epilepsy with brain tumor -- single institute experience.

    Science.gov (United States)

    Jo, Kyung Il; Shin, Hyung Jin; Hong, Seung-Chyul

    2013-09-01

    To determine the clinical characteristics, surgical strategy, and outcome in pediatric lesional epilepsy patients younger than 5years of age undergoing surgery in a single institute. Retrospective data were collected and analyzed on patients younger than 5years of age who underwent lesionectomy for lesional epilepsy at single institute from January 2001 to August 2010. Fourteen pediatric lesional epilepsy patients were enrolled in this study. Engel classification was used to classify seizure outcome. Median preoperative seizure period was 1month (range, 1-21). Median post-operative follow up period was 35months (range 13-84). Ten patients who underwent gross total resection of tumor showed Engel class Ia seizure outcome without any antiepileptic drug (AED). Subtotal resection was performed in four patients to avoid eloquent area injury. Two of these four patients with subtotal removal became seizure-free (Engel class Ia) without AED, while two were in Engel class Ib with AED medication. There was no significant surgical morbidity or mortality. Lesionectomy in children younger than 5years of age is relatively safe and effective in controlling seizures. Short preoperative seizure periods and total removal of tumor might be associated with good outcome. Therefore, early and complete lesionectomy alone may help allow for seizure freedom and optimal brain development in pediatric patients. Copyright © 2013 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  15. 小儿输液的护理体会%Nursing experience of pediatric transfusion

    Institute of Scientific and Technical Information of China (English)

    许卫红

    2014-01-01

    Pediatric transfusion is a common pediatric treatment.For children's not cooperate, parents' spoiling and psychological factors such as the reason of nursing technology,it brought difficulty to pediatric transfusion.In this paper,the author has analyzed the related impact factors of children infusion,and put forward to enhance the quality of care measures,in order to ensure the smooth transfusion in children.%小儿输液是儿科常见的治疗方法。因小儿的好动不配合、家长的过分溺爱及护士的护理技术心理因素等原因,给小儿输液带来了难度。本文分析了影响小儿输液的相关因素,提出了提升优质护理服务措施,确保小儿输液的顺利进行。

  16. Transcoronary bone marrow-derived progenitor cells in a child with myocardial infarction: first pediatric experience.

    Science.gov (United States)

    Limsuwan, Alisa; Pienvichit, Pavit; Limpijankit, Thosaphol; Khowsathit, Pongsak; Hongeng, Suradej; Pornkul, Ratanaporn; Siripornpitak, Suvipaporn; Boonbaichaiyapruk, Sarana

    2010-08-01

    Recent advances in stem cell therapy to restore cardiac function have great promise for patients with congestive heart failure after myocardial infarction in an adult population. We examined the benefits of bone marrow-derived progenitor cells treatment modality for the pediatric patient. We present our first case of transcoronary autologous stem cell transplantation in a 9-year-old girl with refractory congestive heart failure secondary to myocardial infarction 1 year after transcatheter revascularization. The child received daily injections of granulocyte colony-stimulating factor for 3 days prior to the bone marrow aspiration. The bone marrow cells were isolated to constitute CD133+/CD34+ more than 90% of the total number. Subsequently, the progenitor cell suspension was injected via a transcoronary catheter without any complication. Three months after stem cell therapy, her cardiac function, assessed by both cardiac magnetic resonance and echocardiogram, has been improved with the left ventricular ejection fraction at 47% compared to the baseline of 30%. This is the first reported pediatric case of successful transcoronary injection of bone marrow-derived progenitor cells for end-stage heart disease. The procedure is considered safe and feasible for the pediatric population.

  17. Preliminary study in a new protocol for the treatment of oral mucositis in pediatric patients undergoing hematopoietic stem cell transplantation (HSCT) and chemotherapy (CT).

    Science.gov (United States)

    Vitale, Marina Consuelo; Modaffari, Carola; Decembrino, Nunzia; Zhou, Feng Xiao; Zecca, Marco; Defabianis, Patrizia

    2017-08-01

    Oral mucositis (OM) is a debilitating and serious side effect in patients undergoing hematopoietic stem cell transplantation (HSCT) and chemotherapy (CT). Laser therapy is becoming a promising treatment option in these patients, avoiding the necessity of enteral/parenteral nutrition. The aim of this study was to evaluate the efficacy of laser therapy in patients affected by oral mucositis induced by chemotherapy and HSCT. Sixteen onco-hematological pediatric patients receiving chemotherapy and hematopoietic stem cell transplantation, affected by oral mucositis, were enrolled in this study. They were divided in two randomized groups: the laser group and the placebo-control group. Patients in the laser group were treated with HPLT (970 ± 15 nm, 3.2 W (50%), 35-6000 Hz, 240 s) for four consecutive days, once a day; and placebo group underwent sham treatment. The assessment of mucositis was recorded through WHO Oral Mucositis Grading Objective Scale, and pain was evaluated through Visual Analogue Scale (VAS). Patients were monitored and evaluated 3, 7, and 11 days after the first day of laser therapy. Once OM was diagnosed, the patients had mucositis grading assessments before laser or sham application at day 3, 7, and 11 after first application. All patients of laser group demonstrated improvement in pain sensation from day 3 after first application of laser (p < 0.05), ulcerations reduced their dimensions and erythema disappeared. The patients of placebo group had improvement from day 7. In laser group, all mucositis were fully resolved from day 7 (p < 0.05). Oral mucositis negatively impacts on nutritional intake, oral hygiene, and quality of life. Laser therapy appears to be a safe and innovative approach in the management of oral mucositis. In this preliminary study, HPLT encourages to consider laser therapy as a part of onco-hematological protocol, providing to decrease pain and duration of OM induced by CT and HSCT. Further researches will be needed

  18. Meeting children's needs: a mixed-methods approach to a regionalized pediatric surge plan-the Los Angeles County experience.

    Science.gov (United States)

    Berg, Bridget M; Muller, Valerie M; Wilson, Millicent; Amara, Roel; Fruhwirth, Kay; Stevenson, Kathleen; Burke, Rita V; Upperman, Jeffrey S

    2014-01-01

    Children are one of the most vulnerable populations during mass casualty incidents because of their unique physiological, developmental, and psychological attributes. The objective of this project was to enhance Los Angeles County's (LAC) pediatric surge capabilities. The purpose of this study was threefold: (1) determine gaps in pediatric surge capacity and capabilities; (2) double pediatric inpatient capacity; and (3) document a plan to address gaps and meet pediatric inpatient surge. We hypothesized that LAC would be able to meet the identified pediatric surge target by leveraging resources of hospitals within the region. Deliverables included a pediatric surge plan for LAC, pediatric surge training resources, and pediatric supplies for hospitals participating in LAC's Hospital Preparedness Program (HPP). After Institutional Review Board approval, the authors used a mixed-methods approach to explore gaps in hospital capacity and capabilities in a large urban county. Hospitals were surveyed via Qualtrics® on 38 questions regarding capacity, staffing, availability of pediatric supplies, and existing pediatric surge plans. Publicly available inpatient bed data were collected from the Office of Statewide Health Planning and Development for the year ending June 2010 and supplemented by hospital survey responses. Population data was used from US Census 2010. This combined dataset was analyzed for capacity, pediatric designations, and capabilities. To supplement this data, three focus groups were conducted between April 2011 and May 2012. Focus group topics included: supplies and training needed for pediatric surge, surge targets, and plan development and functionality. Hospitals varied in pediatric capacity and capability. Forty-six percent of facilities provide inpatient pediatric services. Forty-one hospitals are designated as an Emergency Department Approved for Pediatrics. Identified gaps included: limited pediatric bed capacity, geographic variability, limited

  19. Understanding Pediatric Dentists' Dental Caries Management Treatment Decisions: A Conjoint Experiment.

    Science.gov (United States)

    Kateeb, E T; Warren, J J; Gaeth, G J; Momany, E T; Damiano, P C

    2016-04-01

    When traditional ranking and rating surveys are used to assess dentists' treatment decisions, the patient's source of payment appears to be of little importance. Therefore, this study used the marketing research tool conjoint analysis to investigate the relative impact of source of payment along with the child's age and cooperativeness on pediatric dentists' willingness to use Atraumatic Restorative Treatment (ART) to restore posterior primary teeth. A conjoint survey was completed by 707 pediatric dentists. Three factors (age of the child, cooperativeness, type of insurance) were varied across 3 levels to create 9 patient scenarios. The relative weights that dentists placed on these factors in the restorative treatment decision process were determined by conjoint analysis. "Cooperativeness" (52%) was the most important factor, "age of the child" (26%) the second-most important factor, followed by "insurance status of the child" (22%). For the third factor, insurance, pediatric dentists were least willing to use ART with publicly insured children (-0.082), and this was significantly different from their willingness to use ART with uninsured children (0.010) but not significantly different than their willingness to use ART for children with private insurance (0.073). Unlike traditional ranking and rating tools, conjoint analysis found that the insurance status of the patient appeared to be an important factor in dentists' decisions about different restorative treatment options. When pediatric dentists were forced to make tradeoffs among different patients' factors, they were most willing to use ART technique with young, uncooperative patients when they had no insurance. Knowledge Transfer Statement: The present study suggests the feasibility of using techniques borrowed from marketing research, such as conjoint analysis, to understand dentists' restorative treatment decisions. Results of this study demonstrate pediatric dentists' willingness to use a particular

  20. Preliminary test of effects of cognitive ability, experience, and teaching methods on Verbal Analogy Test scores.

    Science.gov (United States)

    Rosenberg, D; Willson-Quayle, A; Pasnak, R

    2000-06-01

    The methods from which one can choose when preparing for the GRE Verbal Analogies include books, software, audiotapes, and formal classroom instruction. What teaching method will work best for a given individual? To begin the search for an answer, Gray's test of reasoning ability was given to 28 undergraduates who also answered a questionnaire detailing their experience with analogies. They were randomly assigned to teaching conditions ranging from self-directed workbook study to intensive interactive assistance. No teaching method was superior overall, but interactions showed that (1) students who scored worst on the pretest improved the most, (2) those higher in cognitive functioning and experience performed better after intensive interactive assistance, and (3) those lower in both cognitive functioning and experience did significantly better with self-paced workbooks. This preliminary work suggests that it may be profitable to assess the prior experience and reasoning of potential students and adopt the methods for teaching formal operational thought found empirically to be most suitable.

  1. Preliminary Results from the PrimEx-II experiment at Jefferson Lab

    Energy Technology Data Exchange (ETDEWEB)

    Gasparian, Ashot [NCA& T, Greensboro, NC; Thomas Jefferson National Accelerator Facility (TJNAF), Newport News, VA (United States)

    2016-06-01

    Properties of the neutral pion, as the lightest hadron in Nature, are most sensitive to the basic symmetries and their partial breaking effects in the theory of the strong interaction (QCD). In particular, the po →gg decay width is primarily defined by the spontaneous chiral symmetry breaking effect (chiral anomaly) in QCD. The next order corrections to the anomaly have been shown to be small and are known to a 1% precision level. The PrimEx Collaboration at JLab has developed and performed two Primakoff type experiments to measure the po →gg decay width with a similar precision. The published result from the PrimEx-I experiment, G(p0 →gg ) = 7.82±0.14 (stat.)±0.17 (syst.) eV, was a factor of two more precise than the average value quoted in PDG-2010 [1]. The second experiment was performed in 2010 with a goal of 1.4% total uncertainty to address the next-to-leading-order theory calculations. The preliminary results from the PrimEx-II experiment are presented and discussed in this note.

  2. HACCP and water safety plans in Icelandic water supply: preliminary evaluation of experience.

    Science.gov (United States)

    Gunnarsdóttir, María J; Gissurarson, Loftur R

    2008-09-01

    Icelandic waterworks first began implementing hazard analysis and critical control points (HACCP) as a preventive approach for water safety management in 1997. Since then implementation has been ongoing and currently about 68% of the Icelandic population enjoy drinking water from waterworks with a water safety plan based on HACCP. Preliminary evaluation of the success of HACCP implementation was undertaken in association with some of the waterworks that had implemented HACCP. The evaluation revealed that compliance with drinking water quality standards improved considerably following the implementation of HACCP. In response to their findings, waterworks implemented a large number of corrective actions to improve water safety. The study revealed some limitations for some, but not all, waterworks in relation to inadequate external and internal auditing and a lack of oversight by health authorities. Future studies should entail a more comprehensive study of the experience with the use of HACCP with the purpose of developing tools to promote continuing success.

  3. Experiments, conceptual design, preliminary cost estimates and schedules for an underground research facility

    Energy Technology Data Exchange (ETDEWEB)

    Korbin, G.; Wollenberg, H.; Wilson, C.; Strisower, B.; Chan, T.; Wedge, D.

    1981-09-01

    Plans for an underground research facility are presented, incorporating techniques to assess the hydrological and thermomechanical response of a rock mass to the introduction and long-term isolation of radioactive waste, and to assess the effects of excavation on the hydrologic integrity of a repository and its subsequent backfill, plugging, and sealing. The project is designed to utilize existing mine or civil works for access to experimental areas and is estimated to last 8 years at a total cost for contruction and operation of $39.0 million (1981 dollars). Performing the same experiments in an existing underground research facility would reduce the duration to 7-1/2 years and cost $27.7 million as a lower-bound estimate. These preliminary plans and estimates should be revised after specific sites are identified which would accommodate the facility.

  4. Fetal magnetic resonance imaging: jumping from 1.5 to 3 tesla (preliminary experience)

    Energy Technology Data Exchange (ETDEWEB)

    Victoria, Teresa [The Children' s Hospital of Philadelphia, Radiology Department, Center for Fetal Diagnosis and Treatment, Philadelphia, PA (United States); Jaramillo, Diego; Roberts, Timothy Paul Leslie; Zarnow, Deborah; Johnson, Ann Michelle; Delgado, Jorge; Vossough, Arastoo [The Children' s Hospital of Philadelphia, Radiology Department, Philadelphia, PA (United States); Rubesova, Erika [Stanford University, Department of Radiology, Lucile Packard Children' s Hospital, Stanford, CA (United States)

    2014-04-15

    Several attempts have been made at imaging the fetus at 3 T as part of the continuous search for increased image signal and better anatomical delineation of the developing fetus. Until very recently, imaging of the fetus at 3 T has been disappointing, with numerous artifacts impeding image analysis. Better magnets and coils and improved technology now allow imaging of the fetus at greater magnetic strength, some hurdles in the shape of imaging artifacts notwithstanding. In this paper we present the preliminary experience of evaluating the developing fetus at 3 T and discuss several artifacts encountered and techniques to decrease them, as well as safety concerns associated with scanning the fetus at higher magnetic strength. (orig.)

  5. Post-depositional changes in snow isotope content: preliminary results of laboratory experiments

    Directory of Open Access Journals (Sweden)

    A. A. Ekaykin

    2009-10-01

    Full Text Available Isotopic content of the snow and firn thickness is assumed to be altered significantly due to the post-depositional (PD mass- and isotope exchange with the atmospheric water vapor. If so, these effects should be accounted for in the ice core-based isotope-temperature paleo-reconstructions. In order to study the intensity of the PD processes we set up a series of laboratory experiments. In this paper we describe in detail the experimental technique and briefly overview preliminary results. It is shown that the PD modifications in the upper layer of snow thickness are noticeably strong even under such a low temperature as −35°C (the value typical for the Central Antarctic summer. It is demonstrated that the PD isotopic changes in snow can be approximated as a linear function of the relative mass loss due to snow sublimation. Possible applications for improving the isotope-temperature paleo-reconstructions are shortly discussed.

  6. "Awake Veno-arterial Extracorporeal Membrane Oxygenation" in Pediatric Cardiogenic Shock: A Single-Center Experience.

    Science.gov (United States)

    Schmidt, F; Jack, T; Sasse, M; Kaussen, T; Bertram, H; Horke, A; Seidemann, K; Beerbaum, P; Koeditz, H

    2015-12-01

    In pediatric patients with acute refractory cardiogenic shock (CS), extracorporeal membrane oxygenation (ECMO) remains an established procedure to maintain adequate organ perfusion. In this context, ECMO can be used as a bridging procedure to recovery, VAD or transplantation. While being supported by ECMO, most centers tend to keep their patients well sedated and supported by invasive ventilation. This may be associated with an increased risk of therapy-related morbidity and mortality. In order to optimize clinical management in pediatric patients with ECMO therapy, we report our strategy of veno-arterial ECMO (VA-ECMO) in extubated awake and conscious patients. We therefore present data of six of our patients with CS, who were treated by ECMO being awake without continuous analgosedation and invasive ventilation. Of these six patients, four were 14 years of age. Median time on ECMO was 17.4 days (range 6.9-94.2 days). Median time extubated, while receiving ECMO support was 9.5 days. Mean time extubated was 78 % of the total time on ECMO. Three patients reached full recovery of cardiac function on "Awake-VA-ECMO," whereas the other three were successfully bridged to destination therapy (VAD, heart transplantation, withdrawal). Four out of our six patients are still alive. Complications related to ECMO therapy (i.e., severe bleeding, site infection or dislocation of cannulas) were not observed. We conclude that "Awake-VA-ECMO" in extubated, spontaneously breathing conscious pediatric patients is feasible and safe for the treatment of acute CS and can be used as a "bridging therapy" to recovery, VAD implantation or transplantation.

  7. DEMOGRAPHIC PROFILE OF PEDIATRIC OSTEOSARCOMA IN SOUTH INDIA: A SINGLE INSTITUTION EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Ashok S Komaranchath, L. Appaji, K. C. Lakshmaiah, Mangesh Kamath, Rekha V Kumar

    2015-07-01

    Full Text Available INTRODUCTION: Osteosarcoma is the most common primary malignant bone tumor in children and adolescents, accounting for 4% of all childhood cancers worldwide. In India, the incidence varies from 4.7% to 11.6%, where this malignancy is associated with significant morbidity and mortality. There is paucity of demographic and clinical data for osteosarcoma in India. Objective: To retrospectively assess the demographic and clinical profile of pediatric osteosarcoma presenting at a tertiary cancer care centre of South India. Materials and Methods: From January 2010 to December 2013, all children under the age of 15 years diagnosed with osteosarcoma on histopathology were retrospectively analyzed for age, gender, rural or urban location, history, location of tumour, investigations, stage and histopathological subtype. The findings were formulated to chart the demographic and clinical profile. Results: A total of 37 cases of pediatric osteosarcoma were analyzed. The median age was 13 years with only three patients under the age of 10 years. There was a slight female preponderance with male: female ratio of 1:1.3. Most common mode of presentation was with pain and swelling of local site. Three patients had presented with a pathological fracture. The most common site involved was the distal femur. Over 90% of the cases were conventional osteosarcoma. Around 32% of patients had stage IV disease at presentation. Around 37% of patients from rural areas and 20% of patients from urban areas presented with metastatic disease. Conclusions: The aim of the study was the demographic and clinical description of osteosarcoma in the pediatric age group. A slight female preponderance was noted. The most common sites were consistent with western data except for an increased incidence in the fibula. There was an increased incidence of metastatic disease as compared to western population and a larger proportion of these patients seemed to come from rural areas.

  8. Clinical Characteristics of Pediatric Esophagitis in Southern Iran; A Single-Center Experience

    Directory of Open Access Journals (Sweden)

    Mozhgan Zahmatkeshan

    2013-06-01

    Full Text Available Background: We sought to determine the clinical characteristics of pediatric esophagitis in southern Iran. Methods: This cross-sectional study was conducted over a 4-year period, from 2005 to 2009, in Nemazee Hospital, a tertiary healthcare center in Shiraz, southern Iran. We consecutively included all pediatric patients (<18 years who underwent endoscopy in our center and had pathology-confirmed diagnosis of esophagitis. Data regarding the patients’ demographic characteristics, comorbidities, and clinical findings were recorded using a questionnaire. All the patients underwent upper gastrointestinal endoscopy and biopsy of the esophagus, and the findings were recorded in the questionnaire. Results: We studied 125 children, comprising 61 (48.8% girls and 64 (51.2% boys at a mean age of 6.6±5.5 years. Repeated vomiting was the prominent symptom in our series, with it being reported by 75 (60% patients, followed by fever in 35 (28%. Erythema (33.6%, esophageal ulcer (11.2%, and whitish patch (8.0% were the most common endoscopic findings, while reflux esophagitis (32.8%, chronic (6.4% and acute esophagitis (5.6%, and candida esophagitis (5.6% were the most common histological diagnoses. Only one (0.8% patient was diagnosed as having eosinophilic esophagitis, aspergillosis, and graft-versus-host disease. Conclusion: Reflux was the most common cause of esophagitis in the pediatric population of southern Iran. Contrary to previous reports, the prevalence of eosinophilic esophagitis was far less than that estimated, while the prevalence of opportunistic infections was higher secondary to post-liver transplantation immunosuppression.

  9. Children's (Pediatric) Abdominal Ultrasound Imaging

    Medline Plus

    Full Text Available ... News Physician Resources Professions Site Index A-Z Children's (Pediatric) Ultrasound - Abdomen Children’s (pediatric) ultrasound imaging of ... 30 minutes. top of page What will my child experience during and after the procedure? Ultrasound examinations ...

  10. Screening diagnostics of antivital experiences and propensity toward impulsive, autoagressive behavior in adolescents (preliminary results

    Directory of Open Access Journals (Sweden)

    Bannikov G.S.,

    2014-08-01

    Full Text Available Development of methods for revealing antivital experiences and propensity to autoaggressive behavior in educational institutions is one of the key steps in developing strategies for the primary prevention of suicidal behavior in adolescents. The purpose of this study was to develop an effective screening diagnostic package aimed at identifying antivital experiences and propensity to autoaggressive behavior. The survey methods we used were: Beck Hopelessness Scale, Russell Loneliness Scale, A.G. Shmelev Suicide Risk Questionnaire, PDQ-IV Borderline disorder and Narcissism scales. At the first stage we examined 750 minors aged 12-18 and identified risk group (85 people – 11.4%, which included adolescents with high levels of both individual scales, and their combination. At the second stage we examined 10 adolescents at risk. In 7 of them (70% were identified antivital, suicidal thoughts of passive or compulsive nature, signs of subjective and objective socio- psychological maladjustment. Our preliminary conclusion is that high levels of hopelessness and loneliness in adolescents are stable predictors of mental and emotional distress and psychosocial maladjustment in the period of psychological crises and decompensation of character accentuation of borderline and narcissistic types. These scales can be recommended for primary screening of antivital (depressive experiences and propensity to autoaggressive behavior in adolescents.

  11. Biologism in Psychiatry: A Young Man’s Experience of Being Diagnosed with “Pediatric Bipolar Disorder”

    Directory of Open Access Journals (Sweden)

    Peter Parry

    2014-03-01

    Full Text Available Pediatric bipolar disorder is a diagnosis that arose in the mid 1990s in the USA and has mostly remained confined to that nation. In this article a young American man (under a pseudonym describes his experience of having the diagnosis throughout his adolescent years. His story was conveyed via correspondence and a meeting with the author, an Australian child psychiatrist. The young American’s story reveals several issues that afflict contemporary psychiatry, particularly in the USA, where social and economic factors have contributed to the rise of a dominant biomedical paradigm—or “biologism”. This focus on the “bio” to the relative exclusion of the “psychosocial” in both diagnosis and treatment can have serious consequences as this young man’s story attests. The author explores aspects of his tale to analyze how the pediatric bipolar disorder “epidemic” arose and became emblematic of a dominant biologism. This narrative points to the need, depending on the service and country, to return to or retain/improve a balanced biopsychosocial perspective in child and adolescent mental health. Child psychiatry needs to advocate for health systems that support deeper listening to our patients. Then we can explore with them the full range of contextual factors that contribute to symptoms of individual and family distress.

  12. Taiwanese parents' experience of making a "do not resuscitate" decision for their child in pediatric intensive care unit.

    Science.gov (United States)

    Liu, Shu-Mei; Lin, Hung-Ru; Lu, Frank L; Lee, Tzu-Ying

    2014-03-01

    The purpose of this project was to explore the parental experience of making a "do not resuscitate" (DNR) decision for their child who is or was cared for in a pediatric intensive care unit in Taiwan. A descriptive qualitative study was conducted following parental signing of a standard hospital DNR form on behalf of their critically ill child. Sixteen Taiwanese parents of 11 children aged 1 month to 18 years were interviewed. Interviews were recorded, transcribed, analyzed and sorted into themes by the sole interviewer plus other researchers. Three major themes were identified: (a) "convincing points to sign", (b) "feelings immediately after signing", and (c) "post-signing relief or regret". Feelings following signing the DNR form were mixed and included "frustration", "guilt", and "conflicting hope". Parents adjusted their attitudes to thoughts such as "I have done my best," and "the child's life is beyond my control." Some parents whose child had died before the time of the interview expressed among other things "regret not having enough time to be with and talk to my child". Open family visiting hours plus staff sensitivity and communication skills training are needed. To help parents with this difficult signing process, nurses and other professionals in the pediatric intensive care unit need education on initiating the conversation, guiding the parents in expressing their fears, and providing continuing support to parents and children throughout the child's end of life process. Copyright © 2013. Published by Elsevier B.V.

  13. Surgical cardiac denervation therapy for treatment of congenital ion channelopathies in pediatric patients: a contemporary, single institutional experience.

    Science.gov (United States)

    Costello, John P; Wilson, Jennifer K; Louis, Clauden; Peer, Syed M; Zurakowski, David; Nadler, Evan P; Qureshi, Faisal G; Jonas, Richard A; Greene, E Anne; Berul, Charles I; Moak, Jeffrey P; Nath, Dilip S

    2015-01-01

    Congenital ion channel disorders, including congenital long QT syndrome (LQTS), cause significant morbidity in pediatric patients. When medication therapy does not control symptoms or arrhythmias, more invasive treatment strategies may be necessary. This study examines our institution's clinical experience with surgical cardiac denervation therapy for management of these arrhythmogenic disorders in children. An institutional review board-approved retrospective review identified ten pediatric patients with congenital ion channelopathies who underwent surgical cardiac denervation therapy at a single institution between May 2011 and April 2014. Eight patients had a diagnosis of congenital LQTS, two patients were diagnosed with catecholaminergic polymorphic ventricular tachycardia (CPVT). All patients underwent sympathectomy and partial stellate ganglionectomy via video-assisted thoracoscopic surgery (VATS). Six of the ten patients had documented ventricular arrhythmias preoperatively, and 70% of the patients had preoperative syncope. The corrected QT interval decreased in 75% of patients with LQTS following sympathectomy. Postoperative arrhythmogenic symptoms were absent in 88% of congenital LQTS patients, but both patients with CPVT continued to have symptoms throughout the duration of follow-up. All patients were alive after a median follow-up period of 10 months. Surgical cardiac denervation therapy via VATS is a useful treatment strategy for congenital LQTS patients who fail medical management, and its potential benefit in the management of CPVT is unclear. A prospective comparison of the efficacy of surgical cardiac denervation therapy and implantable cardioverter-defibrillator use in congenital ion channelopathies is timely and crucial. © The Author(s) 2014.

  14. Water privatization, water source, and pediatric diarrhea in Bolivia: epidemiologic analysis of a social experiment.

    Science.gov (United States)

    Tornheim, Jeffrey A; Morland, Kimberly B; Landrigan, Philip J; Cifuentes, Enrique

    2009-01-01

    Water and sanitation services are fundamental to the prevention of pediatric diarrhea. To enhance both access to water and investment, some argue for the privatization of municipal water networks. Water networks in multiple Bolivian cities were privatized in the 1990s, but contracts ended following popular protests citing poor access. A population-based retrospective cohort study was conducted in two Bolivian cities. Data were collected on family water utilization and sanitation practices and on the prevalence of diarrhea among 596 children. Drinking from an outdoor water source (OR, 2.08; 95%CI, 1.25-3.44) and shorter in-home water boiling times (OR, 1.99; 95%CI, 1.19-3.34) were associated with prevalence of diarrhea. Increased prevalence was also observed for children from families using private versus public water services, using off-network water from cistern trucks, or not treating their water in-home. Results suggest that water source, water provider, and in-home water treatment are important predictors of pediatric diarrhea.

  15. Barriers to live donor kidney transplants in the pediatric population: A single-center experience.

    Science.gov (United States)

    Taormina, Shibany P; Galloway, Matthew P; Jain, Amrish

    2017-03-01

    A decrease in live donor pediatric kidney transplants has occurred in the United States. This study investigates barriers that may influence access to live donor kidney transplants in children. Retrospective chart review was conducted for 91 children (69% male, mean age 11.9 years) who underwent pretransplant workup from 2005 to 2015 at an urban pediatric hospital. Fifty-four percent were African American, 32% Caucasian, 8% Arabic, 3% Hispanic, and 3% Others. Government-sponsored insurance (Medicaid/Medicare) was utilized by 73%, and 54% had dual caregivers. Only nine of 68 kidney transplants were live donor transplants. Live donor transplants (11%) were significantly (P=.008) lower than deceased donor transplants (59%) in African Americans. Private insurance was reported by 56% of live donor recipients and 25% of deceased donor recipients. Among live donor recipients, 78% were from dual caregiver families. Caregiver, health-related, financial, and religious/cultural barriers to live donor transplants were reported, several of which may be amenable to positive intervention.

  16. Impact of Clinical Pharmacist on the Pediatric Intensive Care Practice: An 11-Year Tertiary Center Experience.

    Science.gov (United States)

    Tripathi, Sandeep; Crabtree, Heidi M; Fryer, Karen R; Graner, Kevin K; Arteaga, Grace M

    2015-01-01

    With increasing complexity of critical care medicine comes an increasing need for multidisciplinary involvement in care. In many institutions, pharmacists are an integral part of this team, but long-term data on the interventions performed by pharmacists and their effects on patient care and outcomes are limited. We aimed to describe the role of pediatric clinical pharmacists in pediatric intensive care unit (PICU) practice. We retrospectively reviewed the records of pharmacy interventions in the PICU at the Mayo Clinic in Rochester, Minnesota, from 2003-2013, with a distinct period of increased pharmacist presence in the PICU from 2008 onward. We compared demographic and outcome data on patients who did and who did not have pharmacy interventions during 2 periods (2003-2007 and 2008-2013). We identified 27,773 total interventions by pharmacists during the 11-year period, of which 79.8% were accepted by the clinical team. These interventions were made on 10,963 unique PICU admissions and prevented 5867 order entry errors. Pharmacists' interventions increased year over year, including a significant change in 2008. Patients who required pharmacy involvement were younger, sicker, and had longer intensive care unit, hospital, and ventilator duration. Average central line infections and central line entry rates decreased significantly over the study period. Increased pharmacist presence in the PICU is associated with increased interventions and prevention of adverse drug events. Pharmacist participation during rounds and order entry substantially improved the care of critically sick children and should be encouraged.

  17. [Experience with the negative pressure closure system of chronic wounds in pediatric patients].

    Science.gov (United States)

    Dabaghi-Richerand, A; Gómez-Chavarría, J; González-Sánchez, M; Saleme-Cruz, J; Garavito, E

    2013-01-01

    To show the results and advantages of using the negative pressure closure system in a pediatric population with infections and wound closure defects. A retrospective analysis was conducted on pediatric patients in whom the VAC(®) negative pressure wound closure system was used in the Shriners Hospital for Children, Mexico, from January 2008 to December 2012. We were able to include 8 patients treated with this system. We evaluated the cause for use, wound colonizing microorganism, number of days of stay at the hospital, number of times applied, interval of application, and number of days in the hospital until discharge after VAC(®) application, and final treatment. The average days after VAC aplication till discharge was 13.7 days. The final treatment in 7 of the 8 patients was direct closure or application of skin grafts for closure of the wounds. Through this study we were able to observe that, after the application of this treatment, there was an increase in the granulation tissue at the wounds, as well as resolution of the infection. We were able to confirm the efficiency of this treatment in controlling the infection and decreasing skin defects, allowing an easier and earlier wound closure. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  18. Fusarium spp infections in a pediatric burn unit: nine years of experience.

    Science.gov (United States)

    Rosanova, María Teresa; Brizuela, Martín; Villasboas, Mabel; Guarracino, Fabian; Alvarez, Veronica; Santos, Patricia; Finquelievich, Jorge

    2016-01-01

    Fusarium spp are ubiquitous fungi recognized as opportunistic agents of human infections, and can produce severe infections in burn patients. The literature on Fusarium spp infections in pediatric burn patients is scarce. To describe the clinical and epidemiological features as well as outcome of Fusarium spp infections in pediatric burn patients. Retrospective, descriptive study of Fusarium spp infections in a specialized intensive care burn unit. In 15 patients Fusarium spp infections were diagnosed. Median age was 48 months. Direct fire injury was observed in ten patients. The median affected burn surface area was 45%. Twelve patients had a full thickness burn. Fourteen patients had a Garces Index ≥3. Fungal infection developed at a median of 11 days after burn injury. Fungi were isolated from burn wound in 14 patients and from the bone in one patient. Amphotericin B was the drug of choice for treatment followed by voriconazole. Median time of treatment completion was 23 days. One patient (7%) died of fungal infection-related causes. In our series Fusarium spp was an uncommon pathogen in severely burnt patients. The burn wound was the most common site of infection and mortality was low. Copyright © 2016 Elsevier Editora Ltda. All rights reserved.

  19. Social pediatrics: weaving horizontal and vertical threads through pediatric residency.

    Science.gov (United States)

    van den Heuvel, Meta; Martimianakis, Maria Athina Tina; Levy, Rebecca; Atkinson, Adelle; Ford-Jones, Elizabeth; Shouldice, Michelle

    2017-01-13

    Social pediatrics teaches pediatric residents how to understand disease within their patients' social, environmental and political contexts. It's an essential component of pediatric residency training; however there is very little literature that addresses how such a broad-ranging topic can be taught effectively. The aim of this study was to determine and characterize social pediatric education in our pediatric residency training in order to identify strengths and gaps. A social pediatrics curriculum map was developed, attending to 3 different dimensions: (1) the intended curriculum as prescribed by the Objectives of Training for Pediatrics of the Royal College of Physicians and Surgeons of Canada (RCPSC), (2) the formal curriculum defined by rotation-specific learning objectives, and (3) the informal/hidden curriculum as reflected in resident and teacher experiences and perceptions. Forty-one social pediatric learning objectives were extracted from the RCPSC Objectives of Training for Pediatrics, most were listed in the Medical Expert (51%) and Health Advocate competencies (24%). Almost all RCPSC social pediatric learning objectives were identified in more than one rotation and/or seminar. Adolescent Medicine (29.2%), Pediatric Ambulatory Medicine (26.2%) and Developmental Pediatrics (25%) listed the highest proportion of social pediatric learning objectives. Four (10%) RCPSC social pediatric objectives were not explicitly named within learning objectives of the formal curriculum. The informal curriculum revealed that both teachers and residents viewed social pediatrics as integral to all clinical encounters. Perceived barriers to teaching and learning of social pediatrics included time constraints, particularly in a tertiary care environment, and the value of social pediatrics relative to medical expert knowledge. Despite the lack of an explicit thematic presentation of social pediatric learning objectives by the Royal College and residency training program

  20. Pediatric vasculitis.

    Science.gov (United States)

    Barut, Kenan; Sahin, Sezgin; Kasapcopur, Ozgur

    2016-01-01

    The aim of this review is to define childhood vasculitis and to highlight new causative factors and treatment modalities under the guidance of recently published studies. Childhood vasculitis is difficult to diagnose because of the wide variation in the symptoms and signs. New nomenclature and classification criteria were proposed for the diagnosis of pediatric vasculitis. Recently, progress has been made toward understanding the genetic susceptibility to pediatric vasculitis as it was in other diseases. Various radiological techniques provide great opportunities in establishing the diagnosis of pediatric vasculitis. Mild central nervous system disease can accompany Henoch-Schonlein purpura and can go unnoticed. Antineutrophilic cytoplasmic antibody-associated vasculitis is rare in children. Increased severity of the disease, subglottic stenosis, and renal disease are described more frequently among children. Biological therapies are used with success in children as in adults. Future studies, whose aims are to evaluate treatment responses, prognosis and to design guidelines for activity, and damage index of vasculitis for children are required. Henoch-Schonlein purpura and Kawasaki disease are the most frequent vasculitides of children. Experience from adult studies for treatment and prognosis are usually used because of low incidence of other vasculitides in children. Multicenter studies of pediatric vasculitis should be conducted to detail treatment responses and prognosis in children.

  1. Monitoring the hospital management of acute asthma: the Italian Pediatric Network experience.

    Science.gov (United States)

    Martelli, A G; Bianchi, R; Boldrighini, B; Bosoni, M; De Vuono, A; Flores D'Arcais, A; Gargantini, G; Longhi, R; Ortisi, M T; Racchi, E; Parola, L

    2016-11-01

    The Study Group on Accreditation and Quality Improvement of the Italian Society of Pediatrics has developed an observational study about the hospital management of pediatric patients affected by severe asthma, in order to evaluate how the Guidelines for severe asthma in childhood are applied in the daily practice. This study included patients between 2 and 17 years, hospitalized or under short intensive observation for acute asthma. The data collection was carried out through the compilation of on-line forms. The statistical technique used was the Chi Square test. 409 forms were filled in by 32 Italian Centers. 17% of the patients showed severe asthma, 59% moderate and 24% mild. On arrival at the Emergency Room the oximetry was measured in 95% of the patients, the respiratory rate in 64% while the heart rate in 88% of them. 48% of the children were exposed to chest X-ray. More than half of the children received oxygen therapy, 98.5% received short-acting beta-2 agonists and systemic steroid therapy was given to 82% of children, mainly orally. At discharge only half of the children were provided with written instructions for the management of any subsequent asthmatic episode. The analysis of the collected data highlights that not all the children had their oxygen saturation measured, although this parameter is one of the main indicators of disease severity, as well as the respiratory rate, which was detected in a minimal percentage of cases. The frequency of chest X-ray was extremely high, even though it does not have any indication in the majority of asthma cases. The evaluation of the therapeutic treatment denotes an adequate use of the oxygen therapy according to the oximetry values found on arrival, but an abuse of steroid therapy. Critical issues emerge at discharge: children are not always educated about the home management of the disease and the self-evaluation of the illness seriousness. The pediatric network has become an excellent system of monitoring of

  2. Preliminary experience with dexmedetomidine for monitored anesthesia care during ENT surgical procedures.

    Science.gov (United States)

    Busick, Tamra; Kussman, Mary; Scheidt, Troy; Tobias, Joseph D

    2008-01-01

    Dexmedetomidine is an alpha2-adrenergic agonist that produces anxiolysis, amnesia, sedation, potentiation of opioid analgesia, and sympatholysis. It is currently approved by the U.S. Food & Drug Administration for the sedation of adults in the intensive care setting for up to 24 hours during mechanical ventilation. Given its beneficial sedative and anxiolytic properties and limited adverse effect profile, it has been used in several other clinical scenarios. The authors present their experience using dexmedetomidine for monitored anesthesia care (MAC) during "awake" ENT procedures such as thyroplasty, a procedure requiring a patient to verbalize when requested but to otherwise remain immobile to allow for completion of the procedure, and in a patient with post-polio syndrome with poor pulmonary reserve requiring esophagoscopy with dilation and botulinum toxin injection for cricopharyngeal dysfunction. Our preliminary experience suggests that dexmedetomidine provides effective sedation as the primary agent for MAC during such procedures in adult patients. The end-organ effects of dexmedetomidine and previous reports of its use during MAC are reviewed.

  3. Preliminary experiments on pharmacokinetic diffuse fluorescence tomography of CT-scanning mode

    Science.gov (United States)

    Zhang, Yanqi; Wang, Xin; Yin, Guoyan; Li, Jiao; Zhou, Zhongxing; Zhao, Huijuan; Gao, Feng; Zhang, Limin

    2016-10-01

    In vivo tomographic imaging of the fluorescence pharmacokinetic parameters in tissues can provide additional specific and quantitative physiological and pathological information to that of fluorescence concentration. This modality normally requires a highly-sensitive diffuse fluorescence tomography (DFT) working in dynamic way to finally extract the pharmacokinetic parameters from the measured pharmacokinetics-associated temporally-varying boundary intensity. This paper is devoted to preliminary experimental validation of our proposed direct reconstruction scheme of instantaneous sampling based pharmacokinetic-DFT: A highly-sensitive DFT system of CT-scanning mode working with parallel four photomultiplier-tube photon-counting channels is developed to generate an instantaneous sampling dataset; A direct reconstruction scheme then extracts images of the pharmacokinetic parameters using the adaptive-EKF strategy. We design a dynamic phantom that can simulate the agent metabolism in living tissue. The results of the dynamic phantom experiments verify the validity of the experiment system and reconstruction algorithms, and demonstrate that system provides good resolution, high sensitivity and quantitativeness at different pump speed.

  4. Augmented Reality Cubes for Cognitive Gaming: Preliminary Usability and Game Experience Testing

    Directory of Open Access Journals (Sweden)

    Costas Boletsis

    2016-03-01

    Full Text Available Early detection is important in dementia care; however, cognitive impairment is still under-recognised and under-diagnosed. Cognitive screening and training are two important preventative treatments, which can lead to early detection of cognitive decline. In this work, the “Cognitive Augmented Reality Cubes” (CogARC system is presented, i.e. a serious game for cognitive training and screening, utilising an interaction technique based on Augmented Reality and the manipulation of tangible, physical objects (cubes. The game is a collection of cognitive mini-games of preventative nature and is, primarily, targeting elderly players (≥60 years old. A preliminary testing was conducted focusing on the game experience that CogARC offers (utilising the In-Game Experience Questionnaire, the usability of the system (using the System Usability Scale, and the specific user observations and remarks, as documented by open, semi-structured interviews.  Overall, CogARC demonstrated satisfying positive responses, however, the negative reactions indicated that there are specific problems with aspects of the interaction technique and a number of mini-games. The open interview shed more light on the specific issues of each mini-game and further interpretation of user interactions. The current study managed to provide interesting insights into the game design elements, integration of Augmented Reality, tangible interaction of the system, and on how elderly players perceive and use those interaction components. 

  5. Diagnostic reference ranges and the American College of Radiology Dose Index Registry: the pediatric experience

    Energy Technology Data Exchange (ETDEWEB)

    Goske, Marilyn J. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States)

    2014-10-15

    CT scans are powerful tools used in the care of pediatric patients daily. Yet the increased use of CT warrants careful monitoring. This article defines diagnostic reference levels and how they can be used to guide practice. Once a facility has adapted its techniques and protocols to fall within diagnostic reference levels or target values, the facility can expand its quality-improvement efforts to include a new concept, diagnostic reference ranges (DRRs). DRRs take into account the subjective image quality of the examination and provide a minimum estimated patient dose, below which accurate interpretation of an image might be difficult, and an upper estimated dose, above which the patient dose may be higher than necessary. This paper also describes how the American College of Radiology Dose Index Registry can be used by a facility as a continuous quality improvement tool to monitor and manage appropriate patient dose. (orig.)

  6. Obstacles to transcultural caring relationships: experiences of health care staff in pediatric oncology.

    Science.gov (United States)

    Pergert, Pernilla; Ekblad, Solvig; Enskär, Karin; Björk, Olle

    2007-01-01

    This qualitative study explores the caring situation of families with an immigrant background within the context of pediatric oncology care from the perspective of health care staff. Five focus group interviews and 5 complementary individual interviews were conducted after purposive and theoretical sampling, respectively. Grounded theory methodology revealed that obstacles to transcultural caring relationships are a main concern of the health care staff. These obstacles are divided into 4 main categories: linguistic, cultural and religious, social, and organizational. When health care staff fail to recognize obstacles to transcultural caring relationships, the result is inequity in care of families with an immigrant background. Equity in care for all does not mean identical treatment but, rather, care adjusted to the needs of the individual family regardless of background.

  7. Improving patient experience in a pediatric ambulatory clinic: a mixed method appraisal of service delivery

    Directory of Open Access Journals (Sweden)

    Soeteman M

    2015-03-01

    Full Text Available Marijn Soeteman,1 Vera Peters,2 Jamiu O Busari1,3 1Department of Pediatrics, Atrium Medical Center, Heerlen, 2Faculty of Health, Medicine and Life Sciences, 3Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, the Netherlands Objective: In 2013, customer satisfaction surveys showed that patients were unhappy with the services provided at our ambulatory clinic. In response, we performed an appraisal of our services, which resulted in the development of a strategy to reduce waiting time and improve quality of service. Infrastructural changes to our clinic’s waiting room, consultation rooms, and back offices were performed, and schedules were redesigned to reduce wait time to 10 minutes and increase consultation time to 20 minutes. Our objective was to identify if this would improve 1 accessibility to caregivers and 2 quality of service and available amenities. Design: We conducted a multi-method survey using 1 a patient flow analysis to analyze the flow of service and understand the impact of our interventions on patient flow and 2 specially designed questionnaires to investigate patients’ perceptions of our wait time and how to improve our services. Results: The results showed that 79% of our respondents were called in to see a doctor within 20 minutes upon arrival. More patients (55% felt that 10–20 minutes was an acceptable wait time. We also observed a perceived increase in satisfaction with wait time (94%. Finally, a large number of patients (97% were satisfied with the quality of service and with the accessibility to caregivers (94%. Conclusion: The majority of our patients were satisfied with the accessibility to our ambulatory clinics and with the quality of services provided. The appraisal of our operational processes using a patient flow analysis also demonstrated how this strategy could effectively be applied to investigate and improve quality of

  8. The Ross Procedure in Patients among the Pediatric Population, Post Ten Years of Experience

    Directory of Open Access Journals (Sweden)

    Andrey A. Ivanov

    2013-09-01

    Full Text Available The aim of the study was to analyze the results of the surgical treatment in pediatric patients who had undergone the Ross procedure.Material and Methods: The study involved 114 patients between 12 days to 18 years in age. The early and late (up to 5 years results of the treatment were studied. The examination included echocardiography, catheterization of the cardiac chambers and angiocardiography. The case distribution of patients based on diagnosis was as follows: isolated aortic valve stenosis (IAVS in 38 (33.3% patients, aortic valve insufficiency (AVI in 33 (28.9%, and combined heart defects in 56 patients (49.1%.Results: The death rate was 6.14% during the early postoperative period and 1.14% in the late postoperative period; the actuarial survival in the long-term was 98.86%. The complication rate was 51.5%. The most frequent complication was pericarditis (25.6%, whereas cardiac and respiratory failure occurred in 7.6% of the cases and cardiac arrhythmias in 6.1% of the cases. The average time spent in the intensive care unit was 3.48 ± 2.90 days; the hospitalization period on average was 24.70±10.87 days. After surgery, there was a tendency of the echocardiographic parameters to move toward normalization. The frequency of reoperation in the late period was 23.7%, the main reason for which being the conduit dysfunction in the position of the pulmonary artery (PA.Conclusion: The clinical efficacy of the Ross procedure in the treatment of aortic valve malformations in the pediatric group was confirmed. However, in some cases, the need to perform repeated operations due to the increase in the ring size and an increase in the neo-aortic insufficiency during the somatic growth process.

  9. Metastatic osteosarcoma at diagnosis: prognostic factors and long-term outcome--the French pediatric experience.

    Science.gov (United States)

    Mialou, Valerie; Philip, Thierry; Kalifa, Chantal; Perol, David; Gentet, Jean-Claude; Marec-Berard, Perrine; Pacquement, Helene; Chastagner, Pascal; Defaschelles, Anne-Sophie; Hartmann, Olivier

    2005-09-01

    The objective of this report was to estimate long-term outcome and prognostic factors in children and adolescents who presented with metastatic osteosarcoma at diagnosis. Patients were treated in six French pediatric oncology centers with surgery and multiagent chemotherapy, mainly with high-dose methotrexate. Their medical records were reviewed retrospectively. The medical records of patients who were treated for metastatic osteosarcoma from 1987 to 2000 were reviewed. Patients were treated with the chemotherapy regimens recommended for nonmetastatic disease in children (the French Society of Pediatric Oncology OS 87 and OS 94 protocols) or, in a few patients, with other chemotherapy regimens. Surgical excision of the primary tumor and, when possible, of all metastatic sites was performed based on a personalized assessment of each patient's situation. Seventy-eight patients age lungs and 11 to bone). Twenty-eight patients (36%) achieved a complete remission after combination chemotherapy and surgery. The event-free survival and overall survival rates at 5 years were 14% and 19%, respectively. To date, 14 patients (18%) have remained alive with a median follow-up of 112 months. Pretreatment features associated with a shorter event-free survival in the multivariate analysis were metastasis to at least two organs and high alkaline phosphatase level. Patients with at least 1 of these poor prognostic factors had a 2.6% event-free survival rate at 5 years despite treatment. The survival of patients with metastatic osteosarcoma were treated with conventional chemotherapy and surgery remained very poor. Patients should be classified into different prognostic groups and treated accordingly. New therapeutic approaches are warranted to improve the prognosis for patients with the most severe disease.

  10. Percutaneous sclerotherapy of pediatric lymphatic malformations: experience and outcomes according to the agent used.

    Science.gov (United States)

    Gallego Herrero, C; Navarro Cutillas, V

    Analyze statistically the success, number of sessions required and complete duration of treatment of agents used in pediatric percutaneous sclerotherapy of lymphatic malformations, to determine the most suitable. Retrospective study based on outcomes from percutaneous sclerotherapy performed on lymphatic malformations of 56 patients conducted by pediatric interventional radiologist for 14 years. As first approach, the procedure consists of ultrasound-guided introduction of sclerosing agent. Sessions were repeated until clinical resolution. Success, number of sessions and the duration of treatment were recorded and statistical treatment of the data was performed to obtain further conclusions. Lost patients in follow up and other minority agents used were excluded from the data. Eventually, 52 patients treated with OK432 (n=29), Ethibloc (n=5) and combination therapy (n=18) were included. The average number of sessions and duration in months of treatment was respectively 2.38 and 8.6 for OK432, 1.4 and 5.6 for Ethibloc, and 1.83 and 2.30 for dual therapy. The results were statistically significant for the difference in duration between OK432 and dual therapy. Also, 60-80% of patients reached proper results related to success, but the difference was no significant among the agents. Other demographic and anatomical variables were analyzed, not showing any difference, which supports the homogeneity of the sample. Despite of no significant difference in success and number of sessions among agents, longer duration of treatment with OK432 than dual therapy could mean greater health costs and probably greater disturb for patient and family. Copyright © 2017 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Cinacalcet in pediatric and adolescent chronic kidney disease: a single-center experience.

    Science.gov (United States)

    Alharthi, Abdulla A; Kamal, Naglaa M; Abukhatwah, Mohamed W; Sherief, Laila M

    2015-01-01

    Cinacalcet, a calcimimetic drug, has been shown to be efficacious in adult chronic kidney disease (CKD) patients; however, it was not fully studied in pediatric CKD patients. We aimed at assessing the effect of cinacalcet on intact parathyroid hormone (iPTH) secretion in children with CKD-4/5 with iPTH consistently ≥ 300 pg/mL refractory to conventional treatment. This is a prospective cohort analysis of 28 children with uncontrolled hyper-parathyroidism secondary to stage 4 and 5 CKD admitted to a tertiary center during the period from April 2012 to April 2014. Twenty-eight patients with CKD-4/5 were assessed prospectively regarding bone biochemistry, renal ultrasonography, serum iPTH level, and medications. Patients were classified into 3 groups: group 1, 6 patients with CKD-4 on supplemental and supportive therapy; group 2, 6 patients with CKD-5 on hemodialysis and; group 3, 16 patients with CKD-5 on automated peritoneal dialysis. Patients were between the ages of 9 months and 18 years on commencing cinacalcet at doses of 0.5 to 1.5 mg/kg. All patients showed at least a 60% reduction in iPTH (60%-97%). Highly significant reduction in iPTH and serum alkaline phosphatase levels was detected post-cinacalcet. The serum calcium (Ca), phosphate (P), and Ca × P product were unaffected. Treatment was well tolerated with no hypophosphatemia, hypocalcemia, or other adverse effects almost in all patients. Cinacalcet use was proven safe for all pediatric and adolescent patients with CKD-4/5 during the study period, and at the same time most of the patients reached the suggested iPTH target values.

  12. Minimally invasive transxiphoid approach for management of pediatric cardiac tamponade – one center's experience

    Science.gov (United States)

    Haponiuk, Ireneusz; Kwasniak, Ewelina; Chojnicki, Maciej; Steffens, Mariusz; Sendrowska, Aneta; Gierat-Haponiuk, Katarzyna; Leszczyńska, Katarzyna; Paczkowski, Konrad; Zielinski, Jacek

    2015-01-01

    Introduction Cardiac tamponade is excessive collection of fluid in the pericardial sac surrounding the heart that leads to restriction of cardiac function and causes critical cardiogenic shock and rapid circulatory depression. Despite the potential variety of different etiologies in the face of a dangerous decrease of cardiac output, the emergency life-saving procedure is surgical pericardial fluid evacuation. Aim To perform a retrospective analysis of clinical data and the results of minimally invasive transxiphoid pediatric cardiac tamponade evacuation procedures performed in a cardiac surgery center. Material and methods We performed a retrospective analysis of all consecutive patients referred for treatment in our department in a period of 6 years (15 patients) who underwent emergency pericardial drainage after an echocardiographically proven diagnosis. The procedure of choice was minimally invasive transxiphoid fluid evacuation with routine pericardial drainage. Retrospective operative data analysis was performed: clinical symptoms, pre-admission and initial emergency diagnostics and interventions, the morphology and total amount of drained pericardial fluid, length of stay, final results, and overall survival rate. We introduced an original pediatric tamponade index (PTI). The PTI was analyzed according to catecholamine support before the drainage and the length of hospital stay after the procedure. Results All patients survived the procedure. No early complications of the presented minimally invasive subxiphoid approach were noted. Mean PTI in patients with intensive catecholamine support before the operation was significantly higher than in patients without it. Conclusions Minimally invasive surgical transxiphoid interventions appear to be a safe and effective method to provide life-saving support with retrieval of the fluid for further laboratory investigations. PMID:25960801

  13. Unrelated hematopoietic stem cell transplantation in the pediatric population: single institution experience

    Directory of Open Access Journals (Sweden)

    Daniela Hespanha Marinho

    2015-08-01

    Full Text Available OBJECTIVE: Hematopoietic stem cell transplantation has been successfully used to treat the pediatric population with malignant and non-malignant hematological diseases. This paper reports the results up to 180 days after the procedure of all unrelated hematopoietic stem cell transplantations in pediatric patients that were performed in one institution.METHODS: A retrospective review was performed of all under 18-year-old patients who received unrelated transplantations between 1995 and 2009. Data were analyzed using the log-rank test, Cox stepwise model, Kaplan-Meier method, Fine and Gray model and Fisher's exact test.RESULTS: This study included 118 patients (46.8% who received bone marrow and 134 (53.2% who received umbilical cord blood transplants. Engraftment occurred in 89.47% of the patients that received bone marrow and 65.83% of those that received umbilical cord blood (p-value < 0.001. Both neutrophil and platelet engraftments were faster in the bone marrow group. Acute graft-versus-host disease occurred in 48.6% of the patients without statistically significant differences between the two groups (p-value = 0.653. Chronic graft-versus-host disease occurred in 9.2% of the patients with a higher incidence in the bone marrow group (p-value = 0.007. Relapse occurred in 24% of the 96 patients with malignant disease with 2-year cumulative incidences of 45% in the bone marrow group and 25% in the umbilical cord blood group (p-value = 0.117. Five-year overall survival was 47%, with an average survival time of 1207 days, and no significant differences between the groups (p-value = 0.4666.CONCLUSION: Despite delayed engraftment in the umbilical cord blood group, graft-versus-host disease, relapse and survival were similar in both groups.

  14. Influence of Arousal, Previous Experience, and Age on Surgery Preparation of Same Day of Surgery and In-Hospital Pediatric Patients.

    Science.gov (United States)

    Faust, Jan; Melamed, Barbara G.

    1984-01-01

    Studied two pediatric surgery populations (N=66) to determine differences in retention of preparatory information. Results showed that children exposed to a hospital-relevant film retained more information than those children not prepared regardless of age, IQ, previous experience, sex, and time of film preparation. (LLL)

  15. Experiences and Outcomes of Transition from Pediatric to Adult Health Care Services for Young People with Congenital Heart Disease: A Systematic Review.

    Science.gov (United States)

    Heery, Emily; Sheehan, Aisling M; While, Alison E; Coyne, Imelda

    2015-01-01

    This review synthesizes the empirical literature on outcomes and experiences of transfer and transition from pediatric to adult care for young people with congenital heart disease. A systematic review of papers published between January 2001 and May 2013 that examined outcomes or experiences of transfer and transition among young people with congenital heart disease was conducted. Data were extracted by two independent reviewers with the outcomes data combined using narrative synthesis and the experiences data integrated using thematic synthesis. Thirteen papers were included in the review: six reported outcomes following transfer, six reported experiences of transfer and transition, and one reported both outcomes and experiences. The review data indicate that high proportions of young people were lost to follow-up or experienced long gaps in care after leaving pediatric cardiology. Factors that protected against loss to follow-up or lapse in care included: beliefs that specialized adult care was necessary; poorer health status; attendance at pediatric appointments without parents; and pediatric referral to an adult congenital heart disease center. Data on experiences highlighted that many young people were unconcerned about transition, but lacked knowledge about their condition and were insufficiently prepared for transfer. In terms of adult services, many young people desired continuity in the quality of care, youth-oriented facilities, a personalized approach, and for their parents to remain involved in their care, but in a secondary, supportive capacity. In conclusion, the high proportions of young people lost to follow-up highlight the need for formal transition programs, which ensure a planned and coordinated transfer. Patients with congenital heart disease need education throughout adolescence about the implications of their condition, the differences between pediatric and adult services, and self-care management.

  16. Preliminary Flight Results of the Microelectronics and Photonics Test Bed: NASA DR1773 Fiber Optic Data Bus Experiment

    Science.gov (United States)

    Jackson, George L.; LaBel, Kenneth A.; Marshall, Cheryl; Barth, Janet; Seidleck, Christina; Marshall, Paul

    1998-01-01

    NASA Goddard Spare Flight Center's (GSFC) Dual Rate 1773 (DR1773) Experiment on the Microelectronic and Photonic Test Bed (MPTB) has provided valuable information on the performance of the AS 1773 fiber optic data bus in the space radiation environment. Correlation of preliminary experiment data to ground based radiation test results show the AS 1773 bus is employable in future spacecraft applications requiring radiation tolerant communication links.

  17. Pediatric Asthma

    Science.gov (United States)

    ... Science Education & Training Home Conditions Asthma (Pediatric) Asthma (Pediatric) Make an Appointment Refer a Patient Ask a ... meet the rising demand for asthma care. Our pediatric asthma team brings together physicians, nurses, dietitians, physical ...

  18. Pediatric Ophthalmologist

    Science.gov (United States)

    ... Text Size Email Print Share What is a Pediatric Ophthalmologist? Page Content Article Body If your child ... treat your child. What Kind of Training Do Pediatric Ophthalmologists Have? Pediatric ophthalmologists are medical doctors who ...

  19. Experience with a propofol-ketamine mixture for sedation during pediatric orthopedic surgery.

    Science.gov (United States)

    Weatherall, Andrew; Venclovas, Rasa

    2010-11-01

    Various combinations of propofol and ketofol have been described for the provision of procedural sedation in both adults and children. Utilization of 'ketofol' for deep sedation during prolonged pediatric orthopedic procedures has not previously been described. During an orthopedic aid trip, a 1:1 mixture of propofol and ketamine (200 mg of each drawn up to 22 ml) was utilized to provide deep sedation or general anesthesia as an adjunct to regional analgesia for lower limb surgery. Details for 18 patients having a total of 19 procedures were recorded with a record of intraoperative and postoperative parameters including initial bolus doses and infusion rates of ketofol required to produce deep sedation. Mean operating time was 153.7 min (range 64-241 min). The mean initial bolus dose of ketofol was 0.19 ml·kg(-1) (range 0.1-0.5 ml·kg(-1) ) or 1.7 mg·kg(-1) each of propofol and ketamine (range 0.9-4.5 mg·kg(-1) ). The mean upper limit of the infusion rate required to maintain deep sedation was 0.19 ml·kg(-1) ·h(-1) (range 0.07-0.26 ml·kg(-1) ·h(-1) ) or 1.7 mg·kg(-1) ·h(-1) (range 0.6-2.4 mg·kg(-1) ·h(-1) ) and the mean lower limit of the infusion rate was 0.08 ml·kg(-1) ·h(-1) (range 0.02-0.13 ml·kg(-1) ·h(-1) ) or 0.7 mg·kg(-1) ·h(-1) (range 0.2-1.2 mg·kg(-1) ·h(-1) ). The mean initial bolus dose of ketofol was 0.19 ml·kg(-1) (range 0.1-0.5 ml·kg(-1) ). There were no episodes of hypo- or hypertension or of desaturation. Mean time to eye opening after infusion cessation was 5.1 min (median 2 min; range 0-17 min). Ketofol successfully produced deep sedation for prolonged pediatric orthopedic procedures in conjunction with regional analgesia. Further research to confirm its safety and applicability to a wider range of settings is required. © 2010 Blackwell Publishing Ltd.

  20. Portal vein thrombosis in children and adolescents: 20 years experience of a pediatric hepatology reference center

    Directory of Open Access Journals (Sweden)

    Priscila Menezes Ferri

    2012-03-01

    Full Text Available CONTEXT: Portal vein thrombosis refers to a total or partial obstruction of the blood flow in this vein due to a thrombus formation. It is an important cause of portal hypertension in the pediatric age group with high morbidity rates due to its main complication - the upper gastrointestinal bleeding. OBJECTIVE: To describe a group of patients with portal vein thrombosis without associated hepatic disease of the Pediatric Hepatology Clinic of the Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil with emphasis on diagnosis, presentation form and clinical complications, and the treatment of portal hypertension. METHODS: This is a descriptive study of a series of children and adolescents cases assisted from January 1990 to December 2010. The portal vein thrombosis diagnosis was established by ultrasound. RESULTS: Of the 55 studied patients, 30 (54.5% were male. In 29 patients (52.7%, none of the risk factors for portal vein thrombosis was observed. The predominant form of presentation was the upper gastrointestinal bleeding (52.7%. In 20 patients (36.4%, the initial manifestation was splenomegaly. During the whole following period of the study, 39 patients (70.9% showed at least one episode of upper gastrointestinal bleeding. The mean age of patients in the first episode was 4.6 ± 3.4 years old. The endoscopic procedure carried out in the urgency or electively for search of esophageal varices showed its presence in 84.9% of the evaluated patients. The prophylactic endoscopic treatment was performed with endoscopic band ligation of varices in 31.3% of patients. Only one died due to refractory bleeding. CONCLUSIONS: The portal vein thrombosis is one of the most important causes of upper gastrointestinal bleeding in children. In all non febrile children with splenomegaly and/or hematemesis and without hepatomegaly and with normal hepatic function tests, it should be suspect of portal vein thrombosis. Thus, an

  1. Rapid steroid discontinuation for pediatric renal transplantation: a single center experience.

    Science.gov (United States)

    Lau, Keith K; Haddad, Maha N; Berg, Gerre M; Perez, Richard V; Butani, Lavjay

    2007-08-01

    To determine the outcomes of pediatric renal transplant recipients who received immunosuppression consisting of early withdrawal of corticosteroids at a single Northern California center. Protocols using minimal steroid exposure have been recently reported in adult transplant recipients with successful results. We examined the outcomes of pediatric renal transplant recipients who were managed at our center using a protocol with very early discontinuation of steroids after renal transplantation. We retrospectively studied the medical records of all renal transplant recipients followed at the Children's Hospital at the University of California, Davis Medical Center from 01/2004 to 12/2005. All patients were less than 18 yr of age at the time of transplantation. The immunosuppressive protocol included three tapering daily doses of methylprednisolone, together with five doses of thymoglobulin followed by maintenance therapy with tacrolimus and MMF. Eight patients with equal numbers of males and females were transplanted during this time period. There were equal numbers of Caucasians, African-Americans, Hispanics, and Asians. A total of 37.5% (3/8) of the subjects received preemptive transplantation, 25% (2/8) received peritoneal, and 37.5% (3/8) received hemodialysis before transplantation. The median (range) age at transplantation was 12.3 (3.1-16.0) year with a follow-up of 1.7 (0.9-2.8) year. At one yr post-transplantation, 57% (4/7) of patients still required anti-hypertensives. Three children required erythropoietin supplementation after transplantation. The mean delta height standard deviation score at 12 months was 0.20 +/- 0.56. There were no episodes of clinical acute rejection. One patient switched from tacrolimus to sirolimus due to biopsy-proven CAN. No patient became diabetic or required hypoglycemic agents. Surveillance biopsies showed no subclinical acute rejection in any patient. Steroid-free immunosuppression is safe in children after renal

  2. Chronic peritoneal dialysis catheters in children: a fifteen-year experience of the Italian Registry of Pediatric Chronic Peritoneal Dialysis.

    Science.gov (United States)

    Rinaldi, Stefano; Sera, Francesco; Verrina, Enrico; Edefonti, Alberto; Gianoglio, Bruno; Perfumo, Francesco; Sorino, Palma; Zacchello, Graziella; Cutaia, Ignazio; Lavoratti, Giancarlo; Leozappa, Giovanna; Pecoraro, Carmine; Rizzoni, Gianfranco

    2004-01-01

    To analyze data on 503 chronic peritoneal dialysis (CPD) catheters implanted between 1986 and 2000 in pediatric patients enrolled in the Italian Registry of Pediatric Chronic Peritoneal Dialysis (the Registry), comparing three different time periods: 1986-1990, 1991-1995, and 1996-2000. Retrospective study. 23 dialysis centers participating in the Registry. Data were collected from questionnaires filled in every year. The information for each peritoneal catheter included type, site and technique of insertion, exit-site orientation, exit-site care, complications, survival, and reason for removal. 503 catheters were implanted in 363 pediatric patients aged younger than 15 years at the start of CPD: 97 catheters in patients under 2 years of age, 67 in patients aged 2-5 years, and 339 in patients over 5 years of age. Mean patient age at onset of CPD was 8.0 +/- 5.1 years. All catheters were surgically implanted and omentectomy was performed in 82.4% of cases. The catheters used were Tenckhoff [468 (93.0%): 443 double cuff, 25 single cuff] and double-cuffed Valli [35 (7.0%)]. The entry site was in the midline in 153 cases (30.4%) and paramedian in 350 (69.6%). During 9048 dialysis-months we observed 451 catheter-related complications, yielding an incidence of 1 episode/20.1 CPD-months: 330 catheter infections (exit-site and/or tunnel infections), 26 leakages, 26 dislocations, 24 obstructions, 22 cuff extrusions, 6 hemoperitoneums, 17 others. 171 catheters were removed due to catheter-related causes; exit-site and/or tunnel infections were the main cause for removal (75.4%), followed by obstruction, dislocation, outer-cuff extrusion, and leakage. Younger children ( 5 years hazard ratio 0.8, 95%CI 0.5-1.1. In this survey, we observed better catheter survival in comparison with data reported by the Registry in 1998. Catheter survival improved especially in younger children (< 2 years), a group that previously had a decreased catheter survival rate compared to older age

  3. Prospectively gated axial CT coronary angiography: preliminary experiences with a novel low-dose technique

    Energy Technology Data Exchange (ETDEWEB)

    Klass, Oliver; Jeltsch, Martin; Feuerlein, Sebastian; Brunner, Horst; Brambs, Hans-Juergen; Hoffmann, Martin H.K. [University Hospital of Ulm, Department of Diagnostic and Interventional Radiology, Ulm (Germany); Nagel, Hans-Dieter [Philips Healthcare, Department of Science and Technology, Hamburg (Germany); Walker, Matthew J. [CT Clinical Science, Philips Healthcare, Cleveland, OH (United States)

    2009-04-15

    To assess image quality and radiation exposure with prospectively gated axial CT coronary angiography (PGA) compared to retrospectively gated helical techniques (RGH). Forty patients with suspected coronary artery disease (CAD) and a stable heart rate below 65 bpm underwent CT coronary angiography (CTCA) using a 64-channel CT system. The patient cohort consisted of 20 consecutive patients examined using a PGA technique and 20 patients examined using a standard RGH technique. Both groups were matched demographically according to age, gender, body mass index, and heart rate. For both groups, two independent observers assessed image quality for all coronary segments on an ordinal scale from 1 (nonassessable) to 5 (excellent quality). Image quality and radiation exposure were compared between patient groups. There were no significant differences in vessel-based image quality between the two groups (P > 0.05). Mean ({+-} SD) effective radiation exposure in the PGA group was 3.7 {+-} 0.8 mSv compared to 18.9 {+-} 3.8 mSv in the RGH group without ECG-based tube current modulation (P < 0.001). Preliminary experience shows PGA technique to be a promising approach for CTCA resulting in a substantial reduction in radiation exposure with image quality comparable to that of standard RGH technique. (orig.)

  4. Preliminary experience with drug-coated balloon angioplasty in primary percutaneous coronary intervention

    Institute of Scientific and Technical Information of China (English)

    Hee; Hwa; Ho; Julian; Tan; Yau; Wei; Ooi; Kwok; Kong; Loh; Than; Htike; Aung; Nwe; Tun; Yin; Dasdo; Antonius; Sinaga; Fahim; Haider; Jafary; Paul; Jau; Lueng; Ong

    2015-01-01

    We evaluated the clinical feasibility of using drugcoated balloon(DCB) angioplasty in patients undergoingprimary percutaneous coronary intervention(PPCI). Between January 2010 to September 2014,89 STelevation myocardial infarction patients(83% male,mean age 59 ± 14 years) with a total of 89 coronary lesions were treated with DCB during PPCI. Clinical outcomes are reported at 30 d follow-up. Left anterior descending artery was the most common target vessel for PCI(37%). Twenty-eight percent of the patients had underlying diabetes mellitus. Mean left ventricular ejection fraction was 44% ± 11%. DCB-only PCI was the predominant approach(96%) with the remaining 4% of patients receiving bail-out stenting. Thrombolysis in Myocardial Infarction(TIMI) 3 flow was successfully restored in 98% of patients. An average of 1.2 ± 0.5 DCB were used per patient,with mean DCB diameter of 2.6 ± 0.5 mm and average length of 23.2 ± 10.2 mm. At 30-d follow-up,there were 4 deaths(4.5%). No patients experienced abrupt closure of the infarctrelated artery and there was no reported target-lesion failure. Our preliminary experience showed that DCB angioplasty in PPCI was feasible and associated with a high rate of TIMI 3 flow and low 30-d ischaemic event.

  5. An overview of the Tokamak Physics Experiment vacuum vessel preliminary design

    Energy Technology Data Exchange (ETDEWEB)

    Rocco, R.E. [Raytheon Engineers and Constructors, Inc., Princeton, NJ (United States)

    1995-12-31

    The mission of the Tokamak Physics Experiment (TPX) Project is to develop the scientific basis for a compact and continuously operating tokamak fusion reactor. The vacuum vessel, which consists of a double walled torus, ports and supports, is a major element of the TPX machine. This paper provides an overview of the vacuum vessel preliminary design work. The design of the vacuum vessel is being carried out by an industrial team under subcontract to the Princeton Plasma Physics Laboratory. The respective work scopes of this team are discussed. The role of concurrent engineering is presented in the context of this design-build subcontract. A discussion of the engineering requirements, material selection rationale and vacuum vessel configuration is provided. Titanium 6Al-4V will be used to fabricate the vacuum vessel. Significant material concerns were identified with the use of titanium; hydrogen embrittlement and the effects of borated water were the major issues. A research and development (R and D) program was established to resolve these material issues as well as to develop the vessel weld details. A comprehensive analytical effort was established to perform the structural and thermal analysis of the vessel. Design details of the vessel, supports, ports, and flanges are presented.

  6. Pool film boiling experiments on a wire in low gravity: preliminary results.

    Science.gov (United States)

    Di Marco, P; Grassi, W; Trentavizi, F

    2002-10-01

    This paper reports preliminary results for pool film boiling on a wire immersed in almost saturated FC72 recently obtained during an experimental campaign performed in low gravity on the European Space Agency Zero-G airplane, (reduced gravity level 10(-2)). This is part of a long-term research program on the effect of gravitational and electric forces on boiling. The reported data set refers to experiments performed under the following conditions: (1) Earth gravity without electric field, (2) Earth gravity with electric field, (3) low gravity without electric field, and (4) low gravity with electric field. Although a decrease of gravity causes a heat transfer degradation, the electric field markedly improves heat exchange. This improvement is so effective that, beyond a certain field value, the heat flux is no longer sensitive to gravity. Two main film boiling regimes have been identified, both in normal and in low gravity: one is affected by the electric field and the other is practically insensitive to the field influence.

  7. Electromagnetic experiment to map in situ water in heated welded tuff: Preliminary results

    Energy Technology Data Exchange (ETDEWEB)

    Ramirez, A.L.; Daily, W.D.

    1987-03-16

    An experiment was conducted in Tunnel Complex G at the Nevada Test Site to evaluate geotomography as a possible candidate for in situ monitoring of hydrology in the near field of a heater placed in densely welded tuff. Alterant tomographs of 200 MHz electromagnetic permittivity were made for a vertical and a horizontal plane. After the 1 kilowatt heater was turned on, the tomographs indicated a rapid and strong drying adjacent to the heater. Moisture loss was not symmetric about the heater, but seemed to be strongly influenced by heterogeneity in the rock mass. The linear character of many tomographic features and their spatial correlation with fractures mapped in boreholes are evidence that drying was most rapid along some fractures. When the heater was turned off, an increase in moisture content occurred around the heater and along the dry fractures. However, this process is much slower and the magnitude of the moisture increase much smaller than the changes observed during heating of the rock. The interpretation of the tomographs is preliminary until they can be processed without the restrictive assumption of straight ray paths for the signals through the highly heterogeneous rock mass. 15 refs., 4 figs.

  8. Preliminary Λ ^0 arrow p + π ^- Signal for SELEX - Fermilab Experiment 781

    Science.gov (United States)

    Parkhurst, James F.; Dauwe, Loretta J.; E781 Collaboration

    1997-10-01

    SELEX (SEgmented Large X baryon spectrometer), a fixed target experiment at Fermilab, collected data from February to September 1997, using both 650 GeV/c Σ ^-/π ^-, and 550 GeV/c p/π ^+ beams. This run resulted in 2 billion triggered interactions being logged to tape. Primarily designed to study charmed baryons, E781 can also study hyperon production and decays, and the Primakoff effect. Λ ^0 has several decay modes, however it primarily decays into a p and π ^-. A neutral particle decay to two charged particles appears in the spectrometer as two oppositely charged tracks, originating downstream from the primary interaction in the target. Spectrometer magnets provide a transverse momentum kick which spreads the particle trajectories in a direction depending on the particles' charge. Particle momentum is determined from knowledge of the magnetic field and the track curvature. Assuming masses for the positive and negative tracks, the invariant mass and momentum of the initial neutral particle is calculated. A preliminary reconstruction of Λ ^0 decay, including the mass distribution, will be presented.

  9. [The lived experience of family member caring for a person affected by Alzheimer's disease: preliminary results].

    Science.gov (United States)

    Vellone, E; Micci, F; Sansoni, J; Sinapi, N; Cattel, C

    2000-01-01

    The aim of this article is to report the preliminary results from a phenomenological study on the lived experience of Alzheimer's caregivers. Eight caregivers involved in caring for two years at list were interviewed. The analysis of interviews by Giorgi's method showed a multidimensional reality synthesizable in eight spheres of themes: Illness, Patient, Caring, Caregiver's Life and Health, Coping, Spouse/Family, Others, Feelings. Illness has a great impact on the caregivers' life and causes the loss of the affected person even before his/her death. Caring is very hard and emotionally involving. Caregivers mainly complain the lack of support from the National Health System. The continuous involvement in caring produces also health problems, depression, and negative effects within the family. Others are considered as bad. The most common feelings are fear for possible accidents to the patients and remorses. Some caregivers have good coping style putting their faith in God, valuing the closeness of the family and living daily. The utility of the eight spheres of themes are discussed in order to guide the practice toward the caregivers.

  10. Universal newborn hearing screening: preliminary experience at the University Hospital of Cagliari

    Directory of Open Access Journals (Sweden)

    Giulia Pinna

    2012-10-01

    Full Text Available Bilateral congenital or acquired sensorineural hearing loss is a pathological condition affecting 1-2 children per 1,000 live births; it represents a major issue in public health because its late identification can negatively affect speech and language development. The aim of hearing screening is to obtain diagnosis and management of hearing loss as soon as possible; in fact early diagnosis and treatment allow children with congenital hearing impairment to acquire adequate linguistic competence. The present study reports our preliminary experience in newborn hearing screening at Neonatology services of University of Cagliari (Italy. During the first semester of surveillance, between January 2012 and June 2012, hearing screening was performed on a total of 901 babies using two different methods, TEOAEs in healthy neonates and automated ABR in high-risk babies. All infants were screened prior to hospital discharge; in some cases, especially for preterm infants of Neonatal Intensive Care Unit and Puericulture Institute, the screening was performed after discharge, to achieve a possible better global and acoustic maturation; 5 cases of hearing impairment were found. In the present study the Authors confirmed that it is possible to start a universal hearing screening in a relatively short time reaching the percentages suggested by Joint Committee on Infant Hearing.

  11. Is expertise in pediatric surgery necessary to perform laparoscopic splenectomy in children? An experience from a department of general surgery.

    Science.gov (United States)

    Guaglio, Marcello; Romano, Fabrizio; Garancini, Mattia; Degrate, Luca; Luperto, Margherita; Uggeri, Fabio; Scotti, Mauro; Uggeri, Franco

    2012-06-01

    Splenectomy is frequently required in children for various hematologic pathologic findings. Because of progress in minimally invasive techniques, laparoscopic splenectomy (LS) has become feasible. The objective of this report is to present a monocentric experience and to evaluate the efficacy of and complications observed after laparoscopic splenic procedures in a department of general surgery. 57 consecutive LSs have been performed in a pediatric population between January 2000 and October 2010. There were 33 females and 24 males with a median age of 12 years (range 4-17). Indications were: hereditary spherocytosis 38 cases, idiopathic thrombocytopenic purpura 10, sickle cell disease (SCD) 6, thrombocytopenic thrombotic purpura 2 and non-hodgkin lymphoma 1 case. Patients were operated on using right semilateral position, employing Atlas Ligasure vessel sealing system in 49 cases (86%) and Harmonic Scalpel + EndoGIA in 8. In 24 patients (42.1%), a cholecystectomy was associated. Two patients required conversion to open splenectomy (3.5%). In three cases, a minilaparotomy was performed for spleen removal (5.2%). Accessory spleens were identified in three patients (5.2%). Complications (8.8%) included bleeding (two), abdominal collection (one) and pleural effusion (two). There was no mortality. Average operative time was 128 min (range 80-220). Average length of stay was 3 days (range 2-7). Mean blood loss was 80 ml (range 30-500) with a transfusion rate of 1.7% (one patient). Laparoscopic spleen surgery is safe, reliable and effective in the pediatric population with hematologic disorders and is associated with minimal morbidity, zero mortality, and a short length of stay. Ligasure vessel sealing system shortened operative time and blood loss. On the basis of the results, we consider laparoscopic approach the gold standard for the treatment of these patients even in a department of general surgery.

  12. Low-dose head computed tomography in children: a single institutional experience in pediatric radiation risk reduction: clinical article.

    Science.gov (United States)

    Morton, Ryan P; Reynolds, Renee M; Ramakrishna, Rohan; Levitt, Michael R; Hopper, Richard A; Lee, Amy; Browd, Samuel R

    2013-10-01

    In this study, the authors describe their experience with a low-dose head CT protocol for a preselected neurosurgical population at a dedicated pediatric hospital (Seattle Children's Hospital), the largest number of patients with this protocol reported to date. All low-dose head CT scans between October 2011 and November 2012 were reviewed. Two different low-dose radiation dosages were used, at one-half or one-quarter the dose of a standard head CT scan, based on patient characteristics agreed upon by the neurosurgery and radiology departments. Patient information was also recorded, including diagnosis and indication for CT scan. Six hundred twenty-four low-dose head CT procedures were performed within the 12-month study period. Although indications for the CT scans varied, the most common reason was to evaluate the ventricles and catheter placement in hydrocephalic patients with shunts (70%), followed by postoperative craniosynostosis imaging (12%). These scans provided adequate diagnostic imaging, and no patient required a follow-up full-dose CT scan as a result of poor image quality on a low-dose CT scan. Overall physician comfort and satisfaction with interpretation of the images was high. An additional 2150 full-dose head CT scans were performed during the same 12-month time period, making the total number of CT scans 2774. This value compares to 3730 full-dose head CT scans obtained during the year prior to the study when low-dose CT and rapid-sequence MRI was not a reliable option at Seattle Children's Hospital. Thus, over a 1-year period, 22% of the total CT scans were able to be converted to low-dose scans, and full-dose CT scans were able to be reduced by 42%. The implementation of a low-dose head CT protocol substantially reduced the amount of ionizing radiation exposure in a preselected population of pediatric neurosurgical patients. Image quality and diagnostic utility were not significantly compromised.

  13. [Pediatric lung transplantation in Broussais-HEGP: a 23-year experience (1990-2013)].

    Science.gov (United States)

    Boussaud, V; Amrein, C; Guillemain, R; Achouh, P; Fabiani, J-N; Le Pimpec Barthes, F

    2014-01-01

    Pediatric lung transplantations (LTx) remains a small part of LTx performed worldwide. The majority of these Tx concerns young adolescents, transplantations in infants being anecdotic. We conducted a retrospective study of LTx in children and adolescents in one center in Paris from the beginning of the 90's to 2013. Data from Broussais then HEGP were collected retrospectively from 1990 to 2013: 380 LTx were reported in 368 patients including 111 LTx performed among children from 5 to 18 years of age (30%). One hundred and eleven patients received 121 LTx: 86 bilateral LTx, 13 combined lung-liver, 3 monopulmonary, 5 heart-lung and 4 combined heart-lung-liver Tx. Eighty-eight percent of the patients had cystic fibrosis. Median age was 14 years, weight 34 kg and height 144 cm. Median age of donors was 27 years, weight 60 kg and height 167 cm. Conditional survival for children was not different than adults: 72% at one year, 42% at 5 years, 37% at 10 years and 26% at 15 years. There was not overall early mortality after transplantation. Era graft survival was significantly higher after year 2000 (53% at 5 years vs 32% P=0.03). Lung transplantation among children under 18 years have similar outcome to those of adult patients. Copyright © 2014. Published by Elsevier Masson SAS.

  14. Flexion type supracondylar humerus fractures: 12 year experience of a pediatric orthopedics clinic.

    Science.gov (United States)

    Turgut, Ali; Kalenderer, Önder; Bozoğlan, Muhammet; Bacaksız, Tayfun; Ağuş, Haluk

    2015-01-01

    This study aims to review flexion type supracondylar humerus fractures in children and treatment options. Forty-seven patients (26 males, 21 females; mean age 8.6±3.2 years; range 4 to 15 years) who admitted to and were hospitalized in a pediatric orthopedics clinic between January 2002 and January 2014 due to flexion type supracondylar humerus fracture were included in this retrospective study. Fractures were classified according to Wilkins modification of Gartland system. Closed reduction and percutaneous pinning (CRPP) were administered in all patients with type 2 and 3 fractures. An overhead traction or open reduction was applied when closed reduction could not be achieved with three manipulations. Patients were evaluated clinically and radiologically. The results were graded according to Flynn criteria. Four patients with type 1 fracture were treated conservatively. Of the remaining patients, we were able to perform CRPP successfully in 36 (83.7%). While six patients (14%) were treated with open reduction and internal fixation, one patient (2.1%) was treated with overhead traction. The results were excellent or good in 44 patients (93.7%). Compared with extension type fractures, these fractures are seen in older children and are rarer. One should be prepared to perform open reduction especially for type 3 fractures. In our study, results of patients with type 3 fractures treated with CRPP were superior.

  15. Interleukin-1 targeting treatment in familial Mediterranean fever: an experience of pediatric patients.

    Science.gov (United States)

    Başaran, Özge; Uncu, Nermin; Çelikel, Banu Acar; Taktak, Aysel; Gür, Gökçe; Cakar, Nilgun

    2015-07-01

    The aim of this report was to evaluate and discuss treatment of pediatric familial Mediterranean fever (FMF) patients with anti-interleukin1 (IL-1) agents. Refractory or colchicine unresponsive FMF was described as severe and frequent attacks and/or having high acute phase reactance levels despite having a maximum dose of colchicine (2 mg/day). Disease course, adverse effects, duration of follow-up, treatment protocols, responses to the therapies were discussed. Eight patients (6 male, 2 female) having refractory FMF were identified. Mediterranean fever (MEFV) gene analyses revealed homozygous M694V mutations in six patients and heterozygote M694V mutations in one patient and no mutation in one patient. They were all treated with anakinra and/or canakinumab. The use of anti-IL-1 drugs was beneficial to all patients. None of them had any severe adverse effects due to the therapy. Anakinra and canakinumab were effective in patient refractory to colchicine treatment as shown both in our series and in the literature. Therefore, controlled trials are needed to evaluate the safety and long-term efficacy of IL-1 targeting agents in colchicine resistant patients.

  16. Liver transplantation for urea cycle disorders in pediatric patients: a single-center experience.

    Science.gov (United States)

    Kim, Irene K; Niemi, Anna-Kaisa; Krueger, Casey; Bonham, Clark A; Concepcion, Waldo; Cowan, Tina M; Enns, Gregory M; Esquivel, Carlos O

    2013-03-01

    LT has emerged as a surgical treatment for UCDs. We hypothesize that LT can be safely and broadly utilized in the pediatric population to effectively prevent hyperammonemic crises and potentially improve neurocognitive outcomes. To determine the long-term outcomes of LT for UCDs, charts of children with UCD who underwent LT were retrospectively reviewed at an academic institution between July 2001 and May 2012. A total of 23 patients with UCD underwent LT at a mean age of 3.4 yr. Fifteen (65%) patients received a whole-liver graft, seven patients (30%) received a reduced-size graft, and one patient received a living donor graft. Mean five-yr patient survival was 100%, and allograft survival was 96%. Mean peak blood ammonia (NH(3) ) at presentation was 772 μmol/L (median 500, range 178-2969, normal <30-50). After transplantation, there were no episodes of hyperammonemia. Eleven patients were diagnosed with some degree of developmental delay before transplantation, which remained stable or improved after transplantation. Patients without developmental delay before transplantation maintained their cognitive abilities at long-term follow-up. LT was associated with the eradication of hyperammonemia, removal of dietary restrictions, and potentially improved neurocognitive development. Long-term follow-up is underway to evaluate whether LT at an early age (<1 yr) will attain improved neurodevelopmental outcomes.

  17. Wageningen Urban Rainfall Experiment 2014 (WURex14): Experimental setup and preliminary results

    Science.gov (United States)

    van Leth, Thomas C.; Uijlenhoet, Remko; Overeem, Aart; Leijnse, Hidde; Hazenberg, Pieter; Berne, Alexis

    2016-04-01

    Microwave links from cellular communication networks have been shown to be able to provide valuable information concerning the space-time variability of rainfall. In particular over urban areas, where network densities are generally high, they have the potential to complement existing dedicated infrastructure to measure rainfall (gauges, radars). In addition, microwave links provide a great opportunity for ground-based rainfall measurement for those land surface areas of the world where gauges and radars are generally lacking. Such information is not only crucial for water management and agriculture, but also for instance for ground validation of space-borne rainfall estimates such as those provided by the GPM (Global Precipitation Measurement) mission. WURex14 is dedicated to address several errors and uncertainties associated with such quantitative precipitation estimates in detail. The core of the experiment is provided by three co-located microwave links installed between two major buildings on the Wageningen University campus, approximately 2 km apart: a 38 GHz commercial microwave link, provided by T-Mobile NL, and 26 GHz and 38 GHz (dual-polarization) research microwave links from RAL. Transmitting and receiving antennas have been attached to masts installed on the roofs of the two buildings, about 30 m above the ground. This setup has been complemented with a Scintec infrared Large-Aperture Scintillometer, installed over the same path, as well as 5 Parsivel optical disdrometers and an automated rain gauge positioned at several locations along the path. Temporal sampling of the received signals was performed at a rate of 20 Hz. The setup is being monitored by time-lapse cameras to assess the state of the antennas as well as the atmosphere. Finally, data is available from the KNMI weather radars and an automated weather station situated just outside Wageningen. The experiment has been active between August 2014 and December 2015. We give a global overview of

  18. Influence of surgeon experience, hospital volume, and specialty designation on outcomes in pediatric surgery: a systematic review.

    Science.gov (United States)

    McAteer, Jarod P; LaRiviere, Cabrini A; Drugas, George T; Abdullah, Fizan; Oldham, Keith T; Goldin, Adam B

    2013-05-01

    Analyses of volume-outcome relationships in adult surgery have found that hospital and physician characteristics affect patient outcomes, such as length of stay, hospital charges, complications, and mortality. Similar investigations in children's surgical specialties are fewer in number, and their conclusions are less clear. To review the evidence regarding surgeon or hospital experience and their influence on outcomes in children's surgery. A MEDLINE and EMBASE search was conducted for English-language studies published from January 1, 1980, through April 13, 2012. Titles and abstracts were screened in a standardized manner by 2 reviewers. Studies selected for inclusion had to use a measure of hospital or surgeon experience as a predictor variable and had to report postoperative outcomes as dependent response variables. Included studies were reviewed with regard to methodologic quality, and study results were extracted. Sixty-three studies were reviewed. Significant heterogeneity was detected in exposure definitions, outcome measures, and risk adjustment, with the greatest heterogeneity seen in appendectomy studies. Various exposure levels were examined: hospital level in 48 (68%) studies, surgeon level in 11 (17%), and both in 9 (14%). Nineteen percent of studies did not adjust for confounding, and 57% did not adjust for sample clustering. The most consistent methods and reproducible results were seen in the pediatric cardiac surgical literature. Forty-nine studies (78%) showed positive correlation between experience and most primary outcomes, but differences in outcomes and exposure definitions made comparisons between studies difficult. In general, hospital-level factors tended to correlate with outcomes for high-complexity procedures, whereas surgeon-level factors tended to correlate with outcomes for more common procedures. Data on experience-related outcomes in children's surgery are limited in number and vary widely in methodologic quality. Future studies

  19. Safety and retention rate of rufinamide in 300 patients: a single pediatric epilepsy center experience.

    Science.gov (United States)

    Thome-Souza, Sigride; Kadish, Navah E; Ramgopal, Sriram; Sánchez Fernández, Iván; Bergin, Ann M; Bolton, Jeffrey; Harini, Chellamani; Libenson, Mark; Olson, Heather; Peters, Jurriaan; Poduri, Annapurna; Rotenberg, Alexander; Takeoka, Masanori; Kothare, Sanjeev V; Kapur, Kush; Bourgeois, Blaise F D; Loddenkemper, Tobias

    2014-08-01

    Reports of studies evaluating rufinamide as an add-on therapy in children and adolescents with refractory epilepsy are restricted to a few publications. Prospective multicenter studies including children and adults have yielded important information about several types of epilepsies and syndromes. We evaluated the use of rufinamide in a single pediatric center with a large cohort and long-term follow-up period. We retrospectively included patients taking rufinamide from November 2008 to March 2013. Response was defined by a seizure reduction of ≥50% compared to baseline. Three hundred patients with a median age of 9.1 years (range 0.4-29.6 years) were reviewed. Median follow-up was 9 months (range 1-37 months). Epilepsy etiology was classified as genetic (23.7%), structural/metabolic (41%), and unknown cause (35.3%). Overall, rufinamide treatment led to a median seizure frequency reduction of 59.2% from responders to baseline. Seizure reduction was greater in patients with genetic etiology compared to structural/metabolic (66.2% vs. 45.5% responders, p = 0.005). Rufinamide was discontinued in 110 (36.7%) of 300 patients: 63 (21%) due to unsatisfactory response, 47 (15.7%) due to side effects, and in 18 (6%) of those due to both. Most common adverse effects were sleepiness, vomiting, mood changes, nausea, and loss of appetite. Median time to loss of efficacy was 11.6 months (range 3-28 months). Rufinamide provides satisfactory seizure reduction as an adjunctive treatment in refractory epilepsy. Results need to be interpreted in the setting of data acquisition, including inherent biases of retrospective studies. Patients with a known genetic etiology may have better responses than patients with structural/metabolic etiology. Wiley Periodicals, Inc. © 2014 International League Against Epilepsy.

  20. Clinical experiences of undergraduate dental students in pediatric dentistry at Cork University Dental School and Hospital, Ireland.

    LENUS (Irish Health Repository)

    Stewart, Christopher J

    2010-03-01

    The objectives of this study were to evaluate the number and range of clinical procedures completed by undergraduate dental students in pediatric dentistry in Cork University Dental School and Hospital, Ireland, and to compare the number of procedures undertaken with the subsequent examination scores. The work comprised a retrospective audit of clinical logbooks for all of the undergraduate dental students in one cohort through their fourth and fifth clinical years between 2004 and 2006. Thirty-four quantitative logbooks were audited. Students had seen a total of 1,031 patients, and each student had completed a full course of dental treatment for an average of twenty-two children. Students completed means of 30.2 restorative procedures for children, fourteen in deciduous dentition (range six to twenty-eight), and seventeen in permanent dentition (range seven to twenty-eight). Continuity of education and care (measured through children having their treatment fully completed by the same student) was 72 percent. A moderate positive correlation between levels of clinical experience and exam score was identified. All students gained experience in management of child patients with students providing care for an average of thirty children and a minimum of nineteen.

  1. Preliminary stress characterization for an in-situ stimulation experiment at the Grimsel Underground Laboratory

    Science.gov (United States)

    Krietsch, Hannes; Doetsch, Joseph; Gischig, Valentin; Amann, Florian; Jalali, Mohammadreza; Madonna, Claudio; Evans, Keith; Valley, Benoit; Giardini, Domenico; Wiemer, Stefan; Maurer, Hansruedi; Loew, Simon

    2016-04-01

    A decameter-scale in-situ stimulation experiment is currently being executed at the Grimsel Test Site in Switzerland, spanning from hydraulic fracturing to controlled fault-slip experiments. For the feasibility of this project the in-situ stress tensor is of foremost importance. Therefore a unique stress characterization campaign combining stress relief methods (overcoring of USBM and CSIRO-HI probes) with hydraulic fracturing (HF) and hydraulic testing on pre-existing fractures (HTPF) in three boreholes was conducted in a first phase of this project. During all hydraulic stress measurements, micro-seismicity was monitored and localized in real time utilizing a dense network of piezo-electric sensors. In this contribution, we present preliminary results of the stress characterization and compare the derived stress tensor with previous estimates of the stress state. The stress characterization campaign was conducted in three boreholes, one sub-vertical and two sub-horizontal boreholes, assuming that the sub-vertical and one sub-horizontal are parallel to a principal stress component. A major task in this contribution is the integration of the different stress characterization methods. Our results of the different methods (overcoring and HF) are largely consistent, but disagree with some of the previous stress orientation estimates. From the new campaign the overcoring measurements indicate a sub-horizontal sigma1 of 17.3 MPa with a strike of 145°, a sigma2 of 9.7 MPa with 241°/69° and a sigma3 of 8.3 MPa with 055°/21° using an isotropic approach for inversion calculation. Whereas the USBM-Probe measures a projection of the principal stresses in a plane normal to borehole axis, the CSIRO-HI Probe provides the real 3D stress tensor. The HF and HTPF measurements indicate a far-field minimum horizontal stress between 8.7 and 9.1 MPa, consistent with the overcoring. Principal stresses, estimated by location of micro-seismic events during HF and HTPF, suggest that

  2. Pediatric fibromyalgia

    Directory of Open Access Journals (Sweden)

    J. Ablin

    2012-09-01

    Full Text Available Fibromyalgia (FM is currently defined as chronic widespread pain (CWP with allodynia or hyperalgesia to pressure pain. It is classified as one of the large group of soft-tissue pain syndromes. Pain is the cardinal symptom of FM; however, most patients also experience additional symptoms such as debilitating fatigue, disrupted or non-restorative sleep, functional bowel disturbances, and a variety of neuropsychiatric problems, including cognitive dysfunction, anxiety and depressive symptoms. Its pathogenesis is not entirely understood, although it is currently believed to be the result of a central nervous system (CNS malfunction that increases pain transmission and perception. FMS usually involves females, and in these patients it often makes its first appearance during menopause. But it is often diagnosed both in young as well as elderly individuals. Pediatric FMS is a frustrating condition affecting children and adolescents at a crucial stage of their physical and emotional development. Pediatric FMS is an important differential diagnosis to be considered in the evaluation of children suffering from widespread musculoskeletal pain, and must be differentiated from a spectrum of inflammatory joint disorders such as juvenile idiopathic arthritis (JIA, juvenile ankylosing spondylitis, etc. The management of pediatric FMS is centered on the issues of education, behavioral and cognitive change (with a strong emphasis on physical exercise, and a relatively minor role for pharmacological treatment with medications such as muscle relaxants, analgesics and tricyclic agents.

  3. Experiences of african american parents following perinatal or pediatric death: a literature review.

    Science.gov (United States)

    Boyden, Jackelyn Y; Kavanaugh, Karen; Issel, L Michele; Eldeirawi, Kamal; Meert, Kathleen L

    2014-01-01

    A child's death is one of life's most difficult experiences. Little is known about the unique factors that influence the grief experience for bereaved African American parents. Through an integrative review of 10 publications, the authors describe the grief responses, outcomes, and implications for African American parents who experience the death of a child. Four themes emerged: (a) emotional response to loss; (b) factors that added to the burden of loss; (c) coping strategies; and (d) health consequences of grief. Healthcare providers, administrators, and policymakers should be sensitive to the unique needs of African American parents following a child's death.

  4. Experiences of African American Parents Following Perinatal or Pediatric Death: A Literature Review

    Science.gov (United States)

    Boyden, Jackelyn Y.; Kavanaugh, Karen; Issel, L. Michele; Eldeirawi, Kamal; Meert, Kathleen L.

    2013-01-01

    A child’s death is one of life’s most difficult experiences. Little is known about the unique factors that influence the grief experience for bereaved African American parents. Through an integrative review of 10 publications, the authors describe the grief responses, outcomes, and implications for African American parents who experience the death of a child. Four themes emerged: (a) emotional response to loss; (b) factors that added to the burden of loss; (c) coping strategies; and (d) health consequences of grief. Healthcare providers, administrators, and policymakers should be sensitive to the unique needs of African American parents following a child’s death. PMID:24666143

  5. [Low field intra-operative magnetic resonance imaging for brain tumour surgery: preliminary experience].

    Science.gov (United States)

    Roldán, Pedro; García, Sergio; González, Josep; Reyes, Luis Alberto; Torales, Jorge; Valero, Ricard; Oleaga, Laura; Enseñat, Joaquim

    Intra-operative magnetic resonance imaging (iMRI) is a recently introduced tool in the most advanced neurosurgical operating rooms worldwide. We present our preliminary experience in brain tumour surgery with low field PoleStar N30® intraoperative MRI since its introduction in 2013 in the Barcelona Clinic Hospital. A prospective non-randomised study was conducted on cases operated on using iMRI and intention of complete removal up to October 2015. A record was made of the data as regards surgical times, resection rates, histological diagnosis, hospital stay, and survival rates during follow-up. The study included 50 patients, with a mean age of 55 years (±13.7), a preoperative mean Karnofsky of 92 (being 81 post-operatively), and a mean follow-up of 10.5 months (±6.5). There were 26% re-operations due to recurrence. High-grade gliomas were reported in 56%, low-grade gliomas in 24%, and 20% "Other" tumours. Overall hospital stay was 10 days (±4.5). Depending on the histologiacl diagnosis, the "Others" group had a longer hospital stay. Overall, there were 52% complete removal, 18% of maximum removals, and 30% of partial removals. The overall survival rates during follow-up was 84%. iMRI is a safe and effective tool for brain tumour surgery. Its use allows an increase in resection rates, and minimises post-operative complications. Its implementation involves an increase in surgical time, which improves with the characteristic learning curve. More studies are needed to establish its role in the long-term survival of patients. Copyright © 2016 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Preliminary Results of the NASA Beacon Receiver for Alphasat Aldo Paraboni TDP5 Propagation Experiment

    Science.gov (United States)

    Nessel, James; Morse, Jacquelynne; Zemba, Michael; Riva, Carlo; Luini, Lorenzo

    2014-01-01

    NASA Glenn Research Center (GRC) and the Politecnico di Milano (POLIMI) have initiated a joint propagation campaign within the framework of the Alphasat propagation experiment to characterize rain attenuation, scintillation, and gaseous absorption effects of the atmosphere in the 40 GHz band. NASA GRC has developed and installed a K/Q-band (20/40 GHz) beacon receiver at the POLIMI campus in Milan, Italy, which receives the 20/40 GHz signals broadcast from the Alphasat Aldo Paraboni TDP#5 beacon payload. The primary goal of these measurements is to develop a physical model to improve predictions of communications systems performance within the Q-band. Herein, we describe the design and preliminary performance of the NASA propagation terminal, which has been installed and operating in Milan since May 2014. The receiver is based upon a validated Fast Fourier Transform (FFT) I/Q digital design approach utilized in other operational NASA propagation terminals, but has been modified to employ power measurement via a frequency estimation technique and to coherently track and measure the amplitude of the 20/40 GHz beacon signals. The system consists of a 1.2-m K-band and a 0.6-m Qband Cassegrain reflector employing synchronous open-loop tracking to track the inclined orbit of the Alphasat satellite. An 8 Hz sampling rate is implemented to characterize scintillation effects, with a 1-Hz measurement bandwidth dynamic range of 45 dB. A weather station with an optical disdrometer is also installed to characterize rain drop size distribution for correlation with physical based models.

  7. Risk of surgical site infection in paediatric herniotomies without any prophylactic antibiotics: A preliminary experience

    Directory of Open Access Journals (Sweden)

    Dhananjay Vaze

    2014-01-01

    Full Text Available Background: Different studies underline the use of pre-operative antibiotic prophylaxis in clean surgeries like herniotomy and inguinal orchiopexy. But, the meta-analyses do not recommend nor discard the use of prophylactic pre-operative antibiotics. The scarcity of controlled clinical trials in paediatric population further vitiates the matter. This study assessed the difference in the rate of early post-operative wound infection cases in children who received single dose of pre-operative antibiotics and children who did not receive antibiotics after inguinal herniotomy and orchiopexy. Materials and Methods: This randomised prospective study was conducted in Paediatric Surgery department of PGIMER Chandigarh. Out of 251 patients, 112 patients were randomised to the case group and 139 were ascribed to the control group. The patients in control group were given a standard regimen of single dose of intravenous antibiotic at the time of induction followed by 3-4 days of oral antibiotic. Case group patients underwent the surgical procedure in similar manner with no antibiotic either at the time of induction or post-operatively. Results: The incidence of surgical site infection in case group was 3.73 % and that in control group was 2.22%. The observed difference in the incidence of surgical site infection was statistically insignificant (P value = 0.7027. The overall infection rate in case and control group was 2.89%. Conclusions: Our preliminary experience suggests that there is no statistically significant difference in the proportion of early post-operative wound infection between the patients who received single dose of pre-operative antibiotics and the patients who received no antibiotics after inguinal herniotomy and orchiopexy. The risk of surgical site infection in paediatric heriotomies does not increase even if the child′s weight is less than his/her expected weight for age.

  8. Rotator cuff tears in children and adolescents: experience at a large pediatric hospital

    Energy Technology Data Exchange (ETDEWEB)

    Zbojniewicz, Andrew M.; Emery, Kathleen H. [University of Cincinnati College of Medicine, Department of Radiology, Cincinnati Children' s Hospital Medical Center, Cincinnati, OH (United States); Maeder, Matthew E. [University of Cincinnati College of Medicine, Department of Radiology, Cincinnati Children' s Hospital Medical Center, Cincinnati, OH (United States); Lenox Hill Hospital, Department of Radiology, New York, NY (United States); Salisbury, Shelia R. [University of Cincinnati College of Medicine, Division of Biostatistics and Epidemiology, Cincinnati Children' s Hospital Medical Center, Cincinnati, OH (United States)

    2014-06-15

    Prior literature, limited to small case series and case reports, suggests that rotator cuff tears are rare in adolescents. However, we have identified rotator cuff tears in numerous children and adolescents who have undergone shoulder MRI evaluation. The purpose of this study is to describe the prevalence and characteristics of rotator cuff tears in children and adolescents referred for MRI evaluation of the shoulder at a large pediatric hospital and to correlate the presence of rotator cuff tears with concurrent labral pathology, skeletal maturity and patient activity and outcomes. We reviewed reports from 455 consecutive non-contrast MRI and magnetic resonance arthrogram examinations of the shoulder performed during a 2-year period, and following exclusions we yielded 205 examinations in 201 patients (ages 8-18 years; 75 girls, 126 boys). Rotator cuff tears were classified by tendon involved, tear thickness (partial or full), surface and location of tear (when partial) and presence of delamination. We recorded concurrent labral pathology when present. Physeal patency of the proximal humerus was considered open, closing or closed. Statistical analysis was performed to evaluate for a relationship between rotator cuff tears and degree of physeal patency. We obtained patient activity at the time of injury, surgical reports and outcomes from clinical records when available. Twenty-five (12.2%) rotator cuff tears were identified in 17 boys and 7 girls (ages 10-18 years; one patient had bilateral tears). The supraspinatus tendon was most frequently involved (56%). There were 2 full-thickness and 23 partial-thickness tears with articular-side partial-thickness tears most frequent (78%). Insertional partial-thickness tears were more common (78%) than critical zone tears (22%) and 10 (43%) partial-thickness tears were delamination tears. Nine (36%) patients with rotator cuff tears had concurrent labral pathology. There was no statistically significant relationship between

  9. [Therapeutic experience with cefadroxil syrup in acute infections, especially scarlet fever, in pediatric field (author's transl)].

    Science.gov (United States)

    Minamitani, M; Hachimori, K; Nakazawa, H; Tomori, N

    1981-02-01

    Clinical effects were investigated on cefadroxil powder for syrup (containing 100 mg of cefadroxil per 1 g) for acute bacterial infections (mostly scarlet fever) in the field of pediatrics, and the results were obtained as follows. Cefadroxil was applied in 100 cases of scarlet fever. Among 49 cases administered 30-39 mg/kg/day, the results were excellent in 34 cases and good in 15 cases, efficacy ratio being thus 100%. Among 38 cases administered 40-49 mg/kg/day, the results were excellent in 33 cases, and good in 5 cases, efficacy ratio being thus 100%. Out of 4 cases administered 20-29 mg/kg/day, the results were excellent in 3 cases and good in 1 case, while out of 9 cases administered 50-59 mg/kg/day, excellent in 4 cases and good in 5 cases. Among 78 cases of scarlet fever from which beta-hemolytic Streptococcus was proven from swab liquid of palatal tonsil, 67 cases received cefadroxil at a daily dose of 30-49 mg/kg, and the bacteria turned to negative the next day of administration in 72 cases, 2 days later in 6 cases. Cefadroxil was administered at a daily dose of 46 mg/kg for 7 days in 1 case of SSS syndrome of which Staphylococcus aureus was proven from skin lesion, and local bacteria turned to negative, as well as clinical effect was excellent. No pathogen was proven in 1 case of acute tonsillitis, maybe because ampicillin (ABPC) and cefazolin (CEZ) were administered before cefadroxil treatment, and yet a clinical efficacy was judged by administering cefadroxil at a daily dose of 46 mg/kg, though no clinical improvement was observed with the prior antibiotics. As to the side effects of cefadroxil in 102 cases, a slight vomiting was noticed in 6 cases, though the administration could be continued, and a slight rise of GOT or GPT was observed respectively in 3 cases and 1 case, all of which were recovered without abnormal clinical findings. Among the patients of scarlet fever, after beta-hemolytic Streptococcus became negative, reelimination or recurrence

  10. PET/MRI: a novel hybrid imaging technique. Major clinical indications and preliminary experience in Brazil.

    Science.gov (United States)

    Vitor, Taise; Martins, Karine Minaif; Ionescu, Tudor Mihai; Cunha, Marcelo Livorsi da; Baroni, Ronaldo Hueb; Garcia, Marcio Ricardo Taveira; Wagner, Jairo; Campos, Guilherme de Carvalho; Nogueira, Solange Amorim; Guerra, Elaine Gonçalves; Amaro, Edson

    2017-01-01

    In recent years, medical imaging with hybrid techniques has widely accepted and employed in clinical routine. PET/MRI offers significant advantages, including excellent contrast and resolution and reduced ionizing radiation, as compared to well-established PET/CT. Therefore, PET/MRI is a promising modality for oncologic imaging of some regions, such as brain, head and neck, liver and pelvis. This article set out to analyze clinical conditions that could benefit from PET/MRI imaging based on our caseload. The potential of PET/MRI to become the imaging modality of choice for assessment of neurologic and oncologic conditions associated with soft tissues is highlighted. Clinical aspects of PET/MRI and its application to clinical cases are illustrated with examples extracted from the authors' preliminary experience. RESUMO Nos últimos anos, imagens médicas com tecnologias híbridas tornaram-se amplamente aceitas e utilizadas na prática clínica. O PET/RM possui vantagens importantes, incluindo excelentes contrastes e resolução, e menor radiação ionizante, em comparação ao PET/TC. Por isto, é uma modalidade promissora para exames de imagem de pacientes oncológicos, para avaliar o cérebro, cabeça e pescoço, o fígado e a pelve. O objetivo deste artigo foi analisar as situações clínicas que se beneficiariam de exames de PET/RM a partir de uma casuística. Destacamos o potencial desta técnica se tornar o método de imagem de escolha para doenças neurológicas e oncológicas que envolvam partes moles. Os aspectos clínicos de PET/RM e sua aplicação aos casos clínicos são ilustrados com exemplos da experiência inicial dos autores.

  11. Surveying rip current survivors: preliminary insights into the experiences of being caught in rip currents

    Science.gov (United States)

    Drozdzewski, D.; Shaw, W.; Dominey-Howes, D.; Brander, R.; Walton, T.; Gero, A.; Sherker, S.; Goff, J.; Edwick, B.

    2012-04-01

    This paper begins a process of addressing a significant gap in knowledge about people's responses to being caught in rip currents. While rip currents are the primary hazard facing recreational ocean swimmers in Australia, debate exists about the best advice to give swimmers caught in rip currents. Such surf rescue advice - on what to do and how to respond when caught in a rip - relies on empirical evidence. However, at present, knowledge about swimmers reactions and responses to rip currents is limited. This gap is a considerable barrier to providing effective advice to beach goers and to understanding how this advice is utilised (or not) when actually caught in the rip current. This paper reports the findings of a pilot study that focussed on garnering a better understanding of swimmers' experiences when caught in rip currents. A large scale questionnaire survey instrument generated data about rip current survivors' demographics, knowledge of beach safety and their reactions and responses when caught in a rip current. A mix of online and paper surveys produced a total of 671 completed surveys. Respondents were predominantly an informed group in terms of rip current knowledge, beach experience and had a high self-rated swimming ability. Preliminary insights from the survey show that most respondents recalled a "swim across the rip/parallel to the beach" message when caught in the rip and most escaped unassisted by acting on this message. However, while nearly a quarter of respondents recalled a message of "not to panic", short answer responses revealed that the onset of panic inhibited some respondents from recalling or enacting any other type of beach safety message when caught in the rip current. Results also showed that despite the research sample being younger, competent and frequent ocean swimmers, they were more likely to swim at unpatrolled beaches and outside of the red and yellow safety flags. Moreover, they were still caught in a rip current and they

  12. Preliminary experience in the management of tracheobronchial foreign bodies in Lagos, Nigeria.

    Science.gov (United States)

    Falase, Bode; Sanusi, Michael; Majekodunmi, Adetinuwe; Ajose, Ifeoluwa; Oke, David

    2013-01-01

    Aspiration of tracheobronchial foreign bodies commonly affects young children, is potentially life threatening and requires early intervention for extraction. Access to facilities and skill manpower for bronchoscopic extraction is however limited in Nigeria. The aim of this study is to describe the experience in our institution with bronchoscopic removal of tracheobronchial foreign bodies and highlight the challenges encountered. This is a retrospective study of all patients referred to the Lagos State University Teaching Hospital with a diagnosis of tracheobronchial foreign body within the period of February 2008 and February 2013. Data extracted from the medical records were age, sex, time interval between aspiration and presentation, location of tracheobronchial foreign body, bronchoscopic technique, complications and outcome. A total of 24 patients were referred and confirmed at bronchoscopy to have tracheobronchial foreign bodies. Mean age was 6.6 + 5 years. Male to female ratio was 1:1. Delayed presentation was common with 22 patients (91.7%) presenting more than 24 hours after aspiration. Aspirated material was inorganic in 17 patients (70.8%) and organic in 7 patients (29.2%). Location of tracheobronchial foreign bodies was right main bronchus in 16 patients (66.7%), left main bronchus in 6 patients (25%) and the trachea in 2 patients (8.3%). Challenges to speedy and safe removal of the foreign bodies were delayed presentation and a limited range of bronchoscopic equipment early in the series which caused prolonged procedures and increased complications. Two mortalities occurred early in the series; one from airway obstruction and the other from respiratory failure caused by tracheobronchial oedema. Extraction of tracheobronchial foreign bodies was faster, more complete and safer later in the series due to a wider range of bronchoscopy equipment which included both flexible and rigid videobronchoscopy with the use of optical forceps. This preliminary

  13. Surveying rip current survivors: preliminary insights into the experiences of being caught in rip currents

    Directory of Open Access Journals (Sweden)

    D. Drozdzewski

    2012-04-01

    Full Text Available This paper begins a process of addressing a significant gap in knowledge about people's responses to being caught in rip currents. While rip currents are the primary hazard facing recreational ocean swimmers in Australia, debate exists about the best advice to give swimmers caught in rip currents. Such surf rescue advice – on what to do and how to respond when caught in a rip – relies on empirical evidence. However, at present, knowledge about swimmers reactions and responses to rip currents is limited. This gap is a considerable barrier to providing effective advice to beach goers and to understanding how this advice is utilised (or not when actually caught in the rip current.

    This paper reports the findings of a pilot study that focussed on garnering a better understanding of swimmers' experiences when caught in rip currents. A large scale questionnaire survey instrument generated data about rip current survivors' demographics, knowledge of beach safety and their reactions and responses when caught in a rip current. A mix of online and paper surveys produced a total of 671 completed surveys. Respondents were predominantly an informed group in terms of rip current knowledge, beach experience and had a high self-rated swimming ability. Preliminary insights from the survey show that most respondents recalled a "swim across the rip/parallel to the beach" message when caught in the rip and most escaped unassisted by acting on this message. However, while nearly a quarter of respondents recalled a message of "not to panic", short answer responses revealed that the onset of panic inhibited some respondents from recalling or enacting any other type of beach safety message when caught in the rip current. Results also showed that despite the research sample being younger, competent and frequent ocean swimmers, they were more likely to swim at unpatrolled beaches and outside of the red and yellow safety flags. Moreover, they were still

  14. Geomorphic expression of strike-slip faults: field observations vs. analog experiments: preliminary results

    Science.gov (United States)

    Hsieh, S. Y.; Neubauer, F.; Genser, J.

    2012-04-01

    The aim of this project is to study the surface expression of strike-slip faults with main aim to find rules how these structures can be extrapolated to depth. In the first step, several basic properties of the fault architecture are in focus: (1) Is it possible to define the fault architecture by studying surface structures of the damage zone vs. the fault core, particularly the width of the damage zone? (2) Which second order structures define the damage zone of strike-slip faults, and how relate these to such reported in basement fault strike-slip analog experiments? (3) Beside classical fault bend structures, is there a systematic along-strike variation of the damage zone width and to which properties relates the variation of the damage zone width. We study the above mentioned properties on the dextral Altyn fault, which is one of the largest strike-slip on Earth with the advantage to have developed in a fully arid climate. The Altyn fault includes a ca. 250 to 600 m wide fault valley, usually with the trace of actual fault in its center. The fault valley is confined by basement highs, from which alluvial fans develop towards the center of the fault valley. The active fault trace is marked by small scale pressure ridges and offset of alluvial fans. The fault valley confining basement highs are several kilometer long and ca. 0.5 to 1 km wide and confined by rotated dextral anti-Riedel faults and internally structured by a regular fracture pattern. Dextral anti-Riedel faults are often cut by Riedel faults. Consequently, the Altyn fault comprises a several km wide damage zone. The fault core zone is a barrier to fluid flow, and the few springs of the region are located on the margin of the fault valley implying the fractured basement highs as the reservoir. Consequently, the southern Silk Road was using the Altyn fault valley. The preliminary data show that two or more orders of structures exist. Small-scale develop during a single earthquake. These finally

  15. Gaslini's tracheal team: preliminary experience after one year of paediatric airway reconstructive surgery

    Directory of Open Access Journals (Sweden)

    Torre Michele

    2011-10-01

    single tertiary care Centre providing rapid access to endoscopic and surgical manoeuvres on upper and lower airways and the possibility to start immediately cardiopulmonary bypass or ECMO. The preliminary experience of the Tracheal Team shows that good results can be obtained with this multidisciplinary approach in the treatment of complicated cases. The centralization of all the cases in one or few national Centres should be considered.

  16. Continuous Multimodality Monitoring in Children after Traumatic Brain Injury-Preliminary Experience.

    Directory of Open Access Journals (Sweden)

    Adam M H Young

    Full Text Available Multimodality monitoring is regularly employed in adult traumatic brain injury (TBI patients where it provides physiologic and therapeutic insight into this heterogeneous condition. Pediatric studies are less frequent.An analysis of data collected prospectively from 12 pediatric TBI patients admitted to Addenbrooke's Hospital, Pediatric Intensive Care Unit (PICU between August 2012 and December 2014 was performed. Patients' intracranial pressure (ICP, mean arterial pressure (MAP, and cerebral perfusion pressure (CPP were monitored continuously using brain monitoring software ICM+®, Pressure reactivity index (PRx and 'Optimal CPP' (CPPopt were calculated. Patient outcome was dichotomized into survivors and non-survivors.At 6 months 8/12 (66% of the cohort survived the TBI. The median (±IQR ICP was significantly lower in survivors 13.1±3.2 mm Hg compared to non-survivors 21.6±42.9 mm Hg (p = 0.003. The median time spent with ICP over 20 mm Hg was lower in survivors (9.7+9.8% vs 60.5+67.4% in non-survivors; p = 0.003. Although there was no evidence that CPP was different between survival groups, the time spent with a CPP close (within 10 mm Hg to the optimal CPP was significantly longer in survivors (90.7±12.6% compared with non-survivors (70.6±21.8%; p = 0.02. PRx provided significant outcome separation with median PRx in survivors being 0.02±0.19 compared to 0.39±0.62 in non-survivors (p = 0.02.Our observations provide evidence that multi-modality monitoring may be useful in pediatric TBI with ICP, deviation of CPP from CPPopt, and PRx correlating with patient outcome.

  17. Preliminary experiments to estimate the PE.MA.M (PElagic MArine Mesocosm) offshore behaviour

    Science.gov (United States)

    Albani, Marta; Piermattei, Viviana; Stefanì, Chiara; Marcelli, Marco

    2016-04-01

    The phytoplankton community is controlled not only by local environmental conditions but also by physical processes occurring on different temporal and spatial scales. Hydrodynamic local conditions play an important role in marine ecosystems. Several studies have shown that hydrodynamic conditions can influence the phytoplankton settling velocity, vertical and horizontal distribution and formation of cyanobacterial blooms. Mesocosms are useful structures to simulate marine environment at mesoscale resolution; allowing to closely approximate biotic or abiotic parameters of interest directly in nature. In this work an innovative structure named PE.MA.M (PElagic MArine Mesocosm) is presented and tested. Laboratory experiments have been conducted in order to observe seasonal variations of biomass behaviour in two different hydrodynamic conditions: outside as well as whithin the PE.MA.M. We have evaluated whether it is possible to isolate a natural system from external water mass hydrodynamic exchanges and to assume that phytoplankton cells' transition is limited at the net and sea interface. Preliminary experiments test the isolating capacity of the net, to determine the currents' attenuation rate and to estimate the possible PE.MA.M. offshore behaviour. In the first investigation, we monitored the diffusion of phytoplankton cells. The PE.MA.M. exterior and interior were simulated using a plexiglass tank divided into two half-tanks (Aout-Bin) by a septum consisting of a net like a PE.MA.M. The tank was filled up with 10 L of water and only the half-tank Aout was filled up with 10 ml of phytoplankton culture (Clorella sp.). We monitored the chlorophyll concentrations for 24 hours. The two tanks had similar concentrations after 4 hours (2.70322 mg/m³ Aout and 2.37245 mg/m3 Bin) and this constant relationship was maintened until the end of the test. In the second investigation we used clod cards to measure water motions.We conducted two experiments within tank, the first

  18. Retrospective analysis of burn injuries caused by hot milk in 159 pediatric patients: 14 years of experience in a burn unit.

    Science.gov (United States)

    Yontar, Yalcin; Esmaoglu, Aliye; Coruh, Atilla

    2014-07-01

    The aim of this study was to investigate the hot milk burns among the pediatric patients and to compare our experiences with similar studies in the literature. A 14-year retrospective study was conducted on 159 pediatric patients with hot milk burn who hospitalized at the Burn Unit of Erciyes University Medical Faculty. There were 81 male and 78 female patients with a male to female ratio of 1.03:1. The mean age of the patients was 2.7±1.6 years. The initial injury was immersion in 59.7% of the patients and spillage in 40.3%. The mean burned body surface area of the patients was 18.6±10.8%. Twenty-two percent of the patients had moderate, and 78% had major burn trauma. Forty-nine percent of the patients received burn wound debridement and reconstruction with auto-skin grafts. Our burn unit's mortality rate was 1.5% among 542 pediatric patients with hot water, and 5.6% among 159 pediatric patients with hot milk burn during the same period, respectively. Hot milk burns should be considered as separately from other hot liquid burns which do not contain fat such as water, tea, and coffee. Physical and chemical properties of milk because of its high content of fat give rise to more tissue destruction, increased morbidity and mortality.

  19. Pediatric Nurse\\s Educational Role in an International Task: Maternal Education Experience on 0-6 Month Baby Nutrition

    Directory of Open Access Journals (Sweden)

    Derya Suluhan

    2014-06-01

    Full Text Available The World Health Organization (WHO, for the baby\\s optimal growth and development, recommends all mothers all over the world feeding infants only breast milk for the first six months, initiating of additional nutrients after the sixth month, and suggests the need to continue to breastfeed for the first two years. The pediatric nurse works for Head of the Turkish delegation at the disposal of the Kosovo for a period of six months has decided to make a priority about an education on feeding infants (0-6 months as a result of a meeting with local health professionals and mothers. It is aimed to improve the level of knowledge about breastfeeding techniques and importance of breastfeeding of the mothers who have a 0-6 month old baby in Kosovo Mamusa Family Health Center. Besides the tasks where I\\ve been doing as a representative of the Turkish Armed Forces in Kosovo, it is an exciting experience in such a personal and professional sense to identify needs of people, plan and implement an education. The health care team assigned to work in the international arena, served especially to keep abreast of the needs and problems of people and work to fulfill the task of interacting with them. It is suggested to make cooperation with the local health care team to identify the issues of health education needs, to make, maintain and evaluate the planned education. [TAF Prev Med Bull 2014; 13(3.000: 265-268

  20. Treatment of choledochal cyst in a pediatric population. A single institution experience of 15-years. Case series

    Science.gov (United States)

    Silva-Baez, Hector; Coello-Ramírez, Pedro; Ixtabalán-Escalante, Eddy Mizraím; Sotelo-Anaya, Eduardo; Gallo-Morales, Mariana; Cordero-Estrada, Eduardo; Sainz-Escarrega, Victor Hugo; Ploneda-Valencia, César Felipe

    2015-01-01

    Background Choledochal cyst (CC) is a rare congenital anomaly of the bile duct that approximately 75% of the patients are diagnosed in childhood. Without a standardized surgical procedure for the biliary reconstruction, we present our experience over the last 15 years and show the differences between the biliary reconstructions techniques in our population. Methods We did a retrospective hospital archive search for patients admitted to the pediatric surgery department with the diagnosis of a choledochal cyst from January 2000 to June 2015. Results We found 15 patients, of which, 1 was excluded because of missing data from the hospital record. Of the remaining 14, eight had hepaticojejunal (HY) anastomosis in Roux-en-Y, with a 25% rate of complications; six had hepatoduodenal (HD) anastomosis with a rate of complications of 16.6%. The average hospital length of stay in the group of HD vs. HY was 14 ± 1.6-days vs. 19 ± 8.2-days respectively. Discussion There are no standardized surgical reconstruction techniques of the biliary tract after the CC excision, there is literature that supports the biliary reconstruction with an HY and an HD without a distinct advantage over one or the other. Conclusion: In our series HD anastomosis represents a safe procedure with fewer complications than HY. PMID:26900456

  1. The Impact of Adverse Childhood Experiences on an Urban Pediatric Population

    Science.gov (United States)

    Burke, Nadine J.; Hellman, Julia L.; Scott, Brandon G.; Weems, Carl F.; Carrion, Victor G.

    2011-01-01

    Objective: The goal of this study was to investigate the adverse childhood experiences (ACEs) in youth in a low-income, urban community. Study design: Data from a retrospective chart review of 701 subjects from the Bayview Child Health Center in San Francisco are presented. Medical chart documentation of ACEs as defined in previous studies were…

  2. Screening for Adverse Childhood Experiences (ACEs) in an Integrated Pediatric Care Model

    Science.gov (United States)

    Purewal, Sukhdip K.; Bucci, Monica; Wang, Lisa Gutiérrez; Koita, Kadiatou; Marques, Sara Silvério; Oh, Debora; Harris, Nadine Burke

    2016-01-01

    Adverse childhood experiences (ACEs) are stressful or traumatic events that place children at risk of negative health, mental health, and behavioral outcomes. The Center for Youth Wellness (CYW), working in partnership with the Bayview Child Health Center (BCHC), pioneered ACE screening for children and adolescents. This article describes the…

  3. Proton beam therapy for pediatric malignancies: a retrospective observational multicenter study in Japan.

    Science.gov (United States)

    Mizumoto, Masashi; Murayama, Shigeyuki; Akimoto, Tetsuo; Demizu, Yusuke; Fukushima, Takashi; Ishida, Yuji; Oshiro, Yoshiko; Numajiri, Haruko; Fuji, Hiroshi; Okumura, Toshiyuki; Shirato, Hiroki; Sakurai, Hideyuki

    2016-07-01

    Recent progress in the treatment for pediatric malignancies using a combination of surgery, chemotherapy, and radiotherapy has improved survival. However, late toxicities of radiotherapy are a concern in long-term survivors. A recent study suggested reduced secondary cancer and other late toxicities after proton beam therapy (PBT) due to dosimetric advantages. In this study, we evaluated the safety and efficacy of PBT for pediatric patients treated in Japan. A retrospective observational study in pediatric patients who received PBT was performed. All patients aged loss (two cases), cerebral vascular disease, and tissue necrosis occurred in five patients. This study provides preliminary results for PBT in pediatric patients in Japan. More experience and follow-up with this technique are required to establish the efficacy of PBT in this patient population.

  4. [Diagnosis and treatment of pediatric subglottic stenosis: experience in a tertiary care center].

    Science.gov (United States)

    Botto, Hugo Alberto; Pérez, Cinthia Giselle; Cocciaglia, Alejandro; Nieto, Mary; Rodríguez, Hugo Aníbal

    2015-08-01

    Subglottic stenosis is among the most common causes of airway obstruction in children, 90% of which resulting from endotracheal intubation. The diagnosis is based on the patient's clinical, radiologic evaluation, flexible laryngoscopy and rigid airway endoscopy under general anesthesia. It must be suspected in children with respiratory distress after extubation. The therapeutic approach depends on the severity of the subglottic stenosis and the patient's symptoms. We describe our experience with the subglottic stenosis etiologies, diagnosis, treatment and outcome of patients with this condition.

  5. Preliminary planning study for safety relief valve experiments in a Mark III BWR pressure suppression system

    Energy Technology Data Exchange (ETDEWEB)

    McCauley, E.W.; Holman, G.S.

    1980-04-21

    In response to a request from the Water Reactor Safety Research Division of the US NRC, a preliminary study is provided which identifies key features and consideration involved in planning a comprehensive in-plant Safety Relief Valve experimental program for a Mark III containment design. The report provides identification of program objectives, measurement system requirements, and some details quantifying expected system response. In addition, a preliminary test matrix is outlined which involves a supporting philosophy intended to enhance the usefulness of the experimental results for all members of the program team: experimentalists, analysts, and plant operator.

  6. Only fixation for cervical spondylosis: Report of early results with a preliminary experience with 6 cases

    Directory of Open Access Journals (Sweden)

    Atul Goel

    2013-01-01

    Full Text Available Aim: The author reports early post-operative outcome and preliminary experience with an alternative form of treatment of cervical degenerative or spondylotic disease leading to spinal canal stenosis that involves fixation-arthrodesis of the affected spinal segment using one or two (double insurance transarticular screws for each joint. Materials and Methods: During the period of months from March 2013 to July 2013, six patients having cervical spondylotic cord compression were treated with transarticular method of screw fixation of the involved segments. The operation involved section of the spinous process at its base, opening up of the facet joint, denuding of articular cartilage, placement of intraarticular cavity bone graft chips and insertion of either a single or two transarticular screws at each level. The fixation was done in four levels in four patients and at two levels in two patients. Japanese Orthopedic Association score, visual analog scale (neck pain and Odom′s criteria were used to monitor the clinical status of the patients before and after the surgery and at follow-up. Results: Immediate post-operative and a relatively short-term post-operative outcome was remarkably gratifying. During the average period of follow-up of 6 months (range: 3-8 months; there was varying degree of recovery of symptoms. The procedure resulted in firm stabilization and fixation of the spinal segment and provided a ground for arthrodesis. No patient worsened after treatment. During the period of follow-up, all patients showed remarkable and progressive recovery in symptoms. Conclusions: Vertical instability and telescoping, listhesis or overriding of the facets on physical activity seems to be the defining phenomenon in pathogenesis of cervical spondylotic disease. The clinical outcome in our patients suggest that only fixation of the spinal segment can be a rationale form of treatment. Transarticular method of treatment is a simple, safe and

  7. Role of Surgery in Stages II and III Pediatric Abdominal Non-Hodgkin Lymphoma: A 5-Years Experience

    OpenAIRE

    Salem, Mohamed A.; Hamza, Hesham M.; Sayd, Heba A.; Ali, Amany M.

    2011-01-01

    Abdominal Non-Hodgkin lymphomas (NHL) are the most common extra nodal presentation of pediatric NHL. Our aim is to assess the role of surgery as a risk factor and to evaluate the impact of risk-adjusted systemic chemotherapy on survival of patients with stages II and III disease. This study included 35 pediatric patients with abdominal NHL treated over five years at South Egypt Cancer Institute (SECI), Assiut University, between January 2005 and January 2010. The data of every patient include...

  8. Families' experiences of living with pediatric epilepsy: A qualitative systematic review.

    Science.gov (United States)

    Harden, Jeni; Black, Rebecca; Chin, Richard F M

    2016-07-01

    Living with epilepsy in childhood has implications for the child and their family beyond the physical effects associated with epileptic seizures. Qualitative research has emerged, aiming to deliver a greater depth of understanding of the experiences of living with epilepsy from the perspectives of children with epilepsy, their parents, and their siblings. This review of qualitative research had three aims: first, to synthesize the demographic and epilepsy profiles of research participants in eligible studies in order to provide a clear picture of who are included and excluded when studying families' experiences; second, to present and discuss the methodological concerns and implications of research involving children with epilepsy; and third, to synthesize the findings arising from qualitative research with families in order to identify common themes across all relevant studies to date. Papers published in the English language prior to January 2016 were identified following a search of eight electronic databases: Embase, Psychinfo, Medline, CINAHL, Web of Knowledge, ASSIA, Web of Science, and SCOPUS. Studies were included if they involved a sample of children with epilepsy (up to 18years of age), parents, or siblings of children with epilepsy and used qualitative methods. Twenty-one studies were identified as eligible for inclusion in the review. Findings in relation to the three aims were the following: 1) Researchers were seeking an understanding of children's experiences directly from children rather than by parental proxy. However, children with learning disabilities were often excluded from research, meaning that their views are not being heard. Parental research was predominantly with mothers, and father experiences were not often accessed. There was very little research with siblings. 2) The rationale for and ethical implications of the choice of research methods adopted were not always clear, and not all studies gave adequate attention to the development of

  9. Pediatric anterior skull base tumors: Our experience and review of literature

    Directory of Open Access Journals (Sweden)

    N K Venkataramana

    2010-01-01

    Full Text Available Surgery for skull base lesions has advanced considerably in the past few years. The improvement in surgical results could be attributed to the availability of refined imaging modalities, modern technological advances and multidisciplinary team approach. In this report, we present our personal experience in the surgical management of 45 children with a variety of skull base lesions treated over 10 years. This article includes a retrospective analysis of the surgical approaches used and their results with a review of the literature.

  10. Preliminary data for the 20 May 1974, simultaneous evaluation of remote sensors experiment. [water pollution monitoring

    Science.gov (United States)

    Johnson, R. W.; Batten, C. E.; Bowker, D. E.; Bressette, W. E.; Grew, G. W.

    1975-01-01

    Several remote sensors were simultaneously used to collect data over the tidal James River from Hopewell to Norfolk, Virginia. Sensors evaluated included the Multichannel-Ocean Color Sensor, multispectral scanners, and multispectral photography. Ground truth measurements and remotely sensed data are given. Preliminary analysis indicates that suspended sediment and concentrated industrial effluent are observable from all sensors.

  11. Ethical issues at the interface of clinical care and research practice in pediatric oncology: a narrative review of parents' and physicians' experiences

    Directory of Open Access Journals (Sweden)

    de Vries Martine C

    2011-09-01

    Full Text Available Abstract Background Pediatric oncology has a strong research culture. Most pediatric oncologists are investigators, involved in clinical care as well as research. As a result, a remarkable proportion of children with cancer enrolls in a trial during treatment. This paper discusses the ethical consequences of the unprecedented integration of research and care in pediatric oncology from the perspective of parents and physicians. Methodology An empirical ethical approach, combining (1 a narrative review of (primarily qualitative studies on parents' and physicians' experiences of the pediatric oncology research practice, and (2 comparison of these experiences with existing theoretical ethical concepts about (pediatric research. The use of empirical evidence enriches these concepts by taking into account the peculiarities that ethical challenges pose in practice. Results Analysis of the 22 studies reviewed revealed that the integration of research and care has consequences for the informed consent process, the promotion of the child's best interests, and the role of the physician (doctor vs. scientist. True consent to research is difficult to achieve due to the complexity of research protocols, emotional stress and parents' dependency on their child's physician. Parents' role is to promote their child's best interests, also when they are asked to consider enrolling their child in a trial. Parents are almost never in equipoise on trial participation, which leaves them with the agonizing situation of wanting to do what is best for their child, while being fearful of making the wrong decision. Furthermore, a therapeutic misconception endangers correct assessment of participation, making parents inaccurately attribute therapeutic intent to research procedures. Physicians prefer the perspective of a therapist over a researcher. Consequently they may truly believe that in the research setting they promote the child's best interests, which maintains the

  12. Myocarditis - pediatric

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/007307.htm Myocarditis - pediatric To use the sharing features on this page, please enable JavaScript. Pediatric myocarditis is inflammation of the heart muscle in ...

  13. Multiple clinical presentations of lymphoproliferative disorders in pediatric liver transplant recipients: a single-center experience.

    Science.gov (United States)

    Pinho-Apezzato, M L; Tannuri, U; Tannuri, A C A; Mello, E S; Lima, F; Gibelli, N E; Santos, M M; Ayoub, A A; Maksoud-Filho, J G; Velhote, M C; Silva, M M; Andrade, W C; Miyatani, H T

    2010-06-01

    Posttransplantation lymphoproliferative disorder (PTLD) is a serious complication following solid organ transplantation that has been linked to Epstein-Barr virus (EBV) infection. The aim of this article was to describe a single-center experience with the multiplicity of clinical presentations of PTLD. Among 350 liver transplantations performed in 303 children, 13 survivor children displayed a histological diagnosis of PTLD (13/242 survivors; 5.4%). The age at diagnosis ranged from 12 to 258 months (median, 47), and the time from transplantation ranged from 1 to 84 months (median, 13). Ten of these children (76.9%) were EBV-naïve prior to transplantation. Fever was present in all cases. The clinical signs at presentation were anemia (92.3%), diarrhea and vomiting (69.2%), recurrent upper airway infections (38.4%), Waldeyer ring lymphoid tissue hypertrophy (23.0%), abdominal mass lesions (30.7%), massive cervical and mediastinal adenopathy (15.3%), or gastrointestinal and respiratory symptoms (30.7%). One child developed fulminant hepatic allograft failure secondary to graft involvement by PTLD. Polymorphic PTLD was diagnosed in 6 patients; 7 had the diagnosis of lymphoma. Treatment consisted of stopping immunosuppression as well as starting intravenous gancyclovir and anti-CD20 monoclonal antibody therapy. The mortality rate was 53.8%. The clinical presentation of PTLD varied from fever of unknown origin to fulminant hepatic failure. The other symptoms that may be linked to the diagnosis of PTLD are pancytopenia, tonsil and adenoid hypertrophy, cervical or mediastinal lymph node enlargement, as well as abdominal masses. Despite numerous advances, the optimal treatment approach for PTLD is not completely known and the mortality rate is still high.

  14. Towards a quantitative study of the VUV photolysis of methane: preliminary experiment on trichloromethane

    Science.gov (United States)

    Gans, B.; Boyé-Péronne, S.; Douin, S.; Gauyacq, D.

    2010-01-01

    Photolysis of methane in Titan's stratosphere is the starting point of gas phase carbon chemistry. Quantitative studies of methane photolytic products are of utmost importance for Titan atmosphere models. With this aim, two experimental strategies are presented in this article. Preliminary results demonstrate the possibility of using CRDS absorption coupled with pulsed photolysis on the example of a halogenated derivative of methane: Trichloromethane (CHCl_3).

  15. Mass transport phenomena during solidification in microgravity; preliminary results of the first Mephisto flight experiment

    Science.gov (United States)

    Favier, J. J.; Garandet, J. P.; Rouzaud, A.; Camel, D.

    1994-06-01

    The MEPHISTO space facility flew on the Columbia space shuttle in October 1992. The preliminary scientific results, mainly based on the analysis of the Seebeck signal, are presented in this paper. Valuable information was obtained for both planar and cellular solidification regimes. It is shown that mass transfer in the melt during the flight was principally diffusive; however, even in microgravity, slow growth rates may result in significant convective transport. A tentative interpretation of the Seebeck signal for destabilized interfaces is also proposed.

  16. Preliminary results of Resistive Plate Chambers operated with eco-friendly gas mixtures for application in the CMS experiment

    CERN Document Server

    Abbrescia, M

    2016-01-01

    The operations of Resistive Plate Chambers in LHC experiments require Fluorine based (F-based) gases for optimal performance. Recent European regulations demand the use of environmentally unfriendly F-based gases to be limited or banned. In view of the CMS experiment upgrade, several tests are ongoing to measure the performance of the detector with these new ecological gas mixtures, in terms of efficiency, streamer probability, induced charge and time resolution. Prototype chambers with readout pads and with the standard CMS electronic setup are under test. In this paper preliminary results on performance of RPCs operated with a potential eco-friendly gas candidate 1,3,3,3-Tetrafluoropropene, commercially known as HFO-1234ze, with CO2 and CF3I based gas mixtures are presented and discussed for the possible application in the CMS experiment.

  17. Preliminary results of Resistive Plate Chambers operated with eco-friendly gas mixtures for application in the CMS experiment

    CERN Document Server

    Abbrescia, Marcello; Benussi, Luigi; Bianco, Stefano; Cauwenbergh, Simon Marc D; Ferrini, Mauro; Muhammad, Saleh; Passamontic, L; Pierluigi, Daniele; Piccolo, Davide; Primavera, Federica; Russo, Alessandro; Savianoc, G; Tytgat, Michael

    2016-01-01

    The operations of Resistive Plate Chambers in LHC experiments require F-based gases for optimal performance. Recent regulations demand the use of environmentally unfriendly F-based gases to be limited or banned. In view of the CMS experiment upgrade several tests are ongoing to measure the performance of the detector in terms of efficiency, streamer probability, induced charge and time resolution. Prototype chambers with readout pads and with the standard cms electronic setup are under test. In this talk preliminary results on performance of RPCs operated with a potential eco-friendly gas candidate 1,3,3,3-Tetrafluoropropene, commercially known as HFO-1234ze and with CO2 based gas mixtures are presented and discussed for the possible application in the CMS experiment.

  18. Hydrogeological characterization of the Heletz Sands Reservoir, Heletz (Israel) as a preliminary step towards CO2 injection experiments

    Science.gov (United States)

    Bensabat, Jacob; Niemi, Auli; Tsang, Chin-Fu; Sharma, Prabhakar; Carrera, Jesus; Sauter, Martin; Tatomir, Alexandru; Ghergut, Julia; Pezard, Philippe; Edlman, Katriona; Brauchler, Ralf

    2013-04-01

    Hydrogeological characterization of the Heletz Sands Reservoir, Heletz (Israel) as a preliminary step towards CO2 injection experiments One the major components of the EU-FP7 funded MUSTANG project is to conduct a highly controlled series of CO2 injection experiments, aimed at determining field values of key CO2 trapping mechanisms such as dissolution and residual trapping and to establish a comprehensive and consistent dataset for model validation. Prior to injecting CO2 there is a need to achieve a sufficient degree of hydrogeological characterization of the reservoir. In what follows we present a sequence of hydrologic tests to be conducted at Heletz and their expected contribution to the understanding relevant hydrogeology. These include: 1) Chemical characterization of the formation fluid; 2) Flowing Fluid Electrical Conductivity log, aimed at determining the vertical variability of the reservoir permeability in the near well vicinity; 3) Water pulse and pumping tests, aimed at determining the reservoir scale hydraulic properties; 4) Thermal test, aimed at determining the value of the heat transfer coefficient from the reservoir to the borehole fluid, which is responsible for the heating of injected fluid in the borehole; 5) two-well injection and pumping of water and tracers test, in order to determine the impact of heterogeneity on the hydraulic parameters and to identify preferential flow paths in the reservoir. This paper presents the design and planning of the experiments, the results obtained in field and a preliminary interpretation.

  19. The Thirty Gigahertz Instrument Receiver for the QUIJOTE Experiment: Preliminary Polarization Measurements and Systematic-Error Analysis.

    Science.gov (United States)

    Casas, Francisco J; Ortiz, David; Villa, Enrique; Cano, Juan L; Cagigas, Jaime; Pérez, Ana R; Aja, Beatriz; Terán, J Vicente; de la Fuente, Luisa; Artal, Eduardo; Hoyland, Roger; Génova-Santos, Ricardo

    2015-08-05

    This paper presents preliminary polarization measurements and systematic-error characterization of the Thirty Gigahertz Instrument receiver developed for the QUIJOTE experiment. The instrument has been designed to measure the polarization of Cosmic Microwave Background radiation from the sky, obtaining the Q, U, and I Stokes parameters of the incoming signal simultaneously. Two kinds of linearly polarized input signals have been used as excitations in the polarimeter measurement tests in the laboratory; these show consistent results in terms of the Stokes parameters obtained. A measurement-based systematic-error characterization technique has been used in order to determine the possible sources of instrumental errors and to assist in the polarimeter calibration process.

  20. The impact of language barriers and immigration status on the care experience for Spanish-speaking caregivers of patients with pediatric cancer.

    Science.gov (United States)

    Zamora, Eduardo R; Kaul, Sapna; Kirchhoff, Anne C; Gwilliam, Vannina; Jimenez, Ornella A; Morreall, Deborah K; Montenegro, Roberto E; Kinney, Anita Y; Fluchel, Mark N

    2016-12-01

    An increasing proportion of pediatric cancer patients in the United States are Latino and many have Spanish-speaking immigrant parents with limited English proficiency (LEP). Little is known about how language or undocumented immigration status impacts their care experience. A cross-sectional survey was administered to English (N = 310) and Spanish-speaking LEP (N = 56) caregivers of pediatric cancer patients. To assess differences in healthcare experiences between the language groups, t-tests and chi-square statistics were used. Multivariable logistic regression evaluated associations between primary language and knowledge of clinical trial status. Spanish-speaking caregivers were more likely to report higher rates of quitting or changing jobs as a direct result of their child's cancer, and their children were more likely to experience a delay in education. Although Spanish-speaking caregivers reported higher satisfaction with care, 32% reported feeling that their child would have received better care if English was their primary language. Spanish-speaking caregivers were more likely to incorrectly identify whether their child was on a clinical trial compared with English-speaking caregivers. The majority of Spanish-speaking caregivers reported at least one undocumented caregiver in the household and 11% of them avoided or delayed medical care for their child due to concerns over their undocumented immigration status. Language barriers and undocumented immigration status may negatively impact the quality of informed decision-making and the care experience for Spanish-speaking LEP caregivers of pediatric cancer patients. These families may benefit from culturally appropriate Spanish language resources to improve communication and open a dialogue regarding undocumented immigration status. © 2016 Wiley Periodicals, Inc.

  1. A Preliminary Study on 1D Numerical Experiment of Water Debris Flow in Gully

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    In order to improve and enhance the numerical modeling methods and its application on debris flow problems,a preliminary study has been proposed in accordance with the corrected water-sediment numerical model on the premise of revised resistance and sediment capacity equations.Firstly,an overview the recent re- search achievements on numerical simulation of debris flow has been conducted,the results shown that a gener- al numerical model for debris flow can not be existed at all because the complex rheol...

  2. Rapid screening of wheat bran contaminated by deoxynivalenol mycotoxin using Raman spectroscopy: a preliminary experiment

    Science.gov (United States)

    Mignani, A. G.; Ciaccheri, L.; Mencaglia, A. A.; De Girolamo, A.; Lippolis, V.; Pascale, M.

    2016-05-01

    Deoxynivalenol (DON) is a mycotoxin frequently occurring in cereals and derived products, and regulated in many countries. Raman spectroscopy performed using optical fibers, with excitation at 1064 nm and a dispersive detection scheme, was utilized to analyze wheat bran samples naturally contaminated with DON. A multivariate processing of the spectroscopic data allowed to distinguish two classes of contamination, with DON below and above 400 μg/kg, respectively. Only one highly contaminated sample was misclassified. This preliminary result demonstrates the potential of Raman spectroscopy as a useful analytical tool for the non-destructive and rapid analysis of mycotoxins in food.

  3. Frictional sliding in layered rock model: Preliminary experiments. Yucca Mountain Site Characterization Project

    Energy Technology Data Exchange (ETDEWEB)

    Perry, K.E. Jr.; Buescher, B.J.; Anderson, D.; Epstein, J.S. [Idaho National Engineering Lab., Idaho Falls, ID (United States)

    1995-09-01

    An important aspect of determining the suitability of Yucca Mountain as a possible nuclear waste repository requires understanding the mechanical behavior of jointed rock-masses. To this end we have studied the frictional sliding between simulated rock joints in the laboratory using the technique of phase shifting moire interferometry. The models were made from stacks of Lexan plates and contained a central hole to induce slip between the plates when the models were loaded in compression. These preliminary results confirm the feasibility of the approach and show a clear evolution of slip as function of load.

  4. Mass transport phenomena in microgravity: Preliminary results of the first MEPHISTO flight experiment

    Science.gov (United States)

    Favier, Jean Jacques; Garandet, J. P.; Rouzaud, A.; Camel, D.

    1994-01-01

    The MEPHISTO space program is the result of a cooperative effort that involves the French nuclear and space agencies (Commissariat a l'energie atomique, CEA - Centre National d'Etudes Spatiales, CNES) and the American National Aeronautics and Space Administration (NASA). The scientific studies and apparatus development were funded in the frame of the GRAMME agreement between CEA and CNES, the flight costs being taken in charge by NASA. Six flight opportunities are scheduled, with alternating French and American principal investigators. It is the purpose of this paper to briefly present MEPHISTO along with the preliminary results obtained during its first flight on USMP-1 in October 1992.

  5. MR imaging of prostate. Preliminary experience with calculated imaging in 28 cases

    Energy Technology Data Exchange (ETDEWEB)

    Gevenois, P.A.; Van Regemorter, G.; Ghysels, M.; Delepaut, A.; Van Gansbeke, D.; Struyven, J.

    1988-04-01

    The majority of studies with MR imaging in prostate disease are based on a semiology obtained using images weighted in T1 and T2. A study was carried out to evaluate effects of images calculated in T1 and T2 obtained at 0.5T. This preliminary study concerns 28 prostate examinations with spin-echo acquisition and inversion-recuperation parameters, and provided images calculated in T1, weighted and calculated in T2. Images allowed detection and characterization of prostate lesions. However, although calculated images accentuate discrimination of the method, the weighted images conserve their place because of their improved spatial resolution.

  6. Measuring patient experiences in Fabry disease: validation of the Fabry-specific Pediatric Health and Pain Questionnaire (FPHPQ

    Directory of Open Access Journals (Sweden)

    Ramaswami Uma

    2012-09-01

    Full Text Available Abstract Introduction Common symptoms for children with Anderson-Fabry Disease (FD such as acroparaesthesia and gastrointestinal manifestations can only be objectively assessed in patients using a valid instrument. To date, no such instrument exists. Methods A preliminary 40-item measure of symptoms and experience with FD, the Fabry-specific Paediatric Health and Pain Questionnaire (FPHPQ was developed, but lacked a formal assessment of its measurement properties. The FPHPQ was used in the Fabry Outcome Survey (FOS, a registry for all patients with a confirmed diagnosis of FD who are receiving agalsidase alfa, or are treatment naïve and who are managed by physicians participating in FOS. After an item analysis to explore how items performed and combined into domains, a battery of psychometric analyses was performed to assess the measurement properties of this new instrument. Results Eighty-seven children (ages 4-18 years completed the questionnaire. Twenty-three items in three subscales of the questionnaire emerged: pain associated with heat or exertion, pain associated with cold, and abdominal pain and fatigue symptoms. Internal consistency reliability for all three subscales was good (Cronbach alpha ≥ 0.84. Reliability was equally high for all age groups (4-7, 8-12, and 13-18. Test-retest reliability was high for all three subscales (intraclass correlation coefficient ≥ 0.74. Construct validity was demonstrated by moderate correlation with brief pain inventory (BPI, KINDL, and EQ-5D. Known group validity showed all subscales were able to discriminate between Fabry disease severity groups as classified by above or below median of the FOS MSSI (Mainz Severity Score Index grade. The heat or exertion subscale was responsive to change in symptoms between responders and non-responders as defined by change in EQ-5D index scores between the first and second visit. Conclusions Preliminary results indicate that the measurement properties

  7. Preliminary Single-Center Canadian Experience of Human Normothermic Ex Vivo Liver Perfusion: Results of a Clinical Trial.

    Science.gov (United States)

    Bral, M; Gala-Lopez, B; Bigam, D; Kneteman, N; Malcolm, A; Livingstone, S; Andres, A; Emamaullee, J; Russell, L; Coussios, C; West, L J; Friend, P J; Shapiro, A M J

    2017-04-01

    After extensive experimentation, outcomes of a first clinical normothermic machine perfusion (NMP) liver trial in the United Kingdom demonstrated feasibility and clear safety, with improved liver function compared with standard static cold storage (SCS). We present a preliminary single-center North American experience using identical NMP technology. Ten donor liver grafts were procured, four (40%) from donation after circulatory death (DCD), of which nine were transplanted. One liver did not proceed because of a technical failure with portal cannulation and was discarded. Transplanted NMP grafts were matched 1:3 with transplanted SCS livers. Median NMP was 11.5 h (range 3.3-22.5 h) with one DCD liver perfused for 22.5 h. All transplanted livers functioned, and serum transaminases, bilirubin, international normalized ratio, and lactate levels corrected in NMP recipients similarly to controls. Graft survival at 30 days (primary outcome) was not statistically different between groups on an intent-to-treat basis (p = 0.25). Intensive care and hospital stays were significantly more prolonged in the NMP group. This preliminary experience demonstrates feasibility as well as potential technical risks of NMP in a North American setting and highlights a need for larger, randomized studies. © 2016 The American Society of Transplantation and the American Society of Transplant Surgeons.

  8. Taiwanese Parents' Experience of Making a “Do Not Resuscitate” Decision for Their Child in Pediatric Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Shu-Mei Liu, RN, MN

    2014-03-01

    Conclusion: Open family visiting hours plus staff sensitivity and communication skills training are needed. To help parents with this difficult signing process, nurses and other professionals in the pediatric intensive care unit need education on initiating the conversation, guiding the parents in expressing their fears, and providing continuing support to parents and children throughout the child's end of life process.

  9. Cigotica programme: pediatric experiences

    Directory of Open Access Journals (Sweden)

    Lešović Snežana

    2011-01-01

    Full Text Available Introduction The alarming spread of obesity epidemic in children and adolsecents, as well as the absence of tested and efficient measures and programmes on obesity preven­tion indicate the necessity for the establishment of the Centre for the prevention, treatment and rehabilitation of obesity in children and adolescents and the 'Cigotica Programme' at the Special Hospital 'Zlatibor'. The advantage of the 'Cigotica' Programme is the multidisciplinary approach to treating obese children, which implies specific education, dietetic interventions with the reduction in the total daily calorie intake, physical activity, medical, educational and psychological support, change of behavior and lifestyle. Objective To define obesity complications, metabolic risk factors and treatment effects on body composition and metabolic parameters in adolescents participating in the 'Cigotica' Programme. Method 1,030 adolescents were examined (498 girls and 532 boys, aged 12 to 18, average age 15.45, diagnosed with primary obesity, hospitalized at the Centre for the prevention, treatment and rehabilitation of obesity in children and adolescents at the Special Hospital 'Zlatibor', in the period from 27/07/2008 to 03/10/2010. Hospitalization lasted 21 days. Obesity criterion was body mass index (BMI > +2 SD . Body The Special Hospital for the Thyroid Gland and Metabolism Zlatibor mass, BMI, % of fat were obtained by means of Tanita scales for determining body composition using the impendence method. Apart from medical examination, blood pressure was also taken. The levels of triglycerides, total HDL and LDL cholesterols, uric acids and glycemia were determined on the second and twenty-first day of hospitalization after a 12-day fasting period. Results After the multidisciplinary treatment, the average reduction in body mass (p< 0.05 in all adolescents was 5.92 ± 2.71 kg, in boys - 6.24 ±3.24 kg, and in girls -5.86±2.4. During the 21-day hospitalization, the average BMI (p< 0.05 was reduced by -2.12 ± 0.31 in all examinees, in boys by -2.33 ± 48 and in girls by -2.04 ± 0.41 kg/m2. The BMI z-score was considerably lower in all examinees upon release and it was (p<0.05-0.26 ±0.08, in girls 0.28 ±0.06 and in boys 0.31 ± 0.08. % of fat was considerably lower (p< 0.05 in all examinees -1.65 ± 0.23, in girls 1.72 ± 0.32 and in boys 1.50% ± 0.20. The waist circumference was reduced by -7.85 ±3.01 in all examinees, in girls -8.20 ± 4.3 and in boys -7.25 ± 2.6. Hypertension was observed in 28% of adolescents. Two factors of metabolic syndrome were present in 27.6%, and metabolic syndrome was present in 18.3% of the examinees. The disorder in sugar transport was observed in 8.9% of the examinees. Conclusion The effects of the 'Cigotica' Programme are very encouraging and they show that the multidisciplinary approach directed towards the reduction in energetic intake, education, change of lifestyle and habits related to nutrition and physical activity, leads to a considerable reduction in body mass, improvement in blood pressure, laboratory analyses, aerobic capacities and self-confidence in obese adolescents. There are obe­sity complications in a large number of adolescents, which indicates that the obesity problem has not been duly detected by parents or medical workers and that more efficient prevention programmes are needed. A great interest of children, parents, doctors and their participation in the 'Cigotica' Programme are going to contribute to raising awareness of obesity risks and the importance of health prevention in ado­lescents in our region.

  10. The Dysarthria Impact Profile: A Preliminary French Experience with Parkinson’s Disease

    Directory of Open Access Journals (Sweden)

    Alban Letanneux

    2013-01-01

    Full Text Available This preliminary study aimed to adapt the Dysarthria Impact Profile (DIP in French and to confirm its relevance for the assessment of the psychosocial impact of dysarthria in Parkinson's disease (PD. The DIP scale was administered to 10 people with PD and 10 age-matched control subjects. The DIP psychometric properties were calculated (discriminant validity, internal consistency, and concurrent validity, notably by using the Voice Handicap Index (VHI for interscale comparisons. The French version of the DIP discriminated people with PD from control subjects (χ2 test, P<0.05. Good internal consistency was observed in both populations (Cronbach’s α=0.93 for PD people and α=0.76 for control subjects. The DIP was highly correlated with the VHI (Spearman’s ρ=-0.70, P<0.01, confirming the external validity of the scale. There was no direct relationship between PD speech and quality of life as assessed by the Parkinson’s Disease Questionnaire-39 (PDQ-39. Our preliminary data suggest that the French version of the DIP has the potential to make a useful contribution for the assessment and outcome management in acquired dysarthria for both clinicians and researchers.

  11. Early experience with X-ray magnetic resonance fusion for low-flow vascular malformations in the pediatric interventional radiology suite

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Tiffany J. [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Keck School of Medicine of the University of Southern California, Los Angeles, CA (United States); Girard, Erin [Siemens Corporation, Corporate Technology, Princeton, NJ (United States); Shellikeri, Sphoorti; Vossough, Arastoo; Ho-Fung, Victor; Cahill, Anne Marie [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Setser, Randolph [Siemens Medical Solutions USA, Inc., Hoffman Estates, IL (United States)

    2016-03-15

    This technical innovation describes our experience using an X-ray magnetic resonance fusion (XMRF) software program to overlay 3-D MR images on real-time fluoroscopic images during sclerotherapy procedures for vascular malformations at a large pediatric institution. Five cases have been selected to illustrate the application and various clinical utilities of XMRF during sclerotherapy procedures as well as the technical limitations of this technique. The cases demonstrate how to use XMRF in the interventional suite to derive additional information to improve therapeutic confidence with regards to the extent of lesion filling and to guide clinical management in terms of intraprocedural interventional measures. (orig.)

  12. A preliminary investigation of the environmental Control and Life Support Subsystems (EC/LSS) for animal and plant experiment payloads

    Science.gov (United States)

    Wells, H. B.

    1972-01-01

    A preliminary study of the environmental control and life support subsystems (EC/LSS) necessary for an earth orbital spacecraft to conduct biological experiments is presented. The primary spacecraft models available for conducting these biological experiments are the space shuttle and modular space station. The experiments would be housed in a separate module that would be contained in either the shuttle payload bay or attached to the modular space station. This module would be manned only for experiment-related tasks, and would contain a separate EC/LSS for the crew and animals. Metabolic data were tabulated on various animals that are considered useful for a typical experiment program. The minimum payload for the 30-day space shuttle module was found to require about the equivalent of a one-man EC/LSS; however, the selected two-man shuttle assemblies will give a growth and contingency factor of about 50 percent. The maximum payloads for the space station mission will require at least a seven-man EC/LSS for the laboratory colony and a nine-man EC/LSS for the centrifuge colony. There is practically no room for growth or contingencies in these areas.

  13. Frictional sliding in layered rock: Preliminary experiments on stacked Lexan plates

    Energy Technology Data Exchange (ETDEWEB)

    Perry, K.E. Jr.; Epstein, J.S. [Idaho National Engineering Laboratory, Idaho Falls, ID (United States). Fracture Behavior Group; Jung, J. [Sandia National Labs., Albuquerque, NM (United States)

    1995-12-31

    Understanding the mechanical behavior of jointed-rock masses is of critical importance to designing and predicting the performance of a potential nuclear waste repositiry. To this end we have studied the frictional sliding between simulated rock joints using phase shifting moire interferometry. Preliminary calibration models were made from stacks of Lexan plates that were sand-blasted to provide a uniform frictional interface. Load was applied monotonically and phase shifted moire fringe patterns were recorded at three different load states. Plots of slip along the interfaces for the model are presented to demonstrate the ability of the photomechanics technique to provide precise measurements of in-plane displacement, and ultimately the slip between the plates.

  14. Preliminary Experience with a New Multidirectional Videoendoscope for Neuroendoscopic Surgical Procedures.

    Directory of Open Access Journals (Sweden)

    Luigi Maria Cavallo

    Full Text Available We assessed the applicability of a new multidirectional videoendoscope (digiCAMeleon, Karl Storz GmbH, Tuttlingen, Germany in various neuroendoscopic procedures.A 4-mm-diameter rigid videoendoscope (digiCAMeleon, Karl Storz GmbH, Tuttlingen, Germany with 1 sensor and an internal LED light source was tested. The device offers a resolution of 1920 x 1080 pixels and weighs ≈ 215 g. The prototype was tested on three cadaveric heads using three different approaches: a endoscopic endonasal transsphenoidal; b frontal transcortical intraventricular; c supraorbital.We identified several major benefits of the integrated system as applied to endoscopic endonasal, transcortical intraventricular, and endoscopic supraorbital keyhole approaches. These included improved maneuverability of the scope on account of reduced bulk and integration of the camera and fiberoptic light components, a variable angle of view from 0-70 degrees, and a novel feature that can be activated to maintain orientation of the surgical horizon. Our preliminary report highlights the potential for handling the videoendoscope in one hand, as one would a microsurgical instrument. The videoendoscope harbors all its electronic and lighting data into a unique and thin cable, thus resembling a modern "all-in-one" computer technology. Because of its reduced weight and ergonomic shape, controlling its movements is very easy and comfortable, even in the microsurgical environment. Furthermore, the videoendoscope offers the unique feature of orienting the horizon of vision, thanks to the possibility of offering angled views while working; this helps the surgeons to stay oriented with direct visualization and improved control of the instruments over a specific area of interest.The videoendoscope prototype represents an HD-image quality versatile tool in a neurosurgical environment, thanks to its reduced weight and dimensions; in these preliminary simulations, we have identified optimized visibility

  15. Preliminary Experience with a New Multidirectional Videoendoscope for Neuroendoscopic Surgical Procedures

    Science.gov (United States)

    Cavallo, Luigi Maria; Di Somma, Alberto; Solari, Domenico; de Divitiis, Oreste; Bracale, Umberto Marcello; Cappabianca, Paolo

    2016-01-01

    Purpose We assessed the applicability of a new multidirectional videoendoscope (digiCAMeleon, Karl Storz GmbH, Tuttlingen, Germany) in various neuroendoscopic procedures. Methods A 4-mm-diameter rigid videoendoscope (digiCAMeleon, Karl Storz GmbH, Tuttlingen, Germany) with 1 sensor and an internal LED light source was tested. The device offers a resolution of 1920 x 1080 pixels and weighs ≈ 215 g. The prototype was tested on three cadaveric heads using three different approaches: a) endoscopic endonasal transsphenoidal; b) frontal transcortical intraventricular; c) supraorbital. Results We identified several major benefits of the integrated system as applied to endoscopic endonasal, transcortical intraventricular, and endoscopic supraorbital keyhole approaches. These included improved maneuverability of the scope on account of reduced bulk and integration of the camera and fiberoptic light components, a variable angle of view from 0–70 degrees, and a novel feature that can be activated to maintain orientation of the surgical horizon. Our preliminary report highlights the potential for handling the videoendoscope in one hand, as one would a microsurgical instrument. The videoendoscope harbors all its electronic and lighting data into a unique and thin cable, thus resembling a modern "all-in-one" computer technology. Because of its reduced weight and ergonomic shape, controlling its movements is very easy and comfortable, even in the microsurgical environment. Furthermore, the videoendoscope offers the unique feature of orienting the horizon of vision, thanks to the possibility of offering angled views while working; this helps the surgeons to stay oriented with direct visualization and improved control of the instruments over a specific area of interest. Conclusions The videoendoscope prototype represents an HD-image quality versatile tool in a neurosurgical environment, thanks to its reduced weight and dimensions; in these preliminary simulations, we have

  16. Pediatric Dentistese

    Directory of Open Access Journals (Sweden)

    Sharath Asokan

    2017-01-01

    Full Text Available Successful practice of pediatric dentistry depends on the establishment of a good relationship between the dentist and the child. Such a relationship is possible only through effective communication. Pediatric dentistry includes both an art and a science component. The focus has been mostly on the technical aspects of our science, and the soft skills we need to develop are often forgotten or neglected. This paper throws light on the communication skills we need to imbibe to be a successful pediatric dentist. A new terminology “Pediatric Dentistese” has been coined similar to motherese, parentese, or baby talk. Since baby talk cannot be applied to all age groups of children, pediatric dentistese has been defined as “the proactive development-based individualized communication between the pediatric dentist and the child which helps to build trust, allay fear, and treat the child effectively and efficiently.”

  17. Professor Yu Jingmao's Experience in Coordinating and Treating Pediatric Disease with Herbal Pas te%俞景茂膏方调治小儿疾病经验

    Institute of Scientific and Technical Information of China (English)

    任昱

    2014-01-01

    [目的]探讨俞景茂教授运用膏方调治小儿疾病的临证经验。[方法]通过跟师临诊,总结俞师运用膏方治疗小儿顽疾的学术经验,并附验案举隅。[结果]俞师认为,膏方剂型适合小儿服用,强调膏方治疗小儿疾病须辨病、辨证结合,因时、因人制宜。临证时注重调补固本,以平为贵;补中寓攻,以和为要;顾护脾胃,以喜为补。所附小儿哮喘医案1则,俞景茂教授巧用膏方调治2月,哮喘发作次数减少,发作时症状减轻。[结论]俞景茂教授根据小儿生理病理特点,运用膏方个体化辨治小儿诸疾,扶正祛邪,调和阴阳,经验丰赡,值得推广应用。%Objective] To explore professor Yu Jingmao's clinical experience in coordinating and treating pediatric disease with herbal paste. [Method] By fol owing the teacher clinic, the author summarizes professor Yu Jingmao's academic experience of treatment of children with chronic il ness with herbal paste, and for proven cases. [Result] Professor Yu Jingmao uses herbal paste for modulating pediatric intractable disease with curative effect. In his opinion, herbal paste treatment of pediatric diseases must be combined with disease and syndrome differentiation, and considered in accordance with seasonal conditions and the patient's individuality. Professor Yu considers that herbal paste formulations are suitable for children, and pays attention to regulating and nourishing to strengthen the body focused on harmony, reinforcing with elimination based on balance, protecting and tonifying the spleen and stomach based on enjoying oral application. [Conclusion] According to children's physiological and pathological characteristics, professor Yu Jingmao has rich experiences in using herbal paste for personalized syndrome differentiation treatment of pediatric diseases to strengthen body resistance and eliminate evil, regulate Yin and Yang, which is worth generalizing and

  18. Student Participation in Ecological Research: Preliminary Insights from Students' Experiences in the Smoky Mountains

    Science.gov (United States)

    Pacifici, Lara B.; Miller, Craig; Thomson, Norman

    2009-01-01

    Students participating in summer research internships at the Great Smoky Mountain National Park kept electronic journals to document their experiences. We used a combined content analysis to quantify the responses from the students in particular areas of interest and to understand the essence of experiences from the explanations provided in their…

  19. Near-Death Experiences and the "Fantasy-Prone" Personality: Preliminary Findings.

    Science.gov (United States)

    Council, James R.; Greyson, Bruce

    Near-death experiences (NDEs) are subjective experiences at the threshold of death which can include strong positive affect, dissociation from the physical body, and paranormal/transcendental phenomena. Empirical investigation of NDEs has typically relied upon retrospective reports and personality studies of individuals who have come close to…

  20. Pediatric Sepsis.

    Science.gov (United States)

    Prusakowski, Melanie K; Chen, Audrey P

    2017-02-01

    Pediatric sepsis is distinct from adult sepsis in its definitions, clinical presentations, and management. Recognition of pediatric sepsis is complicated by the various pediatric-specific comorbidities that contribute to its mortality and the age- and development-specific vital sign and clinical parameters that obscure its recognition. This article outlines the clinical presentation and management of sepsis in neonates, infants, and children, and highlights some key populations who require specialized care. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Experience with cefepime versus meropenem as empiric monotherapy for neutropenia and fever in pediatric patients with solid tumors.

    Science.gov (United States)

    Oguz, Aynur; Karadeniz, Ceyda; Citak, Elvan Caglar; Cil, Visal; Eldes, Nilufer

    2006-01-01

    A prospective, open-label, randomized, comparative study in pediatric cancer patients was conducted to evaluate the efficacy and safety of cefepime and meropenem in the empiric therapy of febrile neutropenic patients. Febrile episodes were classified as microbiologically documented infection, clinical documented infection, or fever of unknown origin. Clinical response to therapy was classified as success or failure. In this period 37 children with solid tumors including lymphoma, 25 males, 12 females, had neutropenia on 65 occasions. Microbiologically documented infections occurred in 21 episodes (32.31%). Frequency of positive bacteria isolated was higher than gram-negative bacteria. There was no infection-related death. There were no statistical differences between the cefepime and meropenem groups for duration of fever or neutropenia, response rate, and necessity for modification. Cefepime appears to be as effective and safe as meropenem for empiric treatment of febrile episodes in neutropenic pediatric cancer patients.

  2. Preliminary study of tolerance of ambiguity of individuals reporting paranormal experiences.

    Science.gov (United States)

    Houran, J

    1998-02-01

    This research tested the notion that poltergeist-like experiences reflect the need to explain anomalous personal experiences. Thus, it was hypothesized that percipients of poltergeists would score lower on tolerance of ambiguity than controls. Further, it was hypothesized that tolerance of ambiguity would negatively correlate with the number of different categories of poltergeist experience. 30 self-identified percipients of poltergeist-like phenomena and 30 self-identified nonpercipients of the paranormal were administered the Rydell-Rosen Ambiguity Tolerance Scale and Houran and Lange's Poltergeist Experiences Checklist. Results partially supported predictions. Percipients of the paranormal scored significantly lower on tolerance of ambiguity than nonpercipients, but scores on the experiences checklist did not significantly correlate with scores on tolerance of ambiguity. The results supported the main hypothesis but more detailed research is needed to clarify the roles of age and tolerance of ambiguity in the perception of anomalous phenomena.

  3. Role of Surgery in Stages II and III Pediatric Abdominal Non-Hodgkin Lymphoma: A 5-Years Experience

    Directory of Open Access Journals (Sweden)

    Mohamed A. Salem

    2011-03-01

    Full Text Available Abdominal Non-Hodgkin lymphomas (NHL are the most common extra nodal presentation of pediatric NHL. Our aim is to assess the role of surgery as a risk factor and to evaluate the impact of risk-adjusted systemic chemotherapy on survival of patients with stages II and III disease. This study included 35 pediatric patients with abdominal NHL treated over five years at South Egypt Cancer Institute (SECI, Assiut University, between January 2005 and January 2010. The data of every patient included: Age, sex, and presentation, staging work up to determine extent of the disease and the type of resection performed, histopathological examination, details of chemotherapy, disease free survival and overall survival. The study included 25 boys and 10 girls with a median age of six years (range: 2.5:15. Thirty patients (86% presented with abdominal pain, 23 patients (66% presented with abdominal mass and distention, 13 patients (34% presented with weight loss, and intestinal obstruction occurred in six patients (17%. The ileo-cecal region and abdominal lymph nodes were the commonest sites (48.5%, 21% respectively. Burkitt's lymphoma was the most common histological type in 29 patients (83%. Ten (28.5% stage II (group A and 25 (71.5% stage III (group B. Complete resections were performed in 10 (28.5%, debulking in 6 (17% and imaging guided biopsy in 19 (54%. A11 patients received systemic chemotherapy. The median follow up duration was 63 months (range 51-78 months. The parameters that significantly affect the overall survival were stage at presentation complete resection for localized disease. In conclusion, the extent of disease at presentation is the most important prognostic factor in pediatric abdominal NHL. Surgery is restricted to defined situations such as; abdominal emergencies, diagnostic biopsy and total tumor extirpation in localized disease. Chemotherapy is the cornerstone in the management of pediatric abdominal NHL.

  4. Role of Surgery in Stages II and III Pediatric Abdominal Non-Hodgkin Lymphoma: A 5-Years Experience.

    Science.gov (United States)

    Ali, Amany M; Sayd, Heba A; Hamza, Hesham M; Salem, Mohamed A

    2011-03-29

    Abdominal Non-Hodgkin lymphomas (NHL) are the most common extra nodal presentation of pediatric NHL. Our aim is to assess the role of surgery as a risk factor and to evaluate the impact of risk-adjusted systemic chemotherapy on survival of patients with stages II and III disease. This study included 35 pediatric patients with abdominal NHL treated over five years at South Egypt Cancer Institute (SECI), Assiut University, between January 2005 and January 2010. The data of every patient included: Age, sex, and presentation, staging work up to determine extent of the disease and the type of resection performed, histopathological examination, details of chemotherapy, disease free survival and overall survival. The study included 25 boys and 10 girls with a median age of six years (range: 2.5:15). Thirty patients (86%) presented with abdominal pain, 23 patients (66%) presented with abdominal mass and distention, 13 patients (34%) presented with weight loss, and intestinal obstruction occurred in six patients (17%). The ileo-cecal region and abdominal lymph nodes were the commonest sites (48.5%, 21% respectively). Burkitt's lymphoma was the most common histological type in 29 patients (83%). Ten (28.5%) stage II (group A) and 25 (71.5%) stage III (group B). Complete resections were performed in 10 (28.5%), debulking in 6 (17%) and imaging guided biopsy in 19 (54%). A11 patients received systemic chemotherapy. The median follow up duration was 63 months (range 51-78 months). The parameters that significantly affect the overall survival were stage at presentation complete resection for localized disease. In conclusion, the extent of disease at presentation is the most important prognostic factor in pediatric abdominal NHL. Surgery is restricted to defined situations such as; abdominal emergencies, diagnostic biopsy and total tumor extirpation in localized disease. Chemotherapy is the cornerstone in the management of pediatric abdominal NHL.

  5. Clinical Impact and Cost-Effectiveness of Whole Exome Sequencing as a Diagnostic Tool: A Pediatric Center’s Experience

    OpenAIRE

    C Alexander Valencia; Ammar eHusami; Jennifer eHolle; Johnson, Judith A; Yaping eQian; Abhinav eMathur; Chao eWei; Subba Rao Indugula; Fanggeng eZou; Haiying eMeng; Lijun eWang; Xia eLi; Rachel eFisher; Tony eTan; Amber eHogart Begtrup

    2015-01-01

    Background There are limited reports of the use of whole exome sequencing (WES) as a clinical diagnostic tool. Moreover, there are no reports addressing the cost burden associated with genetic tests performed prior to WES. Objective We demonstrate the performance characteristics of WES in a pediatric setting by describing our patient cohort, calculating the diagnostic yield, and detailing the patients for whom clinical management was altered. Moreover, we examined the potential cos...

  6. The experiences of undergraduate nursing students and self-reflective accounts of first clinical rotation in pediatric oncology.

    Science.gov (United States)

    Mirlashari, Jila; Warnock, Fay; Jahanbani, Jahanfar

    2017-07-01

    The clinical practicum is one of the most anticipated components of the nursing program for nursing students. However, the practicum can be anxiety producing for students, especially when it is their first placement in an emotional demanding setting like pediatric oncology unit. Taking care of children with cancer and who are facing the death trajectory is complex and demanding not only for students but also for the experienced nurse. In this qualitative research, the purpose was to explore senior student perceptions and self-reflective accounts of what it was like to care for children with cancer and their family throughout the course of their first practicum on a pediatric oncology unit that also provided children palliative care as needed. Data from the self-reflective journals and interviews were analyzed together using conventional content analysis. The three resultant categories that emerged: state of shock and getting lost, walking in to a mind shaking world and finding the way provided in-depth novel insight on the perceptions of senior undergraduate nursing students as they journey through their first time practicum on a pediatric oncology unit. The findings also confirmed the importance and benefit of reflective journaling to student integrated learning and adjustment in nursing practice. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Gender and urban infrastructural poverty experience in Africa: A preliminary survey in Ibadan city, Nigeria

    Directory of Open Access Journals (Sweden)

    Raimi. A. Asiyanbola

    2012-12-01

    Full Text Available The paper examines gender differences in the urban infrastructural poverty experience in an African city – Ibadan, Nigeria. The result of the cross-sectional survey of 232 households sampled in Ibadan city shows that there is intra-urban variation in the women and men urban infrastructure experience in Ibadan. The result of the correlation analysis shows that there is significant relationship between women and men urban infrastructure experience and the household income, educational level, household size and the stage in the life cycle; only with the urban infrastructure experience of the women is a significant relationship found with the occupation and the responsibility in the household. The result of the multiple linear regression analysis shows that the impact/effect of the socio-cultural, demographic and economic characteristics are more on women experience of urban infrastructure than on men’s experience. While the relative contributions of the economic characteristics, family characteristics and socio-cultural characteristics in that order are all significant in explaining the variance in women’s experience of urban infrastructure, only economic characteristics and family characteristics in that order are found to be significant in the case of the men. Also, the most important socio-cultural demographic and economic variables as shown by the beta coefficients for women are household income, household size, and responsibility in the household, while for men are the household income and the household size. Policy implications of the findings are highlighted in the paper.

  8. Preliminary experiment design of graphite dust emission measurement under accident conditions for HTGR

    Energy Technology Data Exchange (ETDEWEB)

    Peng, Wei, E-mail: pengwei@tsinghua.edu.cn [Institute of Nuclear and New Energy Technology of Tsinghua University, Advanced Nuclear Energy Technology Cooperation Innovation Center, The Key Laboratory of Advanced Nuclear Engineering and Safety, Ministry of Education, Beijing 100084 (China); Chen, Tao; Sun, Qi; Wang, Jie [Institute of Nuclear and New Energy Technology of Tsinghua University, Advanced Nuclear Energy Technology Cooperation Innovation Center, The Key Laboratory of Advanced Nuclear Engineering and Safety, Ministry of Education, Beijing 100084 (China); Yu, Suyuan, E-mail: suyuan@tsinghua.edu.cn [Center for Combustion Energy, The Key Laboratory for Thermal Science and Power Engineering, Ministry of Education, Tsinghua University, Beijing 100084 (China)

    2017-05-15

    Highlights: • A theoretical analysis is used to predict the total graphite dust release for an AVR LOCA. • Similarity criteria must be satisfied between the experiment and the actual HTGR system. • Model experiments should be conducted to predict the graphite dust resuspension rate. - Abstract: The graphite dust movement behavior is significant for the safety analyses of high-temperature gas cooled reactor (HTGR). The graphite dust release for accident conditions is an important source term for HTGR safety analyses. Depressurization release tests are not practical in HTGR because of a radioactivity release to the environment. Thus, a theoretical analysis and similarity principles were used to design a group of modeling experiments. Modeling experiments for fan start-up and depressurization process and actual experiments of helium circulator start-up in an HTGR were used to predict the rate of graphite dust resuspension and the graphite dust concentration, which can be used to predict the graphite dust release during accidents. The modeling experiments are easy to realize and the helium circulator start-up test does not harm the reactor system or the environment, so this experiment program is easily achieved. The revised Rock’n’Roll model was then used to calculate the AVR reactor release. The calculation results indicate that the total graphite dust releases during a LOCA will be about 0.65 g in AVR.

  9. Study to perform preliminary experiments to evaluate particle generation and characterization techniques for zero-gravity cloud physics experiments

    Science.gov (United States)

    Katz, U.

    1982-01-01

    Methods of particle generation and characterization with regard to their applicability for experiments requiring cloud condensation nuclei (CCN) of specified properties were investigated. Since aerosol characterization is a prerequisite to assessing performance of particle generation equipment, techniques for characterizing aerosol were evaluated. Aerosol generation is discussed, and atomizer and photolytic generators including preparation of hydrosols (used with atomizers) and the evaluation of a flight version of an atomizer are studied.

  10. Preliminary design of laser-induced breakdown spectroscopy for proto-Material Plasma Exposure eXperiment.

    Science.gov (United States)

    Shaw, G; Martin, M Z; Martin, R; Biewer, T M

    2014-11-01

    Laser-induced breakdown spectroscopy (LIBS) is a technique for measuring surface matter composition. LIBS is performed by focusing laser radiation onto a target surface, ablating the surface, forming a plasma, and analyzing the light produced. LIBS surface analysis is a possible diagnostic for characterizing plasma-facing materials in ITER. Oak Ridge National Laboratory has enabled the initial installation of a laser-induced breakdown spectroscopy diagnostic on the prototype Material-Plasma Exposure eXperiment (Proto-MPEX), which strives to mimic the conditions found at the surface of the ITER divertor. This paper will discuss the LIBS implementation on Proto-MPEX, preliminary design of the fiber optic LIBS collection probe, and the expected results.

  11. The Thirty Gigahertz Instrument Receiver for the QUIJOTE Experiment: Preliminary Polarization Measurements and Systematic-Error Analysis

    Science.gov (United States)

    Casas, Francisco J.; Ortiz, David; Villa, Enrique; Cano, Juan L.; Cagigas, Jaime; Pérez, Ana R.; Aja, Beatriz; Terán, J. Vicente; de la Fuente, Luisa; Artal, Eduardo; Hoyland, Roger; Génova-Santos, Ricardo

    2015-01-01

    This paper presents preliminary polarization measurements and systematic-error characterization of the Thirty Gigahertz Instrument receiver developed for the QUIJOTE experiment. The instrument has been designed to measure the polarization of Cosmic Microwave Background radiation from the sky, obtaining the Q, U, and I Stokes parameters of the incoming signal simultaneously. Two kinds of linearly polarized input signals have been used as excitations in the polarimeter measurement tests in the laboratory; these show consistent results in terms of the Stokes parameters obtained. A measurement-based systematic-error characterization technique has been used in order to determine the possible sources of instrumental errors and to assist in the polarimeter calibration process. PMID:26251906

  12. The Thirty Gigahertz Instrument Receiver for the QUIJOTE Experiment: Preliminary Polarization Measurements and Systematic-Error Analysis

    Directory of Open Access Journals (Sweden)

    Francisco J. Casas

    2015-08-01

    Full Text Available This paper presents preliminary polarization measurements and systematic-error characterization of the Thirty Gigahertz Instrument receiver developed for the QUIJOTE experiment. The instrument has been designed to measure the polarization of Cosmic Microwave Background radiation from the sky, obtaining the Q, U, and I Stokes parameters of the incoming signal simultaneously. Two kinds of linearly polarized input signals have been used as excitations in the polarimeter measurement tests in the laboratory; these show consistent results in terms of the Stokes parameters obtained. A measurement-based systematic-error characterization technique has been used in order to determine the possible sources of instrumental errors and to assist in the polarimeter calibration process.

  13. Potential flow calculations and preliminary wing design in support of an NLF variable sweep transition flight experiment

    Science.gov (United States)

    Waggoner, E. G.; Phillips, P. S.; Viken, J. K.; Davis, W. H.

    1985-01-01

    NASA Langley and NASA Ames-Dryden have defined a variable-sweep transition-flight experiment utilizing the F-14 aircraft to enhance understanding of the interaction of crossflow and Tollmien-Schlichting instabilities on a laminar-boundary-layer transition. The F-14 wing outer panel will be modified to generate favorable pressure gradients on the upper wing surface over a wide range of flight conditions. Extensive computations have been performed using two-dimensional and three-dimensional transonic analysis codes. Flight-test and computational data are compared and shown to validate the applicability of the three-dimensional codes (WBPPW and TAWFIVE). In addition, results from two preliminary glove designs derived from two different approaches to the design problem are presented. Advantages and disadvantages of each approach are identified, and it is concluded that coupling an analysis code with an automated design procedure yields a powerful code with distinct advantages over a 'cut-and-dry' approach.

  14. [Preliminary research on application of Q method in studying experiences of Chinese medicine famous veteran doctors].

    Science.gov (United States)

    Liu, Meng-Yu; Peng, Jin; Jiang, Miao

    2010-10-01

    As the stands, one-sidedness of subjective understanding and subjective bias is surely existed in the study of Chinese medicine (CM) doctors' experiences, so to find appropriate methods for inheriting the real experiences of experts is needed. Since CM thinking presents as a system integral way of intention thinking and a mental process of subject, to study CM experts' experiences in virtue of Q method, a psychological research method for the subjective sense, must be feasible. The application of Q method was inspected in this article, it was considered to be capable of sorting the experts, integrating the opinions of experts and comparing their opinions from multi-pointviews. A test investigation was carried out by applying Q method to analyze the CM measures, getting from some chosen gynecology specialists, for regain pregnancy in women underwent spontaneous abortion, for exploring the applicative value of Q method in the co-cognizance formation of experts' experiences.

  15. Preliminary study of religious, spiritual and mystical experiences. Thematic analysis of Poles adult’s narratives

    Directory of Open Access Journals (Sweden)

    Marta Magdalena Boczkowska

    2016-07-01

    Full Text Available The aim of this study was to examine narratives of the personal religious, spiritual and mystical experiences of adult Poles (N = 74 and their impact on narrative identity. The method for collecting qualitative data about individual understandings and spiritual, religious and mystical experiences was the narrative interview, developed on the basis of the Life Story Interview. During the analysis, the following key topics were identified: awareness of the presence/protection of God, a peak experience, the awareness of oneness with nature and the world, and a sense of closeness/contact with a person who has died. This study provides specific information on the spiritual, religious and mystical experiences of the investigated group of Poles.

  16. Preliminary Results from the GPS-Reflections Mediterranean Balloon Experiment (GPSR MEBEX)

    Science.gov (United States)

    Garrison, James L.; Ruffini, Giulio; Rius, Antonio; Cardellach, Estelle; Masters, Dallas; Armathys, Michael; Zavorotny, Valery

    2000-01-01

    An experiment to collect bistatically scattered GPS signals from a balloon at 37 km altitude has been conducted. This experiment represented the highest altitude to date that such signals were successfully recorded. The flight took place in August 1999 over the Mediterranean sea, between a launch in Sicily and recovery near Nerpio, a town in the Sierra de Segura, Albacete province of Huelva, Spain. Results from this experiment are presented, showing the waveform shape as compared to theoretical calculations. These results will be used to validate analytical models which form the basis of wind vector retrieval algorithms. These algorithms are already being validated from aircraft altitudes, but may be applied to data from future spaceborne GPS receivers. Surface wind data from radiosondes were used for comparison. This experiment was a cooperative project between NASA, the IEEC in Barcelona, and the University of Colorado at Boulder.

  17. Preliminary Results from the GPS-Reflections Mediterranean Balloon Experiment (GPSR-MEBEX)

    Science.gov (United States)

    Garrison, James L.; Ruffini, Giulio; Rius, Antonio; Cardellach, Estelle; Masters, Dallas; Armatys, Michael; Zavorotny, Valery; Bauer, Frank H. (Technical Monitor)

    2000-01-01

    An experiment to collect bistatically scattered GPS signals from a balloon at 37 km altitude has been conducted. This experiment represented the highest altitude to date that such signals were successfully recorded. The flight took place in August 1999 over the Mediterranean sea, between a launch in Sicily and recovery near Nerpio, a town in the Sierra de Segura, Albacete province of Huelva, Spain. Results from this experiment are presented, showing the waveform shape as compared to theoretical calculations. These results will be used to validate analytical models which form the basis of wind vector retrieval algorithms. These algorithms are already being validated from aircraft altitudes, but may be applied to data from future spacebourne GPS receivers. Surface wind data from radiosondes were used for comparison. This experiment was a cooperative project between NASA, the IEEC in Barcelona, and the University of Colorado at Boulder.

  18. Blastocyst transfer for patients with multiple assisted reproduction treatment failures: preliminary experience.

    Science.gov (United States)

    Sakkas, D; Percival, G; D'Arcy, Y; Lenton, W; Sharif, K; Afnan, M

    2001-01-01

    This preliminary study reports the results obtained from a patient group in which blastocyst culture and transfer were performed, and discusses the advantages and disadvantages of introducing blastocyst transfer in a clinic. Twenty-six patients who had failed to achieve a pregnancy in previous in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatments were offered the choice of a fresh cycle with culture to the blastocyst stage. Of the 26 patients who elected to attempt blastocyst culture, 11 opted to have transfer on day 2 or day 3 due to low numbers of embryos. Of the 15 patients who proceeded to blastocyst culture, 46.2% of the embryos cultured reached the blastocyst stage or later and eight of the patients achieved a clinical pregnancy. More oocytes were collected in this patient group, hence the chances of obtaining blastocysts were higher. Offering blastocyst culture to patients with a reasonable chance of success who have had previous multiple assisted reproduction failures is an acceptable way of introducing blastocyst culture into practice.

  19. Outcome measures to evaluate new technology for tonsillectomy: preliminary experience with Coblation

    Science.gov (United States)

    Shah, Udayan K.; Puchalski, Robert; Briggs, Marianne; Chiavacci, Rosetta; Galinkin, Jeffrey

    2001-05-01

    Evaluating the benefits of new surgical technologies does not end with the observation of successful instrument-to- tissue interaction. The impact of new technologies in medicine today is also gauged by improvements in patients' daily activities and performance. We present our outcomes assessment tool for judging the value of applying a novel tonsillectomy technique, plasma- mediated ablation using Coblation technology. Plasma- mediated ablation (PMA) achieves soft tissue resection in the oropharynx by energizing protons to break bonds. Less heat is released, allowing for less thermal injury, and possibly less pain, than with tonsillectomy performed using electrocautery alone. Children undergoing tonsillectomy by PMA, were evaluated using our outcomes-based scale, which asked families to report the degree of interruption of normal activities for the patient and their family during the post-tonsillectomy recovery period. A preliminary review of several outcomes assessments exemplify the benefits and limitations of this tool. The tracking of valuable data is weighed against the limitations of a short time course relative to the duration of disability, and a poor response rate. Future work aims to improve this data collection tool to allow application to other new technologies in otolaryngology.

  20. Estimation of desmosponge (Porifera, Demospongiae) larval settlement rates from short-term recruitment rates: Preliminary experiments

    Science.gov (United States)

    Zea, Sven

    1992-09-01

    During a study of the spatial and temporal patterns of desmosponge (Porifera, Demospongiae) recruitment on rocky and coral reef habitats of Santa Marta, Colombian Caribbean Sea, preliminary attempts were made to estimate actual settlement rates from short-term (1 to a few days) recruitment censuses. Short-term recruitment rates on black, acrylic plastic plates attached to open, non-cryptic substratum by anchor screws were low and variable (0 5 recruits/plate in 1 2 days, sets of n=5 10 plates), but reflected the depth and seasonal trends found using mid-term (1 to a few months) censusing intervals. Moreover, mortality of recruits during 1 2 day intervals was low (0 12%). Thus, short-term censusing intervals can be used to estimate actual settlement rates. To be able to make statistical comparisons, however, it is necessary to increase the number of recruits per census by pooling data of n plates per set, and to have more than one set per site or treatment.

  1. Acquisition procedures, processing methodologies and preliminary results of magnetic and ROV data collected during the TOMO-ETNA experiment

    Directory of Open Access Journals (Sweden)

    Danilo Cavallaro

    2016-09-01

    Full Text Available The TOMO-ETNA experiment was devised for the investigation of the continental and oceanic crust beneath Mt. Etna volcano and northeastern Sicily up to the Aeolian Islands, through an active source study. In this experiment, a large amount of geophysical data was collected both inland and in the Ionian and Tyrrhenian Seas for identifying the major geological and structural features offshore Mt. Etna and NE Sicily. One of the oceanographic cruises organized within the TOMO-ETNA experiment was carried out on the hydrographic vessel “Galatea” by Italian Navy. During the cruise a detailed magnetic survey and a set of ROV (remotely operated vehicle dives were performed offshore Mt. Etna. The magnetic survey allowed the compilation of a preliminary magnetic map revealing a clear direct relationship between volcanic structures and high frequency magnetic anomalies. Significant positive magnetic anomalies were identified offshore the Timpa area and along the easternmost portion of the Riposto Ridge and correlated to a primitive volcanic edifice and to shallow volcanic bodies, respectively. On the whole, the magnetic anomaly map highlights a clear SW-NE decreasing trend, where high amplitude positive magnetic anomaly pattern of the SW sector passes, northeastwardly, to a main negative one. ROV dives permitted to directly explore the shallowest sectors of the Riposto Ridge and to collect several videos and seafloor samples, allowing us to identify some locally developed volcanic manifestations.

  2. Preliminary studies for the ORganics Exposure in Orbit (OREOcube) Experiment on the International Space Station

    Science.gov (United States)

    Alonzo, Jason; Fresneau, A.; Elsaesser, A.; Chan, J.; Breitenbach, A.; Ehrenfreund, P.; Ricco, A.; Salama, F.; Mattioda, A.; Santos, O.; Cottin, H.; Dartois, E.; d'Hendecourt, L.; Demets, R.; Foing, B.; Martins, Z.; Sephton, M.; Spaans, M.; Quinn, R.

    2013-01-01

    Organic compounds that survive in uncommon space environments are an important astrobiology focus. The ORganics Exposure in Orbit (OREOcube) experiment will investigate, in real time, chemical changes in organic compounds exposed to low Earth orbit radiation conditions on an International Space Station (ISS) external platform. OREOcube is packaged as an identical pair of 10-cm cube instruments, each weighing electronics, microcontroller, and data storage to make each cube an autonomous stand-alone instrument package requiring only a standard power and data interface. We have characterized the influence of mineralogically relevant inorganic materials on the stability, modification, and degradation of the organic molecules under ground laboratory experimental conditions. The results of our laboratory experiments will be used as the basis for the selection of samples for further investigations on the OREOcube ISS experiment. OREOcube is an international collaboration between the European Space Agency, the National Aeronautics and Space Administration, and University partners.

  3. Student Satisfaction or Happiness?: A Preliminary Rethink of What Is Important in the Student Experience

    Science.gov (United States)

    Dean, Aftab; Gibbs, Paul

    2015-01-01

    Purpose: This paper aims to investigate the purpose of the complex open system of higher education and to explore this transformative experience as personal flourishing, where students come to terms with a way of being, matching their potentiality with their agency and leading to profound happiness. There is influential, but not uncontested…

  4. Norwegian fjords as potential sites for CO{sub 2} experiments. A preliminary feasibility study

    Energy Technology Data Exchange (ETDEWEB)

    Golmen, Lars G.; Soerensen, Jan; Haugan, Peter; Bakke, Torgeir; Bjerknes, Vilhelm

    1997-12-31

    Large-scale deposition of CO{sub 2} will probably take place deep in the open oceans. But small-scale experiments on plume dynamics and chemical or biological impacts are more conveniently performed in Norwegian fjords. This report describes a feasibility study treating the physical, biological and legal constraints upon such experiments. Several small and large fjord basins with depths exceeding 500 m exist in western Norway. The report gives guidelines to what further steps should be taken to establish an in-situ CO{sub 2} experiment in a fjord. Twenty-six different basins have been identified in terms of maximum depths, municipal adherence etc. Deep water hydrographic conditions vary relatively little from one fjord to another. Data on the dynamical states and on deep water biology are in general lacking and a baseline study on selected fjords should be performed prior to the final selection. User conflicts and legal aspects must be considered and a complete EIA study will probably be required before any CO{sub 2} experiment can be started in a fjord. 60 refs., 13 figs.

  5. Experience Sampling of Positive Affect in Adolescents with Autism: Feasibility and Preliminary Findings.

    Science.gov (United States)

    Kovac, Megan; Mosner, Maya; Miller, Stephanie; Hanna, Eleanor K; Dichter, Gabriel S

    2016-01-01

    Experience sampling is a powerful method for obtaining ecologically valid data from research participants in real-world contexts. Given the urgent need for innovative and sensitive outcome measures in autism spectrum disorder (ASD) research, the present study sought to examine the feasibility of using experience sampling of positive affect and behavior in adolescents with ASD. Nineteen high functioning adolescents with ASD and 20 sex and age matched controls completed smartphone- and Qualtrics® -based experience sampling of positive affect and behavior six times over four days. Adherence was excellent: adolescents with ASD completed 85% of the assessments, compared to 93% in controls, and response rates were not impacted by age or IQ. Groups did not differ in positive affect overall or as a function of activities, nor did groups differ in the proportion of assessments completed during social or nonsocial activities. However, groups did differ in the proportion of assessments completed during preferred activities. Results suggest that smartphone- and Qualtrics® -based experience sampling with high functioning adolescents with ASD is feasible and captures real-world behaviors that would not be possible using laboratory-based measures.

  6. Preliminary analysis of the MER magnetic properties experiment using a computational fluid dynamics model

    DEFF Research Database (Denmark)

    Kinch, K.M.; Merrison, J.P.; Gunnlaugsson, H.P.;

    2006-01-01

    Motivated by questions raised by the magnetic properties experiments on the NASA Mars Pathfinder and Mars Exploration Rover (MER) missions, we have studied in detail the capture of airborne magnetic dust by permanent magnets using a computational fluid dynamics (CFD) model supported by laboratory...

  7. A Preliminary Theoretical Analysis of a Research Experience for Undergraduates Community Model

    Science.gov (United States)

    Castillo-Garsow, Carlos; Castillo-Chavez, Carlos; Woodley, Sherry

    2013-01-01

    The Mathematical and Theoretical Biology Institute (MTBI) is a successful summer research experience for undergraduates, with a strong record of mentoring Ph.D. graduates, particularly, underrepresented minority students. However, the MTBI program was designed for education in research, not for research in education, and the mechanisms of the…

  8. Preliminary Explorations of Indigenous Perspectives of Educational Management: The Evolving Malaysian Experience.

    Science.gov (United States)

    Bajunid, Ibrahim Ahmad

    1996-01-01

    Articulates the need to understand and seek indigenous perspectives of educational management, using Malaysia's experience as an example. To differentiate culture-free and culture-bound content in educational management, the field's core corpus of theories, concepts, and terminology must be identified; the culture-specific ways of knowing must be…

  9. Student Satisfaction or Happiness?: A Preliminary Rethink of What Is Important in the Student Experience

    Science.gov (United States)

    Dean, Aftab; Gibbs, Paul

    2015-01-01

    Purpose: This paper aims to investigate the purpose of the complex open system of higher education and to explore this transformative experience as personal flourishing, where students come to terms with a way of being, matching their potentiality with their agency and leading to profound happiness. There is influential, but not uncontested…

  10. Preliminary studies for the ORganics Exposure in Orbit (OREOcube) Experiment on the International Space Station

    NARCIS (Netherlands)

    Alonzo, Jason; Fresneau, A.; Elsaesser, A.; Chan, J.; Breitenbach, A.; Ehrenfreund, P.; Ricco, A.; Salama, F.; Mattioda, A.; Santos, O.; Cottin, H.; Dartois, E.; d'Hendecourt, L.; Demets, R.; Foing, B.; Martins, Z.; Sephton, M.; Spaans, M.; Quinn, R.

    2013-01-01

    Organic compounds that survive in uncommon space environments are an important astrobiology focus. The ORganics Exposure in Orbit (OREOcube) experiment will investigate, in real time, chemical changes in organic compounds exposed to low Earth orbit radiation conditions on an International Space Stat

  11. Preliminary studies for the ORganics Exposure in Orbit (OREOcube) Experiment on the International Space Station

    NARCIS (Netherlands)

    Alonzo, Jason; Fresneau, A.; Elsaesser, A.; Chan, J.; Breitenbach, A.; Ehrenfreund, P.; Ricco, A.; Salama, F.; Mattioda, A.; Santos, O.; Cottin, H.; Dartois, E.; d'Hendecourt, L.; Demets, R.; Foing, B.; Martins, Z.; Sephton, M.; Spaans, M.; Quinn, R.

    Organic compounds that survive in uncommon space environments are animportant astrobiology focus. The ORganics Exposure in Orbit (OREOcube)experiment will investigate, in real time, chemical changes in organiccompounds exposed to low Earth orbit radiation conditions on anInternational Space Station

  12. Silent game as Model for Examining Student Online Creativity - Preliminary Results from an Experiment

    DEFF Research Database (Denmark)

    Sørensen, Jannick Kirk

    the creative dialogues developed through a very constrained communicative environment. The participants could only communicate their creative ideas by placing standard LEGO bricks on a plate. No talking or any other communication was allowed. The game used in the experiment is an adoption of the so...

  13. Preliminary studies for the ORganics Exposure in Orbit (OREOcube) Experiment on the International Space Station

    NARCIS (Netherlands)

    Alonzo, Jason; Fresneau, A.; Elsaesser, A.; Chan, J.; Breitenbach, A.; Ehrenfreund, P.; Ricco, A.; Salama, F.; Mattioda, A.; Santos, O.; Cottin, H.; Dartois, E.; d'Hendecourt, L.; Demets, R.; Foing, B.; Martins, Z.; Sephton, M.; Spaans, M.; Quinn, R.

    2013-01-01

    Organic compounds that survive in uncommon space environments are animportant astrobiology focus. The ORganics Exposure in Orbit (OREOcube)experiment will investigate, in real time, chemical changes in organiccompounds exposed to low Earth orbit radiation conditions on anInternational Space Station

  14. Preliminary studies for the ORganics Exposure in Orbit (OREOcube) Experiment on the International Space Station

    NARCIS (Netherlands)

    Alonzo, Jason; Fresneau, A.; Elsaesser, A.; Chan, J.; Breitenbach, A.; Ehrenfreund, P.; Ricco, A.; Salama, F.; Mattioda, A.; Santos, O.; Cottin, H.; Dartois, E.; d'Hendecourt, L.; Demets, R.; Foing, B.; Martins, Z.; Sephton, M.; Spaans, M.; Quinn, R.

    2013-01-01

    Organic compounds that survive in uncommon space environments are an important astrobiology focus. The ORganics Exposure in Orbit (OREOcube) experiment will investigate, in real time, chemical changes in organic compounds exposed to low Earth orbit radiation conditions on an International Space Stat

  15. Review of Experience of a Statewide Poison Control Center With Pediatric Exposures to Oral Antineoplastic Drugs in the Nonmedical Setting.

    Science.gov (United States)

    Thornton, Stephen L; Liu, Jehnan; Soleymani, Kamyar; Romasco, Rebecca L; Farid, Hanieh; Clark, Richard F; Cantrell, F Lee

    2016-01-01

    The use of oral antineoplastic agents in nonmedical settings continues to increase. There are limited data available on pediatric exposures to these agents. We sought to identify characteristics of such exposures. We performed a retrospective review of database of a statewide poison system from 2000 to 2009 for all cases of pediatric exposures to oral antineoplastic agents, which took place in a nonmedical setting. Data collected include gender, age, agent of exposure, dose, drug concentration, reason for exposure, symptoms, outcomes, interventions, and length of hospital stay. There were a total of 328 patients. The mean average age was 4.1 years. Eighty-nine percentage (n = 293) was unintentional. Exposures to 21 different antineoplastic agents were identified. Methotrexate (n = 91) and 6-mercaptopurine (n = 47) were the most common agents encountered. Two hundred ninety-nine (91%) cases had no symptoms reported. When reported, gastrointestinal symptoms (n = 17) and central nervous system sedation (n = 6) were most common. One case of pancytopenia was reported. No deaths were reported in this series. Sixty-seven percent (n = 220) were managed at home, whereas 19 (6%) were admitted to a health care facility. Cases were followed by the poison control center for 0.34 days (SD = 1.40). In this study, exposures to oral antineoplastics were primarily unintentional, asymptomatic, and managed at home. Study limitations include possible reporting bias, inability to objectively confirm exposures, and limited duration of monitoring by the poison control center. In this retrospective review, no significant morbidity or mortality was reported from pediatric exposures to oral antineoplastic drugs in the nonmedical setting.

  16. Surgical results of cranioplasty with a polymethylmethacrylate customized cranial implant in pediatric patients: a single-center experience.

    Science.gov (United States)

    Fiaschi, Pietro; Pavanello, Marco; Imperato, Alessia; Dallolio, Villiam; Accogli, Andrea; Capra, Valeria; Consales, Alessandro; Cama, Armando; Piatelli, Gianluca

    2016-06-01

    OBJECTIVE Cranioplasty is a reconstructive procedure used to restore skull anatomy and repair skull defects. Optimal skull reconstruction is a challenge for neurosurgeons, and the strategy used to achieve the best result remains a topic of debate, especially in pediatric patients for whom the continuing skull growth makes the choice of material more difficult. When the native bone flap, which is universally accepted as the preferred option in pediatric patients, is unavailable, the authors' choice of prosthetic material is a polymethylmethacrylate (PMMA) implant designed using a custom-made technique. In this paper the authors present the results of their clinical series of 12 custom-made PMMA implants in pediatric patients. METHODS A retrospective study of the patients who had undergone cranioplasty at Gaslini Children's Hospital between 2006 and 2013 was conducted. A total of 12 consecutive cranioplasties in 12 patients was reviewed, in which a patient-specific PMMA implant was manufactured using a virtual 3D model and then transformed into a physical model using selective laser sintering or 3D printing. All patients or parents were administered a questionnaire to assess how the patient/parent judged the aesthetic result. RESULTS Patient age at craniectomy ranged from 5 months to 12.5 years, with a mean age of 84.33 months at cranioplasty. The mean extension of the custom-made plastic was 56.83 cm(2). The mean time between craniectomy and cranioplasty was 9.25 months. The mean follow-up duration was 55.7 months. No major complications were recorded; 3 patients experienced minor/moderate complications (prosthesis dislocation, granuloma formation, and fluid collection). CONCLUSIONS In this patient series, PMMA resulted in an extremely low complication rate and the custom-made technique was associated with an excellent grade of patient or parent satisfaction on long-term follow up.

  17. Presentation, Management, and Outcome of Thyroglossal Duct Cysts in Adult and Pediatric Populations: A 14-Year Single Center Experience

    Directory of Open Access Journals (Sweden)

    Hassan Al-Thani

    2016-07-01

    Full Text Available Objectives: A thyroglossal duct cyst (TDC is a frequent congenital midline anomaly of the neck that usually manifests during the first decade of life. We aimed to describe the presentation, management, and outcome of TDC in pediatric and adult cases. Methods: A retrospective observational analysis was conducted for all patients diagnosed and treated for TDC between 2000 and 2014 in a single center in Qatar. Data included patients’ demographics, presentations, preoperative investigations, anesthesia type, histopathological findings, surgical management, recurrences, and complications. Results: We identified 102 patients, of which 57% were males. The mean age of patients was 20.2±15.6 years. A bimodal distribution of TDC has been observed, which peaked between the ages of 6–13 years and at ≥19 years. The preoperative evaluation mainly includes ultrasonography (66%, thyroid function test (44%, and fine-needle aspiration cytology (10%. The median size of the cyst was 25 (2–60 mm. Patients mainly presented with an asymptomatic midline neck mass at or below the hyoid bone (82%, followed by fistula (9%, infection (2%, and dysphagia (2%. Eighty-nine cases were identified preoperatively as TDC. The histopathological findings confirmed TDC with hyoid bone in 61 cases, and TDC alone in 38 cases. Eighty patients underwent the Sistrunk procedure while excision of TDC alone was observed in 18 cases. Five cases of recurrent disease were also treated. Adults had a greater median cyst size (30 (9–60 vs. 22 (2–55 mm; p = 0.005 and required prolonged operation time (69 (1–169 vs. 32.5 (1–140 mins; p = 0.004 compared to the pediatric group. Conclusion: The occurrence of TDC shows a bimodal age distribution. Preoperative evaluation and time for surgery vary whereas clinical presentations, surgical management, and postoperative outcomes are comparable among adult and pediatric groups. Ultrasonography is the preferred diagnostic modality, and the

  18. Pediatric Nurse\\s Educational Role in an International Task: Maternal Education Experience on 0-6 Month Baby Nutrition

    OpenAIRE

    Derya Suluhan; Dilek Yildiz; Berna Eren Fidanci

    2014-01-01

    The World Health Organization (WHO), for the baby\\s optimal growth and development, recommends all mothers all over the world feeding infants only breast milk for the first six months, initiating of additional nutrients after the sixth month, and suggests the need to continue to breastfeed for the first two years. The pediatric nurse works for Head of the Turkish delegation at the disposal of the Kosovo for a period of six months has decided to make a priority about an education on feeding in...

  19. Epstein-Barr virus (EBV) association and latency profile in pediatric Burkitt's lymphoma: experience of a single institution in Argentina.

    Science.gov (United States)

    Lara, Julia; Cohen, Melina; De Matteo, Elena; Aversa, Luis; Preciado, Maria Victoria; Chabay, Paola

    2014-05-01

    The aim of this study is to characterize EBV expression and latency pattern in pediatric Burkitt's lymphoma in a single institution in Argentina. EBV-encoded RNA or protein was analyzed in 27 patients. EBERs was expressed in 37% of patients (29% of immunocompetent and 100% of immunosuppressed patients). EBV-positive cases were observed exclusively in patients younger than 5 years old. EBV association with immunocompetent patients exhibits the sporadic pattern in region under study, while its presence in patients infected with HIV was higher than described previously. EBV latency I profile was present in most of the patients, except for two immunosuppressed patients who displayed LMP1 expression.

  20. [New perspective in liaison psychiatry. Experience at the Pediatric Hospital of the National Medical Center Siglo XXI].

    Science.gov (United States)

    Sauceda García, J M; Maldonado Durán, J M; Angel Montoya Cabrera, M

    1994-01-01

    In hospitalized and chronically ill children, the prevalence of psychopathology is very high. It is necessary that in its prevention, diagnosis and treatment not only professionals of the mental health disciplines intervene but also that the pediatricians, nurses and the family of the patient himself participate actively. Consultation Liaison Child Psychiatry activities at the Pediatric Hospital of the National Medical Center "Siglo XXI" are described. Its goal is to incorporate the mental health professional to the team of hospital care and promote that pediatricians gain a greater conscience of psychological and social factors that are crucial for the sick child.

  1. Characterize Behaviour of Emerging Pollutants in Artificial Recharge: Column Experiments - Experiment Design and Results of Preliminary Tests

    Science.gov (United States)

    Wang, H.; Carrera, J.; Ayora, C.; Licha, T.

    2012-04-01

    Emerging pollutants (EPs) have been detected in water resources as a result of human activities in recent years. They include pharmaceuticals, personal care products, dioxins, flame retardants, etc. They are a source of concern because many of them are resistant to conventional water treatment, and they are harmful to human health, even in low concentrations. Generally, this study aims to characterize the behaviour of emerging pollutants in reclaimed water in column experiments which simulates artificial recharge. One column set includes three parts: influent, reactive layer column (RLC) and aquifer column (AC). The main influent is decided to be Secondary Effluent (SE) of El Prat Wastewater Treatment Plant, Barcelona. The flow rate of the column experiment is 0.9-1.5 mL/min. the residence time of RLC is designed to be about 1 day and 30-40 days for AC. Both columns are made of stainless steel. Reactive layer column (DI 10cm * L55cm) is named after the filling material which is a mixture of organic substrate, clay and goethite. One purpose of the application of the mixture is to increase dissolve organic carbon (DOC). Leaching test in batchs and columns has been done to select proper organic substrate. As a result, compost was selected due to its long lasting of releasing organic matter (OM). The other purpose of the application of the mixture is to enhance adsorption of EPs. Partition coefficients (Kow) of EPs indicate the ability of adsorption to OM. EPs with logKow>2 could be adsorbed to OM, like Ibuprofen, Bezafibrate and Diclofenac. Moreover, some of EPs are charged in the solution with pH=7, according to its acid dissociation constant (Ka). Positively charged EPs, for example Atenolol, could adsorb to clay. In the opposite, negatively charged EPs, for example Gemfibrozil, could adsorb to goethite. Aquifer column (DI 35cm * L1.5m) is to simulate the processes taking place in aquifer in artificial recharge. The filling of AC has two parts: silica sand and

  2. Preliminary Findings of the Photovoltaic Cell Calibration Experiment on Pathfinder Flight 95-3

    Science.gov (United States)

    Vargas-Aburto, Carlos

    1997-01-01

    The objective of the photovoltaic (PV) cell calibration experiment for Pathfinder was to develop an experiment compatible with an ultralight UAV to predict the performance of PV cells at AM0, the solar spectrum in space, using the Langley plot technique. The Langley plot is a valuable technique for this purpose and requires accurate measurements of air mass (pressure), cell temperature, solar irradiance, and current-voltage(IV) characteristics with the cells directed normal to the direct ray of the sun. Pathfinder's mission objective (95-3) of 65,000 ft. maximum altitude, is ideal for performing the Langley plot measurements. Miniaturization of electronic data acquisition equipment enabled the design and construction of an accurate and light weight measurement system that meets Pathfinder's low payload weight requirements.

  3. Zero-gravity cloud physics laboratory: Candidate experiments definition and preliminary concept studies

    Science.gov (United States)

    Eaton, L. R.; Greco, R. V.; Hollinden, A. B.

    1973-01-01

    The candidate definition studies on the zero-g cloud physics laboratory are covered. This laboratory will be an independent self-contained shuttle sortie payload. Several critical technology areas have been identified and studied to assure proper consideration in terms of engineering requirements for the final design. Areas include chambers, gas and particle generators, environmental controls, motion controls, change controls, observational techniques, and composition controls. This unique laboratory will allow studies to be performed without mechanical, aerodynamics, electrical, or other type techniques to support the object under study. This report also covers the candidate experiment definitions, chambers and experiment classes, laboratory concepts and plans, special supporting studies, early flight opportunities and payload planning data for overall shuttle payload requirements assessments.

  4. Preliminary study of feasibility of an experiment looking for excited state double beta transitions in Tin

    CERN Document Server

    Das, Soumik; Raina, P K; Singh, A K; Rath, P K; Cappella, F; Cerulli, R; Laubenstein, M; Belli, P; Bernabei, R

    2015-01-01

    A first attempt to study the feasibility of an experiment to search for double beta decay in $^{124}$Sn and $^{112}$Sn was carried out by using ultra-low background HPGe detector (244 cm$^{3}$) inside the Gran Sasso National Laboratory (LNGS) of the INFN (Italy). A small sample of natural Sn was examined for 2367.5 h. The radioactive contamination of the sample has been estimated. The data has also been considered to calculate the present sensitivity for the proposed search; half-life limits $\\sim$ $10^{17} - 10^{18}$ years for $\\beta^{+}$EC and EC-EC processes in $^{112}$Sn and $\\sim$ $10^{18}$ years for $\\beta^{-}\\beta^{-}$ transition in $^{124}$Sn were measured. In the last section of the paper the enhancement of the sensitivity for a proposed experiment with larger mass to reach theoretically estimated values of half-lives is discussed.

  5. Intracranial pressure monitoring in pediatric and adult patients with hydrocephalus and tentative shunt failure: a single-center experience over 10 years in 146 patients.

    Science.gov (United States)

    Sæhle, Terje; Eide, Per Kristian

    2015-05-01

    OBJECT In patients with hydrocephalus and shunts, lasting symptoms such as headache and dizziness may be indicative of shunt failure, which may necessitate shunt revision. In cases of doubt, the authors monitor intracranial pressure (ICP) to determine the presence of over- or underdrainage of CSF to tailor management. In this study, the authors reviewed their experience of ICP monitoring in shunt failure. The aims of the study were to identify the complications and impact of ICP monitoring, as well as to determine the mean ICP and characteristics of the cardiac-induced ICP waves in pediatric versus adult over- and underdrainage. METHODS The study population included all pediatric and adult patients with hydrocephalus and shunts undergoing diagnostic ICP monitoring for tentative shunt failure during the 10-year period from 2002 to 2011. The patients were allocated into 3 groups depending on how they were managed following ICP monitoring: no drainage failure, overdrainage, or underdrainage. While patients with no drainage failure were managed conservatively without further actions, over- or underdrainage cases were managed with shunt revision or shunt valve adjustment. The ICP and ICP wave scores were determined from the continuous ICP waveforms. RESULTS The study population included 71 pediatric and 75 adult patients. There were no major complications related to ICP monitoring, but 1 patient was treated for a postoperative superficial wound infection and another experienced a minor bleed at the tip of the ICP sensor. Following ICP monitoring, shunt revision was performed in 74 (51%) of 146 patients, while valve adjustment was conducted in 17 (12%) and conservative measures without any actions in 55 (38%). Overdrainage was characterized by a higher percentage of episodes with negative mean ICP less than -5 to -10 mm Hg. The ICP wave scores, in particular the mean ICP wave amplitude (MWA), best differentiated underdrainage. Neither mean ICP nor MWA levels showed any

  6. Video-assisted anal fistula treatment: technical considerations and preliminary results of the first brazilian experience

    OpenAIRE

    Mendes,Carlos Ramon Silveira; FERREIRA, Luciano Santana de Miranda; Sapucaia,Ricardo Aguiar; LIMA, Meyline Andrade; Araujo, Sergio Eduardo Alonso

    2014-01-01

    Backgroung : Anorectal fistula represents an epithelized communication path of infectious origin between the rectum or anal canal and the perianal region. The association of endoscopic surgery with the minimally invasive approach led to the development of the video-assisted anal fistula treatment. Aim : To describe the technique and initial experience with the technique video-assisted for anal fistula treatment. Technique : A Karl Storz video equipment was used. Main steps included the ...

  7. Post-irradiation Examination of the AGR-1 Experiment: Plans and Preliminary Results

    Energy Technology Data Exchange (ETDEWEB)

    Paul Demkowicz

    2001-10-01

    Abstract – The AGR-1 irradiation experiment contains seventy-two individual cylindrical fuel compacts (25 mm long x 12.5 mm diameter) each containing approximately 4100 TRISO-coated uranium oxycarbide fuel particles. The experiment accumulated 620 effective full power days in the Advanced Test Reactor at the Idaho National Laboratory with peak burnups exceeding 19% FIMA. An extensive post-irradiation examination campaign will be performed on the AGR-1 fuel in order to characterize the irradiated fuel properties, assess the in-pile fuel performance in terms of coating integrity and fission metals release, and determine the fission product retention behavior during high temperature accident testing. PIE experiments will include dimensional measurements of fuel and irradiated graphite, burnup measurements, assessment of fission metals release during irradiation, evaluation of coating integrity using the leach-burn-leach technique, microscopic examination of kernel and coating microstructures, and accident testing of the fuel in helium at temperatures up to 1800°C. Activities completed to date include opening of the irradiated capsules, measurement of fuel dimensions, and gamma spectrometry of selected fuel compacts.

  8. Student reflections following exposure to a case-based interprofessional learning experience: Preliminary findings.

    Science.gov (United States)

    Goldberg, Lynette R; Brown, Gina R; Mosack, Victoria A; Fletcher, Phyllis A

    2015-01-01

    This study analyzed students' written reflections following their initial exposure to interprofessional teamwork in case-based problem-solving. A three-hour seminar featuring three sequenced scenarios was developed and offered 12-times over two semesters. A total of 305 students from a variety of healthcare programs worked together with standardized patients in an on-campus laboratory simulating hospital ward and rehabilitation settings. A thematic analysis of students' reflections showed that they valued the shared learning and realistic case study. However, they felt the experience would be strengthened by working in smaller, more representative teams that included students from medicine, psychology, and social work to enable more effective communication and comprehensive case discussion. While useful for future planning, the identified themes did not enable a comparative statistical analysis of what students found helpful and difficult and a re-coding of students' responses now is underway. Implications for measuring the effectiveness of future interprofessional case-based learning center on addressing the identified weaknesses, and establishing a research design that enables a comparison of pre- and post-seminar data, and the effectiveness of the IPE experience compared to profession-specific experiences.

  9. The nursing experience of 103 pediatric hyperpyrexia%103例小儿高热的护理体会

    Institute of Scientific and Technical Information of China (English)

    鄢晓阳

    2013-01-01

    目的:探讨个性化护理在小儿高热中的应用。方法:选择我科近期收治的103例小儿高热患儿,采用个性化护理方案,通过饮食护理、皮肤护理、物理降温、中医中药降温、高热惊厥的预防等方案观察护理疗效。结果:103例小儿高热患儿中,经对症治疗及个性化护理后,仅2例发生高热惊厥,但均成功缓解治疗,无并发症发生。结论:有针对性的选择降温措施有利于防止高热惊厥的发生。%Objective:To study the methods of nursing for pediatric hyperpyrexia. Methods: Choosed 103 cases of pediatric hyperpyrexia to nursing for personalized nursing through diet nursing, skin nursing, physical cooling, traditional Chinese medicine cooling, prevention for hyperpyretic convulsion. Results: There were 2 cases occured hyperpyretic convulsion, and rescued successful y without complication. Conclusion: Choosing effective cooling measure can prevent hyperpyretic convulsion.

  10. Aircraft transfer of pediatric patients with intractable cardiac or airway problems – single-institutional experience of a specialty hospital.

    Science.gov (United States)

    Ando, Makoto; Takahashi, Yukihiro; Park, In-Sam; Tomoike, Hitonobu

    2015-01-01

    There is currently a well-established network for the allocation of donor organs for transplantation in Japan, and emergency patients are often transported by the "Doctor Helicopter". However, interhospital transfer of patients, which can require aircraft with specialized equipment, depends on arrangement by each responsible hospital. Since 2009 there were 41 interhospital aviation transfers of pediatric patients with intractable cardiac or airway diseases seeking surgical treatment at Sakakibara Heart Institute. Of these, 22 were newborns, 21 were on continuous drip infusion and 14 on mechanical ventilator support. In 15 cases (36.6%), a commercial airliner was used, with the remaining using chartered emergency aircraft (eg, local fire department helicopter, Self-Defense-Forces of Japan and the Doctor Helicopter). The median transfer time was 239 min for commercial airliners, 51 min for chartered aircraft departing directly from the referring hospital and 120.5 min for chartered aircraft departing from a nearby location. The efficiency of the transfer exemplified by the percentage of the time on board the aircraft was significantly lower for commercial airliners compared with chartered emergency aircraft. Further efforts and cooperation with government are required to obtain geographically uniform availability of carriers with optimal medical equipment to improve pediatric patient outcomes.

  11. A conceptual framework for advanced practice nursing in a pediatric tertiary care setting: the SickKids' experience.

    Science.gov (United States)

    LeGrow, Karen; Hubley, Pam; McAllister, Mary

    2010-05-01

    Advanced practice nurses (APNs) at The Hospital for Sick Children (SickKids) are pediatric healthcare providers who integrate principles and theories of advanced nursing with specialty knowledge to provide autonomous, independent, accountable, ethical and developmentally appropriate care in complex, often ambiguous and rapidly changing healthcare environments. Caring for children and adolescents requires culturally sensitive and family-centred approaches to care that incorporate a unique body of knowledge. Family-centred care is an approach to planning, delivery and evaluation of healthcare that is governed by the establishment of mutually beneficial partnerships among APNs, health professionals and children/families. The cornerstone of APN practice at SickKids is the recognition of "family" as the recipients of care. By valuing and developing relationships with families, APNs promote excellence in healthcare across the care continuum to optimize the child's and family's physical, emotional, social, psychological and spiritual well-being. This paper outlines the evolution of advanced practice nursing at SickKids, beginning with the introduction of APN roles in the 1970s and culminating in the current critical mass of APNs who have been integrated throughout the hospital's infrastructure. We describe the process used to create a common vision and a framework to guide pediatric advanced nursing practice.

  12. Determinants of graft survival in pediatric and adolescent live donor kidney transplant recipients: a single center experience.

    Science.gov (United States)

    El-Husseini, Amr A; Foda, Mohamed A; Shokeir, Ahmed A; Shehab El-Din, Ahmed B; Sobh, Mohamed A; Ghoneim, Mohamed A

    2005-12-01

    To study the independent determinants of graft survival among pediatric and adolescent live donor kidney transplant recipients. Between March 1976 and March 2004, 1600 live donor kidney transplants were carried out in our center. Of them 284 were 20 yr old or younger (mean age 13.1 yr, ranging from 5 to 20 yr). Evaluation of the possible variables that may affect graft survival were carried out using univariate and multivariate analyses. Studied factors included age, gender, relation between donor and recipient, original kidney disease, ABO blood group, pretransplant blood transfusion, human leukocyte antigen (HLA) matching, pretransplant dialysis, height standard deviation score (SDS), pretransplant hypertension, cold ischemia time, number of renal arteries, ureteral anastomosis, time to diuresis, time of transplantation, occurrence of acute tubular necrosis (ATN), primary and secondary immunosuppression, total dose of steroids in the first 3 months, development of acute rejection and post-transplant hypertension. Using univariate analysis, the significant predictors for graft survival were HLA matching, type of primary urinary recontinuity, time to diuresis, ATN, acute rejection and post-transplant hypertension. The multivariate analysis restricted the significance to acute rejection and post-transplant hypertension. The independent determinants of graft survival in live-donor pediatric and adolescent renal transplant recipients are acute rejection and post-transplant hypertension.

  13. Mudanças na unidade pediátrica: relato de experiência de integração docente-assistencial Changes in the Pediatric unit: report of an experience of nursing pratice integration

    Directory of Open Access Journals (Sweden)

    Edelia del Pilar Neira Huerta

    1996-12-01

    Full Text Available A partir da percepção inicial da unidade pediátrica em que acompanhou e supervisionou as atividades práticas desenvolvidas por alunos de graduação em enfermagem, a autora identifica mudanças significativas implementadas nessa unidade, como resultado de uma experiência de genuína integração docente-assistencial.The author identifies significant changes in a pediatric unit in which she supervised the practical activities developed by undergraduate students, as a result of true nursing teaching and nursing practice integration.

  14. Pitfalls in pediatric radiology

    Energy Technology Data Exchange (ETDEWEB)

    Engelkemier, Dawn R. [Boston Children' s Hospital, Harvard Medical School, Department of Radiology, Boston, MA (United States); Kern Radiology, Bakersfield, CA (United States); Taylor, George A. [Boston Children' s Hospital, Harvard Medical School, Department of Radiology, Boston, MA (United States)

    2015-06-15

    This essay depicts some of the diagnostic errors identified in a large academic pediatric imaging department during a 13-year period. Our aim is to illustrate potential situations in which errors are more likely to occur and more likely to cause harm, and to share our difficult cases so other radiologists might learn without having to experience those situations themselves. (orig.)

  15. Pediatric Clinical Trials: Current Scenario in the Asia Pacific Region

    Directory of Open Access Journals (Sweden)

    Saldanha LM

    2013-07-01

    Full Text Available Lisa Marie Saldanha,1 Saumya Nayak,1 Adeline Sng,1 Mei-Ling Long,1 Elisabeth Schrader,2 Amanur Rahman,3 Elvira Zenaida Lansang,1 Karen Wai,1 Ken Lee41Feasibility and Site Identification Asia, Quintiles East Asia Private Limited, Singapore; 2Quintiles Pediatric Center of Excellence, Durham, NC, USA; 3Faculty of Engineering, National University of Singapore, Singapore; 4Asia Site Services, Quintiles East Asia Private Limited, SingaporeObjective: This site survey was conducted to understand the current pediatric clinical trial landscape across countries in the Asia Pacific region, specifically in terms of interest, experience, capabilities, requirements of the ethics committee, patient availability, and overall challenges involved in conducting pediatric trials.Methods and materials: Between May and June 2012, an English language survey form was sent to sites (identified through Quintiles’ internal database with pediatric capability and referrals from doctors during a preliminary outreach. In July 2012, the responses from the completed survey forms were entered into SurveyMethods, a web-based central repository. Data analysis was performed in August–September 2012 using SurveyMethods.Results: Seventy-seven sites were contacted for this survey across the Asia Pacific region. Sixty-four percent (49 sites completed 63 surveys and confirmed interest to participate in clinical trials in the pediatric population. Seventy-one percent of the sites had prior experience. Eighty percent confirmed needing an assent from pediatric patients; 81%–95% confirmed acceptance of placebo-controlled and pharmacokinetic studies by ethics committees; and 37% cited challenges in conducting studies in this population.Conclusion: This survey indicates that there is a high level of interest among sites in the Asia Pacific region in conducting pediatric trials across various therapeutic indications. No major insurmountable challenges were identified in conducting

  16. Flexible CO2 Laser Fiber in the Pediatric Airway

    Directory of Open Access Journals (Sweden)

    Kimberly K. Caperton

    2011-01-01

    Full Text Available Objective. Our institution has been using a novel flexible laser fiber in pediatric surgical airway procedures, which has been quite successful. The purpose of this paper is to present our preliminary experience in the treatment of pediatric airway lesions using this laser technique. Methods. A case series reviewing 40 patients undergoing 95 laser procedures is reported. Indications included removal of suprastomal granulation tissue, removal of granulation after laryngotracheal reconstruction, subglottic and supraglottic stenoses, recurrent respiratory papillomas, subglottic hemangioma, laryngeal cleft, and left main stem bronchus stenosis. Procedures were performed via microdirect laryngoscopy and bronchoscopy. Results. No complications including postoperative glottic webs, concentric scar formation, or airway fires occurred in any of the patients (after the series was completed, we did experience an airway fire. It was a flash flame that was self-limited and caused no long-term tissue injury. Conclusions. The endoscopic application of a new flexible carbon dioxide laser fiber for management of pediatric airways lesions provides good outcomes in selected patients. Distal respiratory papillomas, subglottic stenosis, and granulation tissue are, in our experience, appropriate indications.

  17. Pediatric Cardiomyopathies.

    Science.gov (United States)

    Lee, Teresa M; Hsu, Daphne T; Kantor, Paul; Towbin, Jeffrey A; Ware, Stephanie M; Colan, Steven D; Chung, Wendy K; Jefferies, John L; Rossano, Joseph W; Castleberry, Chesney D; Addonizio, Linda J; Lal, Ashwin K; Lamour, Jacqueline M; Miller, Erin M; Thrush, Philip T; Czachor, Jason D; Razoky, Hiedy; Hill, Ashley; Lipshultz, Steven E

    2017-09-15

    Pediatric cardiomyopathies are rare diseases with an annual incidence of 1.1 to 1.5 per 100 000. Dilated and hypertrophic cardiomyopathies are the most common; restrictive, noncompaction, and mixed cardiomyopathies occur infrequently; and arrhythmogenic right ventricular cardiomyopathy is rare. Pediatric cardiomyopathies can result from coronary artery abnormalities, tachyarrhythmias, exposure to infection or toxins, or secondary to other underlying disorders. Increasingly, the importance of genetic mutations in the pathogenesis of isolated or syndromic pediatric cardiomyopathies is becoming apparent. Pediatric cardiomyopathies often occur in the absence of comorbidities, such as atherosclerosis, hypertension, renal dysfunction, and diabetes mellitus; as a result, they offer insights into the primary pathogenesis of myocardial dysfunction. Large international registries have characterized the epidemiology, cause, and outcomes of pediatric cardiomyopathies. Although adult and pediatric cardiomyopathies have similar morphological and clinical manifestations, their outcomes differ significantly. Within 2 years of presentation, normalization of function occurs in 20% of children with dilated cardiomyopathy, and 40% die or undergo transplantation. Infants with hypertrophic cardiomyopathy have a 2-year mortality of 30%, whereas death is rare in older children. Sudden death is rare. Molecular evidence indicates that gene expression differs between adult and pediatric cardiomyopathies, suggesting that treatment response may differ as well. Clinical trials to support evidence-based treatments and the development of disease-specific therapies for pediatric cardiomyopathies are in their infancy. This compendium summarizes current knowledge of the genetic and molecular origins, clinical course, and outcomes of the most common phenotypic presentations of pediatric cardiomyopathies and highlights key areas where additional research is required. URL: http

  18. The role of pediatric Physical Medicine and Rehabilitation in the national Leadership Education in Neurodevelopmental Disabilities (LEND) program: The Virginia experience.

    Science.gov (United States)

    Wunderlich, Colleen A; Pariseau, Crystal; Willis, Janet H; Reddy, Madhavi; Bodurtha, Joann

    2008-01-01

    This article describes the role of pediatric Physical Medicine and Rehabilitation (pediatric PM&R) in the Leadership Education in Neurodevelopmental Disabilities (LEND) program. It provides an overview of the LEND program and the field of pediatric rehabilitation, details the scope and resources of the national LEND network, and describes the role of pediatric PM&R within the Virginia LEND (Va-LEND) program. Emphasis is placed on the natural fit of pediatric rehabilitation within the LEND program in order to encourage others in the field to become involved in their own state or regional LEND program.

  19. Preliminary study of kaonic deuterium X-rays by the SIDDHARTA experiment at DAΦNE

    Energy Technology Data Exchange (ETDEWEB)

    Bazzi, M. [INFN, Laboratori Nazionali di Frascati, C.P. 13, Via E. Fermi 40, I-00044 Frascati (Roma) (Italy); Beer, G. [Department of Physics and Astronomy, University of Victoria, P.O. Box 3055, Victoria BC V8W3P6 (Canada); Berucci, C. [Stefan-Meyer-Institut für subatomare Physik, Boltzmanngasse 3, 1090 Wien (Austria); INFN, Laboratori Nazionali di Frascati, C.P. 13, Via E. Fermi 40, I-00044 Frascati (Roma) (Italy); Bombelli, L. [Politecnico di Milano, Dipartimento di Elettronica e Informazione, Piazza L. da Vinci 32, I-20133 Milano (Italy); Bragadireanu, A.M. [INFN, Laboratori Nazionali di Frascati, C.P. 13, Via E. Fermi 40, I-00044 Frascati (Roma) (Italy); IFIN-HH, Institutul National pentru Fizica si Inginerie Nucleara Horia Hulubei, Reactorului 30, Magurele (Romania); Cargnelli, M., E-mail: michael.cargnelli@oaaw.ac.at [Stefan-Meyer-Institut für subatomare Physik, Boltzmanngasse 3, 1090 Wien (Austria); Curceanu, C.; D' Uffizi, A. [INFN, Laboratori Nazionali di Frascati, C.P. 13, Via E. Fermi 40, I-00044 Frascati (Roma) (Italy); Fiorini, C.; Frizzi, T. [Politecnico di Milano, Dipartimento di Elettronica e Informazione, Piazza L. da Vinci 32, I-20133 Milano (Italy); Ghio, F. [INFN Sezione di Roma I and Instituto Superiore di Sanita, I-00161 Roma (Italy); Guaraldo, C. [INFN, Laboratori Nazionali di Frascati, C.P. 13, Via E. Fermi 40, I-00044 Frascati (Roma) (Italy); Hayano, R. [University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo (Japan); Iliescu, M. [INFN, Laboratori Nazionali di Frascati, C.P. 13, Via E. Fermi 40, I-00044 Frascati (Roma) (Italy); Ishiwatari, T. [Stefan-Meyer-Institut für subatomare Physik, Boltzmanngasse 3, 1090 Wien (Austria); Iwasaki, M. [RIKEN, Institute of Physical and Chemical Research, 2-1 Hirosawa, Wako, Saitama 351-0198 (Japan); and others

    2013-06-03

    The study of the K{sup ¯}N system at very low energies plays a key role for the understanding of the strong interaction between hadrons in the strangeness sector. At the DAΦNE electron–positron collider of Laboratori Nazionali di Frascati we studied kaonic atoms with Z=1 and Z=2, taking advantage of the low-energy charged kaons from Φ-mesons decaying nearly at rest. The SIDDHARTA experiment used X-ray spectroscopy of the kaonic atoms to determine the transition yields and the strong interaction induced shift and width of the lowest experimentally accessible level (1s for H and D and 2p for He). Shift and width are connected to the real and imaginary part of the scattering length. To disentangle the isospin dependent scattering lengths of the antikaon–nucleon interaction, measurements of K{sup −}p and of K{sup −}d are needed. We report here on an exploratory deuterium measurement, from which a limit for the yield of the K-series transitions was derived: Y(K{sub tot})<0.0143 and Y(K{sub α})<0.0039 (CL 90%). Also, the upcoming SIDDHARTA-2 kaonic deuterium experiment is introduced.

  20. Preliminary study of kaonic deuterium X-rays by the SIDDHARTA experiment at DAΦNE.

    Science.gov (United States)

    Bazzi, M; Beer, G; Berucci, C; Bombelli, L; Bragadireanu, A M; Cargnelli, M; Curceanu Petrascu, C; Dʼuffizi, A; Fiorini, C; Frizzi, T; Ghio, F; Guaraldo, C; Hayano, R; Iliescu, M; Ishiwatari, T; Iwasaki, M; Kienle, P; Levi Sandri, P; Longoni, A; Marton, J; Okada, S; Pietreanu, D; Ponta, T; Romero Vidal, A; Sbardella, E; Scordo, A; Shi, H; Sirghi, D L; Sirghi, F; Tatsuno, H; Tudorache, A; Tudorache, V; Vazquez Doce, O; Widmann, E; Zmeskal, J

    2013-06-03

    The study of the [Formula: see text] system at very low energies plays a key role for the understanding of the strong interaction between hadrons in the strangeness sector. At the DAΦNE electron-positron collider of Laboratori Nazionali di Frascati we studied kaonic atoms with [Formula: see text] and [Formula: see text], taking advantage of the low-energy charged kaons from Φ-mesons decaying nearly at rest. The SIDDHARTA experiment used X-ray spectroscopy of the kaonic atoms to determine the transition yields and the strong interaction induced shift and width of the lowest experimentally accessible level (1s for H and D and 2p for He). Shift and width are connected to the real and imaginary part of the scattering length. To disentangle the isospin dependent scattering lengths of the antikaon-nucleon interaction, measurements of [Formula: see text] and of [Formula: see text] are needed. We report here on an exploratory deuterium measurement, from which a limit for the yield of the K-series transitions was derived: [Formula: see text] and [Formula: see text] (CL 90%). Also, the upcoming SIDDHARTA-2 kaonic deuterium experiment is introduced.

  1. Preliminary investigation of relations between young students' self-regulatory strategies and their metacognitive experiences.

    Science.gov (United States)

    Dermitzaki, Irini

    2005-12-01

    The present study investigated second-graders' self-regulative behav ior during task engagement and its relations to performance and to students' on-line metacognitive experiences. Participants were 25 individually examined Greek second graders (13 boys and 12 girls; M age: 7.6 yr., SD = 0.2). Students' use of cognitive, metacognitive, and motivational regulatory strategies while performing a cognitive task were directly observed and recorded by two independent observers. Students' task-specific performance was also evaluated. Finally, students' feeling of satisfaction with the solution produced, their estimate of effort expenditure, and estimate of the solution's correctness were assessed. Analysis showed these second grade students' use of self-regulatory strategies and feeling of satisfaction were significantly associated with their performance. However, metacognitive experiences reported after the solution were only slightly related to the students' actual self-regulative behavior during the task, implying that the relations of students' regulatory efforts with their metacognitive processes are still developing at such a young age.

  2. Predictive models applied to groundwater level forecasting: a preliminary experience on the alluvial aquifer of the Magra River (Italy).

    Science.gov (United States)

    Brozzo, Gianpiero; Doveri, Marco; Lelli, Matteo; Scozzari, Andrea

    2010-05-01

    Computer-based decision support systems are getting a growing interest for water managing authorities and water distribution companies. This work discusses a preliminary experience in the application of computational intelligence in a hydrological modeling framework, regarding the study area of the alluvial aquifer of the Magra River (Italy). Two sites in the studied area, corresponding to two distinct groups of wells (Battifollo and Fornola) are managed by the local drinkable water distribution company (ACAM Acque), which serves the area of La Spezia, on the Ligurian coast. Battifollo has 9 wells with a total extraction rate of about 240 liters per second, while Fornola has 44 wells with an extraction rate of about 900 liters per second. Objective of this work is to make use of time series coming from long-term monitoring activities in order to assess the trend of the groundwater level with respect to a set of environmental and exploitation parameters; this is accomplished by the experimentation of a suitable model, eligible to be used as a predictor. This activity moves on from the modeling of the system behavior, based on a set of Input/Output data, in order to characterize it without necessarily a prior knowledge of any deterministic mechanism (system identification). In this context, data series collected by continuous hydrological monitoring instrumentation installed in the studied sites, together with meteorological and water extraction data, have been analyzed in order to assess the applicability and performance of a predictive model of the groundwater level. A mixed approach (both data driven and process-based) has been experimented on the whole dataset relating to the last ten years of continuous monitoring activity. The system identification approach presented here is based on the integration of an adaptive technique based on Artificial Neural Networks (ANNs) and a blind deterministic identification approach. According to this concept, the behavior of

  3. Aespoe Pillar Stability Experiment. Final coupled 3D thermo-mechanical modeling. Preliminary particle mechanical modeling

    Energy Technology Data Exchange (ETDEWEB)

    Wanne, Toivo; Johansson, Erik; Potyondy, David [Saanio and Riekkola Oy, Helsinki (Finland)

    2004-02-01

    SKB is planning to perform a large-scale pillar stability experiment called APSE (Aespoe Pillar Stability Experiment) at Aespoe HRL. The study is focused on understanding and control of progressive rock failure in hard crystalline rock and damage caused by high stresses. The elastic thermo-mechanical modeling was carried out in three dimensions because of the complex test geometry and in-situ stress tensor by using a finite-difference modeling software FLAC3D. Cracking and damage formation were modeled in the area of interest (pillar between two large scale holes) in two dimensions by using the Particle Flow Code (PFC), which is based on particle mechanics. FLAC and PFC were coupled to minimize the computer resources and the computing time. According to the modeling the initial temperature rises from 15 deg C to about 65 deg C in the pillar area during the heating period of 120 days. The rising temperature due to thermal expansion induces stresses in the pillar area and after 120 days heating the stresses have increased about 33% from the excavation induced maximum stress of 150 MPa to 200 MPa in the end of the heating period. The results from FLAC3D model showed that only regions where the crack initiation stress has exceeded were identified and they extended to about two meters down the hole wall. These could be considered the areas where damage may occur during the in-situ test. When the other hole is pressurized with a 0.8 MPa confining pressure it yields that 5 MPa more stress is needed to damage the rock than without confining pressure. This makes the damaged area in some degree smaller. High compressive stresses in addition to some tensile stresses might induce some AE (acoustic emission) activity in the upper part of the hole from the very beginning of the test and are thus potential areas where AE activities may be detected. Monitoring like acoustic emissions will be measured during the test execution. The 2D coupled PFC-FLAC modeling indicated that

  4. 20-Year Experience With Intraoperative High-Dose-Rate Brachytherapy for Pediatric Sarcoma: Outcomes, Toxicity, and Practice Recommendations

    Energy Technology Data Exchange (ETDEWEB)

    Folkert, Michael R.; Tong, William Y. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); LaQuaglia, Michael P. [Department of Pediatric Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Wexler, Leonard H.; Chou, Alexander J.; Magnan, Heather [Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Zelefsky, Michael J. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Wolden, Suzanne L., E-mail: woldens@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

    2014-10-01

    Purpose: To assess outcomes and toxicity of high-dose-rate intraoperative radiation therapy (HDR-IORT) in the management of pediatric sarcoma. Methods and Materials: Seventy-five pediatric patients underwent HDR-IORT for sarcoma from May 1993 to November 2013. The median age was 9 years old (36 patients were ≤6 years old). HDR-IORT was part of initial therapy in 37 patients (49%) and for recurrent disease in 38 patients (51%). Forty-one patients (55%) received HDR-IORT and postoperative external beam RT (PORT), and 22 patients (29%) were previously treated with external beam radiation therapy to the IORT site. Local control (LC), overall survival (OS) and event-free survival (EFS) were estimated using Kaplan-Meier methods. Results: At a median follow-up of 7.8 years for surviving patients, 5-year projected rates of LC, EFS, and OS were 63% (95% confidence interval [CI] 50%-76%), 33% (95% CI 21%-45%), and 43% (95% CI 30%-55%), with a median survival of 3.1 years. The 5-year LC, EFS, and OS rates for patients with recurrent disease were 46% (95% CI, 28%-64%), 30% (95% CI, 13%-46%), and 36% (95% CI, 18%-54%). Acute toxicity ≥grade 3 occurred in 2 (2.5%) treatments; late toxicity ≥grade 3 occurred in 4 (5.3%) patients 0.3-9.9 years after HDR-IORT. The incidence of toxicity ≥grade 3 was not associated with HDR-IORT applicator size, HDR-IORT dose, prior RT or PORT, or prior or postoperative chemotherapy, but all toxicity ≥grade 3 occurred in patients ≤6 years treated with HDR-IORT doses ≥12 Gy. Conclusions: HDR-IORT is a well-tolerated component of multimodality therapy for pediatric sarcoma, allowing additional local treatment while reducing external beam exposure. Taking clinical considerations into account, doses between 8-12 Gy are appropriate for HDR-IORT in patients ≤6 years of age.

  5. E-Commerce Experiences in the Real Estate Industry: a preliminary study in regional Queensland

    Directory of Open Access Journals (Sweden)

    Jeanette Van Akkeren

    2003-05-01

    Full Text Available Computer systems have become commonplace in most SMEs and technology is increasingly becoming a part of doing business. In recent years, the Internet has become readily available to businesses; consequently there has been growing pressure on SMEs to take up e-commerce. However, e-commerce is perceived by many as being unproven in terms of business benefit. This research aims to determine what, if any, benefits are derived from assimilating e-commerce technologies into SME business processes. This paper presents three in-depth case studies from the Real Estate industry in a regional setting. Overall, findings were positive and identified the following experiences: enhanced business efficiencies, cost benefits, improved customer interactions and increased business return on investment.

  6. Purification, crystallization and preliminary X-ray diffraction experiment of nattokinase from Bacillus subtilis natto.

    Science.gov (United States)

    Yanagisawa, Yasuhide; Chatake, Toshiyuki; Chiba-Kamoshida, Kaori; Naito, Sawa; Ohsugi, Tadanori; Sumi, Hiroyuki; Yasuda, Ichiro; Morimoto, Yukio

    2010-12-01

    Nattokinase is a single polypeptide chain composed of 275 amino acids (molecular weight 27,724) which displays strong fibrinolytic activity. Moreover, it can activate other fibrinolytic enzymes such as pro-urokinase and tissue plasminogen activator. In the present study, native nattokinase from Bacillus subtilis natto was purified using gel-filtration chromatography and crystallized to give needle-like crystals which could be used for X-ray diffraction experiments. The crystals belonged to space group C2, with unit-cell parameters a=74.3, b=49.9, c=56.3 Å, β=95.2°. Diffraction images were processed to a resolution of 1.74 Å with an Rmerge of 5.2% (15.3% in the highest resolution shell) and a completeness of 69.8% (30.0% in the highest resolution shell). This study reports the first X-ray diffraction analysis of nattokinase.

  7. Preliminary results of the Artemia salina experiments in biostack on LDEF

    Science.gov (United States)

    Graul, E. H.; Ruether, W.; Hiendl, C. O.

    1992-01-01

    The mosaic egg of the brine shrimp, Artemia salina, resting in blastula or gastrula state represents a system that during further development, proceeds without any further development to the larval stage, the free swimming nauplius. Therefore, injury to a single cell of the egg will be manifest in the larvae. In several experiments, it was shown that the passage of a single heavy ion through the shrimp egg damaged a cellular area large enough to disturb either embryogenesis or further development of the larvae, or the integrity of the adult individual. Emergence from the egg shell was heavily disturbed by the heavy ions as was hatching. Additional late effects, due to a hit by a heavy ion, are delayed of growth and of sexual maturity, and reduced fertility. Anomalies in the body and the extremities could be observed more frequently for the nauplii which had developed from eggs hit by heavy ions.

  8. Hoe Creek II field experiment on underground coal gasification, preliminary results

    Energy Technology Data Exchange (ETDEWEB)

    Aiman, W.R.; Thorsness, C.B.; Hill, R.W.; Rozsa, R.B.; Cena, R.; Gregg, D.W.; Stephens, D.R.

    1978-02-27

    A second in-situ coal gasification experiment was performed by Lawrence Livermore Laboratory at Hoe Creek in Wyoming. The Linked Vertical Wells scheme for in-situ coal gasification was used. The experiment took 100 days for air flow testing, reverse combustion linking, forward combustion gasification, and post-burn steam flow. Air was used for gasification except for a 2-day test with oxygen and steam. Reverse combustion linking took 14 days at 1.6 m/day. Air requirements for linking were 0.398 Mgmol per meter of link assuming a single direct link. The coal pyrolysed during linking was 17 m/sup 3/, which corresponds to a single link 1.0 m in diameter. There was, however, strong evidence of at least two linkage paths. The detected links stayed below the 3 m level in the 7.6 coal seam; however, the product flow from the forward-burn gasification probably followed the coal-overburden interface not the reverse burn channels at the 3 m level. A total of 232 Mgmols (194 Mscf) of gas was produced with heating value above 125 kJ/mol (140 Btu/scf) for significant time periods and an average of 96 kJ/mol (108 Btu/scf). During the oxygen-steam test the heating value was above 270 kJ/gmol (300 Btu/scf) twice and averaged 235 kJ/gmol (265 Btu/scf). The coal recovery was 1310 m/sup 3/ (1950 ton). Gasification was terminated because of decreasing product quality not because of burn through. The product quality decreased because of increasing underground heat loss.

  9. Beneficial uses of geothermal energy description and preliminary results for phase 1 of the Raft River irrigation experiment

    Energy Technology Data Exchange (ETDEWEB)

    Schmitt, R.C.; Spencer, S.G.

    1977-01-01

    The first phase of an experiment using geothermal water for irrigation is described and preliminary results are discussed. The water was from a moderate temperature well, having salinity of about 2000 ppM, and is considered characteristic of the types of geothermal fluids that will be obtained from the young volcanic/young sediment formations of the northern intermountain west. The activity was completed at a location adjacent to ERDA's Raft River Geothermal Project in southern Idaho. About 12.5 acres, of which part had no previous cultivation, were subdivided by crops and irrigation practices for investigation with the geothermal water and a control comparison water from the relatively pure Raft River. Flood and sprinkler application techniques were used and wheat, barley, oats, grasses, alfalfa, potatoes, and garden vegetables were successfully grown. An accompanying experiment evaluated the behavior of an established alfalfa crop located nearby, when most of the irrigation water was geothermal. The experiment addressed heavy metal uptake in plants, plant fluoride retention and damage, plant tolerances to salts, soil alterations and other behavior as a result of the geothermal fluids, all of which were largely believed to eliminate geothermal water from contention for crop growing utilization. Not all analyses and results are complete in this reporting, but first results indicate no apparent difference between the geothermal watered crops and those obtained using the fresh water control. Extensive chemical analyses, neutron activation analyses, and other evaluations of crop samples are discussed, and some of the findings are presented. Although evaluation of crop yields was not an objective, extrapolations from samples indicate that yield results were comparable to those commonly found in the area, and the yield varied little between water sources. (JGB)

  10. Pediatric radiotherapy planning and treatment

    CERN Document Server

    Olch, Arthur J

    2013-01-01

    "This is a very well-written and -organized book covering the planning and delivery aspects unique to pediatric radiotherapy. The author is a respected and well-known medical physicist with extensive pediatric radiotherapy experience. … a very useful book for any clinical physicist treating pediatric cases and seeking contextual and historical perspective. … a great reference for medical physicists who may not see many pediatric cases and can look to this text as a one-stop shop for not only a comprehensive overview, but detailed explanation for specific pediatric disease sites. Overall, it is a great addition to the reference library of any radiation therapy physicist."-Medical Physics, April 2014.

  11. Ablative fractional photothermolysis for the treatment of hypertrophic burn scars in adult and pediatric patients: a single surgeon's experience.

    Science.gov (United States)

    Khandelwal, Anjay; Yelvington, Miranda; Tang, Xinyu; Brown, Susan

    2014-01-01

    Many patients develop hypertrophic scarring after a burn injury. Numerous treatment modalities have been described and are currently in practice. Photothermolysis or laser therapy has been recently described as an adjunct for management of hypertrophic burn scars. This study is a retrospective chart review of adult and pediatric patients undergoing fractional photothermolysis at a verified burn center examining treatment parameters as well as pre- and post-Vancouver Scar Scale scores. Forty-four patients underwent fractional photothermolysis during the study period of 8 months. Mean pretreatment score was 7.6, and mean posttreatment score was 5.4. The mean decrease in score was 2.2, which was found to be statistically significant. There were no complications. Fractional photothermolysis is a safe and efficacious adjunct therapy for hypertrophic burn scars. Prospective trials would be beneficial to determine optimal therapeutic strategies.

  12. Development of a lower extremity wearable exoskeleton with double compact elastic module: preliminary experiments

    Directory of Open Access Journals (Sweden)

    Y. Long

    2017-08-01

    Full Text Available In this paper, a double compact elastic module is designed and implemented in the lower extremity exoskeleton. The double compact elastic module is composed of two parts, i.e., physical human robot interaction (pHRI measurement and the elastic actuation system (EAS, which are called proximal elastic module (PEM and distal elastic module (DEM respectively. The PEM is used as the pHRI information collection device while the DEM is used as the compliance device. A novel compact parallelogram-like structure based torsional spring is designed and developed. An iterative finite element analysis (FEA based optimization process was conducted to find the optimal parameters in the search space. In the PEM, the designed torsional spring has an outer circle with a diameter of 60 mm and an inner hole with a diameter of 12 mm, while in the DEM, the torsional spring has the outer circle with a diameter of 80 mm and the inner circle with a diameter of 16 mm. The torsional spring in the PEM has a thickness of 5 mm and a weight of 60 g, while that in the DEM has a thickness of 10 mm and a weight of 80 g. The double compact elastic module prototype is embedded in the mechanical joint directly. Calibration experiments were conducted on those two elastic modules to obtain the linear torque versus angle characteristic. The calibration experimental results show that this torsional spring in the PEM has a stiffness of 60.2 Nm rad−1, which is capable of withstanding a maximum torque of 4 Nm, while that in the DEM has a stiffness of 80.2 Nm rad−1, which is capable of withstanding a maximum torque of 30 Nm. The experimental results and the simulation data show that the maximum resultant errors are 6 % for the PEM and 4 % for the DEM respectively. In this paper, an assumed regression algorithm is used to learn the human motion intent (HMI based on the pHRI collection. The HMI is defined as the angular position of the human limb joint. A

  13. Pediatric MRI

    Data.gov (United States)

    U.S. Department of Health & Human Services — The NIH Study of Normal Brain Development is a longitudinal study using anatomical MRI, diffusion tensor imaging (DTI), and MR spectroscopy (MRS) to map pediatric...

  14. Pediatric Terminology

    Science.gov (United States)

    The National Institute of Child Health and Human Development (NICHD) is working with NCI Enterprise Vocabulary Services (EVS) to provide standardized terminology for coding pediatric clinical trials and other resea

  15. Teratoma with a malignant somatic component in pediatric patients: the Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP) experience.

    Science.gov (United States)

    Terenziani, Monica; D'Angelo, Paolo; Bisogno, Gianni; Boldrini, Renata; Cecchetto, Giovanni; Collini, Paola; Conte, Massimo; De Laurentis, Tina; Ilari, Ilaria; Indolfi, Paolo; Inserra, Alessandro; Piva, Luigi; Siracusa, Fortunato; Spreafico, Filippo; Tamaro, Paolo; Lo Curto, Margherita

    2010-04-01

    Teratoma with a malignant somatic component (TMSC) is rare but described in adults, whereas information on pediatric presentation is sparse. The Associazione Italiana Ematologia Oncologia Pediatrica identified 14 cases of TMSC. Clinical files and pathology specimens were reviewed. The series (9 female, 5 male) showed the following disease: testis (2), sacrococcygeal (3), ovary (3), retroperitoneum (3), mediastinum (2), and foot soft tissue (1). Distribution of the somatic component was: carcinoma (4), pancreatic neuroendocrine tumor (1), neuroblastoma (3), rhabdomyosarcoma (3), rhabdomyosarcoma plus liposarcoma, chondrosarcoma, neurogenic sarcoma (1), chondrosarcoma plus neuroectodermal sarcoma (1), malignant peripheral nerve sheath tumor (1). Three patients were in stage I, four in stage II, three in stage III, and four in stage IV. All but one patient underwent surgery and only females showed carcinoma components. Nine patients relapsed or progressed and eight died. Six patients are alive and disease-free. Two patients underwent complete resection and four were treated based on transformed histologies. Relapse-free and overall survival rates were 35.7% and 42.8%, respectively (median follow-up, 31 months). Prognosis for germ cell tumors (GCTs) containing MSC is worse than that for GCTs. The pediatric disease appears to be more heterogeneous in tumor site distribution and MSC histology than in adults. Our series suggests no effects of age, histology, or gender on outcome. Surgery has an essential role in localized disease, with complete resection highly desirable. Chemotherapy optimized for histology should include reagents directed to the somatic malignancy, if chemosensitive. Malignant GCT warrants GCT-directed chemotherapy.

  16. Characteristics of long-term live-donor pediatric renal transplant survivors: a single-center experience.

    Science.gov (United States)

    El-Husseini, Amr A; Foda, Mohamed A; Osman, Yasser M; Sobh, Mohamed A

    2006-05-01

    To study the characteristics and the predictors of survival observed in our pediatric live-donor renal transplant recipients with an allograft that functioned for more than 10 yr. One hundred fifteen children underwent renal transplantation between 1976 and 1995. Of these, 30 had functioning allografts for more than 10 yr (range, 11-18). The patients included 18 males and 12 females, with a mean age at transplantation of 13 yr (range, 5-18). Characteristics of the patients, data on graft survival, and determinants of outcome were obtained by reviewing all medical charts. At most recent follow-up (January 2005), the mean daily dose of azathioprine was 1.2 mg/kg (range, 1-2) and that of prednisone was 0.16 mg/kg (range, 0.1-0.2). Mean creatinine clearance was 72 mL/min per 1.73 m(2) (range, 45-112). Acute rejection occurred in 14 (47%) patients. Seven patients had one episode, five had two episodes, and two had three episodes of acute rejection. Three patients (10%) developed malignancy. A substantial proportion of patients (44%) were short, with a height standard deviation score (SDS) less than -1.88, which is below the third percentile for age and gender. One quarter of the patients, more commonly the females, were obese. Other complications included osteoporosis in 16 (53%) patients, avascular bone necrosis in four (13%), post-transplantation diabetes mellitus in three (10%), and hypertension in 18 (60%). Twelve (40%) patients were married and 27% had children post-transplantation. The independent determinants of long-term graft survival were acute rejection and post-transplant hypertension. Despite good renal function, long-term pediatric renal transplant survivors are at risk of significant morbidity. The determinants of long-term graft survival are acute rejection and post-transplant hypertension.

  17. Clinical impact and cost-effectiveness of whole exome sequencing as a diagnostic tool: a pediatric center’s experience

    Directory of Open Access Journals (Sweden)

    C. Alexander Valencia

    2015-08-01

    Full Text Available Background: There are limited reports of the use of whole exome sequencing as a clinical diagnostic tool. Moreover, there are no reports addressing the cost burden associated with genetic tests performed prior to WES.Objective: We demonstrate the performance characteristics of WES in a pediatric setting by describing our patient cohort, calculating the diagnostic yield, and detailing the patients for whom clinical management was altered. Moreover, we examined the potential cost-effectiveness of WES by examining the cost burden of diagnostic workups.Methods: To determine the clinical utility of our hospital’s clinical WES, we performed a retrospective review of the first 40 cases. We utilized dual bioinformatics analyses pipelines based on commercially available software and in-house tools. Results: Of the first 40 clinical cases, we identified genetic defects in twelve (30% patients, of which, 47% of the mutations were previously unreported in the literature. Among the 12 patients with positive findings, 7 have autosomal dominant disease and 5 have autosomal recessive disease. Ninety percent of the cohort opted to receive secondary findings, and of those, secondary medical actionable results were returned in three cases. Among these positive cases there are a number of novel mutations that are being reported here. The diagnostic workup included a significant number of genetic tests with microarray and single gene sequencing being the most popular tests. Significantly, genetic diagnosis from WES led to altered patient medical management in positive cases. Conclusions: We demonstrate the clinical utility of WES by establishing the clinical diagnostic rate and its impact on medical management in a large pediatric center. The cost-effectiveness of WES was demonstrated by ending the diagnostic odyssey in positive cases. Also, in some cases it may be most cost-effective to directly perform WES. WES provides a unique glimpse into the complexity of

  18. Clinical Impact and Cost-Effectiveness of Whole Exome Sequencing as a Diagnostic Tool: A Pediatric Center's Experience.

    Science.gov (United States)

    Valencia, C Alexander; Husami, Ammar; Holle, Jennifer; Johnson, Judith A; Qian, Yaping; Mathur, Abhinav; Wei, Chao; Indugula, Subba Rao; Zou, Fanggeng; Meng, Haiying; Wang, Lijun; Li, Xia; Fisher, Rachel; Tan, Tony; Hogart Begtrup, Amber; Collins, Kathleen; Wusik, Katie A; Neilson, Derek; Burrow, Thomas; Schorry, Elizabeth; Hopkin, Robert; Keddache, Mehdi; Harley, John Barker; Kaufman, Kenneth M; Zhang, Kejian

    2015-01-01

    There are limited reports of the use of whole exome sequencing (WES) as a clinical diagnostic tool. Moreover, there are no reports addressing the cost burden associated with genetic tests performed prior to WES. We demonstrate the performance characteristics of WES in a pediatric setting by describing our patient cohort, calculating the diagnostic yield, and detailing the patients for whom clinical management was altered. Moreover, we examined the potential cost-effectiveness of WES by examining the cost burden of diagnostic workups. To determine the clinical utility of our hospital's clinical WES, we performed a retrospective review of the first 40 cases. We utilized dual bioinformatics analyses pipelines based on commercially available software and in-house tools. Of the first 40 clinical cases, we identified genetic defects in 12 (30%) patients, of which 47% of the mutations were previously unreported in the literature. Among the 12 patients with positive findings, seven have autosomal dominant disease and five have autosomal recessive disease. Ninety percent of the cohort opted to receive secondary findings and of those, secondary medical actionable results were returned in three cases. Among these positive cases, there are a number of novel mutations that are being reported here. The diagnostic workup included a significant number of genetic tests with microarray and single-gene sequencing being the most popular tests. Significantly, genetic diagnosis from WES led to altered patient medical management in positive cases. We demonstrate the clinical utility of WES by establishing the clinical diagnostic rate and its impact on medical management in a large pediatric center. The cost-effectiveness of WES was demonstrated by ending the diagnostic odyssey in positive cases. Also, in some cases it may be most cost-effective to directly perform WES. WES provides a unique glimpse into the complexity of genetic disorders.

  19. Implantable cardioverter defibrillator therapy in pediatric and congenital heart disease patients: a single tertiary center experience in Korea

    Directory of Open Access Journals (Sweden)

    Bo Kyung Jin

    2013-03-01

    Full Text Available Purpose: The use of implantable cardioverter defibrillators (ICDs to prevent sudden cardiac death is increasing in children and adolescents. This study investigated the use of ICDs in children with congenital heart disease. Methods: This retrospective study was conducted on the clinical characteristics and effectiveness of ICD implantation at the department of pediatrics of a single tertiary center between 2007 and 2011. Results: Fifteen patients underwent ICD implantation. Their mean age at the time of implantation was 14.5±5.4 years (range, 2 to 22 years. The follow-up duration was 28.9±20.4 months. The cause of ICD implantation was cardiac arrest in 7, sustained ventricular tachycardia in 6, and syncope in 2 patients. The underlying disorders were as follows: ionic channelopathy in 6 patients (long QT type 3 in 4, catecholaminergic polymorphic ventricular tachycardia [CPVT] in 1, and J wave syndrome in 1, cardiomyopathy in 5 patients, and postoperative congenital heart disease in 4 patients. ICD coils were implanted in the pericardial space in 2 children (ages 2 and 6 years. Five patients received appropriate ICD shock therapy, and 2 patients received inappropriate shocks due to supraventricular tachycardia.During follow-up, 2 patients required lead dysfunction-related revision. One patient with CPVT suffered from an ICD storm that was resolved using sympathetic denervation surgery. Conclusion: The overall ICD outcome was acceptable in most pediatric patients. Early diagnosis and timely ICD implantation are recommended for preventing sudden death in high-risk children and patients with congenital heart disease.

  20. Wearable ultrasonic guiding device with white cane for the visually impaired: A preliminary verisimilitude experiment.

    Science.gov (United States)

    Cheng, Po-Hsun

    2016-01-01

    Several assistive technologies are available to help visually impaired individuals avoid obstructions while walking. Unfortunately, white canes and medical walkers are unable to detect obstacles on the road or react to encumbrances located above the waist. In this study, I adopted the cyber-physical system approach in the development of a cap-connected device to compensate for gaps in detection associated with conventional aids for the visually impaired. I developed a verisimilar, experimental route involving the participation of seven individuals with visual impairment, including straight sections, left turns, right turns, curves, and suspended objects. My aim was to facilitate the collection of information required for the practical use of the device. My findings demonstrate the feasibility of the proposed guiding device in alerting walkers to the presence of some kinds of obstacles from the small number of subjects. That is, it shows promise for future work and research with the proposed device. My findings provide a valuable reference for the further improvement of these devices as well as the establishment of experiments involving the visually impaired.

  1. Flexible robotic retrograde renoscopy: description of novel robotic device and preliminary laboratory experience.

    Science.gov (United States)

    Desai, Mihir M; Aron, Monish; Gill, Inderbir S; Pascal-Haber, Georges; Ukimura, Osamu; Kaouk, Jihad H; Stahler, Gregory; Barbagli, Federico; Carlson, Christopher; Moll, Fredric

    2008-07-01

    To describe a novel flexible robotic system for performing retrograde intrarenal surgery. Remote robotic flexible ureterorenoscopy was performed bilaterally in 5 acute swine (10 kidneys). A novel 14F robotic catheter system, which manipulated a passive optical fiberscope mounted on a remote catheter manipulator was used. The technical feasibility, efficiency, and reproducibility of accessing all calices were assessed. Additionally, laser lithotripsy of calculi and laser ablation of renal papillae were performed. The robotic catheter system could be introduced de novo in eight ureters; two ureters required balloon dilation. The ureteroscope could be successfully manipulated remotely into 83 (98%) of the 85 calices. The time required to inspect all calices within a given kidney decreased with experience from 15 minutes in the first kidney to 49 seconds in the last (mean 4.6 minutes). On a visual analog scale (1, worst to 10, best), the reproducibility of caliceal access was rated at 8, and instrument tip stability was rated at 10. A renal pelvic perforation constituted the solitary complication. Histologic examination of the ureter showed changes consistent with acute dilation without areas of necrosis. A novel robotic catheter system is described for performing retrograde ureterorenoscopy. The potential advantages compared with conventional manual flexible ureterorenoscopy include an increased range of motion, instrument stability, and improved ergonomics. Ongoing refinement is likely to expand the role of this technology in retrograde intrarenal surgery in the near future.

  2. Preliminary results from recent experiments and future roadmap to Shock Ignition of Fusion Targets

    Science.gov (United States)

    Batani, D.; Malka, G.; Schurtz, G.; Ribeyre, X.; Lebel, E.; Giuffrida, L.; Tikhonchuk, V.; Volpe, L.; Patria, A.; Koester, P.; Labate, L.; Gizzi, L. A.; Antonelli, L.; Richetta, M.; Nejdl, J.; Sawicka, M.; Margarone, D.; Krus, M.; Krousky, E.; Skala, J.; Dudzak, R.; Velyhan, A.; Ullshmied, J.; Renner, O.; Smid, M.; Klimo, O.; Atzeni, S.; Marocchino, A.; Schiavi, A.; Spindloe, C.; O'Dell, T.; Vinci, T.; Wolowski, J.; Badziak, J.; Pysarcizck, T.; Rosinski, M.; Kalinowska, Z.; Chodukowski, T.

    2012-11-01

    Shock ignition (SI) is a new approach to Inertial Confinement Fusion (ICF) based on decoupling the compression and ignition phase. The last one relies on launching a strong shock through a high intensity laser spike (<= 1016 W/cm2) at the end of compression. In this paper, first we described an experiment performed using the PALS iodine laser to study laser-target coupling and laser-plasma interaction in an intensity regime relevant for SI. A first beam with wavelength λ = 1.33 μm and low intensity was used to create an extended preformed plasma, and a second one with λ = 0.44 μm to create a strong shock. Several diagnostics characterized the preformed plasma and the interaction of the main pulse. Pressure up to 90 Mbar was inferred. In the last paper of the paper, we discuss the relevant steps, which can be followed in order to approach the demonstration of SI on laser facilities like LMJ.

  3. Investigation of Freeze-Linings in Copper-Containing Slag Systems: Part I. Preliminary Experiments

    Science.gov (United States)

    Fallah-Mehrjardi, Ata; Hayes, Peter C.; Jak, Evgueni

    2013-06-01

    Slag freeze-linings are increasingly used in industrial pyrometallurgical processes to insure that furnace integrity is maintained in aggressive high-temperature environments. Most previous studies of freeze-linings have analyzed the formation of slag deposits based solely on heat-transfer models. The focus of the present research is to determine the impact of slag chemistry and local process conditions on the microstructures, thickness, stability, and heat-transfer characteristics of the frozen deposit at steady-state conditions. The formation of the freeze-linings is studied under controlled laboratory conditions using an air-cooled "cold-finger" technique for Cu-Fe-Si-Al-O slag at equilibrium with metallic copper relevant to the industrial copper smelting processes. The phase assemblages and microstructures of the deposits formed in the cold-finger experiments differ significantly from those expected from phase equilibrium considerations. The freeze-lining deposits have been found, in general, to consist of several layers. Starting from the cold finger, these layers consist of glass; glass with microcrystalline precipitates; closed crystalline layer; and open crystalline layer. Even at steady-state conditions, there was no primary phase sealing layer of delafossite [Cu2O · (Al, Fe)2O3] present at the deposit/liquid interface—these observations differ markedly from those expected from phase equilibrium considerations. The findings have significant practical implications, and potential for the improved design and operation of industrial metallurgical furnaces.

  4. Preliminary experience with extraperitoneal endoscopic radical prostatectomy through duplication of the open technique

    Directory of Open Access Journals (Sweden)

    M. Tobias-Machado

    2005-06-01

    Full Text Available OBJECTIVE: To describe surgical and functional results with extraperitoneal laparoscopic radical prostatectomy with duplication of the open technique, from the experience obtained in the treatment of 28 initial cases. MATERIALS AND METHODS: In a 36-month period, we prospectively analyzed 28 patients diagnosed with localized prostate cancer undergoing extraperitoneal laparoscopic radical prostatectomy. RESULTS: Mean surgical time was 280 min, with mean blood loss of 320 mL. As intraoperative complications, there were 2 rectal lesions repaired with laparoscopic suture in 2 planes. There was no conversion to open surgery. Median hospital stay was 3 days, with return to oral diet in the first post-operative day in patients. As post-operative complications, there were 3 cases of extraperitoneal urinary fistula. Two of these cases were resolved by maintaining a Foley catheter for 21 days, and the other one by late endoscopic reintervention for repositioning the catheter. Five out of 18 previously potent patients evolved with erectile dysfunction. The diagnosis of prostate cancer was confirmed in all patients, with focal positive margin occurring in 3 cases. During a mean follow-up of 18 months, 2 patients presented increased PSA, with no clinical evidence of disease. CONCLUSION: Laparoscopic radical prostatectomy is a laborious and difficult procedure, with a long learning curve. Extraperitoneal access is feasible, and it is possible to practically duplicate the principles of open surgery. The present technique can possibly offer advantages in terms of decreased blood loss, preservation of erectile function and prevention of positive margins.

  5. Preliminary culture and life-cycle experiments with the benthic amphipod Ampelisca abdita

    Energy Technology Data Exchange (ETDEWEB)

    Redmond, M.S.; Jones, J.K.P. (AScI Corp., Newport, OR (United States)); Scott, K.J. (Science Applications International Corp., Narragansett, RI (United States)); Swartz, R.C. (Environmental Protection Agency, Newport, OR (United States))

    1994-08-01

    The tube-dwelling amphipod Ampelisca abdita Mills 1964 has been used extensively in acute sediment toxicity tests and has been shown to be amenable to chronic testing. Ampelisca abdita was held in the lab through several generations when fed algal food in daily static renewals, although culturing success was not consistent. Algal food consisted of one or more of the following: the flagellate Pseudoisochrysis paradoxa Sutton, and the diatoms Phaeodactylum tricornutum Bohlin and Chaetoceros calcitrans (Paulsen) Tokano. Sensitivity of cultured animals to cadmium chloride in 96-h seawater-only tests was comparable to that of field-collected animals. A life-cycle test initiated with juveniles 8 to 10 d old resulted in production of young or fertilized broods in only two of the 12 sample containers in which young were expected. Amphipods were sexually mature at approximately 20 d of age at 25 C, and young were first produced at 34 to 36 d. Short-term tests were used to quantify growth of this species in 10 to 14 d. Results from a variety of experiments indicated that there are still one or more unresolved problems with the culture and chronic testing of Ampelisca abdita. Factors such as nutrition, flow rate, light, and temperature need to be examined further.

  6. Video-assisted anal fistula treatment: technical considerations and preliminary results of the first Brazilian experience.

    Science.gov (United States)

    Mendes, Carlos Ramon Silveira; Ferreira, Luciano Santana de Miranda; Sapucaia, Ricardo Aguiar; Lima, Meyline Andrade; Araujo, Sergio Eduardo Alonso

    2014-01-01

    Anorectal fistula represents an epithelized communication path of infectious origin between the rectum or anal canal and the perianal region. The association of endoscopic surgery with the minimally invasive approach led to the development of the video-assisted anal fistula treatment. To describe the technique and initial experience with the technique video-assisted for anal fistula treatment. A Karl Storz video equipment was used. Main steps included the visualization of the fistula tract using the fistuloscope, the correct localization of the internal fistula opening under direct vision, endoscopic treatment of the fistula and closure of the internal opening which can be accomplished through firing a stapler, cutaneous-mucosal flap, or direct closure using suture. The mean distance between the anal verge and the external anal orifice was 5.5 cm. Mean operative time was 31.75 min. In all cases, the internal fistula opening could be identified after complete fistuloscopy. In all cases, internal fistula opening was closed using full-thickness suture. There were no intraoperative or postoperative complications. After a 5-month follow-up, recurrence was observed in one (12.5%) patient. Video-assisted anal fistula treatment is feasible, reproducible, and safe. It enables direct visualization of the fistula tract, internal opening and secondary paths.

  7. Pediatric melanoma.

    Science.gov (United States)

    Tracy, Elisabeth T; Aldrink, Jennifer H

    2016-10-01

    Childhood melanoma is a rare pediatric malignancy, with fewer than 500 new diagnoses annually. The incidence is increasing, particularly in the adolescent population. This review highlights the epidemiology, clinical presentation, and histopathologic challenges of pediatric melanoma. Surgical resection remains the cornerstone for localized and regionally advanced disease. Adjuvant therapies, including current options and potential novel therapeutics for this unique population will be discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Pediatric Dentistese

    OpenAIRE

    Sharath Asokan; Sivakumar Nuvvula

    2017-01-01

    Successful practice of pediatric dentistry depends on the establishment of a good relationship between the dentist and the child. Such a relationship is possible only through effective communication. Pediatric dentistry includes both an art and a science component. The focus has been mostly on the technical aspects of our science, and the soft skills we need to develop are often forgotten or neglected. This paper throws light on the communication skills we need to imbibe to be a successful pe...

  9. Pediatric Anthropometry

    Science.gov (United States)

    Klinich, Kathleen D.; Reed, Matthew P.

    Anthropometry is the measurement of human size, shape, and physical capabilities. Most pediatric anthropometry data are gathered to describe child growth patterns, but data on body size, mass distribution, range of motion, and posture are used to develop crash test dummies and computational models of child occupants. Pediatric anthropometry data are also used to determine child restraint dimensions, so they will accommodate the applicable population of child occupants.

  10. Virtual Pediatric Hospital

    Science.gov (United States)

    ... Assistant™ Last revised on February 22, 2017 Related Digital Libraries Pediatric GeneralPediatrics.com - the general pediatrician's view of the Internet PediatricEducation.org - a pediatric digital library and learning collaboratory intended to serve as a ...

  11. Nitrogen Limitation Along The Kalahari Transect: Preliminary Results From A Stable Isotope Fertilization Experiment

    Science.gov (United States)

    Wang, L.; Macko, S.; D'Odorico, P.; Ries, L.

    2005-12-01

    Globally, savannas cover ~ 20% of the Earth's land area. Nutrients and soil moisture interactively control vegetation dynamics in many savannas although it is unclear how the relative importance of water and nutrient limitations (especially nitrogen) change with the mean climatic conditions. The Kalahari Transect (KT) in southern Africa traverses a dramatic aridity gradient (from ~ 200 mm to more than 1000 mm of mean annual precipitation (MAP), through the Republic of South Africa, Botswana, Namibia and Zambia), on relatively homogenous soils (deep Kalahari sands). This transect offers the ideal setting to study nutrient and vegetation dynamics without confounding soil effects. To improve the understanding of nitrogen and water controls on savanna vegetation, this study tested the hypothesis that the savannas in the Kalahari switch from conditions of water limitation in the dry areas to nutrient limitation in the wet areas. To this end, we conducted a large-scale stable isotope fertilization experiment using four study sites with different MAP. The transect included sites in Mongu, Zambia (MAP ~950mm), Pandamatenga, Ghanzi, and Tshane, Botswana with MAP ranging between 700 mm and 300 mm. The experimental design consisted of a randomized block design with four 21 m x 13 m plots at each site. Each plot was divided into four 10 m x 6 m subplots with 1 m buffer zone between each subplot. Four treatments (N addition, P addition, N+P addition and control) were randomly applied to the subplots. The experiment began during the dry season, in August, 2004, when 39g/m2 of Ca(NO3)2 (3.3g-N/ m2 ) was evenly applied to the N and N+P subplots, and 7.5g/m2 of Ca(H2PO4)2 (1.7g-P/m2) was applied to the P and N+P subplots, while the control subplots were left with no treatment. The N and N+P additions were enriched with 15N (Ca(15NO3)2 ) to a signature of 10.3 ‰. Before application, soil samples from two different layers (0cm and 50cm) outside the plots and foliar samples of the

  12. Preliminary experience using transthoracic echocardiography guiding percutaneous closure of ruptured right sinus of Valsalva aneurysm

    Institute of Scientific and Technical Information of China (English)

    LI Yue; WANG Guang-yi; WANG Zhi-feng; GUO Liang

    2011-01-01

    Background In the 21st century, minimally invasive treatment is one of the main developmental directions of medical sciences. It is well known that the echocardiography plays an important role during interventional treatments of some structural heart diseases. Because the ruptured right sinus of the Valsalva aneurysm (RRSVA) is a rare disease, there were few reports about percutaneous catheter closure of RRSVA. This study aimed to sum up our experience with transthoracic echocardiography (TTE) during percutaneous catheter closure of RRSVA.Methods Five RRSVA cases were treated with percutaneous catheter closure. The whole procedure was guided and monitored by TTE and fluoroscopy. The maximum diameter of the RRSVA was measured by TTE before and after the catheter passed through the rupture site. A duct occluder 2 mm larger than the maximum diameter was chosen. The closure effects were evaluated with TTE and fluoroscopy immediately after the occluding device was deployed. All patients were followed up by TTE for 8 to 30 months.Results Before the catheter passed through the rupture site the maximum diameter of the RRSVA measured with TTE and aortography were (7.9 ±2.1) mm and (7.8 ± 1.8) mm. After the catheter passed through the rupture site the maximum diameter measured with TTE was (11.2 ± 3.2) mm, which was significantly larger than before the procedure (P <0.05). The percutaneous catheter closure was successful in four cases and failed in one. Compared to the aortography the TTE was better at distinguishing residual shunts from aortic valve regurgitation immediately after the occluding device was deployed. There were no complications during 8 to 30 months of follow-up.Conclusion Transthoracic echocardiography can play an important role during percutaneous catheter closure of RRSVA,especially for estimating the size of the RRSVA after the catheter passes through the rupture site, and differentiating residual shunt from aortic valve regurgitation immediately

  13. Staff empowerment: a medical record department's preliminary experiences with continuous quality improvement.

    Science.gov (United States)

    Markon, E

    1992-11-01

    After observing the results of continuous quality improvement, no one would argue against its value in the workplace. However, learning to apply the concepts requires change on everyone's part, and the challenge lies in effecting this change. Not everyone will want to work in this type of environment and, if the organization is truly committed to continuous quality improvement, those individuals may have to make hard decisions as to whether the organization is the right place for them to work. Certain skills are required for staff empowerment to be successful, and training in these skills is essential. The medical record department staff learned early in this process that, although the group possessed job skills, interaction and team skills were lacking. The Development Dimensions International program helped the managers and staff identify the weaknesses of the group and provided educational tools for improvement. The changes often are so subtle, the group does not realize anything has changed. It was not until recently, when the medical record department staff was requested by administration to identify department quality improvement projects, that the group looked back at where the process started and realized how different things are today from three years ago--now staff members lead team meetings, work-groups are redesigning their job processes, and teams update the rest of the department staff on its progress at department meetings. Everyone expressed a sense of pride and accomplishment that the group had indeed responded to the challenge. The experiences of the medical record department thus far clearly support empowerment of employees.(ABSTRACT TRUNCATED AT 250 WORDS)

  14. Fetal reduction by bipolar cord coagulation in managing complicated monochorionic multiple pregnancies: preliminary experience in China

    Institute of Scientific and Technical Information of China (English)

    HE Zhi-ming; FANG Qun; YANG Yong-zhong; LUO Yan-min; CHEN Jun-hong; CHEN Yong-zhen; ZHOU Yi; CHEN Min-ling

    2010-01-01

    Background Monochorionic multiple pregnancies (MMPs) are associated with higher rates of perinatal morbidity and mortality caused by interfetal vascular anastomoses in the monochorionic placenta, which can lead to fetal health interactions. In some circumstances, selective feticide of the affected fetus is necessary to save the healthy co-twin. We evaluated the effects and safety of our initial experiences using bipolar cord coagulation for the management of complicated MMPs. Methods Using ultrasound-guided bipolar cord coagulation, we performed selective feticide on 14 complicated MMPs (5 with twin-twin transfusion syndrome, 4 with acardia, 3 with discordant structural anomalies, and 2 with severe selective intrauterine growth restriction). One patient with monochorionic triplets received the procedure twice to terminate 2 affected fetuses for different indications. Data regarding the operations, complications and neonatal outcomes were analyzed. Results Cord occlusions were successfully performed in 13/14 (93%) cases. The failure happened in an acardiac fetus and the pregnancy was terminated by induction. The included cases delivered at a mean gestational age of 35.4 weeks with a perinatal survival rate of 11/13 (85%). Three operation-related complications occurred (21%), including membrane rupture of the terminated sac (1 case), preterm labor at 28 weeks gestation (1 case), and chorioamniotic membrane separation (1 case). Amnioinfusion was indicated in 11 procedures to expand the target sacs for entering the trocar and obtaining sufficient working space. However, in all 4 cases of acardia, the acardiac sacs showed extreme oligohydramnios and could not be well expanded by infusion; thus, the trocar had to be inserted from the sac of the preserved co-twin. Conclusions The application of bipolar cord coagulation in complicated MMPs is safe and improves the prognosis. Amnioinfusion is useful in helping to expand the target sac when the working space is limited.

  15. Micromultileaf collimator-based stereotactic radiosurgery for selected arteriovenous malformations: Technique and preliminary experience

    Directory of Open Access Journals (Sweden)

    Jalali Rakesh

    2009-01-01

    Full Text Available Purpose : To report our experience of stereotactic radiosurgery (SRS in consecutively treated patients with arteriovenous malformations (AVMs. Materials and Methods : Of the 87 patients, 23 patients qualified and were treated with SRS as per predefined protocol according to AVM size, location, neurological status, prior bleeding, and the AVM score. All had Spletzer-Martin grade II/III and AVM scores < 2.5. Patients underwent SRS using micromultileaf collimators delivering multiple noncoplanar fixed fields. Doses were prescribed using the Flickinger model. Patients were followed up with magnetic resonance angiography (MRA and digitally subtracted angiography (DSA. Results : The mean nidus volume was 3.65 cc. The mean prescribed maximum dose was 22 Gy and the marginal dose was 19.24 Gy; 12 Gy normal brain volume was 8.39 cc and 12 Gy marginal volume was 5.03 cc. Mean dose to brain stem, pituitary hypothalamic axis, and optic chiasm was 2.5, 0.72, and 0.49 Gy, respectively. At a median follow-up of 22 months (range 1.5-71.2 months, 7 of 10 patients presenting with a neurological deficit showed significant improvement. All 15 patients who underwent MRA 1.5-2 years after SRS had no residual nidus yielding an MRA complete obliteration rate of 100%. Twelve patients also underwent a check DSA, which confirmed obliteration in 11 of them resulting in an accuracy of MRA of 92%. One patient after SRS had transient deterioration of motor power, which resolved completely after a short course of steroids and another had mild worsening of the hemiparesis. All patients are able to lead an active functional life. Conclusions : Careful selection of cases suitable for SRS provides optimum obliteration rates with low toxicity.

  16. Molten salt oxidation of mixed waste: Preliminary bench-scale experiments without radioactivity

    Energy Technology Data Exchange (ETDEWEB)

    Haas, P.A.; Rudolph, J.C.; Bell, J.T.

    1994-06-01

    Molten salt oxidation (MSO) is a process in which organic wastes are oxidized by sparging them with air through a bed of molten sodium carbonate (bp 851 {degrees}C) at {ge} 900{degrees}C. This process is readily applicable to the mixed waste because acidic products from Cl, S, P, etc., in the waste, along with most metals and most radionuclides, are retained within the melt as oxides or salts. Rockwell International has studied the application of MSO to various wastes, including some mixed waste. A unit used by Rockwell to study the mixed waste treatment is presently in use at Oak Ridge National Laboratory (ORNL). ORNL`s studies to date have concentrated on chemical flowsheet questions. Concerns that were studied included carbon monoxide (CO) emissions, NO{sub x}, emissions, and metal retention under a variety of conditions. Initial experiments show that CO emissions increase with increasing NaCl content in the melt, increasing temperature, and increasing airflow. Carbon monoxide content is especially high (> 2000 ppm) with high chlorine content (> 10%). Thermal NO{sub x}, emissions are relatively low ( < 5 ppm) at temperatures < 1000{degrees}C. However, most (85--100%) of the nitrogen in the feed as organic nitrate or amine was released as NO{sub x}, The metal contents of the melt and of knockout pot samples of condensed salt show high volatilities of Cs as CsCl. Average condensed salt concentrations were 60% for barium and 100% for strontium and cobalt. The cerium disappeared -- perhaps from deposition on the alumina reactor walls.

  17. Designing assisted living technologies ‘in the wild’: preliminary experiences with cultural probe methodology

    Directory of Open Access Journals (Sweden)

    Wherton Joseph

    2012-12-01

    , limited emotional or psychological resources, life events, and acute illness. Discussions between researchers and participants about the materials collected (and sometimes about what had prevented them completing the tasks helped elicit further information relevant to assisted living technology design. The probe materials were particularly helpful when having conversations with non-English speaking participants through an interpreter. Conclusions Cultural probe methods can help build a rich picture of the lives and experiences of older people to facilitate the co-production of assisted living technologies. But their application may be constrained by the participant’s physical, mental and emotional capacity. They are most effective when used as a tool to facilitate communication and development of a deeper understanding of older people’s needs.

  18. Preliminary experience of fractionated stereotactic radiosurgery with extend system of Gamma Knife

    Directory of Open Access Journals (Sweden)

    Raj Bisht

    2016-03-01

    Full Text Available Purpose: The purpose of this study is to present multisession stereotactic radiosurgery with initial experience using custom made extend system (ES of Gamma Knife.Methods: The ES is comprised of a carbon fiber frame also called extend frame, vacuum head rest cushion, patient surveillance unit and a configurable front piece with dental impression tray. The extend frame is a rigid connection between patient's head and patient positioning system (PPS of Gamma Knife. A dental impression of patient was created and attached to the frontal piece of extend system. The treatment setup involves positioning the patient within the extend frame using patient specific headrest cushion and front piece. The reference patient’s head position was recorded through measurements of repositioning check tool (RCT apertures using a high precision digital probe before computed tomography (CT scan. The RCT measurements taken before treatment were compared with recorded reference position to ensure appropriate patient treatment position. Volumetric magnetic resonance (MR scan was co-registered with stereotactic CT scan on Leksell Gamma plan. Fused MR to CT images on Gamma Plan was utilized to delineate regions of interest and prepare a precise treatment plan. The presented study includes positional reproducibility check and dosimetric evaluation of ten patients treated with ES.Results: Forty-three fractions on ten patients with prescribed treatment format were delivered successfully. An average tumor volume of 11.26 cm3 (range, 340 mm3 to 59.12 cm3 was treated with ES. The mean tumor coverage of 91.91% (range, 90% to 95% was able to achieve at 50% prescription isodose without compromising adjacent normal structure radiation dose tolerances. The mean inter-fraction positional variation of 0.69 mm influences an inherent strength of immobilization technique. Follow-up of seven patients at a median interval of 16 months (range, 9 months to 26 months showed evidence of 100

  19. Global atmospheric response to specific linear combinations of the main SST modes.. Part I: numerical experiments and preliminary results

    Science.gov (United States)

    Trzaska, S.; Moron, V.; Fontaine, B.

    1996-10-01

    This article investigates through numerical experiments the controversial question of the impact of El Niño-Southern Oscillation (ENSO) phenomena on climate according to large-scale and regional-scale interhemispheric thermal contrast. Eight experiments (two considering only inversed Atlantic thermal anomalies and six combining ENSO warm phase with large-scale interhemispheric contrast and Atlantic anomaly patterns) were performed with the Météo-France atmospheric general circulation model. The definition of boundary conditions from observed composites and principal components is presented and preliminary results concerning the month of August, especially over West Africa and the equatorial Atlantic are discussed. Results are coherent with observations and show that interhemispheric and regional scale sea-surface-temperature anomaly (SST) patterns could significantly modulate the impact of ENSO phenomena: the impact of warm-phase ENSO, relative to the atmospheric model intercomparison project (AMIP) climatology, seems stronger when embedded in global and regional SSTA patterns representative of the post-1970 conditions [i.e. with temperatures warmer (colder) than the long-term mean in the southern hemisphere (northern hemisphere)]. Atlantic SSTAs may also play a significant role. Acknowledgements. We gratefully appreciate the on-line DMSP database facility at APL (Newell et al., 1991) from which this study has benefited greatly. We wish to thank E. Friis-Christensen for his encouragement and useful discussions. A. Y. would like to thank the Danish Meteorological Institute, where this work was done, for its hospitality during his stay there and the Nordic Baltic Scholarship Scheme for its financial support of this stay. Topical Editor K.-H. Glassmeier thanks M. J. Engebretson and H. Lühr for their help in evaluating this paper.--> Correspondence to: A. Yahnin-->

  20. CT-guided thin needles percutaneous cryoablation (PCA) in patients with primary and secondary lung tumors: A preliminary experience

    Energy Technology Data Exchange (ETDEWEB)

    Pusceddu, Claudio, E-mail: clapusceddu@gmail.com [Division of Interventional Radiology, Department of Oncological Radiology, Businco Hospital, Regional Referral Center for Oncologic Diseases, Cagliari, Zip code 09100 (Italy); Sotgia, Barbara, E-mail: barbara.sotgia@gmail.com [Department of Oncological Radiology, Businco Hospital, Regional Referral Center for Oncological Diseases, Cagliari, Zip code 09100 (Italy); Fele, Rosa Maria, E-mail: rosellafele@tiscali.it [Department of Oncological Radiology, Businco Hospital, Regional Referral Center for Oncological Diseases, Cagliari, Zip code 09100 (Italy); Melis, Luca, E-mail: doclucamelis@tiscali.it [Department of Oncological Radiology, Businco Hospital, Regional Referral Center for Oncological Diseases, Cagliari, Zip code 09100 (Italy)

    2013-05-15

    Purpose: To report the data of our initial experience with CT-guided thin cryoprobes for percutaneous cryoablation (PCA) in patients with primary and secondary pulmonary tumors. Material and methods: CT-guided thin needles PCA was performed on 34 lung masses (11 NSCLC = 32%; 23 secondary lung malignancies = 68%) in 32 consecutive patients (24 men and 8 women; mean age 67 ± 10 years) not suitable for surgical resection. Lung masses were treated using two types of cryoprobes: IceRod and IceSeed able to obtain different size of iceball. The number of probes used ranged from 1 to 5 depending on the size of the tumor. After insertion of the cryoprobes into the lesion, the PCA were performed with two 2 (91%) or 3 (9%) cycles each of 12 min of freezing followed by a 4 min active thawing phase and a 4 min passive thawing phase for each one for all treatments. Results: All cryoablation sessions were successfully completed. All primary and metastatic lung tumors were ablated. No procedure-related deaths occurred. Morbidity consisted of 21% (7 of 34) pneumothorax and 3% (1 of 34) cases asymptomatic small pulmonary hemorrhage, respectively, all of CTCAE grade 1 (Common Terminology Criteria for Adverse Events). Low density of entire lesion, central necrosis and solid mass appearance were identify in 21 (62%), 7 (21%) and 6 (17%) of cryoablated tumors, respectively. No lymphadenopathy developed in the region of treated lesions. Technical success (complete lack of enhancement) was achieved in 82%, 97% and 91% of treated lesions at 1-, 3- and 6-months CT follow-up scan, respectively (p < .000). Comparing the tumor longest diameter between the baseline and at 6 month CT images, technical success was revealed in 92% cases (p < .000). Conclusion: Our preliminary experience suggests that PCA is a feasible treatment option. Well-designed clinical trials with a larger patient population are necessary to further investigate the long-term results and prognostic factors.

  1. Using information technology and social networking for recruitment of research participants: experience from an exploratory study of pediatric Klinefelter syndrome.

    Science.gov (United States)

    Close, Sharron; Smaldone, Arlene; Fennoy, Ilene; Reame, Nancy; Grey, Margaret

    2013-03-19

    Recruiting pediatric samples for research may be challenging due to parental mistrust of the research process, privacy concerns, and family time constraints. Recruitment of children with chronic and genetic conditions may further complicate the enrollment process. In this paper, we describe the methodological challenges of recruiting children for research and provide an exemplar of how the use of information technology (IT) strategies with social networking may improve access to difficult-to-reach pediatric research participants. We conducted a cross-sectional descriptive study of boys between the ages of 8 and 18 years with Klinefelter syndrome. This study presented unique challenges for recruitment of pediatric participants. These challenges are illustrated by the report of recruitment activities developed for the study. We reviewed the literature to explore the issues of recruiting children for research using conventional and IT approaches. Success rates of conventional recruitment approaches, such as brochures, flyers in medical offices, and physician referrals, are compared with IT-based outreach. The IT approaches included teleconferencing via a Klinefelter syndrome support group, services of a Web-based commercial recruitment-matching company, and the development of a university-affiliated research recruitment website with the use of paid advertising on a social networking website (Facebook). Over a 3-month period, dissemination of over 150 recruitment brochures and flyers placed in a large urban hospital and hospital-affiliated clinical offices, with 850 letters to physicians and patients were not successful. Within the same period, face-to-face recruitment in the clinical setting yielded 4 (9%) participants. Using Web-based and social networking approaches, 39 (91%) agreed to participate in the study. With these approaches, 5 (12%) were recruited from the national Klinefelter syndrome advocacy group, 8 (19%) from local and teleconference support groups, 10

  2. Long-Term Effects of Haematopoietic Stem Cell Transplantation after Pediatric Cancer: A Qualitative Analysis of Life Experiences and Adaptation Strategies

    Directory of Open Access Journals (Sweden)

    Magali Lahaye

    2017-05-01

    Full Text Available Haematopoietic stem cell transplantation (HSCT improves the survival rate of children and adolescents with malignant and non-malignant conditions; however, the physical, psychological and social burden of such a procedure is considerable both during and after treatment. The present qualitative study investigated the long-term effects of HSCT after pediatric cancer. Thirty adolescent and young adult (AYA survivors (Mage = 23.61 years, SD = 5.21 participated in individual interviews and were invited to speak about their life experiences following their treatment and strategies they use to deal with their past medical experiences and the long-term sequelae. Our results showed the presence of ongoing physical and psychosocial consequences of their past illness and its treatments with wide ranging psychosocial impacts, such as affected self-image, social withdrawal, sense of lack of choice, and need for specific attention. Different strategies were reported to overcome these consequences, such as talking about illness, giving a sense to their past medical experiences, and developing meaningful social relationships. Clinical and research implications are also discussed.

  3. New developments in pediatric psychopharmacology.

    Science.gov (United States)

    Gualtieri, C T; Golden, R N; Fahs, J J

    1983-09-01

    This is a report on recent developments in pediatric psychopharmacology: new drugs and new applications for established drugs. The drugs reviewed include imipramine, amitryptiline, lithium, piracetam, propranolol, tryptophan, clonidine, pyridoxine and fenfluramine. Putative indications include prepubertal depression, school phobia, anorexia nervosa, explosive-aggressive behavior, learning disabilities, attention deficit disorder (hyperactivity), Tourette's syndrome, autism, and the Lesch-Nyhan syndrome. Some of the information presented in this report must be regarded as "preliminary," and caution is advised in its interpretation and application.

  4. Ethical issues at the interface of clinical care and research practice in pediatric oncology: a narrative review of parents' and physicians' experiences

    OpenAIRE

    de Vries Martine C; Houtlosser Mirjam; Wit Jan M; Engberts Dirk P; Bresters Dorine; Kaspers Gertjan JL; van Leeuwen Evert

    2011-01-01

    Abstract Background Pediatric oncology has a strong research culture. Most pediatric oncologists are investigators, involved in clinical care as well as research. As a result, a remarkable proportion of children with cancer enrolls in a trial during treatment. This paper discusses the ethical consequences of the unprecedented integration of research and care in pediatric oncology from the perspective of parents and physicians. Methodology An empirical ethical approach, combining (1) a narrati...

  5. Long-term follow-up of pediatric moyamoya disease treated by combined direct-indirect revascularization surgery: single institute experience with surgical and perioperative management.

    Science.gov (United States)

    Rashad, Sherif; Fujimura, Miki; Niizuma, Kuniyasu; Endo, Hidenori; Tominaga, Teiji

    2016-10-01

    Moyamoya disease (MMD) is a rare occlusive cerebrovascular disease that mainly presents in children as cerebral ischemia. Prompt treatment with either a direct or indirect revascularization procedure is necessary for children with MMD in order to prevent repeated ischemic events. We herein present our experience with combined direct and indirect bypass surgery for the treatment of pediatric MMD as well as our uniquely designed perioperative protocol. Twenty-three patients with MMD, aged between 2 and 16 years old (mean 9.36), underwent 38 combined bypass procedures between 2008 and 2015. All patients underwent single superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis combined with encephalo-duro-myo-synangiosis (EDMS). The perioperative management protocol was stratified into two unique eras: the first era with normotensive care and the second era with strict blood pressure control (systolic 100-130 mmHg) and routine aspirin administration. Patients were followed after surgery for a period ranging between 3 and 131 months (mean 77 months) in yearly clinical and radiological follow-ups. Three postoperative complications were observed: two cases of cerebral hyperperfusion (2/38, 5.3 %) and one case of perioperative minor stroke (1/38, 2.6 %), two of which were in the first era. No strokes, either ischemic or hemorrhagic, were observed in the follow-up period, and the activity of daily living as shown by the modified Rankin Scale improved in 20 patients, with no deterioration being observed in any of our patients. STA-MCA bypass with EDMS is safe and effective for the management of pediatric MMD and provides long-term favorable outcomes. Perioperative care with blood pressure control combined with the administration of aspirin may reduce the potential risk of surgical complications.

  6. Iron chelation with deferasirox for the treatment of secondary hemosiderosis in pediatric oncology patients: a single-center experience.

    Science.gov (United States)

    Ktena, Yiouli P; Athanasiadou, Anastasia; Lambrou, George; Adamaki, Maria; Moschovi, Maria

    2013-08-01

    Pediatric oncology patients are often iron overloaded, due to the multiple blood transfusions necessary during the course of chemotherapy. Our aim is to report the efficacy and safety of deferasirox, an oral iron chelator, in this patient group. Deferasirox was administered to 13 children with malignancies in remission and iron overload. Ferritin, blood urea nitrogen, creatinine, transaminases, and bilirubin were recorded at 4- to 8-week intervals, and hepatic and cardiac iron overload were assessed with magnetic resonance imaging before initiation of treatment. Deferasirox was administered for an average of 6 months (SD=4.5; range, 0.3 to 18.2). Two children presented with skin rash, 1 with gastrointestinal disturbances, and 1 with fully reversible acute renal failure. The mean monthly rate of change in ferritin levels was -10.8 μg/L before initiation of treatment (95% confidence interval [CI], -19.8 to -1.8; P=0.02) and -93.6 μg/L during deferasirox treatment (95% CI, -118.1 to -69.1; PDeferasirox was effective in reducing the iron burden. The adverse effects were easily monitored and managed. Further studies are warranted to investigate the effect of deferasirox on mortality and morbidity in this population.

  7. The effects of the addition of a pediatric surgery fellow on the operative experience of the general surgery resident.

    Science.gov (United States)

    Raines, Alexander; Garwe, Tabitha; Adeseye, Ademola; Ruiz-Elizalde, Alejandro; Churchill, Warren; Tuggle, David; Mantor, Cameron; Lees, Jason

    2015-06-01

    Adding fellows to surgical departments with residency programs can affect resident education. Our specific aim was to evaluate the effect of adding a pediatric surgery (PS) fellow on the number of index PS cases logged by the general surgery (GS) residents. At a single institution with both PS and GS programs, we examined the number of logged cases for the fellows and residents over 10 years [5 years before (Time 1) and 5 years after (Time 2) the addition of a PS fellow]. Additionally, the procedure related relative value units (RVUs) recorded by the faculty were evaluated. The fellows averaged 752 and 703 cases during Times 1 and 2, respectively, decreasing by 49 (P = 0.2303). The residents averaged 172 and 161 cases annually during Time 1 and Time 2, respectively, decreasing by 11 (P = 0.7340). The total number of procedure related RVUs was 4627 and 6000 during Times 1 and 2, respectively. The number of cases logged by the PS fellows and GS residents decreased after the addition of a PS fellow; however, the decrease was not significant. Programs can reasonably add an additional PS fellow, but care should be taken especially in programs that are otherwise static in size.

  8. Longitudinal electroencephalographic (EEG) findings in pediatric anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis: the Padua experience.

    Science.gov (United States)

    Nosadini, Margherita; Boniver, Clementina; Zuliani, Luigi; de Palma, Luca; Cainelli, Elisa; Battistella, Pier Antonio; Toldo, Irene; Suppiej, Agnese; Sartori, Stefano

    2015-02-01

    To contribute to characterize electroencephalographic (EEG) activity in pediatric anti-N-methyl-d-aspartate (anti-NMDA) receptor encephalitis, we reviewed electroclinical data of 5 children with anti-NMDA receptor encephalitis diagnosed in our department. We identified 4 longitudinal electroencephalographic phases: in the early phase, background activity was normal, with intermixed nonreactive slow waves; in the florid phase, background activity deteriorated with appearance of sequences of peculiar rhythmic theta and/or delta activity unrelated to clinical changes, unresponsive to stimuli and antiepileptic medications; in the recovery phase, these sequences decreased and reactive posterior rhythm re-emerged; electroencephalogram normalized 2 to 5 months after onset. In conclusion, in the presence of evocative clinical history, recognizing a characteristic longitudinal electroencephalographic activity could provide ancillary aspects addressing the diagnosis and the overall management of children with anti-N-methyl-d-aspartate receptor encephalitis; in particular, knowing that peculiar and recurrent paroxysmal nonepileptic rhythmic theta-delta patterns can occur in these patients could help distinguish paroxysmal epileptic and nonepileptic electroencephalographic activity.

  9. Pediatric anti-N-methyl-D-aspartate (NMDA) receptor encephalitis: experience of a tertiary care teaching center from north India.

    Science.gov (United States)

    Chakrabarty, Biswaroop; Tripathi, Manjari; Gulati, Sheffali; Yoganathan, Sangeetha; Pandit, Awadh Kishore; Sinha, Aditi; Rathi, Bhim Singh

    2014-11-01

    Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is characterized by acute- or subacute-onset encephalopathy with extrapyramidal, psychiatric, and epileptic manifestations. Diagnosis is confirmed by positive antibodies to NMDA receptor in cerebrospinal fluid and serum. Eleven pediatric cases presented over a 2-year period at a tertiary care teaching hospital in North India. The average age at presentation was 9 years (range: 2.5 to 18 years, median: 10 years) with a slight female predominance (1.2:1). The common modes of presentation were progressive extrapyramidal syndrome with global neuroregression in 45% (5 of 11), epileptiform encephalopathy in 27% (3 of 11), and an overlap between the 2 in 27% (3 of 11). Fifty-eight percent showed significant response to steroids and intravenous immunoglobulin. This entity should be considered in an acute- or subacute-onset encephalopathy if common infectious etiologies are ruled out and there are specific clinical pointers. Early diagnosis and treatment significantly improves the outcome.

  10. Thermal energy storage in aquifiers: preliminary information

    Energy Technology Data Exchange (ETDEWEB)

    Allen, R.D.

    1979-12-01

    Topics discussed include: conceptual designs; numerical modelling; field experiments; relevant technical information; feasibility studies; preliminary aquifer selection considerations; and preliminary design and operating considerations. (TFD)

  11. Neuroendoscopia pediátrica: análisis preliminar de los primeros 32 casos Pediatric neuroendoscopy: preliminary analysis of the first 32 cases

    Directory of Open Access Journals (Sweden)

    Luis Alonso Fernández

    2008-03-01

    y disminuyó el rango de complicaciones, con lo cual la estadía hospitalaria fue considerablemente más cortaINTRODUCTION. The endoscopic techniques have been used more frequently in the last years, which is associated with the development of new lens and cameras. In neurosurgery, they are used for the treatment of non-communicating hydrocephaly, biopsy of the intraventricular tumors and the fenestration of intracranial cysts, among other multiple indications. METHODS. This procedure was carried out in "Juan Manuel Márquez" Pediatric Teaching Hospital from August 2003 to August 2005. The patients were 32 children between 6 days and 15 years old. The basic surgical technique was applied through a hole made by frontal trephination that allowed the access to the ventricular system and the performance of the procedure depending on the diagnosis. The patients were followed up and evaluated by computerized axial tomography at 3, 6 and 12 postoperative months. RESULTS. The patients treated mainly suffered from hydrocephaly and intracranial tumors and cysts. The age group 10-15 (13 children, 40 % predominated. 8 patients were under 1, accounting for 28 % of the total. The most common aetiology was the non-communicating hydrocephaly, which in 15 patients was secondary to an aqueductal stenosis. The most frequent endoscopic procedure was the premammillary ventriculostomy of the third ventricle. It was possible to carry out the communication procedure and the patients's symptoms decreased. The postoperative evolution was successful in 27 patients (84 % and only 5 patients (16 % did not resolve. The method did not produce severe complications. CONCLUSIONS. The neuroendoscopy proved to be an alternative to the derivations in certain patients, specially in children with non-communicating hydrocephaly. It allowed a significant reduction of the expenses in derivative systems and diminished the range of complications, with which the length of hospital stay was considerably shorter

  12. Case report of LCP pediatric hip osteosynthesis of a proximal ...

    African Journals Online (AJOL)

    Case report of LCP pediatric hip osteosynthesis of a proximal femoral ... Pan African Medical Journal ... We present a case report demonstrating the experience of the department of pediatric orthopaedics of the University Orthopedic Hospital at ...

  13. Immediate conversion to CAS after neurological intolerance at cross-clamping test during CEA: a preliminary experience.

    Science.gov (United States)

    Guy Bianchi, P; Tolva, V; Dalainas, I; Bertoni, G; Cireni, L; Trimarchi, S; Rampoldi, V; Casana, R

    2012-02-01

    The aim of this preliminary study is to evaluate the feasibility and efficacy of CAS as treatment option to endarterectomy when carotid shunt cannot be used safely. The medical records concerning 469 carotid stenosis treated between January 2006 and December 2009 were retrospectively reviewed, focusing on cross-clamp intolerance during CEA. Patients with cross-clamping intolerance were divided in two groups. Group 1: those that concluded the open procedure with the use of a shunt, and Group 2: those who experience immediate brain intolerance and coma and were immediately converted to an endovascular procedure. Mortality and neurological adverse event rate were compared between shunted CEA and cross-clamping intolerant cases converted into CAS. The secondary end-point was long-term survival. Carotid cross-clamp intolerance occurred in 30 cases (8.7%). CEA with Pruitt-Inahara's shunt was performed in 17 cases with a perioperative neurological adverse event rate of 23.5%. In 13 cases limitations to shunting due to quick onset of coma and/or an unfavorable anatomy were encountered. In these 13 cases the open intervention was immediately converted into endovascular procedure. Technical success was achieved in all the converted to CAS cases (100%), with a perioperative neurological adverse event rate of 7.7% (P=0.35 between the two groups). No significant difference emerges comparing patient's survival between the cases Nevertheless, the small dimension of this survey, immediate conversion to CAS resulted feasible with a lower risk of neurological adverse events if compared to CEA with shunt, and could be considered as an alternative to CEA when carotid shunt cannot be used safely.

  14. Production of microspheres labeled with holmium-166 for liver cancer therapy: the preliminary experience at IPEN/CNEN-SP

    Energy Technology Data Exchange (ETDEWEB)

    Costa, Renata F.; Azevedo, Mariangela B.M.; Nascimento, Nanci; Sene, Frank F.; Martinelli, Jose R.; Osso Junior, Joao A., E-mail: renatafcosta@usp.b [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil)

    2009-07-01

    Microspheres labeled with therapeutic radionuclides for malignancies of liver are widely used in many countries. The internal radionuclide therapy uses a permanently implanted device, such as Therasphere{sup R} or SIR-Spheres{sup R}, or a biodegradable device that provides structural support for the radionuclide of choice and causes the tumor reduction. Three different types of material supports have been investigated, i.e., biodegradable polymer-based, glass-based and resin-based microspheres. Nowadays there is a project concerning the labeling of these 3 materials with {sup 166}Ho being developed at IPEN-CNEN/SP and coordinated by the Radiopharmacy Directory. {sup 166}Ho(t{sub 1/2}=26.8 h) is a beta minus emitter (E{sub max}=1.84 MeV), with right properties for radiotherapy and can be produced with the low power Brazilian Nuclear Reactor IEA-R1m. The aim of this work is to describe the stage of development of this project. The initial experience used resin-based microspheres, a cation exchange resin labeled with {sup 166}Ho, it showed the essential characteristics for liver therapy. Preliminary results of the preparation of glass-based microspheres labeled with {sup 165}Ho showed that 5% of Ho{sub 2}O{sub 3} was incorporated in an aluminosilicate glass, through the process of spheronization by flame, which produced spherical microspheres with 20-40mum particle size. The preparation of biodegradable material, polymer-based microspheres, is in its initial stage and the objective is to prepare and label with {sup 165}Ho different polymer-based microspheres. These combined efforts have been done to offer a national radiotherapeutic product for the the Brazilian nuclear medicine community at fair value and also to offer a viable possibility of treatment for patients affected by liver malignancies. (author)

  15. Serodiagnosis of celiac disease in children referred for evaluation of anemia: A pediatric hematology unit′s experience

    Directory of Open Access Journals (Sweden)

    Deepak Bansal

    2011-01-01

    Full Text Available Background: Children presenting with typical clinical features of celiac disease (CD are diagnosed relatively easily, however, diagnosis remains challenging and is often delayed when they present with ′difficult to treat anemia′ without overt gastrointestinal manifestations. Index study was undertaken to report profile of patients referred to pediatric hematology unit with ′difficult anemia′ who subsequently were diagnosed with CD. Materials and Methods: The records of 83 patients (1988-2008 with CD were scrutinized retrospectively who had presented with predominant hematological manifestations. Results: CD was confirmed histologically in 31 (37%, while 52 (63% were diagnosed by serology alone. The mean age at diagnosis was 8.0 ± 2.8 years. The mean duration of symptom-diagnosis interval was 40.9 ± 30.6 months. Eighty-one (98% children had anemia (Hb < 11 g/dl and 55 (66% had received iron supplements without discernible benefit. Thirty-nine (47% patients received a blood transfusion. Thirty-six (43% patients did not have diarrhea. Majority of the patients had either a microcytic-hypochromic (48% or dimorphic (43% anemia. Twenty-four (33% had thrombocytosis, while 5 (7% had thrombocytopenia. Mean duration of follow-up for patients on roll in the clinic for more than six months was 17.7 ± 20.9 months. Conclusion: Pediatricians and hematologists need to be aware of the extra-intestinal manifestations of CD. Prolonged duration of symptoms and a diagnosis at a relatively older age is striking in children presenting with predominantly hematological manifestations. Investigations for CD are recommended in children presenting with iron deficiency anemia refractory to hematinics or who have coexisting growth retardation. Necessity for biopsy in overtly symptomatic cases is discussed.

  16. Evaluation of antivenom therapy for Vipera palaestinae bites in children: experience of two large, tertiary care pediatric hospitals.

    Science.gov (United States)

    Pivko-Levy, Dikla; Munchnak, Itamar; Rimon, Ayelet; Balla, Uri; Scolnik, Dennis; Hoyte, Christopher; Voliovitch, Yair; Glatstein, Miguel

    2017-04-01

    Antivenom has been successfully used to treat systemic and progressive, local manifestations of envenomation inflicted by Vipera (V.) palaestinae, the most common venomous snake in Israel. The objective of this study was to evaluate the fixed dose V. palaestinae monovalent (equine) immunoglobulin G antivenom used in two pediatric emergency departments. In particular, we wanted to assess the need for repeated antivenom administration and the rate of adverse antivenom effects in children. A retrospective chart review was performed for all children admitted with definite or probable signs of V. palaestinae envenomation to Chaim Sheba Medical Center and Kaplan Medical Center between 1 March 2008 and 1 March 2014. Extracted data included: age, location of bite, time to hospital arrival, time to antivenom administration if indicated, outcomes, and complications of the envenomation and adverse effects to the antivenom. 57 patients met inclusion criteria; they ranged from 1 to 17 years in age and median age was 9.5 years. Clinical manifestations were evident in 55 (96.4%) of victims: 18 presented with minimal local signs and 37 showed marked progressive, local features (rapidly progressing edema) and signs of systemic envenomation: tachycardia (20), vomiting (17), abdominal pain (11) and hypotension (6). Two patients developed compartment syndrome and underwent surgical decompression (both received only a loading dose of antivenom with no subsequent maintenance dose). One patient developed thrombocytopenia and three patients presented with mild coagulopathy. Antivenom was administered to 25 (42%) children. Indications for antivenom administration included moderate to severe local signs (19 patients) and systemic signs (6 patients). None of these patients developed adverse reactions, serum sickness, or other side effects to the antivenom. One patient received a single additional 30mL dose of antivenom, due to hypotension and syncope, with good response. In children, 50

  17. Child Neurology Education for Pediatric Residents.

    Science.gov (United States)

    Albert, Dara V F; Patel, Anup D; Behnam-Terneus, Maria; Sautu, Beatriz Cunill-De; Verbeck, Nicole; McQueen, Alisa; Fromme, H Barrett; Mahan, John D

    2017-03-01

    The aim of this study was to evaluate whether the current state of child neurology education during pediatric residency provides adequate preparation for pediatric practice. A survey was sent to recent graduates from 3 pediatric residency programs to assess graduate experience, perceived level of competence, and desire for further education in child neurology. Responses from generalists versus subspecialists were compared. The response rate was 32%, half in general pediatric practice. Only 22% feel very confident in approaching patients with neurologic problems. This may represent the best-case scenario as graduates from these programs had required neurology experiences, whereas review of Accreditation Council of Graduate Medical Education-accredited residency curricula revealed that the majority of residencies do not. Pediatric neurologic problems are common, and pediatric residency graduates do encounter such problems in practice. The majority of pediatricians report some degree of confidence; however, some clear areas for improvement are apparent.

  18. Ethical issues at the interface of clinical care and research practice in pediatric oncology: a narrative review of parents' and physicians' experiences.

    NARCIS (Netherlands)

    Vries, M.C. de; Houtlosser, M.; Wit, J.M.; Engberts, D.P.; Bresters, D.; Kaspers, G.J.L.; Leeuwen, E. van

    2011-01-01

    BACKGROUND: Pediatric oncology has a strong research culture. Most pediatric oncologists are investigators, involved in clinical care as well as research. As a result, a remarkable proportion of children with cancer enrolls in a trial during treatment. This paper discusses the ethical consequences o

  19. Ethical issues at the interface of clinical care and research practice in pediatric oncology: a narrative review of parents' and physicians' experiences.

    NARCIS (Netherlands)

    Vries, M.C. de; Houtlosser, M.; Wit, J.M.; Engberts, D.P.; Bresters, D.; Kaspers, G.J.L.; Leeuwen, E. van

    2011-01-01

    BACKGROUND: Pediatric oncology has a strong research culture. Most pediatric oncologists are investigators, involved in clinical care as well as research. As a result, a remarkable proportion of children with cancer enrolls in a trial during treatment. This paper discusses the ethical consequences

  20. Ethical issues at the interface of clinical care and research practice in pediatric oncology: a narrative review of parents' and physicians' experiences.

    NARCIS (Netherlands)

    Vries, M.C. de; Houtlosser, M.; Wit, J.M.; Engberts, D.P.; Bresters, D.; Kaspers, G.J.L.; Leeuwen, E. van

    2011-01-01

    BACKGROUND: Pediatric oncology has a strong research culture. Most pediatric oncologists are investigators, involved in clinical care as well as research. As a result, a remarkable proportion of children with cancer enrolls in a trial during treatment. This paper discusses the ethical consequences o

  1. [Celiac disease and its diagnostic evolution. Comparisons and experiences in a hospital pediatric department (1975-1992). I].

    Science.gov (United States)

    Della Morte, M A; Sala, M R; Morelli, P; Meschi, V; Silva, A; Valli, F

    1992-01-01

    The coeliac disease (CD) or gluten-sensitive enteropathy (GSE) is a permanent intolerance to wheat gliadin and to correlated proteins inducing malabsorption and typical damages of the jejunal mucosa (total or subtotal villous atrophy = SVA) in genetically-predisposed individuals ("DQW2"). A large amount of research has been devoted to CD pathogenesis: the most recent studies, thanks to sophisticated and experimental methods, support the pathogenetic immunological theory and the one of direct cytotoxicity. The correct diagnostic procedure for CD, established in 1970 by the European Society for Pediatric Gastroenterology and Nutrition (ESPGAN), suggested three small bowel mucosal biopsies. In the last years, because of the difficulties of such a practice, the necessity of non-invasive diagnostic approaches has developed; such approaches have been verified in absorption tests (one-hour blood xylose, intestinal permeability methods) and in immunogenetic tests (antibodies antigliadin, anti-reticulin, anti-endomysium, anti 90 KD glycoprotein, anti-human jejunum, HLA I/II antigens). The specific MHC antigens establish CD's incidence in several population and in particular situations, as in first-degree relatives and in diseases associated with CD (dermatitis herpetiformis (DH), insulin dependent diabetes mellitus (IDDM) and other auto-immune syndromes). The specific serum antibodies singly used as first level screening if estimated in combination with absorption tests, reach the highest levels of specificity and sensibility in CD diagnosis. It's anyway fundamental the comparison with at least a typical CD histological feature, caused by a challenge with a sufficient gluten to be carried in dubious cases and in non high auxological risk age (ESPGAN 1989). Adolescence is a period of frequent non compliance with a gluten-free diet and of particular psychological and physical problems: the apparent "gluten insensitivity", typical of teen-agers and adults, recalls the

  2. Chloral hydrate in pediatric magnetic resonance imaging: evaluation of a 10-year sedation experience administered by radiologists

    Energy Technology Data Exchange (ETDEWEB)

    Delgado, Jorge; Toro, Rodrigo; Rascovsky, Simon; Arango, Andres; Angel, Gabriel J.; Calvo, Victor; Delgado, Jorge A. [Fundacion Instituto de Alta Tecnologia Medica, Department of Radiology, Medellin (Colombia)

    2014-08-21

    Chloral hydrate is a sedative that has been used for magnetic resonance imaging (MRI). To evaluate the use, effectiveness and safety of chloral hydrate administered by radiologists for the sedation of children who require MRI procedures. We retrospectively reviewed the clinical charts for all patients ages 0 - 10 years old who underwent sedation with chloral hydrate for MRI from January 2000 to December 2010. Demographic factors, dose information, indication for MRI, therapeutic failures and adverse reactions to the drug were reviewed. One thousand, seven hundred and three children (946 males, 757 females) with a median age of 2.5 years (range: 4 days - 9.91 years) received chloral hydrate. Moderate to deep sedation was achieved in 1,618/1,703 (95%) of the patients, 35/1,703 (2.1%) of the patients failed to achieve moderate to deep sedation, and 47/1,703 (2.8%) of the patients woke up during MRI examination. Adverse reactions were present in 31/1,703 (1.8%) of the patients. Three severe adverse reactions occurred (0.18%). A single dose of chloral hydrate (40-60 mg/kg) was administered to 1,477/1,703 patients (86.7%). An additional dose of chloral hydrate (10-20 mg/kg), given 15 min after the first dose or when the patient woke up during the MRI examination, was required in 226/1,703 patients (13.3%). The likelihood of requiring an additional dose in children older than 2 years was 2.2 times the likelihood compared to children younger than 2 years (OR = 2.2 [95%CI: 1.6-3.0]). The use of a reduced dose (<50 mg/kg) was not associated with a higher therapeutic failure rate (OR = 1.04 [95%CI 0.57-1.89]). Chloral hydrate is an appropriate sedation option for pediatric patients in MRI services when strict patient selection criteria are met. The use of a reduced dose does not affect the effectiveness of sedation. The lack of data regarding the presence of transient oxygen desaturation, the time to induce sedation and the exact duration of sedation are limitations of this

  3. Experience of 23 cases of pediatric heart transplantation%儿童心脏移植23例的经验

    Institute of Scientific and Technical Information of China (English)

    陈思; 董念国; 王博; 刘金平; 苏伟; 蔡杰; 张菁

    2016-01-01

    目的 总结23例儿童心脏移植的临床经验.方法 回顾性分析2008年9月至2015年12月单中心实施的23例儿童心脏移植的资料,重点对适应证、术后并发症及存活率加以分析.结果 23例患儿行心脏移植,其中男性12例,女性11例.患儿行心脏移植时年龄为3个月至18岁(年龄中位数为14岁),体重为5.2~57.0 kg(体重中位数为36.0 kg).术前诊断为包括心肌病16例(69.6%),先天性心脏病5例(21.7%),心脏肿瘤2例(8.7%).受者均接受ABO血型相同或相容供心.免疫抑制方案为采用钙调磷酸酶抑制剂+吗替麦考酚酯+泼尼松.术后14例发生并发症,包括心功能不全4例,心律失常2例,肺部感染6例,肾功能不良2例,排斥反应3例;2例受者出现心功能衰竭,需要体外膜肺氧合辅助.患者术后均康复出院,射血分数大于50%,随访期间仅1例受者于术后19个月死亡.结论 心脏移植治疗儿童终末期心脏病是安全、有效的,应注意选择合适的供、受者,加强术中操作和术后的管理,积极预防并发症,以提高受者存活率.%Objective Although heart transplantation (HTx) has become a standard therapy for end-stage heart diseases,experience with pediatric HTx is limited in China.In this article,we will try to provide the experience with indications,complications,perioperative management,immunosuppressive therapy,and survival for pediatric HTx based on our clinical work.Method This is a retrospective chart review of the pediatric patients undergoing HTx at Department of Cardiovascular Surgery of Union Hospital from September 2008 to December 2015.We summarized the indications,surgical variables,postoperative complications,and survival for these patients.Result Twenty-three pediatric patients presented for HTx at Union Hospital of Tongji Medical College,of whom 12 were male.The age at the time of transplantation ranged from 3 months to 18years (median 14 years).Patient weight ranged from 5.2 kg to 57

  4. Recommended Curriculum for Training in Pediatric Transplant Infectious Diseases.

    Science.gov (United States)

    Danziger-Isakov, Lara; Allen, Upton; Englund, Janet; Herold, Betsy; Hoffman, Jill; Green, Michael; Gantt, Soren; Kumar, Deepali; Michaels, Marian G

    2015-03-01

    A working group representing the American Society of Transplantation, Pediatric Infectious Diseases Society, and International Pediatric Transplant Association has developed a collaborative effort to identify and develop core knowledge in pediatric transplant infectious diseases. Guidance for patient care environments for training and core competencies is included to help facilitate training directed at improving the experience for pediatric infectious diseases trainees and practitioners in the area of pediatric transplant infectious diseases. © The Author 2013. Published by Oxford University Press on behalf of the Pediatric Infectious Diseases Society. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  5. Pediatric mature B-cell non Hodgkin lymphoma treatment with LMB-96 protocol. The Children Cancer Hospital Egypt experience

    Directory of Open Access Journals (Sweden)

    Hany Abdel Rahman

    2015-01-01

    22.1% respectively. BM-/CNS+ patients had OS 72.4%±18.8% and EFS 67.6%±19.7% at 36 months. Conclusion: TLS and chemotherapy related toxicity remains a major challenge affecting the outcome of pediatric mature B cell NHL. We identified bone marrow involvement as a risk factor affecting treatment outcome. Aggressive supportive care measures are mandatory to avoid unacceptable high toxicity related mortality.

  6. Pediatric cardiology. Clinical and practical experiences with heart diseases of children, juveniles and young adults; Kinderkardiologie. Klinik und Praxis der Herzerkrankungen bei Kindern, Jugendlichen und jungen Erwachsenen

    Energy Technology Data Exchange (ETDEWEB)

    Haas, Nikolaus A. [Herz- und Diabeteszentrum NRW, Bad Oeynhausen (Germany). Klinik fuer angeborene Herzfehler; Kleideiter, Ulrich [Klinik fuer Kinder- und Jugendmedizin, Coesfeld (Germany)

    2011-07-01

    The book on pediatric cardiology covers the following chapters: (I) Fundamentals and diagnostics: pediatric cardiologic anamnesis, electrocardiograms, thorax X-radiography, MRT and CT of the heart, nuclear medical diagnostics, exercise tests, heart catheter examination, electrophysiological tests. (II) Leading symptoms: Cyanosis, cardiac murmur, thorax pain, palpitation, syncopes. (III) Disease pictures: congenital heart defects, acquired heart defects, cardiomyopathies, heart rhythm disturbances, heart insufficiency, arterial hypertension, pulmonary hypertension, other heart involving syndromes. (IV) Therapy: Catheter interventional therapy, post-surgical pediatric cardiac therapy, surgery involving the life-support machine, mechanical cardiovascular support systems, initial treatment of newborns with critical heart defects, heart transplantation, vaccination of children with heart diseases, medicinal therapy.

  7. The outcome of patients with renal involvement in pediatric-onset systemic lupus erythematosus--a 20-year experience in Asia.

    Science.gov (United States)

    Lee, P-Y; Yeh, K-W; Yao, T-C; Lee, W-I; Lin, Y-J; Huang, J-L

    2013-12-01

    Systemic lupus erythematosus (SLE) predominantly affects women of childbearing age, but 15-20% of cases are diagnosed during childhood. It is important for physicians to understand the epidemiology and clinical presentation for early detection and diagnosis of this disease in difference races. The aim of this retrospective review was to provide a 20-year experience for initial clinical and laboratory manifestations and outcomes in pediatric-onset SLE (pSLE) in a medical center in Asia. We reviewed medical records between April 1990 and June 2012 of patients with a diagnosis of International Classification of Diseases, Ninth Revision (ICD-9) code 710.0 (SLE), who admitted or received follow-up in the Department of Pediatrics at Chang Chung Memorial Hospital. Patients with a diagnosis of SLE prior to their 18th birthday and followed up at our hospital were eligible for inclusion in this study. Medical records regarding age, gender, date of birth and diagnosis, clinical manifestations at diagnosis, laboratory results, image studies and the classification criteria were reviewed. Patients received regular outpatient department follow-up and laboratory survey every 1-6 months. The study cohort consisted of 189 patients; 164 females (86.87%) and 25 males (13.23%). The overall mean age at pSLE diagnosis was 12.62 ± 2.77 years. The most common clinical symptom was malar rash, followed by arthritis and oral ulcers. There was no significant difference in clinical and laboratory manifestations between females and males. More than half of the patients presented with renal involvement initially. The most common histological finding was Class IV lupus nephritis (LN), especially in males (p = 0.034) and young age. Even with severe LN, the rate of end-stage renal disease (ESRD) was low if adequate treatment was initiated. The 5, 10 and 15-year ESRD-free survival rates were 95.4%, 94.0% and 89.9% in patients with biopsy-proven LN. However, infection was the leading cause of

  8. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... Resources Professions Site Index A-Z Children's (Pediatric) Nuclear Medicine Children’s (pediatric) nuclear medicine imaging uses small ... of Children's Nuclear Medicine? What is Children's (Pediatric) Nuclear Medicine? Nuclear medicine is a branch of medical ...

  9. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... News Physician Resources Professions Site Index A-Z Children's (Pediatric) Nuclear Medicine Children’s (pediatric) nuclear medicine imaging ... the limitations of Children's Nuclear Medicine? What is Children's (Pediatric) Nuclear Medicine? Nuclear medicine is a branch ...

  10. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... Resources Professions Site Index A-Z Children's (Pediatric) Nuclear Medicine Children’s (pediatric) nuclear medicine imaging uses small ... of Children's Nuclear Medicine? What is Children's (Pediatric) Nuclear Medicine? Nuclear medicine is a branch of medical ...

  11. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... Physician Resources Professions Site Index A-Z Children's (Pediatric) Nuclear Medicine Children’s (pediatric) nuclear medicine imaging uses ... limitations of Children's Nuclear Medicine? What is Children's (Pediatric) Nuclear Medicine? Nuclear medicine is a branch of ...

  12. Pediatric heart surgery - discharge

    Science.gov (United States)

    ... discharge; Heart valve surgery - children - discharge; Heart surgery - pediatric - discharge; Heart transplant - pediatric - discharge ... Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; 2016:chap 434. ...

  13. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... Professions Site Index A-Z Children's (Pediatric) Nuclear Medicine Children’s (pediatric) nuclear medicine imaging uses small amounts ... Children's Nuclear Medicine? What is Children's (Pediatric) Nuclear Medicine? Nuclear medicine is a branch of medical imaging ...

  14. Pediatric sleep apnea

    Science.gov (United States)

    Sleep apnea - pediatric; Apnea - pediatric sleep apnea syndrome; Sleep-disordered breathing - pediatric ... During sleep, all of the muscles in the body become more relaxed. This includes the muscles that help keep ...

  15. Children's (Pediatric) Nuclear Medicine

    Science.gov (United States)

    ... Professions Site Index A-Z Children's (Pediatric) Nuclear Medicine Children’s (pediatric) nuclear medicine imaging uses small amounts ... Children's Nuclear Medicine? What is Children's (Pediatric) Nuclear Medicine? Nuclear medicine is a branch of medical imaging ...

  16. Parental experience of family stress during hematopoietic stem cell transplantation of pediatric patients in germ-free isolation in Taiwan.

    Science.gov (United States)

    Wu, Jane; Mu, Pei-Fan; Tsay, Shiow-Luan; Chiou, Tzeon-Jye

    2005-01-01

    This qualitative inquiry study used convenience sampling through in-depth interviews to obtain life experiences and feelings of parents while their children underwent hematopoietic stem cell transplantation. Eleven parents of children younger than 18 years undergoing hematopoietic stem cell transplantation in a medical center in north Taiwan consented to participate in this study and provide oral and written responses in Mandarin or Taiwanese. Semistructured interviews lasting 60 minutes were conducted privately and audiotaped. Verbatim transcriptions of the interviews were examined by the content analysis method. The trustworthiness of the data was examined by Lincoln and Guba (Naturalistic Inquiry. Newbury Park, Calif: Sage; 1985) principles. Results indicated that family stress experiences of parents of children undergoing hematopoietic stem cell transplants include 4 themes: parental psychological distress, family lifestyle disturbances, parents' coping patterns, and family resources. The results of this study provide evidence of the nature of parents' experiences while their children undergo hematopoietic stem cell transplantation and provide guidelines for family-centered nursing care.

  17. Pandemic Influenza Pediatric Office Plan Template

    Energy Technology Data Exchange (ETDEWEB)

    HCTT CHE

    2010-01-01

    This is a planning tool developed by pediatric stakeholders that is intended to assist pediatric medical offices that have no pandemic influenza plan in place, but may experience an increase in patient calls/visits or workload due to pandemic influenza.

  18. Pediatric tracheostomy.

    Science.gov (United States)

    Campisi, Paolo; Forte, Vito

    2016-06-01

    Tracheotomy refers to a surgical incision made into a trachea. Tracheostomy, on the other hand, refers to a surgical procedure whereby the tracheal lumen is positioned in close proximity to the skin surface. Tracheostomy is an uncommon procedure in the pediatric population. When required tracheostomy is typically performed as an open surgical procedure under general anesthesia with the patient intubated. However, it may need to be performed under local anesthesia or over a rigid bronchoscope in the patient with a precarious airway. Over the past half century, the primary indication for pediatric tracheostomy has shifted from acute infectious airway compromise to the need for prolonged ventilatory support in neurologically compromised children. The surgical technique, choice of tracheostomy tube, and post-operative care requires a nuanced approach in infants and young children. This article will review these topics in a comprehensive fashion. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Pediatric biobanking

    DEFF Research Database (Denmark)

    Salvaterra, Elena; Giorda, Roberto; Bassi, Maria T

    2012-01-01

    and data handling, and return of results as faced in 10 European countries. Because of the lack of comparative analyses of these topics, a pilot study was designed. Following a qualitative methodology, a questionnaire draft mostly including open-ended queries was developed, tested, and sent by e...... their own choices (n=26). Based on the collected data, dedicated recommendations are needed to govern unique ethical and regulatory issues surrounding pediatric biobanking.......Ethical, legal, and social issues related to the collection, storage, and use of biospecimens and data derived from children raise critical concerns in the international debate. So far, a number of studies have considered a variety of the individual issues crucial to pediatric biobanking...

  20. Pediatric parasomnias.

    Science.gov (United States)

    Mason, Thornton B A; Pack, Allan I

    2007-02-01

    Parasomnias in childhood are common, and often more frequent than in adults. The large number of parasomnias underscore that sleep is not simply a quiescent state, but can involve complex episodes of movement, ranging from subtle to dramatic and complex. Clinicians should be aware that many pediatric parasomnias are benign, self-limited, and may not persist into late childhood or adolescence. Importantly, parasomnias in childhood often differ in type from adults. Nevertheless, parasomnias across ages can be classified as: 1) disorders of arousal (from non-rapid eye movement, or NREM, sleep); 2) parasomnias usually associated with REM sleep; and 3) other parasomnias. We detail here issues in the clinical diagosis, evaluation, and management of multiple pediatric parasomnias. The further study of parasomnias in children may help elucidate the multi-factorial etiologies of these fascinating conditions, shedding light on the potential genetic bases as well as environmental contributions.

  1. Outcome of Single Kidney Transplant From Pediatric Donors Younger Than 5 Years of Age After Cardiac Death in China: A Single Center Experience.

    Science.gov (United States)

    Wang, Yaomin; Lv, Junhao; Xie, Wenqing; Huang, Hongfeng; Peng, Wenhan; Wu, Jianyong; Chen, Jianghua

    2015-06-01

    This study was conducted to evaluate the outcomes of single kidney transplant from pediatric donors in China younger than 5 years old after cardiac death. We retrospectively reviewed single renal transplants from pediatric donors of cardiac death between January 2012 and June 2013 at the First Affiliated Hospital of Zhejiang University, China. Eleven recipients received single kidney transplant from 6 pediatric donors of cardiac death donors at our center (aged, transplant. No episodes of acute rejection occurred. No vascular thrombosis or stenosis after ureteroneocystostomy was seen. One patient had urine leakage on the eighth day after transplant, and was cured through a ureter reimplantation. The graft size increased significantly the first month after transplant compared with that recorded immediately after reperfusion (P = .011). The 1-year patient/graft survival was 100%. Use of single kidney from pediatric donors after cardiac death (aged, < 5 y) is a safe and effective procedure and can greatly expand the donor pool.

  2. Development of a Pediatric Visual Field Test.

    Science.gov (United States)

    Miranda, Marco A; Henson, David B; Fenerty, Cecilia; Biswas, Susmito; Aslam, Tariq

    2016-12-01

    We describe a pediatric visual field (VF) test based on a computer game where software and hardware combine to provide an enjoyable test experience. The test software consists of a platform-based computer game presented to the central VF. A storyline was created around the game as was a structure surrounding the computer monitor to enhance patients' experience. The patient is asked to help the central character collect magic coins (stimuli). To collect these coins a series of obstacles need to be overcome. The test was presented on a Sony PVM-2541A monitor calibrated from a central midpoint with a Minolta CS-100 photometer placed at 50 cm. Measurements were performed at 15 locations on the screen and the contrast calculated. Retinal sensitivity was determined by modulating stimulus in size. To test the feasibility of the novel approach 20 patients (4-16 years old) with no history of VF defects were recruited. For the 14 subjects completing the study, 31 ± 15 data points were collected on 1 eye of each patient. Mean background luminance and stimulus contrast were 9.9 ± 0.3 cd/m(2) and 27.9 ± 0.1 dB, respectively. Sensitivity values obtained were similar to an adult population but variability was considerably higher - 8.3 ± 9.0 dB. Preliminary data show the feasibility of a game-based VF test for pediatric use. Although the test was well accepted by the target population, test variability remained very high. Traditional VF tests are not well tolerated by children. This study describes a child-friendly approach to test visual fields in the targeted population.

  3. Puberdade precoce: a experiência de um ambulatório de Ginecologia Infanto-Puberal Precocious puberty: the experience of o Pediatric and Adolescent Gynecology Clinic

    Directory of Open Access Journals (Sweden)

    Márcia Neves de Carvalho

    2007-02-01

    Full Text Available OBJETIVO: avaliar os casos com suspeita de puberdade precoce, em relação à classificação diagnóstica e etiológica, atendidos no período compreendido entre os anos de 2000 e 2005. MÉTODOS: foram revisados os prontuários de 58 pacientes com suspeita diagnóstica de puberdade precoce atendidas no período compreendido entre os anos de 2000 e 2005 para análise de dados relevantes. Os critérios de inclusão foram desenvolvimento de mamas e/ou pêlos pubianos antes dos oito anos de idade. As pacientes foram classificadas de acordo com o quadro clínico e os exames complementares em uma das seguintes categorias: puberdade precoce central (PPC, pseudopuberdade precoce, telarca precoce e pubarca precoce. RESULTADOS: dos 58 casos revisados, 28 tiveram diagnóstico de PPC, um de pseudopuberdade precoce, dez de telarca precoce e 19 de pubarca precoce. Todos os casos de PPC foram de origem idiopática, com exceção de uma paciente em que houve ativação do eixo hipotálamo-hipófise-ovariano secundária a hiperplasia adrenal congênita. Houve um caso com suspeita diagnóstica de pseudopuberdade precoce devido à síndrome de McCune-Albright. Todos os casos de telarca precoce foram de origem idiopática, exceto um caso que foi associado a hipotireoidismo primário. Todos os casos de pubarca precoce foram de origem idiopática. CONCLUSÕES: dentre os casos atendidos com diagnóstico de puberdade precoce no período de cinco anos, o diagnóstico final predominante foi PPC e a grande maioria dos casos foi de origem idiopática, havendo baixa incidência de patologias orgânicas.PURPOSE: to evaluate the classification and the etiology of girls attended in a Pediatric and Adolescent Gynecology Clinic. METHODS: The hospital charts of 58 female patients attended from 2000 to 2005 with diagnosis of probable precocious puberty were reviewed and relevant data analyzed. Inclusion criteria were breast and/or pubic hair growth before eight years old. The

  4. Creating beauty: the experience of a fashion collection prepared by adolescent patients at a pediatric oncology unit.

    Science.gov (United States)

    Veneroni, Laura; Clerici, Carlo Alfredo; Proserpio, Tullio; Magni, Chiara; Sironi, Giovanna; Chiaravalli, Stefano; Roncari, Luisa; Casanova, Michela; Gandola, Lorenza; Massimino, Maura; Ferrari, Andrea

    2015-01-01

    Adolescent patients with cancer need psychological support in order to face the traumatic event of cancer diagnosis and to preserve continuity with their normal lives. Creative projects or laboratories may help young patients express their thoughts and feelings. The Youth Project developed activities dedicated to adolescents to give them a chance to vent their creative spirit and express themselves freely. In the first project, the teenagers designed their own fashion collection in all its various stages under the artistic direction of a well-known fashion designer, creating their own brand name (B.Live), and organized a fashion show. In all, 24 patients from 15 to 20 years old took part in the project. The fashion project proved a fundamental resource in helping the young patients involved to regain a positive self-image and the feeling that they could take action, both on themselves and in their relations with others. Facilitating the experience of beauty may enable hope to withstand the anguish caused by disease. This experience integrated the usual forms of psychological support to offer patients a form of expression and support during the course of their treatment.

  5. [Management of beta-thalassemias in a developing country. Experience of a pediatric service in Oran (Algeria)].

    Science.gov (United States)

    Bouhass, R A; Kabouya, E A; Smahi, C; Benaceur, S M; Aguercif, M

    1992-02-01

    The management of beta-thalassemia in a developing country faces a host of organizational, logistic, and funding problems. Experience acquired against this background of multiple deficiencies is reported here. Only 60% of children with documented beta-thalassemia were monitored more or less regularly. The remaining 40% died or were lost to follow-up. Clinical results were acceptable in terms of growth but transfusion goals (pretransfusion Hb greater than or equal to 10 g/dl) were achieved in only 7% of cases and adverse effects to transfusions proved difficult to prevent. Lastly, funding remained grossly inadequate since only 5.4% of actual costs in drugs and small equipment were covered. This lack of funds has a major impact on decision-making concerning the care of this type of patient.

  6. Pain Experience and Behavior Management in Pediatric Dentistry: A Comparison between Traditional Local Anesthesia and the Wand Computerized Delivery System

    Science.gov (United States)

    D'Antò, Vincenzo; Fauxpoint, Gabriel; De Rosa, Sara; Vallogini, Giulia

    2017-01-01

    Aim. To evaluate the pain experience and behavior during dental injection, using the Wand computerized delivery system versus conventional local anesthesia in children and adolescents. Methods. An observational crossover split mouth study was performed on 67 patients (aged 7 to 15 years), requiring local anesthesia for dental treatments in both sides of the dental arch. Patients received both types of injections in two separate appointments, one with the use of a Computer Delivery System (the Wand STA system) and one with the traditional syringe. The following data were recorded: pain rating; changes in heart rate; level of collaboration; patient satisfaction. The data were analyzed using ANOVA for quantitative outcomes and nonparametric analysis (Kruskal–Wallis) for qualitative parameters. Results. The use of the Wand system determined significantly lower pain ratings and lower increase of heart rate than the traditional syringe. During injection, the number of patients showing a relaxed behavior was higher with the Wand than with the traditional local anesthesia. The patient level of satisfaction was higher with the Wand compared to the conventional local anesthesia. Conclusions. The Wand system may provide a less painful injection when compared to the conventional local anesthesia and it seemed to be better tolerated with respect to a traditional syringe. PMID:28293129

  7. Pain Experience and Behavior Management in Pediatric Dentistry: A Comparison between Traditional Local Anesthesia and the Wand Computerized Delivery System

    Directory of Open Access Journals (Sweden)

    Annelyse Garret-Bernardin

    2017-01-01

    Full Text Available Aim. To evaluate the pain experience and behavior during dental injection, using the Wand computerized delivery system versus conventional local anesthesia in children and adolescents. Methods. An observational crossover split mouth study was performed on 67 patients (aged 7 to 15 years, requiring local anesthesia for dental treatments in both sides of the dental arch. Patients received both types of injections in two separate appointments, one with the use of a Computer Delivery System (the Wand STA system and one with the traditional syringe. The following data were recorded: pain rating; changes in heart rate; level of collaboration; patient satisfaction. The data were analyzed using ANOVA for quantitative outcomes and nonparametric analysis (Kruskal–Wallis for qualitative parameters. Results. The use of the Wand system determined significantly lower pain ratings and lower increase of heart rate than the traditional syringe. During injection, the number of patients showing a relaxed behavior was higher with the Wand than with the traditional local anesthesia. The patient level of satisfaction was higher with the Wand compared to the conventional local anesthesia. Conclusions. The Wand system may provide a less painful injection when compared to the conventional local anesthesia and it seemed to be better tolerated with respect to a traditional syringe.

  8. Respiratory management of pediatric patients with spinal cord injuries: retrospective review of the duPont experience.

    Science.gov (United States)

    Padman, Raj; Alexander, Michael; Thorogood, Christine; Porth, Susan

    2003-03-01

    Pulmonary complications contribute to morbidity and mortality in spinal cord injuries (SCIs). A retrospective review of 20 years of experience with tracheostomy- and ventilator-dependent SCI children is presented. The authors developed and analyzed a database of 47 children (average age = 11.4 years). Of the patients, 27% had concomitant brain injuries, 6% had prior histories of reactive airway disease, and 2% had thoracic fractures. Injuries were caused by motor vehicle accidents (53%); gunshot wounds (19%); sports-related accidents (19%); and vascular injuries, transverse myelitis, or spinal tumors (8%). Of the injuries, 52% were high level (C1 to C2) and 48% were mid- or low level (C3 to C5). Two groups were analyzed for demographic information. Complications included tracheitis, atelectasis, and pneumonia. Mean tidal volume was 14 cm2/kg (maximum = 22 cm2/kg). Bedside lung function parameters were attempted to assess readiness and the rapidity of weans. T-piece sprints were used to successfully wean 63% of patients. Successfully weaned patients were compared with those not weaned. No deaths or readmissions for late-onset respiratory failure postwean occurred. The authors' clinical impression favors higher tidal volumes and aggressive bronchial hygiene to minimize pulmonary complications and enhance weaning. Successfully weaned patients had fewer complications. A critical pathway for respiratory management of SCI children is presented.

  9. Pain Experience and Behavior Management in Pediatric Dentistry: A Comparison between Traditional Local Anesthesia and the Wand Computerized Delivery System.

    Science.gov (United States)

    Garret-Bernardin, Annelyse; Cantile, Tiziana; D'Antò, Vincenzo; Galanakis, Alexandros; Fauxpoint, Gabriel; Ferrazzano, Gianmaria Fabrizio; De Rosa, Sara; Vallogini, Giulia; Romeo, Umberto; Galeotti, Angela

    2017-01-01

    Aim. To evaluate the pain experience and behavior during dental injection, using the Wand computerized delivery system versus conventional local anesthesia in children and adolescents. Methods. An observational crossover split mouth study was performed on 67 patients (aged 7 to 15 years), requiring local anesthesia for dental treatments in both sides of the dental arch. Patients received both types of injections in two separate appointments, one with the use of a Computer Delivery System (the Wand STA system) and one with the traditional syringe. The following data were recorded: pain rating; changes in heart rate; level of collaboration; patient satisfaction. The data were analyzed using ANOVA for quantitative outcomes and nonparametric analysis (Kruskal-Wallis) for qualitative parameters. Results. The use of the Wand system determined significantly lower pain ratings and lower increase of heart rate than the traditional syringe. During injection, the number of patients showing a relaxed behavior was higher with the Wand than with the traditional local anesthesia. The patient level of satisfaction was higher with the Wand compared to the conventional local anesthesia. Conclusions. The Wand system may provide a less painful injection when compared to the conventional local anesthesia and it seemed to be better tolerated with respect to a traditional syringe.

  10. Therapeutic plasma exchange in pediatric patients of Guillain-Barre syndrome: Experience from a Tertiary Care Centre

    Directory of Open Access Journals (Sweden)

    Maitrey Gajjar

    2016-01-01

    Full Text Available Background and Objective: Therapeutic Plasma Exchange (TPE is performed effectively and safely in adult patients, but the use of TPE is limited in paediatric patients due to lack of universally accepted indications and technical challenges like establishment of adequate vascular access, low blood volume, increased incidence of adverse events during procedure and poor co-operation of patients during procedure. We present our experience of TPE in paediatric patients to assess the effectiveness and safety of TPE in paediatric patients. Materials and Methods: A total 122 TPE procedures were performed in 40 paediatric patients between 3 to 15 years of age group with Guillain Barre Syndrome (GBS. TPE procedures were performed on alternate days depending on the clinical condition of the patient. Patient′s total blood volume was calculated as per Nadler′s formula and processed through central double lumen catheter. 1-1.5 plasma volume was exchanged with normal saline and fresh frozen plasma. Results: A total of 122 TPE procedures (with an average of three procedures per patient were performed on 40 paediatric patients. More than three TPE procedures were performed in 29 patients, of which 27 patients showed improvement from grade-0 and grade-I to grade-III. One did not show any response and succumbed to the disease. Complications were observed in 14 patients which were well managed. Inadequate vascular access was most common complication observed in 11 patients. Conclusion: TPE in paediatric patients has been increasing and has been shown to be effective as first line or adjunctive therapy in selected diseases. It is safe procedure when volume shifts, calcium supplementation and venous access are taken care.

  11. Pediatric Neck Mass

    Directory of Open Access Journals (Sweden)

    Guilherme Machado de Carvalho

    2015-11-01

    Full Text Available Introduction  Neck masses include a wide variety of diagnostic possibilities, with more than 60 etiologies that depend on clinical aspects such as age, location and time of disease progression. The interview and physical examination guide research that cross the neck masses in pediatric patients in 3 groups: infectious / inflammatory, and neoplastic embryonic remnants. The aim of this study was to present a protocol for evaluation of neck masses in the pediatric age group, based on a review of literature on the subject and experience of this service. Materials and Methods Survey of literature data from PubMed / Medline, Google Scholar and Scopus Database without language restriction, since 1980 sources, with the MeSH term "Pediatric neck mass".  Results Prepared flowchart guidelines to be followed according with diagnostic suspicions. Patients were divided into 3 groups according to the initial clinical manifestations and according to etiological hypotheses formulated recommend evaluations protocols.  Conclusion The standardization of the evaluation of neck masses in children proves valuable and can help in the differential diagnosis of different etiologies involved.

  12. Why Health Care Needs Design Research: Broadening the Perspective on Communication in Pediatric Care Through Play.

    Science.gov (United States)

    Knutz, Eva; Ammentorp, Jette; Kofoed, Poul-Erik

    2015-01-01

    Today's pediatric health care lacks methods to tap into the emotional state of hospitalized pediatric patients (age 4-6 years). The most frequently used approaches were developed for adults and fail to acknowledge the importance of imaginary experiences and the notion of play that may appeal to children. The scope of this article is to introduce a new design-oriented method of gathering information about the emotional state of pediatric patients using an experimental computer game called the Child Patient game (CPgame). The CPgame was developed at a Danish hospital, and the results of the preliminary tests show that games could serve as a system in which children are willing to express their emotions through play. The results are based on two comparative analyses of the CPgame through which it is possible to identify three different types of players among the patients playing the game. Furthermore, the data reveal that pediatric patients display a radically different play pattern than children who are not in hospital. The inquiry takes an interdisciplinary approach; it has obvious health care-related objectives and seeks to meet the urgent need for new methods within health care to optimize communication with young children. At the same time, design research (i.e., the development of new knowledge through the development of a new design) heavily impacts the method.

  13. Pediatric Appendicitis.

    Science.gov (United States)

    Rentea, Rebecca M; St Peter, Shawn D

    2017-02-01

    Appendicitis is one of the most common surgical pathologies in children. It can present with right lower quadrant pain. Scoring systems in combination with selective imaging and surgical examination will diagnose most children with appendicitis. Clinical pathways should be used. Most surgical interventions for appendicitis are now almost exclusively laparoscopic, with trials demonstrating better outcomes for children who undergo index hospitalization appendectomies when perforated. Nonoperative management has a role in the treatment of both uncomplicated and complicated appendicitis. This article discusses the workup and management, modes of treatment, and continued areas of controversy in pediatric appendicitis. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Pediatric vitiligo.

    Science.gov (United States)

    Silverberg, Nanette B

    2014-04-01

    Vitiligo is a disease of pigment loss. Most investigators currently consider vitiligo to be a disorder that occurs as a result of autoimmune destruction of melanocytes, supported by identification of antimelanocyte antibodies in many patients, and the presence of comorbid autoimmune disease in patients with and family members of individuals with vitiligo. One-half of vitiligo cases are of childhood onset. This article presents a current overview of pediatric vitiligo including comorbidities of general health, psychological factors, therapeutic options, and long-term health considerations.

  15. Pediatric urticaria.

    Science.gov (United States)

    Tsakok, Teresa; Du Toit, George; Flohr, Carsten

    2014-02-01

    Although urticaria is not a life-threatening disease, its impact on quality of life in children should not be overlooked. A systematic search of online databases, including Medline, was performed to inform a review aiming to equip clinicians with an evidence-based approach to all aspects of pediatric urticaria. This review hinges on an illustrative case and includes a summary table of studies pertaining to disease management in children. The multiple issues faced by patients, their families, and treating clinicians are highlighted, and the current literature on the presentation, natural history, investigation, and management of this poorly understood condition is assessed.

  16. Pediatric palliative care

    Directory of Open Access Journals (Sweden)

    Trapanotto Manuela

    2008-12-01

    Full Text Available Abstract The WHO defines pediatric palliative care as the active total care of the child's body, mind and spirit, which also involves giving support to the family. Its purpose is to improve the quality of life of young patients and their families, and in the vast majority of cases the home is the best place to provide such care, but for cultural, affective, educational and organizational reasons, pediatric patients rarely benefit from such an approach. In daily practice, it is clear that pediatric patients experience all the clinical, psychological, ethical and spiritual problems that severe, irreversible disease and death entail. The international literature indicates a prevalence of incurable disease annually affecting 10/10,000 young people from 0 to 19 years old, with an annual mortality rate of 1/10,000 young people from birth to 17 years old. The needs of this category of patients, recorded in investigations conducted in various parts of the world, reveal much the same picture despite geographical, cultural, organizational and social differences, particularly as concerns their wish to be treated at home and the demand for better communications between the professionals involved in their care and a greater availability of support services. Different patient care models have been tested in Italy and abroad, two of institutional type (with children staying in hospitals for treating acute disease or in pediatric hospices and two based at home (the so-called home-based hospitalization and integrated home-based care programs. Professional expertise, training, research and organization provide the essential foundations for coping with a situation that is all too often underestimated and neglected.

  17. The effect of pediatric knowledge on hospice care costs.

    Science.gov (United States)

    Lindley, Lisa C; Mixer, Sandra J; Cozad, Melanie J

    2014-05-01

    The cost of hospice care is rising. Although providing care for children at end of life may be costly for hospices, it is unclear whether or not gaining pediatric knowledge and even establishing a pediatric program may be done cost effectively. The purpose of our study was to examine the effect of possessing pediatric knowledge (i.e., pediatric program, pediatric experience) on core hospice care costs. Using 2002 to 2008 California hospice data, the findings of the regression analysis suggest that having pediatric knowledge does not significantly increase nursing, physician, and medical social service costs. Having a pediatric program was related to increased counseling costs. Our findings shed important light on the minimal costs incurred when hospices decide to develop pediatric knowledge.

  18. Preliminary experience in the monitoring of geothermal probes by borehole logging; Erste Erfahrungen bei der bohrlochgeophysikalischen Ueberpruefung von Erdwaermesonden

    Energy Technology Data Exchange (ETDEWEB)

    Baumann, Karsten [Bohrlochmessung-Storkow GmbH, Storkow (Germany)

    2010-05-15

    Authorities as well as waterworks experts have long been calling for a control strategy to ensure that groundwater protection is considered in geothermal projects. So far, control options for geothermal probes were lacking, which raised doubts about the efficiency of sealing. Waterworks experts also were unable to understand why new groundwater wells or groundwater measuring fonts are subject to careful control via geophysical borehole logs while geothermal probes with a depth of 100 m and more can be installed nearby without adequate monitoring. The contribution presents a preliminary approach for monitoring and testing of shallow geothermal probes. (orig.)

  19. Visualization of periventricular collaterals in moyamoya disease with flow-sensitive black-blood magnetic resonance angiography: preliminary experience.

    Science.gov (United States)

    Funaki, Takeshi; Fushimi, Yasutaka; Takahashi, Jun C; Takagi, Yasushi; Araki, Yoshio; Yoshida, Kazumichi; Kikuchi, Takayuki; Miyamoto, Susumu

    2015-01-01

    Fragile abnormal collaterals in moyamoya disease, known as "moyamoya vessels," have rarely been defined. While flow-sensitive black-blood magnetic resonance angiography (FSBB-MRA) is a promising technique for visualizing perforating arteries, as of this writing no other reports exist regarding its application to moyamoya disease. Six adults with moyamoya disease underwent FSBB-MRA. It depicted abnormal collaterals as extended lenticulostriate, thalamic perforating, or choroidal arteries, which were all connected to the medullary or insular artery in the periventricular area and supplied the cortex. This preliminary case series illustrates the potential for FSBB-MRA to reveal abnormal moyamoya vessels, which could be reasonably defined as periventricular collaterals.

  20. Pediatric Palliative Care: A Personal Story

    Science.gov (United States)

    ... Try it free Find out why Close Pediatric Palliative Care: A Personal Story NINRnews Subscribe Subscribed Unsubscribe 312 ... patient—and her family. The story demonstrates how palliative care can positively influence a patient's and family's experience ...

  1. Pediatric Palliative Care: A Personal Story

    Medline Plus

    Full Text Available ... of Rachel—a pediatric neuroblastoma patient—and her family. The story demonstrates how palliative care can positively influence a patient's and family's experience with illness. Category Science & Technology License Standard ...

  2. Pediatric Palliative Care: A Personal Story

    Medline Plus

    Full Text Available ... a patient's and family's experience with illness. Category Science & Technology License Standard YouTube License ... LIFE Before Death Pediatric Palliative Care - Duration: 5:27. ...

  3. Pediatric Palliative Care: A Personal Story

    Medline Plus

    Full Text Available ... of Rachel—a pediatric neuroblastoma patient—and her family. The story demonstrates how palliative care can positively influence a patient's and family's experience with illness. Category Science & Technology License Standard ...

  4. Colgajo sural reverso en pacientes pediátricos: experiencia de 6 años Reverse sural flap in pediatric patients: 6 years experience

    Directory of Open Access Journals (Sweden)

    S. De la Cruz Reyes

    2012-12-01

    Full Text Available Entre las técnicas reconstructivas de miembros inferiores se encuentra el colgajo neurocutáneo de flujo reverso utilizando el paquete neurovascular sural, técnica conocida pero con escasa experiencia publicada en infantes. El objetivo de este trabajo es presentar y analizar 10 casos clínicos en los que se utilizó el colgajo sural reverso en pacientes de edad pediátrica. Realizamos un estudio retrospectivo, descriptivo y observacional, que incluye a todos los pacientes menores de 16 años a los que se les realizó una reconstrucción con colgajo sural reverso durante el período comprendido entre marzo del 2004 y abril del 2010 en el Centenario Hospital Miguel Hidalgo de Aguascalientes, México. Se incluyeron 10 casos con una mediana de edad de 10 años (rango de 3 a 15 años, 6 masculinos y 4 femeninos. El mecanismo del trauma en 6 de los casos fue por lesión en motocicleta, en 2 paientes atropello por automóvil, 1 caso por lesión en bicicleta y 1 caso con lesión por proyectil de arma de fuego. Las áreas afectadas fueron región dorsal del pie en 5 casos, región calcánea en 4 casos, y una lesión maleolar externa. La mediana del diámetro de las superficies afectadas fue de de 8.8 cm. Tres pacientes presentaron complicaciones postoperatorias menores, 2 epidermólisis distales y 1 dehiscencia parcial del colgajo. No se presentó ninguna complicación grave ni hubo perdidas de colgajos. Los resultados fueron considerados como favorables en el 100 % de los pacientes al término del seguimiento. La técnica de reconstrucción del miembro inferior, específicamente en el caso de lesiones en pie, con colgajo neurocutáneo sural en isla de flujo reverso es, a nuestro juicio, una opción eficaz de tratamiento también para pacientes pediátricos.Among the lower leg reconstructive techniques, the reverse sural neurocutaneous flap is a well known technical option, with little experience reported in infants. Our aim is the pesentation and

  5. Prioritizing Possibilities for Child and Family Health: An Agenda to Address Adverse Childhood Experiences and Foster the Social and Emotional Roots of Well-being in Pediatrics.

    Science.gov (United States)

    Bethell, Christina D; Solloway, Michele R; Guinosso, Stephanie; Hassink, Sandra; Srivastav, Aditi; Ford, David; Simpson, Lisa A

    A convergence of theoretical and empirical evidence across many scientific disciplines reveals unprecedented possibilities to advance much needed improvements in child and family well-being by addressing adverse childhood experiences (ACEs), promoting resilience, and fostering nurturance and the social and emotional roots of healthy child development and lifelong health. In this article we synthesize recommendations from a structured, multiyear field-building and research, policy, and practice agenda setting process to address these issues in children's health services. Between Spring of 2013 and Winter of 2017, the field-building and agenda-setting process directly engaged more than 500 individuals and comprised 79 distinct agenda-setting and field-building activities and processes, including: 4 in-person meetings; 4 online crowdsourcing rounds across 10 stakeholder groups; literature and environmental scans, publications documenting ACEs, resilience, and protective factors among US children, and commissioning of this special issue of Academic Pediatrics; 8 in-person listening forums and 31 educational sessions with stakeholders; and a range of action research efforts with emerging community efforts. Modified Delphi processes and grounded theory methods were used and iterative and structured synthesis of input was conducted to discern themes, priorities, and recommendations. Participants discerned that sufficient scientific findings support the formation of an applied child health services research and policy agenda. Four overarching priorities for the agenda emerged: 1) translate the science of ACEs, resilience, and nurturing relationships into children's health services; 2) cultivate the conditions for cross-sector collaboration to incentivize action and address structural inequalities; 3) restore and reward for promoting safe and nurturing relationships and full engagement of individuals, families, and communities to heal trauma, promote resilience, and prevent

  6. Diagnosis and immunophenotype of 188 pediatric lymphoblastic lymphomas treated within a randomized prospective trial: experiences and preliminary recommendations from the European childhood lymphoma pathology panel.

    NARCIS (Netherlands)

    Oschlies, I.; Burkhardt, B.; Chassagne-Clement, C.; d'Amore, E.S.; Hansson, U.; Hebeda, K.M.; McCarthy, K.; Kodet, R.; Maldyk, J.; Mullauer, L.; Porwit, A.; Schmatz, A.I.; Tinguely, M.; Abramov, D.; Wotherspoon, A.; Zimmermann, M.; Reiter, A.; Klapper, W.

    2011-01-01

    The majority of lymphoblastic (precursor cell) neoplasms presents as leukemias. Consequently, the guidelines for lineage determination and subtyping of precursor cell neoplasms were primarily established for flow cytometry methods. Large-scale studies of nonleukemic lymphoblastic lymphomas are lacki

  7. Paranormal experience and the COMT dopaminergic gene: a preliminary attempt to associate phenotype with genotype using an underlying brain theory.

    Science.gov (United States)

    Raz, Amir; Hines, Terence; Fossella, John; Castro, Daniella

    2008-01-01

    Paranormal belief and suggestibility seem related. Given our recent findings outlining a putative association between suggestibility and a specific dopaminergic genetic polymorphism, we hypothesized that similar exploratory genetic data may offer supplementary insights into a similar correlation with paranormal belief. With more affordable costs and better technology in the aftermath of the human genome project, genotyping is increasingly ubiquitous. Compelling brain theories guide specific research hypotheses as scientists begin to unravel tentative relationships between phenotype and genotype. In line with a dopaminergic brain theory, we tried to correlate a specific phenotype concerning paranormal belief with a dopaminergic gene (COMT) known for its involvement in prefrontal executive cognition and for a polymorphism that is positively correlated with suggestibility. Although our preliminary findings are inconclusive, the research approach we outline should pave the road to a more scientific account of elucidating paranormal belief.

  8. Pediatric tracheomalacia.

    Science.gov (United States)

    Fraga, Jose Carlos; Jennings, Russell W; Kim, Peter C W

    2016-06-01

    Tracheomalacia (TM) is defined as an increased collapsibility of the trachea due to structural anomalies of the tracheal cartilage and/or posterior membrane. Tracheomalacia has a wide range of etiologies but is most commonly present in children born with esophageal atresia and tracheal esophageal fistula. Clinical symptoms can range from minor expiratory stridor with typical barking cough to severe respiratory distress episodes to acute life-threatening events (ALTE). Although the majority of children have mild-to-moderate symptoms and will not need surgical intervention, some will need life-changing surgical treatment. This article examines the published pediatric literature on TM, discusses the details of clinical presentation, evaluation, diagnosis, and a variety of treatments.

  9. Professor WANG Shou-chuan's experience in treating pediatric lung system diseases%汪受传教授治疗小儿肺系疾病经验

    Institute of Scientific and Technical Information of China (English)

    王明明

    2011-01-01

    To introduce Professor WANG Shou-chuan's experience in treating pediatric lung system diseases. Professor WANG puts forward that the method of treating recurrent respiratory tract infection is to regulate yingqi and weiqi with modified guizhi longgu muli decoction for patients with disharmony between yingqi and weiqi and invigorate the lung and the spleen with modified yupingfeng powder and yigong powder for patients with deficiency of lung and spleen qi. Professor WANG thinks that the method of treating bronchial asthma is to expel wind, resolve phlegm, consolidate vital base and resist wind. In the acute stage of bronchial asthma the method is to expel wind, resolve phlegm and promote the lung in dispersing and descending. In the remission stage of bronchial asthma the method is to invigorate the qi, blood, yin and yang of the lung, the spleen and the kidney in order to consolidate vital base and resist wind in the end.Professor WANG believes that that heat, depression, phlegm and blood stasis are the main pathological mechanism of child viral pneumonia, the methods of treating viral pneumonia is to clear heat, eliminate depression, dissipate phlegm and remove blood stasis.%文章介绍汪受传教授治疗小儿肺系疾病的临床经验.汪教授提出,反复呼吸道感染患儿营卫失和者常用桂枝加龙骨牡蛎汤加减,以调和营卫,肺脾气虚者常用玉屏风散合异功散加减,以补肺理脾;支气管哮喘治从祛风化痰、固本御风,哮喘发作时当祛风化痰、宣肃肺气,哮喘缓解期应补益肺脾肾之气血阴阳,最终固本以御风;热、郁、痰、瘀为小儿病毒性肺炎的主要病理要素,病毒性肺炎当治从清热解郁涤痰化瘀.

  10. Nursing Experience on 100 Cases of Pediatric Severe Pneumonia%小儿重症肺炎100例护理体会

    Institute of Scientific and Technical Information of China (English)

    冯淑芳

    2012-01-01

      Objective To summary the nursing experience on pediatric severe pneumonia, providing reference for clinical nursing. Methods In our hospital from February 2011 to February 2012 100 cases of pediatric severe pneumonia to do retrospective analysis, to explore the nursing experience, including respiratory tract, balanced eating, correct hypoxia, observation resoures, etc. Results Through the systematic treatment and care, the cure rate as high as 97% in the research, the mean hospital stay was (7.2±1.2)days, only three cases of congen